Derriford Appearance Research Articles

A preliminary report on the development of a validated tool for measuring psychosocial outcomes for massive weight loss patients

To validate the newly developed patient report outcome measure (PROM): the Post Bariatric Outcome Tool (PBOT). The tool is designed and developed for massive weight loss patients seeking body contouring procedures. The PBOT was piloted with three cohorts: massive weight loss patients seeking body contouring; massive weight loss patients who have had body contouring; and healthy, non-obese subjects as controls matched for age and gender. Each cohort completed two PROMS at week one, and then for a second time at week three. The PROMS used were the new Post Bariatric Outcome Tool (PBOT) and the Derriford Appearance Scale 24 (DAS24). The PBOT was shown to be reliable both in terms of its internal consistency and test-retest reliability. Comparison to the DAS24 demonstrated the PBOT to be valid. However, the cohorts were small and responsiveness was not tested. This needs to be tested in further larger validation studies, ideally, with comparison to functional scales such as the SF-36 or other validated massive weight loss body contouring PROMs; such as the Body Q.

Persistent self-consciousness about facial appearance, measured with the Derriford appearance scale 59, in patients after long-term biochemical remission of acromegaly.

Acromegaly is associated with impaired quality of life (QoL) and causes anatomical disproportions, which may contribute to the decreased QoL after successful treatment. The Derriford appearance scale 59 (DAS59) is a questionnaire measuring psychological distress and disruptions to everyday life associated with self-consciousness of appearance. Investigate the psychological distress and dysfunction related to self-consciousness about appearance and its effect on QoL in patients in long-term remission of acromegaly. Patients (>18 years old) treated for acromegaly at the Department of Endocrinology of the Radboud University Medical Center Nijmegen were invited to participate. A gender-, age- and body mass index matched control group was provided by the patients themselves. Participants were asked to complete the modified DAS59-, research and development 36- (RAND-36), acromegaly quality of life questionnaire (AcroQoL) and a sociodemographic questionnaire. Differences between patient- and control groups and correlations between questionnaire scores and clinical characteristics collected from medical records were analyzed. Questionnaire scores. Of the 120 respondents, 73 agreed to participate [all cured or under biochemical control, median remission time 10.5 years (range 2.3-43.6 years)]. Of these, 34 (46.6%) reported self-consciousness about their appearance. Twenty-nine of these patients (85.3%) pointed out their face to be a prominent source of self-consciousness. Fifty-seven matched control subjects were included as well. Significant correlations were found between the scores of the DAS59 and the AcroQoL, RAND-36 and VAS in patients. Even after long-term remission of acromegaly, a large number of patients are self-conscious about their appearance, leading to psychological distress and disruptions to everyday life and decreased QoL. Facial features were the most important source of self-consciousness. This stresses the importance of addressing self-consciousness of appearance and the need for additional support in this regard during follow-up in these patients.

Liposuction for Submental Lymphedema Improves Appearance and Self‐Perception in the Head and Neck Cancer Patient

Patients who have undergone treatment for head and neck cancer are at risk for neck lymphedema, which can severely affect quality of life. Liposuction has been used successfully for cancer patients who suffer from posttreatment limb lymphedema. The purpose of our study was to review the outcomes of head and neck cancer patients at our center who have undergone submental liposuction for posttreatment lymphedema. Prospective cohort study. Oncology center in tertiary hospital setting. Head and neck cancer patients who underwent submental liposuction for posttreatment lymphedema were included. Nine patients met the study criteria. Patients completed 2 surveys (Modified Blepharoplasty Outcome Evaluation and the validated Derriford Appearance Scale) pre- and postoperatively to assess satisfaction. Patients' pre- and postoperative photos were graded by independent observers to assess outcomes objectively. Our study demonstrated a statistically significant improvement in patients' self-perception of appearance and statistically significant objective scoring of appearance following submental liposuction. Submental liposuction improves the appearance and quality of life for head and neck cancer patients suffering from posttreatment lymphedema by way of improving their self-perception and self-confidence.

The long-term psychosocial outcomes following excision of sacrococcygeal teratoma: a national study

ObjectiveThe overall effect of the reported long-term sequelae following sacrococcygeal teratoma (SCT) excision on the psychosocial and sexual development has not been addressed appropriately in the literature. The aim of...

