Anxiety and/or depression: which symptoms contribute to adverse clinical outcomes after amputation?

Abstract

Background

One of the most serious complications of diabetes mellitus (DM) is a diabetic foot ulcer (DFU), with lower extremity amputation (LEA).

Aims

This study aims to explore the role of anxiety and depression on mortality, reamputation and healing, after a LEA due to DFU.

Methods

A sample of 149 patients with DFU who underwent LEA answered the Hospital Anxiety and Depression Scale and a sociodemographic and clinical questionnaire. This is a longitudinal and multicenter study with four assessment moments that used Cox proportional hazards models adjusted for demographic and clinical variables.

Results

Rate of mortality, reamputation and healing, 10 months after LEA were 9.4%, 27.5% and 61.7%, respectively. Anxiety, at baseline, was negatively associated with healing. However, depression was not an independent predictor of mortality. None of the psychological factors was associated with reamputation.

Conclusion

Results highlight the significant contribution of anxiety symptoms at pre-surgery, to healing after a LEA. Suggestions for psychological interventions are made.

Keywords:

• Diabetic foot ulcer
• amputation
• reamputation
• healing
• depression
• anxiety
• mortality

Acknowledgements

The authors gratefully acknowledge the contributions of the Multidisciplinary Diabetic Foot Clinics of five hospitals: Centro Hospitalar Universitário do Porto, Centro Hospitalar Vila Nova de Gaia/Espinho, Centro Hospitalar Tâmega e Sousa, Unidade Local de Saúde do Alto Minho, Vascular Surgery Department of Centro Hospitalar de São João and Vascular Surgery Department and Physical Medicine and Rehabilitation Department of Hospital de Braga. The authors also wish to thank all patients who agreed to participate in this study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institution and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all participants included in this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was conducted at Psychology Research Centre (PSI/01662), University of Minho, and supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education through National Funds and co-financed by FEDER through COMPETE2020 under the PT2020 Partnership Agreement [POCI-01-0145-FEDER-007653]. This work was also supported by UID/MAT/00013/2013 and SFRH/BD/87704/2012 from the Portuguese Foundation for Science and Technology.