Psychological treatments for persistent depression: A systematic review and meta-analysis of quality of life and functioning outcomes.

To date it is unclear whether psychological therapies have potential to improve quality of life and functioning in patients with persistent depression. This meta-analysis examines the effect of psychological therapies for improving quality of life and functioning in patients with persistent forms of depression. Data sources include Medline and Meta-Analytic Psychotherapy Database (METAPSY), searched 07/2021. Eligible studies were randomized controlled trials where participants had major depressive disorder on entry and met criteria for a persistent form of depression, for example, chronic, treatment resistant or recurrent depression. Standardized mean differences (Hedge’s g) were calculated in random-effects meta-analyses. Fourteen studies met inclusion criteria (N = 1898). Psychological interventions were associated with improvements in patients’ quality of life at the end of treatment: pooled g = 0.24 (95% confidence intervals [CIs] 0.13–0.34); low to moderate levels of heterogeneity (I² = 0% [95% CI 0%–41.2%]). Quality of life at follow-up: pooled g = 0.21 (95% CI 0.01–0.32); low to high levels of heterogeneity considering the wide CI for I² (I² = 10.36% [95% CI 0%–77.5%]). The psychological interventions were associated with improvements in patients’ functioning at end of treatment: pooled g = 0.34 (95% CI 0.21–0.48); low to high levels of heterogeneity considering the wide CI for I² (I² = 0% [95% CI 0%–81.7%]). Functioning at follow-up resulted in: pooled g = 0.33 (95% CI 0.15–0.50); low to high levels of heterogeneity considering the wide CI for I² (I² = 0% [95% CI 0%–86.2%]). This meta-analysis highlights the potential benefits of psychological therapies for improving quality of life and functioning in patients with persistent depression, with strongest long-term effects for mindfulness-based cognitive therapy, interpersonal therapy in combination with antidepression medication, and long-term psychoanalytic psychotherapy

From injured body to changes in self-identity: A research on adults with acquired physical impairments

