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A Prospective Longitudinal Study of Trajectories of Depressive Symptoms After Dysvascular Amputation.

ABSTRACT: OBJECTIVES:Characterize the course of depressive symptoms during the first year after dysvascular amputation and identify factors that predict symptom trajectories. DESIGN:Prospective cohort study of individuals undergoing lower extremity amputation (LEA), surveyed at 4 time points (perioperative period, 6 weeks, 4 months, and 12 months postamputation). Multilevel modeling was used to describe and predict trajectories. SETTING:Four Veterans Affairs medical centers, a university hospital, and a level I trauma center. PARTICIPANTS:Participants (N=141; 74% retention) were a consecutive sample, eligible if they were undergoing their first unilateral LEA secondary to dysvascular disease. INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURE:Patient Health Questionnaire-9. RESULTS:Approximately 40% of participants endorsed at least moderate depressive symptoms at perioperative baseline. Individuals with greater depressive symptoms in the perioperative period concurrently reported greater pain, poorer self-rated health, and prior mental health treatment. In the first 6 weeks after amputation there was a substantial improvement in depressive symptoms, especially among individuals with greater symptoms at baseline. Depressive symptoms were generally stable after 6 weeks. None of the covariates assessed significantly predicted trajectories of depressive symptom improvement. CONCLUSIONS:Watchful waiting may be the most appropriate course of action for many patients in the first 6 weeks after amputation. After 6 weeks, however, symptom levels tend to stabilize, suggesting that active intervention is called for if patients remain depressed at this point. Some patients may benefit from more proactive intervention, such as those with prior mental health treatment histories.

SUBMITTER: Roepke AM

PROVIDER: S-EPMC7504975 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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A Prospective Longitudinal Study of Trajectories of Depressive Symptoms After Dysvascular Amputation.

Roepke Ann Marie AM Turner Aaron P AP Henderson Alison W AW Goldberg Simon B SB Norvell Daniel C DC Czerniecki Joseph M JM Williams Rhonda M RM

Archives of physical medicine and rehabilitation 20181231 8

<h4>Objectives</h4>Characterize the course of depressive symptoms during the first year after dysvascular amputation and identify factors that predict symptom trajectories.<h4>Design</h4>Prospective cohort study of individuals undergoing lower extremity amputation (LEA), surveyed at 4 time points (perioperative period, 6 weeks, 4 months, and 12 months postamputation). Multilevel modeling was used to describe and predict trajectories.<h4>Setting</h4>Four Veterans Affairs medical centers, a univer ...[more]

