The association between mental health functioning and nontraumatic lower extremity amputations in veterans with diabetes.
OBJECTIVE
The objective of this study was to evaluate the association between mental health functioning and lower extremity amputations (LEAs) in veterans with diabetes.


METHODS
A retrospective study of 1999 Large Veteran Health Survey (LVHS) respondents with diabetes who were Veterans Health Administration clinic users in fiscal years (FYs) 1998-2000 was performed. The outcome measure was type of LEAs (major, minor and none) in FY 2000. The primary independent variable was mental health functioning [adapted Medical Outcomes Study Short Form-36 mental component summary (MCS) score, with higher being better] from the LVHS. Multinomial logistic regressions were performed to evaluate the association between MCS score and LEAs, adjusting for control variables derived from FY 1999.


RESULTS
Of the 114,890 individuals included in the study, there were 450 (3.9 per 1000 individuals) major and 431 (3.8 per 1000 individuals) minor LEAs in FY 2000. Individuals with major and minor LEAs had lower mean MCS scores than those without LEAs (39.9, 42.2 and 43.4). After controlling for other independent variables, a five-point increase in MCS score was associated with a 5% decrease in the risk of major LEAs (odds ratio [OR]=0.95; 95% confidence interval [95% CI]=[0.94, 0.96]) but was not related to minor LEAs (OR=1.01; 95% CI=[0.97, 1.05]).


CONCLUSIONS
Footcare programs need to assess individuals for mental health functioning as a risk factor and to develop appropriate interventions to reduce the risk of major amputation.
Tseng
Chin-Lin
CL
Department of Veteran Affairs-Center for Health Care Knowledge and Management, VA New Jersey Health Care System, East Orange, NJ 07018, USA. chin-lin.tseng@va.gov
Sambamoorthi
Usha
U
Helmer
Drew
D
Tiwari
Anjali
A
Rosen
Amy K
AK
Rajan
Mangala
M
Pogach
Leonard
L
D000368:Aged; D000671:Amputation, Surgical / Q000523:psychology* / Q000706:statistics & numerical data*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology*; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data*