Dissertação apresentado ao ISPA-Instituto Universitário para obtenção do grau de Doutor em Psicologia Aplicada: Especialidade Psicologia da ClinicaBackground: The experience of becoming physically impaired, especially in lower limb adult amputees and in working-aged patients with vision loss, has deserved little attention by research in general. The weight of some variables associated with these experiences on depressive levels has been stressed by some studies. However, little is known about it. Aims: The current dissertation aimed at filing in the knowledge gap regarding these topics. We intended to explore the experience of acquired physical impairment, focusing on changes in self-identity, in two groups: working-aged adults with vision loss; and adults who suffered a lower limb amputation. In addition, we aimed at exploring a possible connection between the most relevant emerged variables of these experiences and the depressive levels: the self-awareness of impairment; and the selfidentifications with the impairment. Method: Two independent studies were performed, both was cross-sectional and using mixed-methods: study 1 was on the experiences of vision loss of 38 patients at rehabilitation setting (mean age of 42.7; SD=14.5); and study 2 was on the experiences of lower limb amputation in 42 patients (mean age of 61; SD=13.5) followed-up at a general hospital‟s rehabilitation medicine unit. Qualitative data on the experiences of impairment was collected by two semi-structured interviews for each patient. The interviews were performed by an independent and trained psychologist, under the supervision of a senior psychologist and psychotherapist. 80 interviews were conducted in study 1 and 84 interviews in study 2. Depressive levels were assessed using CES-D. The content analysis was performed using the Categorical and Coding analysis proposed by Bardin. Results: Qualitative data from the study 1, on the experiences of vision loss, retrieved seven themes, most of them focused on changes in self-identity. These results supported a new model for the adjustment process to vision loss, based on patients‟ self-awareness of impairment and self-identifications with the impairment. 39.5% (n=15) of patients met CES-D criteria for depression. Higher depressive levels (P<.05) were found in patients who: lost vision for longer; begun their rehabilitation later; were more aware of their impairment; and those who reported an inadequate social support (P<.01). A positive correlation was found between CES-D scores and vision loss evolution (.333; P=.036), and between CES-D scores and rehabilitation time (.335; P=.035). In study 2, eight themes emerged from the interviews. Qualitative results supported a theoretical model for the changes in self-identity related to lower limb loss beyond the body image. 31% (n=13) met CES-D criteria for Depression. Higher depressive levels (p<.05) were found in those who showed: greater self-awareness of impairment; lower identification with the impairment; and worse appraisals towards the prosthesis, social support and well-being. Conclusions: In both studies the changes in self-identity, especially in terms of selfawareness of impairment and self-identifications with the impairment, arose as core milestones of the adjustment process to the impairment. The relationship found between the variables related to the experience of impairment and depressive levels suggests two conclusions: the changes in self-identity caused by the impairment might be one of the important causes for the rising of depressive levels; the increase in depressive levels in these populations might be, at first, the reflex of the adjustment process to the many personal losses and therefore, do not necessarily reveal a bad adaptation to the impairment nor a mental health problem. ---------- RESUMO ----------Enquadramento: A experiência de amputação de membro inferior em adultos, e a experiência de perda irreversível de visão em adultos não idosos, são dois temas que têm tido pouca atenção por parte da investigação científica. O peso desta experiência ao nível da identidade dos sujeitos e a relação dessas variáveis com os níveis de depressividade são temas considerados relevantes, embora ainda pouco estudados. Objectivos: A presente dissertação veio no propósito de produzir alguma evidência acerca dos tópicos referidos. Com estes estudos pretendemos explorar as experiências incapacidade física adquirida e as suas implicações para a identidade dos sujeitos em dois grupos de sujeitos: adultos que tenham sofrido amputação de membro inferior; e adultos não idosos com perda irreversível e severa de visão. Outro dos objectivos destes estudos foi a investigação preliminar de potenciais relações entre variáveis como a autoconsciência de incapacidade e as auto-identificações com a incapacidade e os níveis de depressividade. Método: Para atingir os objectivos do nosso estudo, delineamos duas investigações independentes. Estudo 1: 38 sujeitos com perda irreversível de visão (média de idades de 42.7 anos; desvio padrão de 14.5), todos eles em fase de reabilitação. Estudo 2: 42 sujeitos amputados (média de idades de 61; desvio padrão de 15.6), todos eles em seguimento na consulta de medicina física e de reabilitação num hospital geral. Em ambos os estudos as experiências de incapacidade foram recolhidas através de uma metodologia qualitativa, com recurso a entrevistas semi-estruturadas realizadas individualmente a cada sujeito. Cada entrevista foi realizada por um investigador independente, formado em Psicologia e com experiencia clínica com este tipo de populações. As entrevistas foram supervisionadas por um Psicólogo e Psicoterapeuta Sénior. Os níveis de depressividade foram avaliados usando o CES-D. A análise do conteúdo das entrevistas foi realizada com base no método de codificação categorial não indutivo de Bardin. Resultados: Os resultados qualitativos do estudo 1 (perda de visão) revelaram sete temas, a maior parte dos quais acerca das alterações ao nível da própria identidade. Esses resultados suportaram um modelo compreensivo para o processo de ajustamento à perda de visão, com base na auto-consciência de incapacidade e nas auto-identificações à incapacidade dos sujeitos estudados. As pontuações no CES-D de 39.5% (n=15) dos sujeitos cumpriram os critérios para depressão clínica. Maiores níveis de depressão (P<.05) foram encontrados nos sujeitos que: tinham perdido a visão há mais tempo; começaram a reabilitação mais tardiamente; estavam mais conscientes a sua incapacidade; e percepcionaram um pior suporte social (P<.01). Foi encontrada uma correlação positiva entre as pontuações dos sujeitos no CES-D e duas variáveis: o tempo decorrido entre o primeiro diagnóstico da doença responsável pela perda de visão e o momento em que o sujeito ficou clinicamente com baixa visão ou cego (.333; P=.036); o tempo de reabilitação (.355; P=.035). No estudo 2 emergiram oito temas sobre a experiência de amputação. Esses resultados suportaram também um modelo teórico compreensivo para as alterações na identidade dos sujeitos, decorrentes da situação de amputação. 31% (n=13) dos sujeitos apresentaram pontuações no CES-D que cumpriram os critérios para depressão clínica. Maiores níveis de depressão (P<.05) foram encontrados nos sujeitos que apresentaram: maior auto-consciência de incapacidade; menor identificação à incapacidade; pior relação com a prótese; pior percepção do suporte social; e pior percepção do bem-estar. xii Conclusões: Nos dois estudos a auto-consciência de incapacidade e as autoidentificações com a incapacidade surgiram como duas variáveis chave do processo de ajustamento à incapacidade, demonstrando o potencial efeito transformador destas situações de incapacidade para identidade dos sujeitos. A associação encontrada entre as variáveis relativas à experiência de incapacidade e os níveis de depressividade parece sugerir duas conclusões: as alterações na identidade decorrentes da situação de incapacidade física adquirida poderão ser uma das importantes causas do aumento dos níveis de depressividade; o aumento dos níveis de depressividade poderão ser, num primeiro momento, reflexo do processo de ajustamento às perdas sofridas e não traduzir, necessariamente, uma má adaptação à situação de incapacidade, nem um problema de saúde mental.Programa Operacional de Potencial Humano, QREN Portugal, 2007-201

