title: Application of the five stages of grief to diabetic limb loss and amputation.
abstract: A potentially underappreciated member of the multidisciplinary approach to diabetic limb salvage is that of psychiatry. Diabetic patients are more likely to experience depression, and diabetic patients with depression are more likely to undergo an amputation. Also, both diabetes and depression independently increase the healthcare costs in the United States. The objective of the present investigation was to increase knowledge among diabetic foot practitioners with respect to psychiatric and other mental health patient-care issues, specifically the potential application of the 5 stages of grief to diabetic limb loss and amputation. We enlisted the assistance of a clinical professor from the psychiatry department at our institution to review the 5 stages of grief, provide context specific for application to diabetic limb loss, and offer clinically relevant guidelines for surgeons to better understand and communicate with their patients at each stage. The 5 stages reviewed were denial, anger, bargaining, depression, and acceptance. We hope that the present review will increase the body of knowledge with respect to relevant psychiatric issues and the diabetic foot and provide a starting point for increased awareness with respect to this important, yet underappreciated, aspect of patient care.
authors.affiliation: Resident, Podiatric Surgical Residency Program, Temple University Hospital, Philadelphia, PA.
authors.forename: Kerianne E
authors.initials: KE
authors.lastname: Spiess
authors.affiliation: Resident, Podiatric Surgical Residency Program, Temple University Hospital, Philadelphia, PA.
authors.forename: Anna
authors.initials: A
authors.lastname: McLemore
authors.affiliation: Resident, Podiatric Surgical Residency Program, Temple University Hospital, Philadelphia, PA.
authors.forename: Priscilla
authors.initials: P
authors.lastname: Zinyemba
authors.affiliation: Assistant Professor, Department of Psychiatry, Temple University Hospital, Philadelphia, PA.
authors.forename: Natalia
authors.initials: N
authors.lastname: Ortiz
authors.affiliation: Associate Professor, Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA. Electronic address: ajmeyr@gmail.com.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Meyr
mesh_terms: D000671:Amputation, Surgical / Q000523:psychology*; D003863:Depression; D017719:Diabetic Foot / Q000523:psychology* / Q000601:surgery; D006117:Grief; D006801:Humans; D023821:Limb Salvage / Q000523:psychology*; D010348:Patient Care Team
keywords: amputation support group; depression; mental health; screening; wound