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A secondary aim was to evaluate whether trajectories of depression were associated with elevated symptoms of posttraumatic stress (PTS) at 6\u2009months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Secondary longitudinal data analysis of an inception cohort study of persons with new\u2010onset limb loss. Participants completed assessments at three intervals (initial, 3 months, and 6 months).<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Hospitalized care, acute rehabilitation, ambulatory care, and community.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Participants were recruited from consecutive cases of amputation surgery in a metropolitan hospital system over a period of 4\u2009years (2002\u20132007). The final sample (<jats:italic>n<\/jats:italic>\u2009=\u2009203) was predominantly White (79.3%) and male (78.8%) with an average age of 49.4\u2009years (standard deviation [SD]\u2009=\u200914.6).<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measure(s)<\/jats:title><jats:p>Depression was assessed via the Patient Health Questionnaire\u20109 (PHQ\u20109); posttraumatic stress symptoms were measured via the PTSD checklist\u2013 Civilian Version (PCL\u2010C).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Four trajectories of depression were identified via Latent Growth Mixture Modeling: <jats:italic>Resilience<\/jats:italic> (73.2%), <jats:italic>Chronic Depression<\/jats:italic> (11.2%), <jats:italic>Emerging Depression<\/jats:italic> (8.9%), and <jats:italic>Recovery<\/jats:italic> (6.7%). Average pain intensity significantly predicted trajectory membership. Membership in the <jats:italic>Chronic Depression<\/jats:italic> class predicted elevated 6\u2010month PTS compared to all other classes; membership in the <jats:italic>Resilience<\/jats:italic> class predicted lower PTS than in the <jats:italic>Chronic<\/jats:italic> and <jats:italic>Emerging Depression<\/jats:italic> classes but did not differentiate from the <jats:italic>Recovery<\/jats:italic> trajectory.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Findings reveal that the course of depression post\u2010amputation is heterogenous, with varying profiles of symptom development, maintenance, and remission. A majority of individuals were classified as <jats:italic>Resilient<\/jats:italic>, whereas a substantial minority of individuals developed clinically significant depression between 3 and 6 months (<jats:italic>Emerging Depression<\/jats:italic>), suggesting that early screening during acute care may be insufficient. We detected a significant prospective relation between depression trajectories and distal PTS, advancing the potential clinical utility of trajectory modeling as a risk surveillance tool.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pmrj.13095","type":"journal-article","created":{"date-parts":[[2023,11,2]],"date-time":"2023-11-02T10:52:49Z","timestamp":1698922369000},"page":"594-604","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Heterogeneous trajectories of depression and resilience following limb amputation"],"prefix":"10.1002","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0657-7316","authenticated-orcid":false,"given":"Jed N.","family":"McGiffin","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine University of Washington School of Medicine  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9555-2347","authenticated-orcid":false,"given":"Dawn M.","family":"Ehde","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine University of Washington School of Medicine  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9793-3653","authenticated-orcid":false,"given":"Rhonda M.","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine University of Washington School of Medicine  Seattle Washington USA"},{"name":"VA Puget Sound Health Care System, Seattle Division Rehabilitation Care Services  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8260-4435","authenticated-orcid":false,"given":"George A.","family":"Bonanno","sequence":"additional","affiliation":[{"name":"Department of Counseling and Clinical Psychology, Teachers College Columbia University  New York City New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,1,4]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2007.11.005"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40141-020-00293-1"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/09638288.2022.2122599"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2021.02.027"},{"issue":"7","key":"e_1_2_8_6_1","first-page":"256","article-title":"Depression among amputees","volume":"44","author":"Kashani JH","year":"1983","journal-title":"J Clin Psychiatry"},{"issue":"12","key":"e_1_2_8_7_1","first-page":"1169","article-title":"Social discomfort and depression in a sample of adults with leg amputations","volume":"73","author":"Rybarczyk BD","year":"1992","journal-title":"Arch Phys Med Rehabil"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269215508094710"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc\u20102016\u2010000366"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdiacomp.2010.07.002"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2017.10.092"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1037\/0090\u20105550.41.4.285"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269215509339001"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM196311282692203"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1945.02860260019007"},{"issue":"1","key":"e_1_2_8_16_1","first-page":"20","article-title":"Rehabilitation of the limbless; 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