Occupational health, well-being and ability to work in a sample of portuguese nurses

Background/Objective: Occupational health is a multidisciplinary activity aiming to keep people mentally and physically well and safe at work. In nurses, it has deserved a particular attention, considering the complexity and demanding nature of the job. The current study aims to investigate the association between psychosocial variables, including coping with work (BriefCOPE) and psychosocial factors of work (COPSOQ-II), and ability to work (WAI) among Portuguese nurses. Methods: An observational cross-sectional study with 111 Portuguese nurses was conducted and the outcome measures include socio-demographical variables, COPSOQ, BriefCOPE and WAI. To study the variables presented in the original database, a sociodemographic characterization was performed, followed by an exploratory factor analysis (EFA) to the COPSOQ and BriefCOPE dimensions. To quantify, test and confirm the results obtained in the previous analyses, a confirmatory factor analysis (CFA) was performed. Results: Key coping dimensions were closely associated with better ability to work among nurses, particularly the use of instrumental support, planning, quantitative demands, and emotional demands. The EFA for BriefCOPE suggested a 5-factor structure, which is a slightly different factor structure for the corresponding 3 theoretical dimensions, and the CFA results show that the model is not fit to the data. Regarding the COPSOQ-II scale, the EFA suggested the same 8-factor structure of the original scale’s theoretical model. For this scale, most of values obtained in CFA are consistent with the cut-off values, so a fit of the model to the data is possible. Conclusions: The current study focus on potential factors playing a role in key well-being and coping with work outcomes on the psychosocial characterization of Portuguese nurses.publishe

Experiences of working-age adults with depression of psychodynamic couple therapy: a thematic analysis using a phenomenological approach

The current study draws on interviews with service users about their experiences to inform the practice of psychodynamic couple therapy for depression. Five participants, who had received at least six months of psychodynamic couple therapy in London (UK) for the treatment of severe distress and depression, completed a semi‐structured interview. They were recruited using a purposive sampling technique. Data was analysed using a phenomenological approach to thematic analysis. Six themes were identified in relation to participants' experiences of couple therapy. Key aspects highlighted by participants include: the therapist, described as a ‘third person’, became a referee and mediated the communication within the couple, providing a different perspective, enabling a safe environment for reciprocal listening; the process of making links with the past enabled participants to understand their current behaviour as individual and dysfunctional areas as a couple; the therapist's ability to understand the couple as individuals rather than as a unified entity was key; therapist neutrality and capacity to empathise with the couple was valued by participants. The study highlighted the intertwined dynamic between relationship difficulties and depression. Participants were not able to make a clear distinction between these two experiences, and this microcosm may reflect the difficulties that clients face in accessing public services, which have historically held a more individualistic perspective of distress.</jats:p

Experiences of working-age adults with depression of psychodynamic couple therapy: a thematic analysis using a phenomenological approach

