ABSTRACT Depression is often associated with many adverse health conditions and lower socio-economic status. Stressful conditions like presence of disability coupled with traditional negative societal attitude towards disability may result in higher level of depression in the individuals with disability than in general population and can cause other health problems as well. Therefore, the purposes of this study are to explore the association of depression with its biosocial correlates among individuals with lower extremity amputations (LEA) living in Kolkata, India. Eighty-five participants with traumatic LEA and 105 control participants with no amputation participated in this study. The depression levels of the participants were measured with Beck Depression Index (BDI). All participants were also measured with the following sets of health traits, using standard techniques－1) physical: body weight, stature, body mass index (BMI), blood pressure, total cholesterol, triglycerides, blood glucose, hemoglobin%, 2) functional: functional outcome or degree of independence in daily activities, and 3) social: economic condition, and social discomfort. No significant difference was found in mean BDI scores for individuals with LEA and control participants. Higher BDI scores were associated with chronic energy deficiency. None of the other physical health traits was associated with depression level. Higher depression was associated with poor socio-economic conditions like low economic condition, dependency on others for daily activity, occupational constraints due to disability and perceived problems in conjugal life. Therefore, economic development with a positive social attitude toward people with disability is essential for the mental wellbeing of the individuals with LEA.
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nullMozumdar, A. and Roy, S. (2010) Depression in adult males with lower extremity amputation and its bio-social correlates. Health, 2, 878-889. doi: 10.4236/health.2010.28131.
 American Psychiatric Association (APA). (1994) Diagnostic and statistical manual of mental disorders. 4th Edition, Washington, D.C.
Mathew, R.J., Largen, J. and Claghorn, J.L. (1979) Biological symptoms of depression. Psychosomatic Medicine, 41(6), 439-443.
Kashani, J.H., Frank, R.G., Kashani, S.R., Wonderlich, S.A. and Reid, J.C. (1983) Depression among amputees. Journal of Clinical Psychiatry, 44(7), 256-258.
Whyte, A.S. and Niven, C.A. (2001) Psychological distress in amputees with phantom limb pain. Journal of Pain and Symptom Management, 22(5), 938-946.
Rybarczyk, B.D., Nyenhuis, D.L., Nicholas, J.J., Schulz R, Alioto, R.J. and Blair, C. (1992) Social discomfort and depression in a sample of adults with leg amputations. Archives of Physical and Medical Rehabilitation, 73(12), 1169-1173.
Rybarczyk, B, Nyenhuis, D.L., Nicholas, J.J., Cash, S.M. and Kaiser, J. (1995) Body image, perceived social stigma, and the prediction of psychosocial adjustment to leg amputation. Rehabilitation Psychology, 40(2), 95- 110.
Williamson, G.M., Schulz, R., Bridges, M.W. and Behan, A.M. (1994) Social and psychological factors in adjustment to limb amputation. Journal of Social Behavior and Personality, 9(2), 249-268.
Carter, R. (2000) Coping and depression in older adults who have a lower limb amputation. Unpublished doctoral dissertation, University of Birmingham, England.
Condie, E., Jones, D., Treweek, S. and Scott, H. (1996) A one-year national survey of patients having a lower limb amputation. Physiotherapy, 82(1), 14-20.
Weiss, G.N., Gorton, T.A., Read, R.C., Neal, L.A. (1990) Outcomes of lower extremity amputations. Journal of American Geriatric Society, 38(8), 877-883.
Madan, M., Peles, E., Halkin, H., Nitzan, H., Azaria, M., Gitel, S., Dolfin, D. and Modan, B. (1998) Increased cardiovascular disease mortality rates in traumatic lower limb amputees. American Journal of Cardiology, 82(10), 1242-1247.
Mozumdar, A. and Roy, S.K. (2006) Validity of an alternative anthropometric trait as cardiovascular diseases risk factor: Example from individuals with lower extremity amputation. European Journal of Clinical Nutrition, 60(10), 1180-1188.
Joynt, K.E., Whellan, D.J. and O’Connor, C.M. (2003) Depression and Cardiovascular Disease: Mechanisms of Interaction. Biological Psychiatry, 54(3), 248-261.
Shinn, E.H., Poston, W.S., Kimball, K.T., St Jeor, S.T. and Foreyt, J.P. (2001) Blood pressure and symptoms of depression and anxiety: A prospective study. American Journal of Hypertension, 14(7), Part 1, 660-664.
Jonas, B.S. and Lando, J.F. (2000) Negative affect as a prospective risk factor for hypertension. Psychosomatic Medicine, 62(2), 188-196.
Anderson, R.J., Freedland, K.E., Clouse, R.E. and Lustman, P.J. (2001) The prevalence of comorbid depression in adults with diabetes: A meta-analysis. Diabetes Care, 24(6), 1069-1078.
