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

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 Groom 2 . 1. King’s College London, UK. 2. King’s College Hospital, UK.

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

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

Method Patient arrives at 6- months later… clinic and checks in at reception Patient approached Onward referral to by limb specialist limb reconstruction reconstruction mental specialist nurse- health services offers information offered. sheet Patient Clinician views provided with results in EPR iPad and logs and discusses in with hospital any issues . ID and initials Questionnaire results transferred immediately to electronic patient record.

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).

Results N % Total Patients Screened 298 194 65.3 Depression No Symptoms 38 12.8 Some Symptoms 65 21.9 Probable Major Depression 12 18.2 Depression Severity Mild (PHQ9 <15) 31 10.4 Moderate (PHQ9 15-19) 22 7.4 Severe (PHQ9 >19) 19 6.4 Suicidal Ideation 220 74.1 Anxiety No Symptoms 14 4.7 Mild Anxiety 63 21.2 Probable Anxiety Disorder Severe Symptoms (GAD>14) 39 13.1 Anxiety Severity

Results N % Total Patients Screened 298 194 65.3 Depression No Symptoms 38 12.8 Some Symptoms 65 21.9 Probable Major Depression 12 18.2 Depression Severity Mild (PHQ9 <15) 31 10.4 Moderate (PHQ9 15-19) 22 7.4 Severe (PHQ9 >19) 19 6.4 Suicidal Ideation 220 74.1 Anxiety No Symptoms 14 4.7 Mild Anxiety 63 21.2 Probable Anxiety Disorder Severe Symptoms (GAD>14) 39 13.1 Anxiety Severity

Results N % Total Patients Screened 298 194 65.3 Depression No Symptoms 38 12.8 Some Symptoms 65 21.9 Probable Major Depression 12 18.2 Depression Severity Mild (PHQ9 <15) 31 10.4 Moderate (PHQ9 15-19) 22 7.4 Severe (PHQ9 >19) 19 6.4 Suicidal Ideation 220 74.1 Anxiety No Symptoms 14 4.7 Mild Anxiety 63 21.2 Probable Anxiety Disorder Severe Symptoms (GAD>14) 39 13.1 Anxiety Severity

Results N % Total Patients Screened 298 194 65.3 Depression No Symptoms 38 12.8 Some Symptoms 65 21.9 Probable Major Depression 12 18.2 Depression Severity Mild (PHQ9 <15) 31 10.4 Moderate (PHQ9 15-19) 22 7.4 Severe (PHQ9 >19) 19 6.4 Suicidal Ideation 220 74.1 Anxiety No Symptoms 14 4.7 Mild Anxiety 63 21.2 Probable Anxiety Disorder Severe Symptoms (GAD>14) 39 13.1 Anxiety Severity

Results N % Total Patients Screened 298 194 65.3 Depression No Symptoms 38 12.8 Some Symptoms 65 21.9 Probable Major Depression 12 18.2 Depression Severity Mild (PHQ9 <15) 31 10.4 Moderate (PHQ9 15-19) 22 7.4 Severe (PHQ9 >19) 19 6.4 Suicidal Ideation 220 74.1 Anxiety No Symptoms 14 4.7 Mild Anxiety 63 21.2 Probable Anxiety Disorder Severe Symptoms (GAD>14) 39 13.1 Anxiety Severity

Results N % Total Patients Screened 298 194 65.3 Depression No Symptoms 38 12.8 Some Symptoms 65 21.9 Probable Major Depression 12 18.2 Depression Severity Mild (PHQ9 <15) 31 10.4 Moderate (PHQ9 15-19) 22 7.4 Severe (PHQ9 >19) 19 6.4 Suicidal Ideation 220 74.1 Anxiety No Symptoms 14 4.7 Mild Anxiety 63 21.2 Probable Anxiety Disorder Severe Symptoms (GAD>14) 39 13.1 Anxiety Severity

Results N % Total Patients Screened 298 84 29.2 PTSD* Some Symptoms (PCL 1-3) 26 9.0 Probable PTSD (PCL >3) 259 87.5 Alcohol misuse No alcohol problem (AUDIT <8) 28 9.5 Hazardous drinking (AUDIT 8-15) 1 0.3 Harmful drinking (AUDIT 16-19) Probable alcohol dependence (AUDIT >19) 8 8.7 9 6.7 Probable drug dependence* *PTSD and drug dependence measure completed in 288 and 135 patients respectively.

Results N % Total Patients Screened 298 84 29.2 PTSD* Some Symptoms (PCL 1-3) 26 9.0 Probable PTSD (PCL >3) 259 87.5 Alcohol misuse No alcohol problem (AUDIT <8) 28 9.5 Hazardous drinking (AUDIT 8-15) 1 0.3 Harmful drinking (AUDIT 16-19) Probable alcohol dependence (AUDIT >19) 8 8.7 9 6.7 Probable drug dependence* *PTSD and drug dependence measure completed in 288 and 135 patients respectively.

Results N % Total Patients Screened 298 84 29.2 PTSD* Some Symptoms (PCL 1-3) 26 9.0 Probable PTSD (PCL >3) 259 87.5 Alcohol misuse No alcohol problem (AUDIT <8) 28 9.5 Hazardous drinking (AUDIT 8-15) 1 0.3 Harmful drinking (AUDIT 16-19) Probable alcohol dependence (AUDIT >19) 8 8.7 9 6.7 Probable drug dependence* *PTSD and drug dependence measure completed in 288 and 135 patients respectively.

Results N % Total Patients Screened 298 84 29.2 PTSD* Some Symptoms (PCL 1-3) 26 9.0 Probable PTSD (PCL >3) 259 87.5 Alcohol misuse No alcohol problem (AUDIT <8) 28 9.5 Hazardous drinking (AUDIT 8-15) 1 0.3 Harmful drinking (AUDIT 16-19) Probable alcohol dependence (AUDIT >19) 8 8.7 9 6.7 Probable drug dependence* *PTSD and drug dependence measure completed in 288 and 135 patients respectively.

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

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.

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.