PMID: 30605638

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Project description:BackgroundThere are gaps in understanding longitudinal patterns and predictors of perinatal depressive symptoms in sub-Saharan Africa. This study aimed to explore trajectories of depressive symptoms and associated factors from pregnancy to 9 months post partum among Kenyan women.MethodsIn this prospective cohort study, we analysed data from the PrEP Implementation for Mothers in Antenatal Care (PrIMA) study in which HIV-negative women were enrolled in pregnancy and followed up to 9 months post partum in 20 public sector maternal-child health clinics in western Kenya. Pregnant women were eligible for enrolment if they were not infected with HIV, aged 15 years or older, and were able to provide consent. Eligible participants were screened and enrolled between Jan 15, 2018, and July 31, 2019, and followed up to 9 months post partum, with the last participant study visit conducted on Jan 15, 2021. Study nurses serially assessed depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CESD-10), intimate partner violence with the Hurt, Insult, Threaten, Scream scale, and social support with the Medical Outcomes Study scale. Generalised estimating equations were used to identify correlates of moderate-to-severe depressive symptoms (CESD-10 score ≥10) and group-based trajectory modelling identified discrete trajectories of perinatal depressive symptoms.FindingsAmong 4447 participants in the main PrIMA study, 3555 had complete depressive symptom data in pregnancy and depressive symptom data post partum and were included in the primary analysis. Median age was 24·0 years (IQR 21·0-28·7), 1330 (38%) participants had low social support, and 278 (8%) reported intimate partner violence in pregnancy. All participants (100%) were female and all (100%) were of African Kenyan ethnicity. Prevalence of moderate-to-severe depressive symptoms was higher in pregnancy than post partum (870 [24·5%; 95% CI 23·1-25·9] vs 597 [6·8%; 15·6-18·1]; p<0·0001). Five patterns of depressive symptoms were identified; persistent moderate-to-severe depressive symptoms in pregnancy and post partum (295 [8·3%]), moderate-to-severe depressive symptoms in pregnancy that resolved post partum (139 [3·9%]), moderate-to-severe depressive symptoms that emerged post partum (40 [1·1%]), chronically mild symptoms (2709 [76·2%]), and no depressive symptoms (372 [10·5%]). Emergent moderate-to-severe depressive symptoms were associated with older age. Emergent, persistent, and resolving moderate-to-severe depressive symptoms were associated with intimate partner violence during pregnancy; and persistent and resolving moderate-to-severe depressive symptoms were associated with low social support and high HIV risk (all p<0·05). Moderate-to-severe depressive symptom risk was significantly increased with intimate partner violence (adjusted odds ratio 2·07 [95% CI 1·81-2·31]; p<0·0001), low social support (1·74 [1·56-1·95]; p<0·0001), and partner HIV-positive status (1·48 [1·22-1·78]; p<0·0001). 23·34% (95% CI 18·77-27·65) of cases of perinatal moderate-to-severe depressive symptoms were attributable to low social support.InterpretationOne third of women had perinatal moderate-to-severe depressive symptoms; nearly half of these had higher severity phenotypes of resolving, persistent, and emerging moderate-to-severe depressive symptoms that might require tailored interventions. Perinatal women with comorbid psychosocial stressors such as intimate partner violence and previous pregnancy loss should be prioritised for mental health services that augment social support within routine maternal-child health care.FundingNational Institutes of Health.TranslationFor the Kiswahili translation of the abstract see Supplementary Materials section.

Project description:BackgroundPeople with dysvascular lower limb amputation (LLA) achieve one-third of the recommended steps per day and experience severe disability. Although physical function improves with rehabilitation after dysvascular LLA, physical activity remains largely unchanged, and factors contributing to limited daily step count are unknown.ObjectivesTo identify factors that contribute to daily step count after dysvascular LLA.DesignCross-sectional, secondary data analysis.SettingOutpatient rehabilitation facilities.ParticipantsFifty-eight patients with dysvascular major LLA (age: 64 ± 9 years, body mass index: 30 ± 8 kg/m2 , male: 95%, transtibial LLA: 95%).MethodsData were collected by a blinded assessor after dysvascular LLA. Candidate explanatory variables included (1) demographics, (2) LLA characteristics, (3) comorbidities and health behaviors, and (4) physical function. Variables with univariate associations with log steps/day (transformed due to non-normality) were included in a multiple linear regression model using backward elimination to identify factors that explained significant variability in log steps/day.Primary outcome measureThe primary outcome, daily step count, was measured with accelerometer-based activity monitors worn by participants for 10 days.ResultsParticipants took an average (± SD) of 1450 ± 1309 steps/day. After backward elimination, the final model included four variables explaining 62% of the overall daily step count (P < .0001): 2-minute walk distance (32%), assistive device use (11%), cardiovascular disease (10%), and pre-amputation walking time (11%).ConclusionsAverage daily step count of 1450 steps/day reflects the lowest category of sedentary behavior. Physical function, cardiovascular disease, and pre-amputation walking time explain 62% of daily step count after dysvascular LLA. Although physical rehabilitation commonly focuses on improving physical function, interventions to increase daily step count after dysvascular LLA should also consider chronic disease and health behaviors that predate LLA.Level of evidenceIII.

