Risk of depression following traumatic limb amputation—a general population-based cohort study

Abstract

<jats:p> Background: Individuals with traumatic limb amputation (TLA) may be at risk of depression, but evidence of increased depression after TLA from longitudinal studies has been limited. It is also unknown whether physical function, cognitive function, and employment prior to amputation affects depression risk. We aimed to examine longitudinal associations between TLA and depression in working age men, and to explore the role of pre-amputation occupational and individual characteristics. Methods: A Swedish national register-based cohort of 189,220 men born between 1952 and 1956, and who attended conscription assessments in adolescence, was followed from 1985 to 2009. Physical, cognitive, and psychological characteristics were measured at the conscription examination, and occupational information was obtained from the 1985 census. Main outcome measures were hospital inpatient and outpatient admissions for depression. Results: In total, 401 men underwent TLA; mean age at amputation was 42.5 years (SD 7.4). Cox regression produced an unadjusted hazard ratio (95% confidence interval) of 2.61 (1.62–4.21) for risk of subsequent depression associated with TLA compared with the general population. Adjustment for occupational, physical, cognitive, and psychological characteristics did not change the association much, producing a hazard ratio of 2.53 (1.57–4.08). Conclusions: TLA is associated with an increased risk of depression in men over more than two decades of follow up. Occupational and individual characteristics prior to amputation did not greatly change depression risk following amputation. We speculate that a coordinated combination of social support and medical management may help reduce persistent depression risk in men who experience amputation. </jats:p>

Depression in disabling medical conditions – current perspectives

“…Among patients who underwent limb amputation, depression has been associated with factors such as severity of injury (number of amputations), and disability, according to a systematic review of 9 studies (19). Other factors identified in cohort studies include multimorbidity (20), moderate and low cognitive function (36), poor physical fitness (36), low stress resilience (36), and pre-surgery depression (37). A 12-month cohort study drew attention to the moderation effect that perceived social support might have between functioning and depression (38).…”

Assessment of Disability and Depression Following Amputation Among Adults in Korea

“…Amputation is a life-changing experience that affects physical ability, body image, quality of life, and stress resilience, all of which are factors associated with depression. 1,2 However, most previous studies [3][4][5] examining the risk of depression among people with amputation have been conducted in special populations (eg, veterans), confined to traumatic amputation, and limited by cross-sectional designs. Hence, we investigated the risk of subsequent depression after all-cause amputation in this nationwide, population-based, retrospective cohort study in Korea.…”