Impact of necrotising fasciitis on quality of life: A qualitative analysis

Mortality rates from severe necrotising soft tissue infections are improving progressively, therefore more emphasis should be placed on assessing and improving the quality of life of surviving patients. We investigated the functional and psychological issues, ability to social integration and self-perception of appearance in such patients presenting to our unit over 4 years. To conduct the study, we used the Short Form-36 and the Derriford Appearance Scale-24, which were distributed to those willing to participate. Ten patients have returned fully completed questionnaires. The overall quality of life and level of distress about the changed appearance were moderate (average SF-36 score of 65.8, DAS-24 score of 38). Statistical correlations between the scores and demographics were carried out using the Spearman rank correlation test. The capability of psychosocial adjustment was shown to improve with longer follow-up time and older age. However pain, physical limitations and energy levels were considerably more relevant in the older individuals and improved slower with time compared to psychological issues. Our results act as a good indicator of the quality of life in people dealing with the aftermath of necrotising soft tissue infections, but further, more extensive studies are required to achieve comprehensive and statistically significant results.

Appearance concerns and psychosocial adjustment following head and neck cancer: A cross-sectional study and nine-month follow-up

Psychosocial difficulties have been reported in head and neck cancer (HNC) patients, yet only few studies have assessed the impact of altered appearance following HNC treatment using theoretically selected measures of appearance-related distress. This study investigated appearance-related adjustment following HNC, and demographic and socio-cognitive predictors of adjustment. HNC patients (n = 49) completed baseline questionnaires and a nine-month postal follow-up (n = 20). Participants showed considerable variation in appearance-related adjustment, with females reporting higher levels of appearance-related distress (derriford appearance scale [DAS-24]) than females in the general population and male HNC survivors. Depression scores on the hospital anxiety and depression scale were higher than UK norms whilst anxiety was similar to UK norms. There were no significant differences between baseline and follow-up data. Fear of negative evaluation (a central feature of social anxiety) was a significant predictor of appearance-related adjustment at baseline, whilst dispositional optimism was a significant predictor of appearance-related adjustment at baseline and follow-up. Qualitative responses showed themes of appearance and disability, and coping strategies. Findings suggest that appearance-related adjustment post-HNC varies considerably and psychosocial services working with HNC patients should consider this broad pattern of response. Future research to examine the role of socio-cognitive predictors of appearance-related adjustment could progress development of effective psychological interventions.

The Psychosocial Impact of Living with an Ocular Prosthesis

Objective: Many patients are satisfied with their ocular prosthesis, but some describe problems with social interactions, body image and self-esteem. Although both clinical practice and research suggest that the severity of a disfiguring condition does not predict distress, there has been little research with patients living with an ocular prosthesis. The objective was to explore the psychological impact of living with an artificial eye or cosmetic shell and determine the relationship between psychological well-being and clinical and psychosocial factors.Methods: A cross-sectional study between March and September 2008 at the ocular prosthesis clinic of Moorfields Eye Hospital, UK. The primary outcome measures were mood as measured by the Hospital Anxiety and Depression Scale (HADS) and appearance-related social anxiety and social avoidance, as measured by the Derriford Appearance Scale (DAS24).Results: Mean scores on the HADS and DAS24 were within normal range, but a considerable proportion of participants were experiencing significant levels of distress. Psychosocial adjustment was unrelated to most clinical and demographic variables, but was associated with a series of cognitive processes.Conclusions: Psychological variables, rather than clinical or demographic factors, are associated with how a patient adjusts to wearing an ocular prosthesis. Such factors might be amenable to change through psychosocial intervention.

Appearance Distress and Dysfunction in the Elderly: International Contrasts Across Italy and the UK Using DAS59

As the global population grows, the percentage of those over 60 will escalate disproportionately. Their needs will become an ever more dominant feature of public policy and healthcare provision. Older adults' appearance is often removed from cultural ideals and stereotypes of beauty, often seen as synonymous with "youth." This has seen older adults' concerns about appearance and body image somewhat sidelined in practice and in research. This study investigates the extent to which self-consciousness of appearance is associated with distress and dysfunction in those over 60 years old. Furthermore, we contrast the extent of this phenomenon in two European nations, UK and Italy, and consider the direct impact and interaction of cultural context and participant gender. To make an objective measurement of distress and dysfunction, we translated a widely used psychometric measure, the Derriford Appearance Scale 59 following an established and reliable translation protocol. Data were collected from community samples. The Italian translation was sound, with acceptability in the Italian-speaking sample and acceptable internal consistency scores for full-scale and subscales. ANOVA analysis demonstrated that for overall adjustment, and all subscale scores, the Italians were more distressed about their appearance than UK comparators. Moreover, there were significant differences between Italian women and men, with Italian women more distressed than Italian men overall, and also general self-consciousness, sexual self-consciousness, and social self-consciousness subscales. These results are considered in the context of aging and cultural and gender issues in appearance, including the Italian concept of bella figura. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Appearance concerns among women with neurofibromatosis: examining sexual/bodily and social self‐consciousness