Horsten, M., Wamala, S.P., Vingerhoets, A., Orth-Gomer K. (1997) Depressive symptoms, social support, and lipid profile in healthy middle-aged women. Psychosomatic Medicine, 59(5), 521-528.
Olusi, S.O. and Fido, A.A. (1996) Serum lipid concentrations in patients with major depressive disorder. Biological Psychiatry, 40(11), 1128-1131.
Steegmans, P.H., Fekkes, D., Hoes, A.W., Bak, A.A., van der Does, E. and Grobbee, D.E. (1996) Low serum cholesterol concentration and serotonin metabolism in men. British Medical Journal, 312(7025), 221.
Steegmans, P.H., Hoes, A.W., Bak, A.A., van der Does, E. and Grobbee, D.E. (2000) Higher prevalence of depressive symptoms in middleaged men with low serum cholesterol levels. Psychosomatic Medicine, 62(2), 205-211.
Hyyppa, M.T., Kronholm, E., Virtanen, A., Leino, A. and Jula, A. (2003) Does simvastatin affect mood and steroid hormone levels in hypercholesterolemic men? A randomized double-blind trial. Psychoneuroendocrinology, 28(2), 181-194.
Istvan, J., Zavela, K. and Weidner, G. (1992) Body weight and psychological distress in NHANES I. International Journal of Obesity and Related Metabolic Disorder, 16(12), 999-1003.
Carpenter, K.M., Hasin, D.S., Allison, D.B. and Faith, M.S. (2000) Relationships between obesity and DSM-IV major depressive disorder, suicide ideation, and suicide attempts: Results from a general population study. American Journal of Public Health, 90(2), 251-257.
Bruce, L., Seeman, T.E., Merrill, S.S., Blazer, D.G. (1994) The impact of depressive symptomatology on physical disability: MacArthur Studies of Successful Aging. American Journal of Public Health, 84(11), 1796-1799.
Stansfeld, S.A., Marmot, M.G. (1992) Social class and minor psychiatric disorder in British Civil Servants: A validated screening survey using the General Health Questionnaire. Psychological Medicine, 22(3), 739-749.
Behel, J.M., Rybarczyk, B., Elliott, T.R., Nicholas, N.J., Nyenhuis, D. (2002) The role of perceived vulnerability in adjustment to lower extremity amputation: A preliminary investigation. Rehabilitation Psychology, 47(1), 92- 105.
Kleck, R., Ono, H. and Hastorf, A.H. (1966) The effects of physical deviance upon face-to-face interaction. Human Relations, 19(4), 425-436.
Snyder, M.L., Kleck, R.E., Strenta, A. and Mentzer, S.J. (1979) Avoidance of the handicapped: An attributional ambiguity analysis. Journal of Personality and social Psychology, 37(12), 2297-2306.
Goffman, I. (1963) Stigma: Notes on the Management of Spoiled Identity. Prentice Hall, Englewood Cliffs.
Simonsick, E.M., Kasper, J.D. and Phillips, C.L. (1998) Physical disability and social interacion: Factors associated with low social contacts and home cofinement in disabled older women (The women’s health and aging study). Journal of Gerontology: Social Sciences, 53B(4), S209-17.
Weinstein, C.L. (1985) Assertiveness, anxiety, and interpersonal discomfort among amputees: Implications for assertiveness training. Archives of Physical Medicine and Rehabilitation, 66(10), 687-689.
Smith, D.G., Horn, P., Malchow, D.R.N, et al. (1995) Prosthetic history, prosthetic charges, and functional outcome of the isolated, traumatic below-knee amputee. Journal of Trauma: Injury, Infection and Critical Care, 38(1), 44-47.
Kegel, B., Carpenter, M.L. and Burgess, E.M. (1977) A survey of lower-limb amputees: Prostheses, phantom sensations, and psychosocial aspects. Bulletin of Prosthetics Research, 10(27), 43-60.
Peters, E.J.G, Childs, M.R., Wunderlich, R.P., Harkless, L.B., Armstrong, D.G. and Lavery, L.A. (2001) Functional status of persons with diabetes-related lower- extremity amputations. Diabetes Care, 24(10), 1799- 1804.
Thompson, D.M. and Haran, D. (1984) Living with an amputation: What it means for patients and their helpers. International Journal of Rehabilitation Research, 7(3), 283-293.
Hagberg, E., Berlin, ?.K. and Renstr?m, P. (1992) Function after through-kneecompared with below-knee and above-knee amputation. Prosthetics and Orthotics International, 16(3), 168-173.
Williamson, G.M. (1995) Restriction of normal activities among older adult amputees: The role of public self- consciousness. Journal of Clinical Geropsychology, 1(3), 229-242.
Williamson, G. and Walters, A. (1996) Perceived impact of limb amputation on sexual activity: A study of adult amputees. Journal of Sex Research, 33(3), 221-230.