Background: Depression is a complex condition that affects over 320 million people worldwide and entails risks of relapse and suicide. As a result of the increasing number of adults experiencing symptoms of depression and anxiety in the United Kingdom, Improving Access to Psychological Therapies (IAPT) services have been established to assist individuals with these difficulties. The National Institute for Health and Care Excellence (NICE) guidelines have recommended behavioural couple therapy for the treatment of depression, but public provision is limited. Despite the wide range of literature that explains the link between couple wellbeing and mental health outcomes for adults and children, there is an evidence gap around the experiences of psychodynamic couple therapy. Method: Five participants completed a semi-structured interview, following at least six months of couple therapy for the treatment of severe distress and depression. They were recruited from an internationally renowned couple therapy provider in London, using a purposive sampling technique. Data was analysed using a phenomenological approach to thematic analysis. Results: Participants described the therapist as a “third person” who became a referee, and mediated the communication within the couple and provided a different perspective, which enabled a safe environment for reciprocal listening. A crucial aspect of couple therapy was the process of making links with the past, which enabled participants to understand their current behaviour as individual and dysfunctional areas as a couple. The process of creating connections with the past was meaningful for all participants, and some perceived fostering self-reflective skills as a practical tool, but others wanted to receive direct guidance. Three main active ingredients facilitated the therapeutic process: the therapist’s ability to understand the couple as individuals rather than as a unified entity; the therapist neutrality and capacity to empathise and connect with the couple. At the end of therapy, most participants reflected that their overall therapy experience has been helpful and highlighted a positive impact in terms of their depression, perspectives and connecting with emotions, not only for the couple involved but also in the wider system. Conclusions: This study highlighted the intertwined dynamic between relationship difficulties and depression. Participants were not able to make a clear distinction between these two experiences and this microcosm may reflect the difficulties that clients face in public services, which have historically held an individualistic perspective of distress

A Autoimagem, Regulação Emocional, Ansiedade, Stress e Depressão em Sujeitos com Obesidade, submetidos a Cirurgia Bariátrica