Neurofibromatosis (NF) 1 and 2 have distinct appearance effects, yet little research has examined patients' appearance concerns. We assessed appearance concerns and self-consciousness, self-esteem, and loneliness among women with NF. Women with NF1 (n = 79) and NF2 (n = 48) completed the Derriford Appearance Scale to assess appearance concerns and sexual/bodily and social self-consciousness, Rosenberg Self-Esteem Scale, and UCLA Loneliness Scale. Women's appearance concerns were coded to determine whether they were NF-related and whether psychosocial factors contributed to the concerns. A total of 85% of women reported appearance concerns, many of which were NF-related and attributed to psychosocial factors. Women with NF1 reported significantly more sexual/bodily self-consciousness but similar levels of social self-consciousness compared with women with NF2. Significantly higher sexual/bodily self-consciousness was found among married/cohabiting women regardless of NF group. Compared with general population norms and breast cancer survivors (BCS), women with NF1 reported significantly greater sexual/bodily and social self-consciousness. Women with NF2 reported less sexual/bodily self-consciousness compared with population norms, yet tended to report greater sexual/bodily self-consciousness than BCS. Women with NF2 reported significantly greater social self-consciousness compared with population norms and BCS. For both NF1 and NF2, higher levels of sexual/bodily and social self-consciousness were related to lower self-esteem and higher levels of social self-consciousness to more loneliness. Appearance concerns are prevalent, and social self-consciousness is high, among women with NF1 and NF2. Women with NF1 compared with NF2 experience more sexual/bodily self-consciousness. Providers should assess the impact of NF on women's self-perceptions and address sexual, body image, and social concerns.

The Effect of Septorhinoplasty on Quality of Life and Nasal Function in Asians

This is the first study that aimed to assess the effects of septorhinoplasty on quality of life (QOL) in an Asian population. The study consisted of 2 parts. First, the Derriford Appearance Scale 59 (DAS-59) was translated into Korean, and the reliability and validity were assessed by administering the Korean version of Derriford Appearance Scale 59 (DAS-59K) and 36-item short-form health survey to 88 inpatients scheduled for operations. Then, a prospective study was conducted which included 31 patients who underwent primary septorhinoplasty from October 2008 through May 2009. The changes in QOL and nasal symptoms were evaluated by comparing the preoperative and postoperative 3 month DAS-59K and nasal obstruction symptom evaluation scales. Principal component analysis of the DAS-59K showed an optimum 5-factor and the Cronbach α for each factor was greater than 0.7. Significant correlation was found between the DAS-59K and 36-item short-form health survey. Objective evaluation showed at least an improvement in every patient. After septorhinoplasty, there was improvement at scores related to general self-consciousness, negative self-concept, and physical stress (P < 0.05). The pattern of improvement differed by sex, age, and the presence of external nose deviation. Mean nasal obstruction symptom evaluation scores decreased significantly after surgery. The DAS-59K is a reliable and valid test, which can be a useful tool to assess individual response to living with problems of appearance. Septorhinoplasty improves both QOL and nasal function which should be taken into consideration in future counseling of individual patients expecting septorhinoplasty.

