limb reconstruction . Faith Matcham 1 , Lauren Rayner 1 , Sandesh - - PowerPoint PPT Presentation

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Nov 07, 2023 35 likes •216 views

The prevalence of common mental disorders in patients undergoing major limb reconstruction . Faith Matcham 1 , Lauren Rayner 1 , Sandesh Shetty 2 , Mohit Bansal 2 , Deborah Bond 2 , Sarah Phillips 2 , Anna Simpson 1 , Matthew Hotopf 1 , Graeme

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SLIDE 1

The prevalence of common mental disorders in patients undergoing major limb reconstruction.

Faith Matcham1, Lauren Rayner1, Sandesh Shetty2, Mohit Bansal2, Deborah Bond2, Sarah Phillips2, Anna Simpson1, Matthew Hotopf1, Graeme Groom2.

  • 1. King’s College London, UK.
  • 2. King’s College Hospital, UK.
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SLIDE 2

Purpose of the study

To identify the prevalence of common mental disorders in patients undergoing complex limb reconstruction.

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SLIDE 3

Background

  • Patients undergoing limb reconstruction vulnerable

to mental health problems (Scott et al., 2001).

  • Treatment emphasis on restoration and

rehabilitation of physical health.

  • IMPARTS* aims to develop informatics to improve

detection and management of common mental disorders in medical settings.

*Integrating Mental and Physical healthcare: Research, Training and Services

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SLIDE 4

Method

Patient arrives at clinic and checks in at reception

Patient approached by limb reconstruction specialist nurse-

  • ffers information

sheet Patient provided with iPad and logs in with hospital ID and initials Questionnaire results transferred immediately to electronic patient record.

Clinician views results in EPR and discusses any issues.

Onward referral to specialist limb reconstruction mental health services

  • ffered.

6-months later…

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SLIDE 5

Results

  • In total, 298 individual patients were screened between April 2012-

November 2013 .

  • Measures included:
  • Depression (PHQ-9)
  • Anxiety (GAD-7)
  • Post-Traumatic Stress Disorder (PCL-4)
  • Alcohol Dependence (AUDIT)
  • Drug Use
  • Also measured but not reported here: Smoking, Occupational Status, and

Physical Function (LEFS).

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SLIDE 6

Results

N %

Total Patients Screened

298

Depression No Symptoms

194 65.3

Some Symptoms

38 12.8

Probable Major Depression

65 21.9

Depression Severity Mild (PHQ9 <15) 12 18.2 Moderate (PHQ9 15-19) 31 10.4 Severe (PHQ9 >19) 22 7.4 Suicidal Ideation 19 6.4 Anxiety No Symptoms 220 74.1 Mild Anxiety 14 4.7 Probable Anxiety Disorder 63 21.2 Anxiety Severity Severe Symptoms (GAD>14) 39 13.1

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SLIDE 7

Results

N %

Total Patients Screened

298

Depression No Symptoms

194 65.3

Some Symptoms

38 12.8

Probable Major Depression

65 21.9

Depression Severity Mild (PHQ9 <15) 12 18.2 Moderate (PHQ9 15-19) 31 10.4 Severe (PHQ9 >19) 22 7.4 Suicidal Ideation 19 6.4 Anxiety No Symptoms 220 74.1 Mild Anxiety 14 4.7 Probable Anxiety Disorder 63 21.2 Anxiety Severity Severe Symptoms (GAD>14) 39 13.1

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SLIDE 8

Results

N %

Total Patients Screened

298

Depression No Symptoms

194 65.3

Some Symptoms

38 12.8

Probable Major Depression

65 21.9

Depression Severity Mild (PHQ9 <15) 12 18.2 Moderate (PHQ9 15-19) 31 10.4 Severe (PHQ9 >19) 22 7.4 Suicidal Ideation 19 6.4 Anxiety No Symptoms 220 74.1 Mild Anxiety 14 4.7 Probable Anxiety Disorder 63 21.2 Anxiety Severity Severe Symptoms (GAD>14) 39 13.1

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SLIDE 9

Results

N %

Total Patients Screened

298

Depression No Symptoms

194 65.3

Some Symptoms

38 12.8

Probable Major Depression

65 21.9

Depression Severity Mild (PHQ9 <15) 12 18.2 Moderate (PHQ9 15-19) 31 10.4 Severe (PHQ9 >19) 22 7.4 Suicidal Ideation 19 6.4 Anxiety No Symptoms 220 74.1 Mild Anxiety 14 4.7 Probable Anxiety Disorder 63 21.2 Anxiety Severity Severe Symptoms (GAD>14) 39 13.1

