Longitudinal Experience and Determinants for Common Mental Health Problems, Phantom Limb and Functional Outcome in Lower Limb Amputees.

Abstract

Amputation of a limb is equivalent to loss of a person's life. Psychological aspects are essential factors in dealing with the disability and functional outcome is a significant concern. Longitudinal studies have not examined the experience and determinants of common mental health problems and functional outcome in lower limb amputees. A total of 103 lower limb amputees were recruited and followed up for 6 months. Patients were assessed on Hospital Anxiety and Depression Scale (HADS) and Social Functioning (SF-36) Quality of life, semi-structured clinical interview for psychiatric disorders and phantom limb at baseline (in hospital), at 2weeks, 3months and 6months, respectively after discharge. Holistic care was provided through psychological counselling, supportive sessions, medications if required, rehabilitation counselling, prosthesis implantation, and treatment as usual. Holistic care resulted in a statistically significant reduction in anxiety, depression and overall psychiatric morbidity as measured on HADS (p < 0.001). There was a significant improvement in all the domains of SF-36 (p -< 0.001) except the role of limitation due to physical activity. The intervention also resulted in a statistically significant reduction in the presence of phantom limbs. Amputees should be provided holistic care under one roof, which was found to be very useful in treating psychiatric morbidity, social functioning and quality of life.