Predictors of Mental Health in Adults with Congenital Craniofacial Conditions Attending the Australian Craniofacial Unit

Objective : Adults with craniofacial conditions experience more psychosocial problems than adults in the general population, but little is known about the factors that render a person more or less susceptible to these problems. Guided by research on adults with other conditions that affect appearance, this study examined predictors of psychosocial outcome in adults with craniofacial conditions. Design : Single-sample cross-sectional design. Setting : The Australian Craniofacial Unit, Women's and Children's Hospital, Adelaide, one of the main craniofacial treatment centers in Australia. Participants : Adults (N = 93; 36.9% of the potential sample) with congenital craniofacial conditions (excluding cleft lip and/or cleft palate) who were treated in the Australian Craniofacial Unit. Main Outcome Measures : All participants completed measures assessing anxiety, depression, and quality of life (Hospital Anxiety and Depression Scale, Short-Form Health Survey) and variables predicted to affect these outcomes (SF-36 Health Survey - Multidimensional Scale of Perceived Social Support, Rosenberg Self-Esteem Scale, Cleft Satisfaction Profile, Brief Fear of Negative Evaluation Scale, Derriford Appearance Scale). Results : Multiple regression analyses revealed that anxiety was predicted by social support, self-esteem, and fear of negative evaluation, while depression was predicted by self-esteem and social support. Physical quality of life was not predicted by any of the measures. Satisfaction with appearance, gender, age, and education were not related to outcome. Conclusions : Interventions designed to increase perceived social support and self-esteem and reduce fear of negative evaluation appear to be indicated and may assist in establishing a causal relationship between these variables.

Preoperative Symptoms of Body Dysmorphic Disorder Determine Postoperative Satisfaction and Quality of Life in Aesthetic Rhinoplasty

In patients seeking aesthetic rhinoplasty, a high prevalence of body dysmorphic disorder symptoms has recently been reported. However, the impact of these symptoms on the outcomes after rhinoplasty remains elusive. This large-scale study determines the influence of preoperative body dysmorphic disorder symptoms on patients' postoperative satisfaction and quality of life, using validated questionnaires. A 1-year prospective study of 166 adult patients undergoing cosmetic rhinoplasty in a tertiary referral center was performed. Severity of body dysmorphic disorder symptoms was assessed by the modified Yale-Brown Obsessive Compulsive Scale. Postoperative satisfaction was evaluated using a visual analog scale for patients' appraisal of nasal shape and the Rhinoplasty Outcome Evaluation. Generic quality of life was quantified by the Sheehan Disability Scale, whereas the appearance-related disruption of everyday life was measured by the Derriford Appearance Scale-59. Preoperative body dysmorphic disorder symptom scores inversely correlated with postoperative satisfaction at 3 months (visual analog scale nasal shape: rho = -0.43, p < 0.001; Rhinoplasty Outcome Evaluation: rho = -0.48, p < 0.001) and 12 months (rho = -0.40, p < 0.001; and rho = -0.41, p < 0.001, respectively) after surgery. In addition, body dysmorphic disorder symptom scores positively correlated with Sheehan Disability Scale scores and Derriford Appearance Scale-59 scores at 3 months (rho = 0.43, p < 0.001 and rho = 0.48, p < 0.001, respectively) and 12 months (rho = 0.32, p < 0.001, and rho = 0.48, p < 0.001, respectively) postoperatively. This study provides the first evidence of the negative impact of preoperative body dysmorphic disorder symptoms on subjective outcomes after rhinoplasty, hence unveiling a crucial factor in patient dissatisfaction after aesthetic rhinoplasty.

Quantitative assessment of appearance changes and related distress in cancer patients

This study examined both the frequency of appearance-related symptoms and distress resulting from these symptoms in cancer patients receiving chemotherapy. Self-report questionnaires were distributed to 753 outpatients receiving ≧ 4 weeks of treatment at an outpatient chemotherapy center. Valid responses were returned by 638 patients (response rate, 84.7%). Participants were questioned about 57 appearance-related symptoms (AS) and 23 non-appearance-related physical symptoms (non-AS); psychological well-being was assessed using a shortened version of the Derriford Appearance Scale 59. Questionnaire responses were obtained from 264 male and 374 female patients (mean age, 59.5 years; range, 18-85 years). Most respondents (80.3%) were concerned with changes in appearance resulting from treatment. By sex and disease type, women suffered more than men, and treatment for breast cancer created the greatest distress for women. Cancer patients are concerned about a variety of AS, and these may result in greater distress than non-AS. AS-related information and care are increasingly being sought in advance of treatment.

The long-term psychosocial impact of corrective surgery for adults with strabismus

Background/AimLong-term assessments of the impact of strabismus surgery in adults are rare and very limited in focus. Consequently, this study was designed to consider the psychosocial status of adults a...

