Mental health and quality of life in diabetic lower limb amputees

Abstract

Aim: To determine any significant difference in the mental health status and quality of life in lower limb amputees living with diabetes when compared to individuals living with diabetes without a lower limb amputation. Methods: A prospective, matched, non-experimental, longitudinal and comparative study was conducted at a specialised diabetic foot clinic and diabetic foot ward, both located at Mater Dei Hospital. The sample was divided into two groups. Group 1: 38 participants who had undergone a minor lower limb amputation including digital, transmetatarsal, tarsometatarsal, midtarsal or Syme amputations and group 2: 38 participants without amputation or history of amputation (Control Group). Participants were recruited via a state registered podiatrist during their routine podiatry appointment. Two questionnaires to screen for mental health status and quality of life were utilised: namely the Self Reporting Questionnaire 20 (SRQ 20) and the Euro Quality of Life Tool (EQ-5D5L). Participants were reviewed twice: 1 week and 6 months post amputation and asked to answer the aforementioned questionnaires. Any changes in the respondent’s answers were recorded. Results: Two participants from group 1 passed away between time 0 and time 1. The Shapiro Wilk test was used to test for normality of the data and non-parametric tests were used. The mean SRQ 20 scores for group 1 were significantly higher than the non-amputee counterparts at both time 0 and time 1 (p<0.01). In addition, the mean SRQ 20 scores at time 0 were higher than at time 1, for both groups (p<0.05). The mean EQ 5D 5L values for group 1, were higher than those of group 2 at both time 0 and time 1. Furthermore, the mean EQ 5D 5L values for group 1 showed no significant difference between time 0 and time 1 for all the variables except pain/discomfort and anxiety/depression. For group 2, the mean EQ 5D 5L values showed no significant difference between time 0 and time 1 except for the variable labelled anxiety/depression. Conclusion: The findings of this study suggest that both mental health and quality of life are negatively affected after minor lower limb amputation (LLA). Mental health disorders in particular were proven to be present one week after minor LLA, however, were alleviated six months after amputation. QoL in amputees also improved after six months, however, patients still had moderate problems with regards to mobility, and slight problems with regards to self-care and usual activities. When it came to individuals living with diabetes who did not sustain an amputation, it was found that there were no mental health disorders present during the study period. However, when this group of individuals were specifically screened for anxiety and depression with the EQ 5D 5L questionnaire, results indicated that individuals living with diabetes without LLA also endured anxiety and depression symptoms related to their disease. The findings of this study imply that mental health disorders must not be relegated to the bottom of priorities in national health systems but given the importance that they deserve. The study recommends screening for mental health disorders such as depression as early as diagnosis and throughout the course of the condition.