title: Psychological adjustment to lower limb amputation amongst prosthesis users.
abstract: OBJECTIVE
  Clinical reports indicate that many lower limb amputees experience problems with psychological adjustment. Although depressive responses to amputation have been well investigated, there has been insufficient attention to other aspects of adjustment. This study aimed to determine the prevalence of psychological morbidity in an amputee population and identify variables associated with increased distress. Particular attention was given to cognitive models of emotion which postulate a key role for self-consciousness and appearance-related beliefs.
  
  
  METHODS
  A cross-sectional survey of 67 adult lower limb prosthesis users who had experienced amputation within the last five years. Outcome measures were the Psychosocial Adjustment Scale of the Trinity Amputation and Prosthesis Experience Scales, the Hospital Anxiety and Depression Scale, the Self Consciousness Scale and the Appearance Schemas Inventory.
  
  
  RESULTS
  Using conservative cut-off scores the prevalence of anxiety and depression was 29.9 and 13.4%, respectively. Appearance-related beliefs were associated with both distress and psychosocial adjustment difficulties. Public but not private self-consciousness was associated with distress and psychosocial adjustment difficulties.
  
  
  CONCLUSIONS
  Clinicians need to monitor amputees for distress over a longer time period than the initial post-operative phase. It is particularly important to assess for anxiety. Interventions that target appearance-related beliefs may be of benefit to this population.
authors.affiliation: Clinical Psychology Services, Southwell Rd, Mansfield, Nottingham, NG18 4HH, UK. Rachel.Atherton@nottshc.nhs.uk
authors.forename: Rachel
authors.initials: R
authors.lastname: Atherton
authors.forename: Noelle
authors.initials: N
authors.lastname: Robertson
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000523:psychology*; D001007:Anxiety / Q000453:epidemiology*; D001186:Artificial Limbs / Q000523:psychology*; D001828:Body Image; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006801:Humans; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012917:Social Adjustment; D006113:United Kingdom