The effect of depression on prosthesis prescription in men and women who have undergone a lower limb amputation.
Daniel C Norvell, Aaron P Turner, David C Morgenroth and 4 others
PMID 37035925WHAT IT FOUND
Veterans with depression were less likely to receive a prosthesis, especially women.
Men with transtibial amputations and depression had over three times the odds of receiving a prescription compared to women with the same profile. This disparity suggests depression acts as a specific barrier to care for women veterans.
Key findings
01Men were more likely to receive a prosthesis prescription than women overall (59% versus 45%).
02The disparity was greatest in those with transtibial amputations and major depressive disorder, where men had over three times the odds of receiving a prescription compared to women.
03Among those who did receive a prescription, men had a shorter mean time to prescription than women, though this difference was not statistically significant in the crude analysis.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study included only 60 women compared to 2802 men, making the estimates for women highly imprecise with very wide confidence intervals. The results are specific to the U.S. veteran population and may not generalize to non-veterans or other causes of amputation like trauma or cancer. The study relied on administrative data and could not account for all clinical factors influencing prescription decisions, such as residual limb length or specific clinician biases. The exclusion of patients who died within the first year without a prescription may introduce bias, as it assumes they would not have received a prosthesis had they survived.
Declared interests
No potential conflict of interest was reported by the author(s).
The easy way to misread this
Do not conclude that depression causes women to be denied prosthetics. The study shows an association in a very small sample of women (n=60). The wide confidence intervals mean the true size of the disparity is uncertain, and other unmeasured factors related to gender and healthcare access may be responsible.