Adaptation to Limb Loss: Heterogeneous Trajectories of Resilience and Depression Predict Posttraumatic Stress

Research Objectives To identify longitudinal trajectories of depression in the first six months following amputation and to explore baseline predictors of these trajectories. A secondary aim was to utilize trajectories as predictors of PTSD as a 6-month distal outcome. Design Archival data from two inception cohort studies of persons with new onset limb loss. Participants completed assessments at initial, -3 and 6-month follow-ups. Setting hospitalized care, acute rehabilitation, ambulatory care, and community. Participants Individuals with new limb loss were recruited from consecutive cases within a large metropolitan hospital system over a four-year period (2002-2007). Final sample (n = 203) was predominantly male (78.8%) and white (83.3%) with an average age of 49.4 years (SD = 14.58) at the time of amputation. Interventions N/A. Main Outcome Measures Patient Health Questionnaire-9 (PHQ-9); PTSD checklist – Civilian Version (PCL-C). Results Using Latent Growth Mixture Modeling, four trajectories of depression were identified: resilience (73.2%), recovery (6.7%), emerging depression (8.9%), and chronic depression (11.2%). Pain intensity was a significant baseline predictor of trajectory membership, whereas demographic covariates were non-significant. In distal outcome analyses, trajectory membership significantly predicted PTSD at 6-months. Pairwise comparisons revealed significantly elevated PTSD in the chronic-depression trajectory versus all other classes; the resilient class had significantly fewer PTSD symptoms than the emerging depression class but did not differentiate from the recovery trajectory. Conclusions Findings support the conclusion that the course of depression post-amputation is heterogeneous, with varying profiles of symptom development and remission. Although the majority of individuals were classified as resilient, average depression was mildly elevated in the resilient class immediately post-amputation, underscoring the challenging nature of acute recovery. Further, a substantial minority of individuals (8.9%) developed clinically significant depression between 3 and 6-months, suggesting that early screening during acute care may be insufficient for the detection of emerging depression. The derivation of latent classes of depression in longitudinal data may prove useful as a clinical tool for the early identification of those at risk for PTSD, a diagnosis with unique time-course requirements. Author(s) Disclosuress None