Psychosocial Impact of Diabetic Foot Amputation

According to a 1998 article in the British Medical Journal, when amputation is necessary, the patient can experience grief similar to that caused by the loss of a loved one. Sadness and anxiety are normal reactions to amputation, as well as preoccupation with loss of physical function and loss of body image. Since diabetics are twice as likely to become depressed as physically healthy people, according to the National Institute of Mental Health, the added blow of amputation can be very difficult for them to cope with.

Grief

• The British Medical Journal article compared widows grieving the loss of their spouse with patients grieving the loss of their body part. Both groups had difficulty believing the loss, had clear visual memories of the person or part, and a sense of their continuing presence. The sense of continuing presence manifests in the amputee as the "phantom limb." As time passed, both groups reported a diminishing of this sense of presence. In the case of the phantom limb, the phantom limb seemed to merge with the prosthesis. Returning to work tended to help both groups, but only a third of the amputees were able to resume their previous employment.

Coping Styles

• The prospect of impaired mobility gave rise to depression both before and after surgery, according to the study in the British Medical Journal. Depression can delay rehabilitation and makes the management of diabetes itself problematic. The groups of amputees who had the most adverse psychological reactions in the study of widows and amputees were those who had a history of anxiety and depression before the surgery, and those who were rigidly self-reliant.

Delayed Reaction

• According to the British Medical Journal, the self-reliant amputation patients in the study seemed to do well at first, but after about 13 months, they were significantly more likely to experience phantom limb pain than others. This group compares with people who show little grief when they suffer the loss of their loved one, but who later develop symptoms that resemble those of the person who has died.

Psychosocial Evaluation

• According to an article in the Journal of Orthotics and Prosthetics, a relationship exists between an amputee's perception of his body image and his psychosocial well-being. According to author James Breakey, Ph.D., "significant correlations tend to support other studies in which physical disability was found to increase a person's tendency toward anxiety, depression, low self-esteem and less satisfaction with life."

Treatment

• Amputation is a traumatic event and since depression contributes to poorer health outcomes and is itself a serious condition, people who have experienced amputation should be assessed and treated for depression or anxiety, if necessary. Treatment options include psychotherapy, medication or a combination of the two.