Lupine Publishers | Scholarly Journal Of Psychology And Behavioral Sciences
Abstract
Background: According to Ministry of Health
since the beginning of the great marches return (GMR) in March 2018, the number
of injured people 35.703, who had amputated limbs was 157 The amputees may
experiences body images disturbances, stress, depression, and anxiety, Many
reviews and studies done to define the psychological burden of amputations,
Social supports received by different amputees is vital in structuring
effective treatment plan as a holistic approach in treating these physically
disabled patients.
Aim: the objective of current study is
to examine the efficacy of peer support group in alleviating the emotions state
of Depression, Anxiety and stress among amputees in Gaza strip.
Method: Using semi-experimental (pre, post
and follow-up) design, 60 Amputees after assessment using DASS , assigned to
Peer Group Support (PGS). and its effect measured on the dependent variable,
Emotional state of Depression, Anxiety and Stress. Result: The prevalence of
depression in the amputee is estimated to be (%59), anxiety is (59.6%), and
stress is (%65.5), The mean score of the patients’ depression, stress and
anxiety before intervention was 1.8424 after the intervention of the peers
group support in the post test measurements was reduced to 0.8668 compared to
that of pretest measurements which is significant in value of (p<0.05).
Conclusion: The results of this study showed
that utilizing the peer group support is effective for alleviating the
emotional state of depression, stress and anxiety among patients with
amputation.
Keywords: Depression; anxiety; stress; peer group
support; DASS
Introduction
Most
of human being are born as complete whole, mind and body is connected.
Unfortunately, this system is sometimes disintegrated by disease or unfortunate
accidents. An amputation is a significant loss and can cause many lifestyle
changes. Whether the limb is removed as a result of trauma or disease, patients
experience a change in their wellbeing, mobility and ability to perform
activities of daily living like dressing, toileting and bathing. Amputation is
defined as-the surgical or spontaneous partial or complete removal of a limb or
projecting body part covered by skin and is one of the most common acquired
disabilities [1-4]. In Gaza strip during the last Thirty years ago
approximately 1543 were living with amputations through the wars launched by
the occupation on the Gaza Strip, and after the start of the Great Marches
Return (GMR), which left 157 cases of amputations [5,6], whether it is upper or
lower, Individuals with amputations comprise a diverse clinical population,
with significant heterogeneity observed in the level, cause, gender, and age
distribution of this condition, as well as the degree of disability
experienced, both physical and psychosocial [7], The researcher during work
with the amputation as supervisor of Psychosocial support unit in community
mental health directorate note a various types of psychological complications
among the patient who had amputation.
The
amputees may experience body images disturbances, anxiety, depression, and
post-traumatic stress disorder (PTSD). Many reviews and studies done to define
the prevalence of such problems, especially on depression [8]. Unresolved
adjustment problems are long-term issues following limb amputation and it may
progress into depression if it is not treated adequately [5], The prevalence of
depression in the amputee and the general population is estimated to be 28% and
3.6-10.6%, respectively [9-15], Risk factors for depression among amputees
include higher levels of pain as well as anxiety. Pedras reported up to 64%
amputees experienced anxiety symptoms following the amputation. When depression
is accompanied by anxiety disorders, such as post-traumatic stress disorder
(PTSD), higher levels of symptomatic distress and higher rates of suicidal
behavior are reported [16,4]. This drew the attention of researchers to study
some variables on these individuals and try to find a competent therapeutic
models fit for Palestinian culture and overcome the challenges of staff
shortage, The study used the quasi-experimental approach, and the
quasi-experimental approach is related to doing Practical experiments, which
are defined an evidence-based measures, are prepared by researchers and linked
to the circumstances surrounding specific phenomena, helping to draw some
conclusions from the relationships between the variables that affect phenomena
[17-19]. The importance of the study is in the aspect that the study deals
with, as this aspect carries great importance in both scientific and practical
terms, current study aimed to examine the effectiveness of peer support groups
on alleviating the emotions state of depression, anxiety and stress among
amputees in the Gaza Strip.
Methodology
Study population
The
study population includes all Amputees enrolled in Healing the wound program in
mental health directorate in Gaza governorate; Figure 1 shows the distribution
and percentage of the amputees according to Age.
Figure 1: The Distributions of participants according to age.
Sample
The
sample consisted of (60) Amputees, the sample assigned to Peer Group Support
(PGS), in the cycle three 2018 of the Healing the wound program, All of them
assigned to Peer Group Support.
Questionnaire design and PGS protocol
After
reviewing the literature and after interviewing experts who were dealing with
similar subject at different levels, all the information that could help in
achieving the study objectives were collected, reviewed and formalized to be
suitable for this study. After many stages of brain storming, consulting,
amending, and reviewing executed by the researchers, DASS scales was adopted to
assess the emotional state of depression anxiety and stress, and Protocol of
PGS and Socio- demographic questioner were developed.
