The Use of a Standard Measure of Emotional Distress to Evaluate Early Counseling Intervention in Patients with Amputations

Few attempts have been made to measure with standardized tests the outcome of counseling for people with amputations. The choice of an appropriate instrument to record emotional distress without the confounding effects of physical disability is often a problem. For this article, a 12-item version of the General Health Questionnaire (GHQ) has been used to overcome this difficulty. The study investigates the distress reported on the GHQ by 58 patients on the first visit to the limb-fitting center within a few weeks of their amputation and again 4 to 6 months later. Eighteen (31%) of these patients elected to have a counseling session, and their follow-up scores are compared with those who did not opt for counseling. The scores of both groups at both time periods are compared with their reports of other problems listed in a second questionnaire. At the first appointment, the group who chose counseling showed higher GHQ scores than those who did not. There was a reliable difference in the scores of those who responded ‘Yes’ or ‘No’ to problems such as anger, depression, and effect on relatives. At follow-up, the scores of both groups had increased, suggesting more awareness of emotional distress 4 to 6 months after surgery. Counseling had not affected this result, although there was a difference in the rate of reporting of practical problems in the counseled versus the uncounseled group. The association between higher scores and reports of difficulty with other emotional issues was still apparent, suggesting some stable validity of the GHQ in this population. The GHQ has shown evidence of utility and validity in measuring the actual levels of emotional distress reported by patients in the early weeks after amputation and again some months after amputation. Those who elected to have counseling had higher scores initially. Both the counseled and the uncounseled groups showed an increase at follow up, indicating the need to target patients for possible counseling at about the 6-month point. The GHQ could then evaluate the effect of this intervention.