title: A predictive model of anxiety and depression symptoms after a lower limb amputation.
abstract: BACKGROUND
  Patients with Diabetic Foot Ulcer (DFU) show high levels of depression and anxiety symptoms. The loss of a limb is undoubtedly a devastating experience and several studies have shown that anxiety and depression symptoms are a common reaction after a lower limb amputation (LLA). However, no study has focused on the immediate emotional reactions to LLA as a personal factor based on the ICF Model.
  
  
  OBJECTIVE
  This study focused on the characterization of anxiety and depression levels, before and after surgery, differences in levels of depression and anxiety before and after surgery and the predictors of anxiety and depression one month after surgery, in a sample of patients with DFU.
  
  
  METHODS
  This was a longitudinal study with 179 patients with Diabetes Mellitus Type 2 and DFU indicated for amputation, screened for the presence of anxiety and depression symptoms during the hospitalization that preceded amputation and one month after surgery, during a follow-up consultation.
  
  
  RESULTS
  The results showed a significant effect of anxiety and depression symptoms at pre-surgery in the prediction of anxiety and depression symptoms one month after LLA. Patients showed higher levels of anxiety than depression symptoms at pre-surgery, although anxiety significantly decreased on month after surgery. Both anxiety and depression symptoms contributed to depression after LLA, although anxiety at pre-surgery was the only predictor of anxiety at post-surgery.
  
  
  CONCLUSIONS
  Tailored multidisciplinary interventions need to be developed providing support before and after an amputation surgery, in order to reduce anxiety and depression symptoms and promote psychological adjustment to limb loss.
authors.affiliation: School of Psychology, Applied Psychology Department, University of Minho, Campus Gualtar, 4710-057 Braga, Portugal. Electronic address: susanapedras@gmail.com.
authors.forename: Susana
authors.initials: S
authors.lastname: Pedras
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar do Porto, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal. Electronic address: rui.morais.carvalho@gmail.com.
authors.forename: Rui
authors.initials: R
authors.lastname: Carvalho
authors.affiliation: School of Psychology, Applied Psychology Department, University of Minho, Campus Gualtar, 4710-057 Braga, Portugal. Electronic address: gracep@psi.uminho.pt.
authors.forename: M Graça
authors.initials: MG
authors.lastname: Pereira
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000523:psychology*; D000674:Amputees / Q000523:psychology*; D001007:Anxiety / Q000209:etiology*; D001008:Anxiety Disorders / Q000209:etiology; D003863:Depression / Q000209:etiology*; D003866:Depressive Disorder / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D017719:Diabetic Foot / Q000601:surgery*; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged
keywords: Amputation; Anxiety; Depression; Diabetic Foot Ulcer; Post- surgery; Pre-surgery