Depression and anxiety symptoms after lower limb amputation: the rise and fall

Objective: To examine the time course of anxiety and depressive symptoms over a three year period after amputation. Design and settings: A prospective study in inpatients admitted to a rehabilitation ward after lower limb amputation. Subjects: Successive admissions over a one-year period of whom 68 were alive at follow-up, 2-3 years later, Interventions: Nil. Main measures: Hospital Anxiety and Depression Scale (HADS) on admission and discharge from inpatient rehabilitation and at a 2.7(SD = 0.4) year mean follow-up period with correlation to demographic and patient features. Results: Of the 68 responding patients, 12 (17.6%) and 13 (19.1%) had symptoms of depression and anxiety respectively. This compared to an original incidence of 16 (23.5%) for both on admission and 2 (2.9%) on discharge. This rise in incidence from time of discharge was highly significant for both depression (P<0.001) and anxiety (P<0.001). Depression at follow-up was correlated to depressive symptoms at admission (P=0.03) and to having other significant comorbidities (P=0.02). Anxiety symptoms were commoner in younger patients (P=0.03). There was no association with age, gender, living in isolation, vascular cause for amputation, wearing a limb prosthesis or length of original inpatient stay. Conclusions: Depression and anxiety are common after lower limb amputation but resolve during inpatient rehabilitation. The incidence then rises again after discharge.