A systematic review of questionnaires to measure the impact of appearance on quality of life for head and neck cancer patients

Facial disfigurement is often experienced by head and neck cancer (HNC) patients following surgery and has a significant impact on their quality of life (QOL). The aim of the current review is to assess patient-reported outcome (PRO) measures for use in HNC patients, appraise the psychometric properties of QOL instruments that include an appearance domain and determine which instrument/s might be the most appropriate for use in HNC patients in clinical practice and research. A systematic search of the English-language literature was performed using the Medline and PsycINFO electronic databases. PRO measures designed to assess QOL and the impact of disfigurement on QOL were identified. Instruments were evaluated based on their development and validation criteria, appearance domain content and use in assessing QOL outcomes in HNC patients. From 530 articles, 18 QOL questionnaires were identified. Only five PRO instruments were considered suitable for review: University of Washington QOL questionnaire (UWQOLQ); Head and Neck Survey (HNS); European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck 35 (EORTC QLQ-H&N35); Derriford Appearance Scale 59 (DAS59) and the Derriford Appearance Scale 24 (DAS24). The UW-QOL has better coverage of appearance issues than the EORTC QLQ-H&N35 and the HNS, is well validated and demonstrates promising psychometric properties. The DAS24 and DAS59 which are devoted solely to appearance issues and are not specific to HNC, have had psychometric properties tested in large scale studies, but have only been used in clinical practice in a limited number of studies. The available evidence suggests the UW-QOL is the most appropriate screening tool to assess appearance issues in clinical practice. The DAS24 shows promise as a research tool for improving understanding of how appearance affects QOL in HNC patients.

A Cross Sectional, Observational Survey to Assess Levels and Predictors of Psychological Wellbeing in Adults with Epidermolysis Bullosa.

Epidermolysis bullosa (EB) describes a cluster of genetically determined skin disorders. Symptoms can be painful, disabling and disfiguring, yet there is little research on the psychological impact of the disease. The study aim was to measure psychological wellbeing in adults with EB; and to examine the association between psychological wellbeing and self efficacy, health locus of control and adjustment to appearance in an observational, cross sectional survey. Questionnaire packs comprising the General Health Questionnaire (GHQ-12), the General Self Efficacy Scale (GSE), the Multidimensional Health Locus of Control Scale (MHLOC), and the Derriford Appearance Scale (DAS-24), were sent to approximately 385 adults with EB. The data were analysed using SPSS. Eighty-seven participants responded. Scores on the GHQ-12 showed non-problematic psychological health in 36% of the sample; levels bordering on clinical disorder in 32.1% and severe psychological distress in 31.9%. No correlations were found between demographic factors (age and sex) or clinical factors (EB type and perceived severity) and psychological well-being. Scores on the GSE, the internal locus of control sub-scale of the MHLOC and the DAS-24 showed them to be statistically significant correlates of psychological wellbeing (P<0.001; P<0.018; and P<0.001 respectively). In a regression analysis, adjustment to appearance and self efficacy accounted for 24% of the variation in psychological wellbeing. Adults with EB might be at risk of experiencing poor psychological health. Interventions designed to enhance disease self management, self efficacy and improve body image are likely to be beneficial in this clinical group.

A cross sectional, observational survey to assess levels and predictors of psychological wellbeing in adults with epidermolysis bullosa

Epidermolysis bullosa (EB) describes a cluster of genetically determined skin disorders. Symptoms can be painful, disabling and disfiguring, yet there is little research on the psychological impact of the disease. The study aim was to measure psychological wellbeing in adults with EB; and to examine the association between psychological wellbeing and self efficacy, health &lt;em&gt;locus&lt;/em&gt; of control and adjustment to appearance in an observational, cross sectional survey. Questionnaire packs comprising the General Health Questionnaire (GHQ-12), the General Self Efficacy Scale (GSE), the Multidimensional Health Locus of Control Scale (MHLOC), and the Derriford Appearance Scale (DAS-24), were sent to approximately 385 adults with EB. The data were analysed using SPSS. Eighty-seven participants responded. Scores on the GHQ-12 showed non-problematic psychological health in 36% of the sample; levels bordering on clinical disorder in 32.1% and severe psychological distress in 31.9%. No correlations were found between demographic factors (age and sex) or clinical factors (EB type and perceived severity) and psychological well-being. Scores on the GSE, the internal locus of control sub-scale of the MHLOC and the DAS-24 showed them to be statistically significant correlates of psychological wellbeing (P&amp;lt;0.001; P&amp;lt;0.018; and P&amp;lt;0.001 respectively). In a regression analysis, adjustment to appearance and self efficacy accounted for 24% of the variation in psychological wellbeing. Adults with EB might be at risk of experiencing poor psychological health. Interventions designed to enhance disease self management, self efficacy and improve body image are likely to be beneficial in this clinical group.