Project description:ObjectivesThe objective was to assess the prevalence of perinatal depressive symptoms and determine the trajectories of marital adjustment and depressive symptoms and their reciprocal relationships among Chinese perinatal women.DesignThis was a prospective, longitudinal cross-lagged study.SettingThe study was conducted at the outpatient department of the largest women's and children's hospital in China, which is located in Chengdu, Sichuan Province.ParticipantsFour hundred and sixty-three mothers were conveniently sampled.Main outcome measuresThe Dyadic Adjustment Scale and the Chinese version of the Edinburgh Postnatal Depression Scale were used to evaluate marital adjustment and depressive symptoms, respectively, at three time points: the first trimester of pregnancy (T1), the third trimester of pregnancy (T2) and 6 weeks after childbirth (T3). Descriptive statistics were used to assess the prevalence of perinatal depressive symptoms, and repeated-measures analysis of variance (ANOVA) was used to determine the trajectories of marital adjustment and depressive symptoms among the participants. A cross-lagged model was used to explore the reciprocal relationship between marital adjustment and depressive symptoms.ResultsThe prevalence of perinatal depressive symptoms among our participants ranged from 21.2% to 24.0%. Repeated-measures ANOVA showed that during the perinatal period there was a significant tendency towards worse marital adjustment (F=33.031, p=0.000) and a slight but not significant reduction in depressive symptoms (F=1.883, p=0.153) among the participants. The cross-lagged model showed that maternal marital adjustment at T1 significantly and negatively predicted depressive symptoms at T2 (β=-0.165, p<0.001), and that depressive symptoms at T2 significantly and negatively predicted marital adjustment at T3 (β=-0.135, p<0.001). However, the predictive effects of depressive symptoms at T1 on marital adjustment at T2 and that of marital adjustment at T2 on depressive symptoms at T3 were not significant.ConclusionThe prevalence of perinatal depressive symptoms ranged from 21.2% to 24.0% among the participants. During the perinatal period, the marital adjustment of women tended to be worse; however, there was no significant change in depressive symptoms. This study showed that better marital adjustment at T1 was a protective factor against maternal depressive symptoms at T2, and a higher level of depressive symptoms at T2 was a risk factor for worse marital adjustment at T3.

Project description:ImportanceDepressive symptoms during pregnancy influence the development and health of the offspring, underscoring the need for timely intervention. However, the course of depressive symptoms across the perinatal period remains unclear, thus complicating screening and referral guidelines.ObjectiveTo examine the course and stability of depressive symptoms across the perinatal period in multiple, ethnically diverse independent observational cohorts.Design, setting, and participantsThis cohort study included self-reported depressive symptoms at multiple time points from 7 prospective cohorts spanning 3 continents (United Kingdom: Avon Longitudinal Study of Parents and Children from 1991 to 1995; Canada: Maternal Adversity, Vulnerability and Neurodevelopment from 2003 to 2007; Montreal Antenatal Well-being Study from 2019 to 2022; Alberta Pregnancy Outcomes and Nutrition from 2009 to 2014; and Singapore: Growing Up in Singapore Toward Healthy Outcomes from 2009 to 2013; Singapore Preconception Study of Long-Term Maternal and Child Outcomes from 2015 to 2019; and Mapping Antenatal Maternal Stress from 2019 to 2022). Participants were recruited either during preconception or pregnancy and observed into the postnatal period. All data from each cohort were analyzed from July 2022 to April 2023.Main outcomes and measuresSelf-reported depressive symptoms from pregnancy to 2 years following childbirth using either the Edinburgh Postnatal Depression Scale or the Center for Epidemiological Studies Depression were analyzed independently within each cohort using item response theory (IRT) techniques. K-means clustering was used to identify groups of participants with similar trajectories.ResultsA total of 11 563 pregnant women (mean [SD] age, 29 [5] years; 569 [4.9%] East Asian women; 304 [2.6%] Southeast Asian women; 10 133 [87.6%] White women) self-reported depressive symptoms from pregnancy to 2 years following childbirth. Analytic methods from Item Response Theory identified 3 groups of mothers based on depressive symptoms: low, mild, and high levels in each of the 7 cohorts. Mothers within and across all cohorts had stable trajectories of maternal depressive symptoms from pregnancy onwards. Mothers with clinical levels of depressive symptoms likewise showed stable trajectories from pregnancy into the postnatal period.Conclusions and relevanceIn this study, trajectories of depressive symptoms remained stable from pregnancy across the perinatal period, a finding that conflicts with a continuing emphasis on postpartum or postnatal onset of depression that persists in some health policy guidelines. Interventions and public health initiatives should focus on reducing depressive symptoms during pregnancy in addition to following birth.

Dataset Information

A Prospective Longitudinal Study of Trajectories of Depressive Symptoms After Dysvascular Amputation.

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A Prospective Longitudinal Study of Trajectories of Depressive Symptoms After Dysvascular Amputation.

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