SLR - June 2017 - Sneha Anil Patel

Perceived Social Support Moderates the Relationship Between Activities of Daily Living and Depression After Lower-Limb Loss

Reference: Anderson DR, Roubinov DS, Turner AP, Williams RM, Norvell DC, Czerniecki JM. Perceived Social Support Moderates the Relationship Between Activities of Daily Living and Depression After Lower Limb Loss. Rehabil Psychol. 2017 Apr 13.

Scientific Literature Review

Reviewed By: Sneha Anil Patel, DPM
Residency Program: Crozer Keystone Health System

Podiatric Relevance: Podiatrists often are the primary health professional to treat lower-extremity ulcerations that can result in lower-extremity amputation. The authors of this article aimed to understand if a relationship exists between depression, level of activities of daily living and perceived social support. Developing a thorough understanding of every patient’s social history and social support system may help identify patients that would benefit from increased social support during the postamputation period.

Methods: This prospective cohort study included participants treated at one of four hospitals between 2005 and 2008. Two hundred thirty-nine patients were identified who had received lower-limb amputation. Patients included in the study were those who received a lower-extremity amputation secondary peripheral vascular disease (PVD) or diabetes. Patients were assessed at six weeks and 12 months postoperatively. All participants were asked to complete a questionnaire regarding demographics at six weeks postoperatively that included questions regarding present depressive symptoms, social support, mobility and activities of daily living (ADLs) preoperatively. At 12 months, patients were asked to complete another questionnaire regarding current depressive symptoms. Different patient assessment tools/questionnaires were utilized to analyze ADLs, mobility and perceived social support and to determine relationships between each of these factors.   

Results: Seventy-three patients met the inclusion criteria and completed surveys at six months and 12 months. The mean age of participants was 61.2 years. Ninety-two percent of patients were males, and 82.2 percent were Caucasian. 57.5 percent of participants had below-knee amputations, 32.9 percent received transmetatarsal amputations and the rest had undergone above-knee amputations. Nearly half of patients included earned less than $25,000 per year and were married. 39.7 percent of patients reported a decrease in depressive symptoms, 49.3 percent reported an increase in depressive symptoms and 11 percent reported no change. With regard to ADL functions, perceived social support and mobility, no differences were noted between patients who completed both assessments and patients who did not. No significant change was noted when comparing depressive symptoms at six weeks postoperatively and at 12 months postoperatively. Of significance is that patients with poor ADLS when combined with lower levels of social support exhibited higher depressive symptoms at 12 months.

Conclusions: Social support and ADLs have been studied separately by experts as having influence over depressive symptoms. This study is the first to examine the interaction between social support and ADLs as it relates to depressive symptoms in patients post amputation of the lower extremity. Patients with poor baseline ADLs and less social support exhibited greater depressive symptoms. These patients with lower baseline ADLs may require higher levels of social support to possibly reduce depressive symptoms. Perceived social support may be a measure that can be modified to decrease depressive symptoms post amputation. Health professionals treating these patients should pay close attention to social history and should encourage dialogue regarding social support, depression and ADLs, which may be barriers during the postamputation recovery period. 

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