As a peer visitor, it is not your role to diagnose any mental health challenges or disorders nor is it your role to treat them.  Your role is to listen, support and refer the person for professional help as needed.  While it’s not your role to diagnose or treat any mental health challenges, it may be helpful for you to understand depression, anxiety, and quality of life.  This way you better understand what the person you’re visiting is communicating to you. In addition, it may help you in supporting them but also in providing resources or reaching out for help if it’s needed.

As previously stated, everybody responds differently to both the prospect and the outcomes of amputation. After learning that amputation may be necessary, people often fluctuate between feeling anxiety and depression.

Depression

Depression is a very common mental health disorder that affects how one feels, the way one thinks, and how one acts.  In persons who have undergone amputation as a result of trauma, the incidence of depression ranges from 21 to 63%.  Persons who have been amputated secondary to trauma have a greater risk for depressive symptoms (46%) as compared to those who have had an amputation as a result of vascular causes (38%) or cancer (16%) (Mckechnie & John, 2014).  For persons with single-limb amputation, the rate of depression and anxiety increases with the level of amputation.  Surprisingly, in at least one study, they found that persons with multiple amputations had lower levels of anxiety and depression. The hypothesis is that those with an extreme level of injury may be able to put their circumstances into perspective, being glad to be alive as opposed to focussing on the disability.  Persons with upper extremity amputations had higher levels of depression and less adjustment to their prosthesis when compared to persons with lower-limb amputations (Desteli et al, 2007). Having presented these numbers, it’s very important to remember that everybody is different and responds in a different way to amputation. These numbers are generalizations.

Depression, in persons with amputation, is associated with decreased use of prostheses, activity restriction, and poorer self-rated health.  Horgan and Maclahlan (2004) in their review of adjustment to lower limb amputation found that most studies included reported depression for a period up to two years post-amputation. They did not find elevated rates of depression, compared to the normal population, 2 to 10 years post-amputation.

While depression is treatable, only those qualified should treat it. It can affect one’s quality of life, and ability to function and can lead to further physical and emotional problems. The symptoms associated with depression are:

• Feeling sad or having a depressed mood
• Lost interest in activities
• Change in appetite-weight loss or gain
• Trouble falling asleep or sleeping too much
• Increased fatigue
• Increased pace or slowed movement or speech (observable to others)
• Feeling guilty
• Difficulty making decisions
• Thoughts of death or suicide

Although your role is not to treat depression, as a peer visitor there are many things you can do to help. These include:

• Starting a conversation; letting them know that you’re there for them
• Help them reach out for support such as counseling
• If they are already receiving therapy, support them in continuing that therapy
• And very importantly, take care of yourself.

Difference between grief and depression

Often, feelings of sadness and grief are mistaken for being depressed. Though grieving is natural and shares some similar features to depression, they differ in various ways.

Some symptoms are similar for both grief and depression. These include intense sadness, insomnia, poor appetite, and weight loss.

Anxiety

Twenty-five to 57% of persons with amputation, as a result of traumatic injury, experience anxiety. As with depression, persons with upper extremity amputations experience a higher level of anxiety than those with lower extremity amputations.  Anxiety levels are further increased in persons with amputation of the dominant hand.

Anxiety is a feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome.  Anxiety disorders, on the other hand, cause people to have excessive fear and anxiety.  These disorders can lead persons with amputation to avoid situations that lead to the worsening of their symptoms.  There are many types of anxiety disorders such as specific phobias, generalized anxiety disorder, and agoraphobia. The peer visitor’s role in supporting a person who is experiencing anxiety is similar to that of supporting persons with symptoms of depression.

Quality of life

Depression, anxiety, and post-traumatic stress are correlated with lower quality of life. Quality of life is significantly poorer in patients with uni- or bilateral lower-limb amputation compared to the non-amputated population (Holzer, et al 2014).  These differences are greatest in the following aspects of quality of life:

• physical functioning
• role limitations due to physical problems
• role limitations due to emotional problems
• vitality and
• mental health

Check Your Understanding

This is a self-assessment to check your understanding of the concepts presented in this section. You can attempt the activity multiple times.