Results and Discussion
Figure
1 shows. The Distributions of participants according to age, as the age ratio
“15-25” equals 30%. The largest percentage was between the ages of “26-35”
years, and the lowest percentage was more than “35 years” equal to 11.7%. A
paired sample t test was used to detect the differences between the mean scores
of the semi-experimental group on (the pre and posttest) and (post and follow
up test) on the overall degree of feelings related to (anxiety, depression, and
psychological stress) at a level of significance equal to p <0.05 after
applying the program. Table 1 illustrates that the level of significance in a
measure of feelings related to (anxiety, depression, and stress) in the pre and
posttest is less than 0.05, and the results showed that the t value is greater
than the critical value of 2, so there are statistically significant
differences in the pre and posttest for anxiety, stress, and depression at the
level of significance p <0.05 where the value of the statistical
significance in all scales equals 0.000 less than 0.05, this result reflect the
effectiveness of program in alleviating the emotional state of depression,
anxiety and stress, also regarding the level of significance in a measure of
feelings related to (anxiety, depression, and psychological stress) in the
post-test and follow up test is less than 0.05, and the results showed that the
t value is greater than critical value which is equal to 2, That is, there are
statistically significant differences in the post-test and follow up test of
emotional state of anxiety, stress, and depression at the level of significance
p <0.05 where the value of the statistical significance in all scales equals
0.000 less than 0.05, which means, there is a statistical indication that the
effectiveness of the program is reduced in alleviating feelings of anxiety,
stress and depression in the long run from the implementation of the program.
Compared
with the past qualitative research, the current study supported the positive
findings regarding the use of peer support with amputation. Recurring themes of
decreased loneliness and increased emotional support were previously reported
as benefits of peer support which is supported by the findings of the current
study, that the emotional state of ( depression, anxiety and stress) was 61.4%
in pretest and become 28.8 % (Table 1) this indicates. That is, there are
statistically significant differences in the pre and posttest in a measure of
feelings related to (anxiety, depression, and stress)., The important role of increased
social support in post amputation rehabilitation was commonly identified and
was also reported in the current study. Whilst social support increased
following participation in a peer support program, it was also an important
mediating effect on reduced psychological distress [20]. Previous qualitative
research and the findings from the present study suggest that there is an
important relationship between peer support, and emotional state of amputees,
this result reflect the effectiveness of Peer Group Support in alleviating the
emotional state of depression, anxiety and stress, However processes associated
with attending the Peer Group Support (as measured by follow up test) The
results of the comparison between the posttest and the follow-up test show that
the measurement of feelings related to depression, anxiety and stress increased
slightly on the follow-up test, but compared to the pre-test we can say that
the effectiveness of the program is still ongoing and this rise expresses the
need for social support on an ongoing basis [21], which participants found in
peer support groups and this is evidence that Peer Group Support are effective
in address these feelings. This finding may suggest that the personal benefits
obtained, which also indicated by the verbal feedback that the researcher
receive it from participant, and the social relationships formed during the
group may have continued (and developed) after the intervention ended, And the
best evidence for this is that a group of people with amputation who
participated in these groups have formed a club of their own in order to
continue to provide support to each other. This represents one of the most
prominent success stories that this program has achieved. This finding
indicates that facilitating Peer Group Support (PGS) may have beneficial
implications for amputees [22-27].
Conclusion
Current
study showed that the clinician should pay more attention to detect early
symptoms psychological distress. also the findings suggest that there are many
factors are associated with psychological co morbidity, Compared with the past
qualitative research identified in the review, the current study supported the
positive findings regarding the use of peer support with amputation [28,29].
Recurring themes of decreased loneliness and increased emotional support were
previously reported as benefits of peer support which is supported by the
findings of the current study, that the emotional state of ( depression,
anxiety and stress) was 61.4% in pretest and become 22.8 % (Table 1), this
result reflect the effectiveness of Peer Group Support in alleviating the
emotional state of depression, anxiety and stress.
Table 1: Test
results illustrate the mean differences in feelings related to (anxiety,
depression, and stress) in the quasi-experimental group in the pre and
posttest.
Recommendations
Practical implications
The
findings from this study suggest that peer group support program may be an
effective intervention for improving the psychosocial wellbeing of Amputees.
These findings have implications for service-users, clinicians, guidelines and
organizations.
Further study
a)
Randomize control trial to support the efficacy of Peer Group Support and to
compare the result with other type of intervention [6].
b)
study to determine the psychological burden of amputations among general
amputees population
c)
long term study to understand the dynamic of social support and its relation to
reengage the amputees in the society.
d)
Run study include female with amputation to have more representative result.
e)
study the personal treat which may play role in amputees reengagement.
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