O’Toole, D.M., Goldberg, R.T. and Ryan, B. (1985) Functional changes in vascular amputee patients: Evaluation by Barthel Index, PULSES Profile, and ESCROW Scale. Archives of Physical Medicine and Rehabilitation; 66(8), 508-511.
Shukla, G.D., Sahu, S.C., Tripathi, R.P. and Gupta, D.K. (1982) A psychiatric study of amputees. British Journal of Psychiatry, 141(1), 50-53.
Tyc, V.L. (1992) Psychosocial adaptation of children and adolescents with limb deficiencies: A review. Clinical Psychology Review, 12(3), 275-291.
Gerhards, F., Florin, I. and Knapp, T. (1984) The impact of medical, reeducational, and psychological variables and rehabilitation outcome in amputees. International Journal of Rehabilitation Research, 7(4), 379-388.
Cansever, A., Uzun, O., Yildiz, C., Ates, A. and Atesalp, A.S. (2003) Depression in men with traumatic lower part amputation: a comparison to men with surgical lower part amputation. Military Medicine, 168(2), 106-109.
Horgan, O. and MacLachlan, M. (2004) Psychosocial adjustment to lower-limb amputation: A review. Disability and Rehabilitation, 26(14-15), 837-850.
Dalal, A.K. (2000) Social attitudes and rehabilitation of people with disability: The Indian experience. Arab Journal of Rehabilitation, 5(1), 15-21.
Ministry of Law, Justice and Company Affairs. (1996) The persons with disabilities (equal opportunities, protection of rights and full participation) act 1995. Government of India, New Delhi.
National Sample Survey Organization. (2003) A report on disabled persons, Report 485, 55th Round. Ministry of Statistics and Program Implementation, Government of India, New Delhi.
Beck, A.T., Steer, R.A. and Brown, G.K. (1996) Manual for beck depression inventory–II. Psychological Corp, San Antonio.
Hughes, R.B., Robinson-Whelen, S., Taylor, H.B., Petersen, N.J. and Nosek, M.A. (2005) Characteristics of depressed and nondepressed women with physical disabilities. Archives of Physical Medicine and Rehabilitation; 86(3), 473-479.
Platisa, N. and Devecerski, G. (2006) Types of psychological reactions in patients with lower-extremity amputations. Medicinski Pregled, 59(3-4), 149-154.
Bodenheimer, C., Kerrigan, A.J., Garber, S.L., Monga, T.N. (2000) Sexuality in persons with lower extremity amputations. Disability and Rehabilitation, 22(9), 409- 415.
Frank, R.B., Kashani, J.H., Kashani, S.R., Wonderlich, S.A., Umlauf, R.L. and Ashkanazi, G.S. (1984) Psychological response to amputation as a function of age and time since amputation. British Journal of Psychiatry, 144(5), 493-497.
Basu, S., Chattopadhyay, D., Deb, A., Ash, S., Samajder, J., Deb, Z. and Basu, S. (1995) Adoption of beck depression inventry into Bengali and its clinical validity. Bulletin of Indian Psychiatric Society, 5(1), 5-9.
Weiner, J.S. and Laurie, J.A. (1981) Practical Human Biology. Academic Press, London.
Mozumdar, A. and Roy, S.K. (2004) Method for estimation of body weight of lower extremity amputees and its implication on their nutritional assessment. American Journal of Clinical Nutrition, 80(4), 868-875.
Bhattacharya, N., Chattopadhyay, M. and Rudra, A. (1987) Changes in level in rural West Bengal: Social consumption. Economic and Political Weekly, 22(1), 33.
Chattopadhyay, M. (1990) Perceptions of villages about changes in level of living in West Bengal. The Administrator; 25(1), 97-113.
Treweek, S.P. and Condie, M.E. (1998) Three measures of functional outcome for lower limb amputees: A retrospective review. Prosthetics and Orthotics International, 22(3), 178-185.
Wilson, P.W., D’Agostino, R.B., Levy, D., Belanger, A.M., Silbershatz, H. and Kannel, W.B. (1998) Prediction of coronary heart disease using risk factor categories. Circulation, 97(18), 1837-1847.
Fisher, K. and Hanspal, R.S. (1998) Phantom pain, anxiety, depression, and their relation in consecutive patients with amputated limbs: Case reports. British Medical Journal, 316(7135), 903-904.
Furst, L. and Humphrey, M. (1983) Coping with the loss of a leg. Prosthetics and Orthotics International, 7(3), 152-156.
Breakey, J.W. (1997) Body Image: The lower-limb amputee. Journal of Prosthetics and Orthotics, 9(2), 58-66.
Hill, A., Niven, C.A., Knussen, C. and McCreath, S.W. (1995) Rehabilitation outcome in long-term amputees. British Journal of Therapy and Rehabilitation, 2(11), 593-598.
Papassotiropoulos, A. and Heun, R. (1999) Screening for depression in the elderly: A study on misclassification by screening instruments and improvement of scale performance. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 23(3), 431-446.