title: Depressive symptoms and mental health service utilization among persons with limb loss: results of a national survey.
abstract: OBJECTIVE
  To describe the prevalence of depressive symptoms, risk factors, and mental health service utilization in a national limb-loss sample.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Participants were interviewed by telephone.
  
  
  METHODS
  A stratified sample by etiology of 914 persons with limb loss, derived from people who contacted the Amputee Coalition of America from 1998 to 2000.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Center for Epidemiologic Study Depression Scale (CES-D 10-item), pain bothersomeness, characteristics of the amputation, sociodemographics, and mental health service utilization.
  
  
  RESULTS
  Prevalence for significant depressive symptoms (CES-D score, >/=10) was 28.7%. Risk factors included being divorced or separated, living at the near-poverty level, having comorbid conditions, being somewhat bothered or extremely bothered by back pain and phantom limb pain, and having residual limb pain for persons aged 18 to 54. Having higher education was a buffer against depressive symptoms. Almost 22% of the sample and 44.6% of persons with significant depressive symptoms received mental health service in the previous year. For persons with significant depressive symptoms, 32.9% reported needing mental health service but not receiving them, and 67.1% reported not needing mental health service.
  
  
  CONCLUSIONS
  Depressive symptoms are prevalent among persons with limb loss. Proper management of pain and medical comorbidity may mitigate depressive symptoms. Education about depressive symptoms and treatment options may improve receipt of mental health service among persons with limb loss reporting significant levels of depressive symptoms.
authors.affiliation: Department of Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, MD, USA. bethdarnall@verizon.net
authors.forename: Beth D
authors.initials: BD
authors.lastname: Darnall
authors.forename: Patti
authors.initials: P
authors.lastname: Ephraim
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Wegener
authors.forename: Timothy
authors.initials: T
authors.lastname: Dillingham
authors.forename: Liliana
authors.initials: L
authors.lastname: Pezzin
authors.forename: Paddy
authors.initials: P
authors.lastname: Rossbach
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: MacKenzie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000674:Amputees / Q000706:statistics & numerical data*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D014481:United States / Q000453:epidemiology