Depression and its associated risk factors among lower limb amputee at Hospital Kuala Lumpur and Hospital Sultanah Bahiyah - a cross sectional study / Mohamad Iqbal Mohaini

Background: Amputation is a surgical procedure performed to remove non­ functioning limb. A limb becomes damaged as a result of medical causes such as diabetic complication, peripheral vascular, malignancy as well as non-medical causes collectively called trauma. Clinical reports have indicated that a significant number of lower limb amputees are experiencing psychological adjustment problems. Research has shown that there is a relatively high prevalence of depression in the amputee population. To date, there is a dearth of studies documenting depression among lower limb amputees in Malaysia
Objective: The objective of this study is to determine the prevalence of depression among lower-limb amputees and examine several salient factors impacting on depression. These include socio-demographic factors, clinical variables, perceived social supports and quality of life.
Methodology: This is a cross-sectional study involving one hundred and ninety-six lower limb amputees who attended the Rehabilitation Medicine Clinics at Hospital Kuala Lumpur and Hospital Sultanah Bahiyah Alor Setar. Level of depressive symptoms, perceived social support, quality of life and clinical depression were measured using Beck Depression (BDI), Multi-Dimensional Perceived Social Support (MSPSS), World Health Organisation Quality of Life Brief Scale (WHOQOL-BREF) and Mini-International Neuropsychiatric Interview (MINI) respectively. The validated Malay version of these questionnaires were also used.
Results: Ninety-three (47.4%) lower limb amputees out of 196 respondents had depressive symptoms based on BDI. 48 respondents or 24.5% were diagnosed to have clinical depression. The findings revealed that depression associated with younger age, being single and low educational background as far as socio-demographic factors were concerned. In the case clinical factors, depression was found to be associated with bilateral side of amputation, trauma as a reason for amputation, absence of prosthesis as type of walking aid, shorter duration of amputation, and absence of medical co-morbidity among amputees. Low social support and poor quality of life were also found to be associated with depression. Multivariate analyses showed low perceived social supports (p<0.05; OR 26.45) and absence of medical comorbidities (p<0.05; OR 50.07) among amputees emerged as a significant predictor of depression among lower limb amputees in this study.
Conclusion: Present study demonstrated high percentage of clinical depression in lower limb amputees. Without proper diagnosis and timely intervention, depression may complicate the rehabilitation process and bring detrimental psychological sequelae. These findings should encourage the rehabilitation clinicians to screen for depression in those attending their services to ensure a holistic management in these patients. All of the risk factors discovered in this study may help the clinicians to identify the high-risk group and to treat them accordingly.