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Risk of depression following traumatic limb amputation: a general population-based cohort study
Örebro University, School of Health Sciences.ORCID iD: 0000-0002-5567-9431
Örebro University, School of Medical Sciences. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, UK. (Clinical Epidemiology and Biostatistics)ORCID iD: 0000-0001-6328-5494
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Public Health Sciences, Stockholm University, Sweden. (Clinical Epidemiology and Biostatistics)ORCID iD: 0000-0002-2088-0530
2019 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, article id 1403494819868038Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Individuals with traumatic limb amputation (TLA) may be at risk of depression, but evidence of increased depression after TLA from longitudinal studies has been limited. It is also unknown whether physical function, cognitive function, and employment prior to amputation affects depression risk. We aimed to examine longitudinal associations between TLA and depression in working age men, and to explore the role of pre-amputation occupational and individual characteristics.

Methods: A Swedish national register-based cohort of 189,220 men born between 1952 and 1956, and who attended conscription assessments in adolescence, was followed from 1985 to 2009. Physical, cognitive, and psychological characteristics were measured at the conscription examination, and occupational information was obtained from the 1985 census. Main outcome measures were hospital inpatient and outpatient admissions for depression.

Results: In total, 401 men underwent TLA; mean age at amputation was 42.5 years (SD 7.4). Cox regression produced an unadjusted hazard ratio (95% confidence interval) of 2.61 (1.62–4.21) for risk of subsequent depression associated with TLA compared with the general population. Adjustment for occupational, physical, cognitive, and psychological characteristics did not change the association much, producing a hazard ratio of 2.53 (1.57–4.08).

Conclusions: TLA is associated with an increased risk of depression in men over more than two decades of follow up. Occupational and individual characteristics prior to amputation did not greatly change depression risk following amputation. We speculate that a coordinated combination of social support and medical management may help reduce persistent depression risk in men who experience amputation.

Place, publisher, year, edition, pages
Sage Publications, 2019. article id 1403494819868038
Keywords [en]
Amputation, cohort, depression, traumatic
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
URN: urn:nbn:se:oru:diva-75828DOI: 10.1177/1403494819868038ISI: 000482801800001PubMedID: 31405332OAI: oai:DiVA.org:oru-75828DiVA, id: diva2:1345224
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2019-01236
Note

Funding Agencies:

Örebro University Hospital Research Foundation  OLL-488821  429431 

UK Economic and Social Research Council (ESRC)  RES-596-28-0001  ES/JO19119/1 

Available from: 2019-08-23 Created: 2019-08-23 Last updated: 2019-09-10Bibliographically approved

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Lindner, Helen Y.Montgomery, ScottHiyoshi, Ayako

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