title: The association between mental health functioning and nontraumatic lower extremity amputations in veterans with diabetes.
abstract: 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.
authors.affiliation: 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
authors.forename: Chin-Lin
authors.initials: CL
authors.lastname: Tseng
authors.forename: Usha
authors.initials: U
authors.lastname: Sambamoorthi
authors.forename: Drew
authors.initials: D
authors.lastname: Helmer
authors.forename: Anjali
authors.initials: A
authors.lastname: Tiwari
authors.forename: Amy K
authors.initials: AK
authors.lastname: Rosen
authors.forename: Mangala
authors.initials: M
authors.lastname: Rajan
authors.forename: Leonard
authors.initials: L
authors.lastname: Pogach
mesh_terms: 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*