Behavioral Health Outcomes in the 12 Months Following Major Limb Loss Among Active Duty Service Members Treated in the Military Health System, 2001–2017

Introduction: Over 2,100 active duty service members (ADSM) have experienced traumatic limb loss since 2001. Combat-injured ADSMs have over 3 times the odds of developing a behavioral health condition as compared to those with noncombat injuries. Additionally, severity of injury has been associated with increased risk of post-traumatic stress disorder and depression, which increase the risk of suicidal behavior. Despite previous research, studies have not investigated incident behavioral health diagnoses in the 12 months following amputation and the highest-risk subpopulations. Materials and Methods: A retrospective cohort study using existing electronic health record data identified ADSMs experiencing major limb loss between 2001 and 2017. Incident behavioral health conditions diagnosed in the 12 months following limb loss were identified. Disorders typically diagnosed in childhood were excluded. Wilcoxon rank-sum tests and chi-squared tests calculated differences between those with and without a diagnosis in the 12 months post-amputation. Logistic regression models calculated odds ratios and 95% CIs measuring the association between significant demographic and amputation characteristics and between post-amputation incident behavior health diagnosis and incident traumatic brain injury (TBI) and incident behavioral health diagnosis for each diagnostic category. Results: Approximately 56% of ADSMs were diagnosed with an incident behavioral health condition in the 12 months following major limb loss. Those diagnosed with a condition were likely to be younger, enlisted ADSMs, and sustaining a combat-related lower extremity amputation. The most common diagnosis was adjustment disorder (31%). Over 41% were also diagnosed with a TBI. Unadjusted odds of a behavioral health condition were 3.3 (95% CI: 2.8-4.0) times higher among those also diagnosed with a TBI. Conclusions: In this study, more than half of ADSMs experiencing major limb loss developed incident behavioral health conditions within the first 12 months. This study highlights the need for awareness of the potentially increased risk of these diagnoses in the acute period following amputation.