9. Connected health issues Some health issues are commonly connected with having an amputation. Because these health issues are so common among people with an amputation, the person should be carefully monitored for these health issues throughout all phases of the support pathway. Sometimes these are called secondary conditions (refer to the Glossary). We do not include all the possible health issues below, but describe the common issues identified (from research and experiential knowledge) during development of the guidance.
9.1 Psychosocial wellbeing and mental health conditions Psychosocial wellbeing, quality of life, body image and sexuality are connected. Psychosocial adjustment after a limb amputation is complex, with interplay between individual psychological and environmental factors [125, 126]. Frequently, people experience anxiety and depression before and after the amputation [127, 128]. Traumatic injury-related amputation is a risk factor for the person also experiencing post-traumatic stress disorder [129]. Post-traumatic stress is also associated with more mental health disorders of anxiety and depression, and poorer outcomes with activities and participation [130]. The presence of phantom limb pain after amputation is also a risk factor for depression, poor psychosocial adjustment and withdrawal from social activities [130]. The research is clear that early assessment and psychological treatment, before and after surgery (because of the association with adjustment) and also for some months after the amputation (some suggest up to 12 months after), facilitate the person’s psychosocial adjustment [126]. The person’s response to limb amputation will be influenced by a range of personal and contextual factors [126]. Psychosocial adjustment varies between people. Some people perceive the limb amputation as devastating, and others perceive the major life-changing event as a challenge and find a new meaning and purpose in life. There are three overlapping patterns related to the coping styles that people use in their psychosocial adjustment [130]: 1. active/confrontative (direct planning, taking action, problem solving) versus passive/avoidant (dependence on others, avoiding adjustment issues) 2. optimistic/positivistic versus pessimistic/ fatalistic (challenge for personal growth versus surrender to a sick role)
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3. social/emotional (seeking social support, seeking audience for venting, asking for help) versus cognitive (internal self-examination, working on acceptance, denial).
© icareTM | Insurance and Care NSW 2021
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icare Guidance for people with a limb amputation 2021
