The rapid resolution of depression and anxiety symptoms after lower limb amputation

Abstract

Objective : To ascertain the course of depressive and anxiety symptoms shortly after amputation and again after a period of inpatient rehabilitation. Design and settings : A cohort study in inpatients admitted to a rehabilitation ward after lower limb amputation. Subjects : One hundred and five successive admissions over a one-year period. Interventions : Nil. Main measures : Hospital Anxiety and Depression Scale (HADS) on admission and discharge with correlation to demographic and patient features. Results : At admission, 28 (26.7%) and 26 (24.8%) patients had symptoms of depression and anxiety respectively. This dropped to 4 (3.8%) and 5 (4.8%) by time of discharge, a mean of 54.3 days later. These reductions were statistically significant, as was the association between patients having symptoms of both depression and anxiety (P < 0.001). Patient stay was longer in those with symptoms (depression, P < 0.03; anxiety P < 0.001). There was no association with level of amputation, success of limb-fitting, age or gender. Depressive symptoms were associated with presence of other medical conditions (P < 0.01) and anxiety scores with living in isolation (P < 0.05). Conclusion : Depression and anxiety are commonly reported after lower limb amputation and previously thought to remain high for up to 10 years. We have found that levels of both depression and anxiety resolve rapidly. It is possible that a period of rehabilitation teaching new skills and improving patient independence and mobility may modify the previous bleak outlook of amputees. This positive finding may be useful in the rehabilitation of even the most distressed of amputees.