Depressive symptoms and quality of life among lower limb amputees

Abstract

ABSTRACT Background: Lower limb amputation is a common and oldest surgical procedure used for treatment of traumatic and non-traumatic conditions. Complications faced by patients following unilateral lower limb amputation include depressive symptoms and physical impairment that affect their quality of life. Objective: This study described the prevalence of depressive symptoms and quality of life status of unilateral lower limb amputees at MOI and MNH in Dar es Salaam, Tanzania. Material and methods: This is a cross-sectional descriptive study of 50 patients who underwent unilateral lower limb amputation at MOI or MNH between November 2017 and March 2018. Base demographics were recorded and patients were assessed for depressive symptoms and quality of life, using the Patient Health Questionnaire (PHQ-9) and EQ-5D research tools respectively at the two weeks post operation visit. Data were analyzed using Statistical Package for Social Scientists (SPSS) from IBM using student t-test and chi-square test. Results: 50 patients who underwent unilateral lower limb amputation at MOI or MNH between November 2017 and March 2018 and were enrolled in the study; males were 30(60%) and females were 20(40%). The prevalence of patients who developed depression that needed medical intervention (PHQ9 score of ≥10) was 22%, (12.4-36%). More males (53.85%) developed depression than females (46.15%) approached significance (p=0.090). Participants who had amputations as a result of trauma were more likely to be depressed (54.55%) than those who had an amputation due to non-traumatic causes (45.45%)(p=0.5). younger patients with median age of 35 years (IQR 24-45 years) were more likely to be depressed than older median age of 52years(IQR 32-60 years) (p=0.04).

Quality of life was lower in lower limb amputees compared to general population median EQ VAS score ~ 100. Furthermore participants who were not depressed had better quality of life (median EQ VAS score = 78, IQR 73-80) than those who were depressed (median EQ VAS score =62, IQR 58-700) statistically significant (p=0.01). Conclusion: Depression is common after lower extremity amputation. Depression was associated with young age. There was a trend to association with male gender. There was no association with the cause of amputation, relative support or level of amputation. Quality of life is lower among amputees compared to general population and even lower in depressed patients. Recommendations: Individuals’ especially young adults and possibly men, who suffer unilateral lower limb amputation, may need special attention with proper counseling to prevent depression.