How Do Depression and Distress Affect Surgical Outcomes in Diabetic Amputation?

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A poster presented at the recent American Society of Podiatric Surgeons (ASPS) Annual Surgical Conference finds that diabetes-related extremity amputation depression and distress (DREADD) is a complication following amputation and surgeons should screen for depression.¹
 
The study included 20 patients who underwent partial or total toe amputations or partial ray resections, excluding traumatic amputations.¹ The authors noted 18 patients had increased Patient Health Questionnaire-9 (PHQ-9) scores within 30 days post-amputation, increasing from 3.65 to 12.35. PHQ-9 scores above 10 indicate at least moderate depressive symptoms, according to the study.
 
Depression is bidirectionally linked to type 2 diabetes, increasing the risk of foot ulcers, mortality, and major non-traumatic amputation, as well as post-amputation depression when diagnosed preoperatively, notes the study.¹ Researchers added that depressive symptoms in patients with type 2 diabetes may impair ulcer healing and adherence to treatment.
 
“Our qualitative results suggest non-traumatic amputations can be emotionally traumatic, with some patients fearing major amputation more than death,” note the authors.¹ They coined the acronym DREADD to describe the phenomenon.
 
Researchers advocated surgeons screen patients with type 2 diabetes for depressive symptoms before and after non-traumatic amputations, referring them to mental health specialists as needed.¹ The study notes potential for developing a new psychiatric/mental health subspecialty to address the psychological impacts of diabetes such as DREADD.
 
Reference
1. Brooks BM, Brooks BM, Arp AS, et al. Diabetes-Related Extremity Amputation Depression & Distress (DREADD). Presented at the American Society of Podiatric Surgeons Annual Surgical Conference, Oct. 18–19, 2024, New Orleans, LA.

Photo courtesy of Collin Pehde, DPM