Translation and Validation of the Nepalese Version of Derriford Appearance Scale (DAS59)

Objectives: To establish a valid and reliable translated version of Derriford Appearance Scale (DAS 59) for Nepali population. Methods: A standard translation-back-translation procedure was used followed by evaluation of semantic, conceptual and society equivalence by the committee and changes were made according to recommendations. This corrected version was pretested and a final version was developed. A validation study was performed using the final version on 424 patients including 212 patients with clinical appearance problems and similar number of young adults who had no concern for facial appearance. Reliability was assessed by cronbach’s alpha value and test-retest correlation coefficient. Discriminate and convergent validity were assessed by comparison between clinical and normal population and correlation with Beck’s Anxiety Inventory(BAI), Beck’s Depression Inventory(BDI)and General Health questionnaire (GHQ) Results: The results indicated excellent internal consistency (Cronbach’s alpha = 0.98) and good test –retest reliability (0.91 for clinical population, 0.86 for normal population). The Discriminate validity was good with statistically significant differences between clinical and normal population .The convergent validity was confirmed by good correlation with other related psychometric tools. Conclusion: A valid and reliable Nepali DAS59 version was developed which can be used for research and clinical assessment of patients with appearance problems and concerns.

The psychological impact of split-thickness skin grafts

To measure the psychological distress associated with a split-thickness skin graft (STSG). A retrospective postal questionnaire survey of 102 patients who had undergone a STSG procedure within the last 3.5 years. Outcomes measures included the Hospital Anxiety and Depression Scale (HADS), Derriford Appearance Scale (DAS-59) and subjective rating scales (SRS) of noticeability and worry about the grafted and donor area. Scores on the SRS correlated positively with HADS and DAS-59 scores. Rates of anxiety were higher than depression (19% vs 13%, respectively). Greater than 10% of the sample experienced significant appearance-related distress when compared to standardised test norms. Concerns about the grafted area were higher than for the donor site, but those concerned about the graft were also likely to be concerned about the donor area. Aged (< 60 years) and reason for surgery (trauma as opposed to cancer) were associated with significantly higher scores on appearance measures. STSG is not associated with high levels of psychological distress, However, there is a small but significant monitory who experience appearance-related distress, low mood and anxiety who would benefit from targeted psychological intervention, Demographic factors, such as age or gender, and length of time since surgery, are not useful discriminators in identifying vulnerable individuals. Simple SRS of visibility and worry correlate significantly with standardised psychological measures. These can be used as a short and effective screening tool to identify individuals who would benefit from postoperative psychological input. DECLARATION OF INTERNET: There were no external sources sources of funding for this study. The authors have no conflicts of interest to declare.

The Psychosocial Benefits of Secondary Hydroxyapatite Orbital Implant Insertion and Prosthesis Wearing for Patients With Anophthalmia

Anophthalmia is associated with a range of psychosocial difficulties and hydroxyapatite orbital implant insertion and prosthesis wearing is the predominant rehabilitation therapy for anophthalmia. However, few articles have compared preoperative and postoperative psychosocial outcomes using standardized questionnaires. This study aimed to investigate the psychosocial benefits of hydroxyapatite orbital implant insertion and prosthesis wearing in this patient population. In all, 36 participants were tested preoperatively and 6-months postoperatively using standardized measures of anxiety and depression (Hospital Anxiety and Depression Scale), social anxiety and social avoidance (Derriford Appearance Scale-Short Form), and quality of life (World Health Organization Quality of Life Scale-Short Form). Before treatment, levels of depression were comparable with population norms; however, levels of general anxiety were slightly raised, levels of social anxiety, social avoidance, and quality of life were significantly poorer than population norms. Treatment resulted in significant improvement in psychosocial adjustment with improvements in all study variables for the participant group as a whole. Hydroxyapatite orbital implant insertion and prosthesis wearing offers significant improvements in psychological and physical functioning for patients with anophthalmia.