title: Anxiety and depression following traumatic limb amputation: a systematic review.
abstract: BACKGROUND
  Traumatic amputation can result in multiple physical, psychological and socio-economic sequalae. While there has been a significant increase in investment and public profile of the rehabilitation of patients who have experienced traumatic limb amputation, little is known about the prevalence of anxiety and depression, especially in the long term.
  
  
  OBJECTIVE
  To determine the association between traumatic limb amputation and anxiety and depression.
  
  
  METHODS
  A literature search of available databases including Cochrane, Medline, Embase, and PsycINFO was performed for relevant studies since 2002. Secondary outcomes included the effect on employment, substance misuse, relationships and quality of life.
  
  
  METHODS
  Randomised control trials, observational studies or reviews which met the inclusion, exclusion and quality criteria.
  
  
  RESULTS
  Levels of anxiety and depression are significantly higher than in the general population. Significant heterogeneity exists between studies making meta-analyses inappropriate. Improved rehabilitation is having a positive effect on employment rates. There appears to be no significant effect on substance abuse and relationships.
  
  
  CONCLUSIONS
  All studies demonstrated high prevalence of anxiety and depression in post-traumatic amputees. No good prospective data exists for levels of anxiety and depression beyond two years of follow up and this should be an area of future study.
authors.affiliation: Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham B15 2SQ, United Kingdom. Electronic address: stuartmckechnie@hotmail.com.
authors.forename: P S
authors.initials: PS
authors.lastname: Mckechnie
authors.affiliation: College of Medicine, Swansea University, Swansea SA2 0ST, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: John
mesh_terms: D000223:Adaptation, Psychological; D000673:Amputation, Traumatic / Q000453:epidemiology / Q000523:psychology* / Q000534:rehabilitation; D001007:Anxiety / Q000175:diagnosis* / Q000453:epidemiology / Q000534:rehabilitation; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology / Q000534:rehabilitation; D004644:Emotions; D004651:Employment / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D007398:Interpersonal Relations; D011788:Quality of Life / Q000523:psychology*; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology*; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data
keywords: Amputation; Amputee; Anxiety; Depression; Traumatic