The impact of amputation on psychiatric outcomes after burn injury

Amputation after burn injury is linked to psychiatric burden, but prior studies are small with short follow-up.

TriNetX was queried for adults with burn injury between 30 August 2005 and 1 January 2023. Amputees and non-amputees were 1:1 propensity-score matched on demographics, comorbidities, substance use, psychiatric history, antidepressant use, and burn extent. New-onset outcomes were assessed at 6 months, 1 year, and 2 years with Benjamini-Hochberg correction. Opioid use, mental health service use, and outcomes by amputation level were secondary analyses.

Each matched cohort had 2361 patients. At 6 months, amputees had higher rates of anxiety (11.03% vs 5.60%, hazard ratio [HR] 2.06), depression (9.19% vs 5.36%, HR 1.75), adjustment disorder (3.93% vs 1.65%, HR 2.59), and antidepressant initiation (19.40% vs 11.23%, HR 1.73; all p < 0.001), each persisting through 2 years after correction. Post-traumatic stress disorder was elevated through 1 year and substance use disorder at 6 months only. Sleep disorders and suicidal ideation did not differ. Opioid use was higher at every interval (81.52% vs 57.99% at 6 months, HR 1.92). Psychotherapy use was also higher (9.40% vs 5.50%, HR 1.74) but under half the rate of antidepressant initiation. Proximal amputation carried roughly twice the 6-month incidence of anxiety and adjustment disorder as distal amputation, persisting through 2 years.

Burn-related amputation is associated with sustained psychiatric morbidity that scales with amputation level, and antidepressant initiation outpaces psychotherapy. These hypothesis-generating findings support level-stratified screening and investigation of pain as a contributor.