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SLIDE 10

Results

N %

Total Patients Screened

298

Depression No Symptoms

194 65.3

Some Symptoms

38 12.8

Probable Major Depression

65 21.9

Depression Severity Mild (PHQ9 <15) 12 18.2 Moderate (PHQ9 15-19) 31 10.4 Severe (PHQ9 >19) 22 7.4 Suicidal Ideation 19 6.4 Anxiety No Symptoms 220 74.1 Mild Anxiety 14 4.7 Probable Anxiety Disorder 63 21.2 Anxiety Severity Severe Symptoms (GAD>14) 39 13.1

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SLIDE 11

Results

N %

Total Patients Screened

298

Depression No Symptoms

194 65.3

Some Symptoms

38 12.8

Probable Major Depression

65 21.9

Depression Severity Mild (PHQ9 <15) 12 18.2 Moderate (PHQ9 15-19) 31 10.4 Severe (PHQ9 >19) 22 7.4 Suicidal Ideation 19 6.4 Anxiety No Symptoms 220 74.1 Mild Anxiety 14 4.7 Probable Anxiety Disorder 63 21.2 Anxiety Severity Severe Symptoms (GAD>14) 39 13.1

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SLIDE 12

Results

N % Total Patients Screened 298 PTSD* Some Symptoms (PCL 1-3) 84 29.2 Probable PTSD (PCL >3) 26 9.0 Alcohol misuse No alcohol problem (AUDIT <8) 259 87.5 Hazardous drinking (AUDIT 8-15) 28 9.5 Harmful drinking (AUDIT 16-19) 1 0.3 Probable alcohol dependence (AUDIT >19) 8 8.7 Probable drug dependence* 9 6.7

*PTSD and drug dependence measure completed in 288 and 135 patients respectively.

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SLIDE 13

Results

N % Total Patients Screened 298 PTSD* Some Symptoms (PCL 1-3) 84 29.2 Probable PTSD (PCL >3) 26 9.0 Alcohol misuse No alcohol problem (AUDIT <8) 259 87.5 Hazardous drinking (AUDIT 8-15) 28 9.5 Harmful drinking (AUDIT 16-19) 1 0.3 Probable alcohol dependence (AUDIT >19) 8 8.7 Probable drug dependence* 9 6.7

*PTSD and drug dependence measure completed in 288 and 135 patients respectively.

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SLIDE 14

Results

N % Total Patients Screened 298 PTSD* Some Symptoms (PCL 1-3) 84 29.2 Probable PTSD (PCL >3) 26 9.0 Alcohol misuse No alcohol problem (AUDIT <8) 259 87.5 Hazardous drinking (AUDIT 8-15) 28 9.5 Harmful drinking (AUDIT 16-19) 1 0.3 Probable alcohol dependence (AUDIT >19) 8 8.7 Probable drug dependence* 9 6.7

*PTSD and drug dependence measure completed in 288 and 135 patients respectively.

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SLIDE 15

Results

N % Total Patients Screened 298 PTSD* Some Symptoms (PCL 1-3) 84 29.2 Probable PTSD (PCL >3) 26 9.0 Alcohol misuse No alcohol problem (AUDIT <8) 259 87.5 Hazardous drinking (AUDIT 8-15) 28 9.5 Harmful drinking (AUDIT 16-19) 1 0.3 Probable alcohol dependence (AUDIT >19) 8 8.7 Probable drug dependence* 9 6.7

*PTSD and drug dependence measure completed in 288 and 135 patients respectively.

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SLIDE 16

Results

N % Total Patients Screened 298 PTSD* Some Symptoms (PCL 1-3) 84 29.2 Probable PTSD (PCL >3) 26 9.0 Alcohol misuse No alcohol problem (AUDIT <8) 259 87.5 Hazardous drinking (AUDIT 8-15) 28 9.5 Harmful drinking (AUDIT 16-19) 1 0.3 Probable alcohol dependence (AUDIT >19) 8 8.7 Probable drug dependence* 9 6.7

*PTSD and drug dependence measure completed in 288 and 135 patients respectively.

In total, 101 (33.9%) individual patients attending an outpatient appointment had screening results indicating a need for some form of psychological support.

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SLIDE 17

Conclusions

  • The consequences of undergoing limb

reconstruction more than just physical.

  • The benefits of early detection and

management of such problems are significant.

  • There is urgent need to integrate mental

health care as part of early management of severely injured patients.

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SLIDE 18

Acknowledgements

  • IMPARTS provides a screening package including technical development,

equipment, development of mental health care pathways, ongoing mental health training and supervision, and bespoke self-help materials.

  • IMPARTS is funded by King’s Health Partners Academic Health Science

Centre, the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London.

  • Funding for the Limb Reconstruction Nurse Specialist facilitating screening

and the mental health service time is provided by the King’s College Hospital Limb Reconstruction Trust.