Introdução: A obesidade é uma doença crónica de proporções epidémicas, representando um grave problema de saúde pública a nível mundial. A obesidade é um fator de risco significativo para numerosas comorbilidades tanto psicológicas, como físicas, que estão associadas ao aumento global da mortalidade e à diminuição da esperança de vida em dez anos. Estudos indicam uma forte a relação entre obesidade e saúde mental, com o aparecimento de quadros depressivos, ansiosos e de stress. Estudos corroboram que, os tratamentos para a obesidade passam por dois conjuntos, consoante as comorbilidades e histórico individual de cada paciente. O primeiro corresponde ao tratamento de primeira linha e compreende intervenções ao nível geral do estilo de vida de cada paciente, dieta adaptada, exercício físico, intervenção psicológica e medicação e o tratamento de última linha, surge a realização de cirurgia bariátrica, que tem como objetivos a redução do peso corporal, a melhoria das comorbilidades e também a melhoria da qualidade de vida dos pacientes. Objetivos: Este estudo pretendeu explorar as variáveis psicológicas potencialmente associadas ao excesso de peso e obesidade. Com uma caracterização das variáveis psicológicas no que respeita à sintomatologia de depressão, stress, ansiedade e das dimensões da regulação emocional e da imagem corporal. Assim como, testar a hipótese de haver diferenças significativas nas variáveis psicológicas mencionadas, entre os três grupos de sujeitos: normoponderais, excesso de peso sem cirurgia e excesso e peso com cirurgia. Amostra e Métodos: A amostra foi constituída por 407 indivíduos, 363 (89.2%) do sexo feminino e 44 (10.8%) do sexo masculino. A idade foi compreendida entre os 18 e 60 anos. Os participantes preencheram um questionário de dados sociodemográficos e completaram quatro instrumentos de autorresposta que avaliaram a regulação emocional (DERS-SF), os sintomas de depressão, ansiedade e stress (DASS-21), a imagem corporal (BIS-18) e a presença de sintomas psicopatológicos (BSI-18). Resultados: Entre a amostra total do grupo conclui-se que 108 (26.5%) tinham excesso de peso sem realizar cirurgia bariátrica, 165 (40.5%) tinham excesso de peso com cirurgia bariátrica realizada e 134 (32.9%) eram considerados normoponderais através do IMC. Através de análises de variância, revelou que existiam diferenças significativas na variável impulsos da regulação emocional, no grupo de excesso de peso com cirurgia bariátrica. Na sintomatologia depressiva, ansiosa e stress, não houve diferença significativa entre os grupos. Na forma como visionam o corpo foram considerados resultados significativos entre o grupo normoponderal, mostrando um maior cuidado corporal. Na somatização dos sintomas, não foram encontrados resultados significativos. No entanto os resultados das regressões lineares múltiplas para os sujeitos com IMC ≥25, correlacionaram-se positivamente, sugerindo que a idade mais jovem, a imagem corporal, a não-aceitação, proteção corporal, clareza e objetivos poderão ser possíveis preditores de sintomatologia depressiva, ansiosa e do stress ligada à obesidade. Conclusão: A presente investigação foi desenvolvida com o propósito de contribuir para o enriquecimento de estudos atuais, referentes à saúde mental, apresentado uma melhor caracterização psicológica da população obesa e bariátrica, assim como, conhecer as variáveis por ela influenciadas e que melhorias poderão ser feitas em estudos futuros na população portuguesa. Assim como contribuir para repensar em protocolos clínicos de avaliação e seguimento desta população. Contudo é reconhecível a importância de dar continuidade a estudos com esta população, dado que, mesmo com os conhecimento e estudo dos variáveis preditores da obesidade, não obstem de, neste processo, haver propensa a contrair perturbações patologias, tais são as mudanças na vida destes sujeitos. Seria importante uma avaliação psicossocial destes pacientes, assim como um racional de todo o processo para o sucesso terapêutico destes sujeitos e o estudo de todas as variáveis do indivíduo para resultados e planos mais individualizados e robustos. / Introduction: Obesity is a chronic disease of epidemic proportions, representing a major public health problem worldwide. Obesity is a significant risk factor for numerous comorbidities both psychological and physical, which are associated with increased overall mortality and decreased life expectancy in ten years. Studies indicate a strong relationship between obesity and mental health, with the onset of depression, anxiety, and stress. Studies corroborate that treatments for obesity go through two sets, depending on the comorbidities and individual history of each patient. The first corresponds to the first-line treatment and includes interventions at the general level of each patient's lifestyle, adapted diet, physical exercise, psychological intervention, and medication. The last-line treatment is bariatric surgery, which aims to reduce body weight, improve comorbidities, and also improve the quality of life of patients. Objectives: This study aimed to explore the psychological variables associated with overweight and obesity. With a characterization of the psychological variables regarding the symptoms of depression, stress, anxiety and the dimensions of emotional regulation and body image. As well as, to test the hypothesis of having significant differences in the psychological variables mentioned, between the three groups of subjects: healthy, overweight without surgery and overweight with surgery. Sample and Methods: The sample consisted of 407 subjects, 363 (89.2%) female and 44 (10.8%) male. The age was between 18 and 60 years. Participants completed a questionnaire of sociodemographic data and completed four self-report instruments that assessed emotion regulation (DERS-SF), symptoms of depression, anxiety and stress (DASS-21), body image (BIS-18) and the presence of psychopathological symptoms (BSI-18). Results: Among the total group sample it was concluded that 108 (26.5%) were overweight without bariatric surgery, 165 (40.5%) were overweight with bariatric surgery performed, and 134 (32.9%) were considered healthy by BMI. Through variance analysis, it was revealed that there were significant differences in the variable emotional regulation impulses in the overweight group with bariatric surgery. In depressive, anxious, and stress symptoms, there were no significant differences between the groups. In the way they view their bodies, significant results were found among the healthy group, showing greater body care. In the somatization of symptoms, no significant results were found. However, the results of multiple linear regressions for subjects with BMI ≥25 correlated positively, suggesting that younger age, body image, non-acceptance, body protection, clarity, and goals may be possible predictors of depressive, anxiety, and stress symptoms linked to obesity. Conclusion: This research was developed with the purpose of contributing to the studies regarding mental health, presenting a better psychological characterization of the obese population psychological characterization of the obese and bariatric population, as well as to know the variables influenced by it and what improvements may be made in future studies in the Portuguese population. Portuguese population. As well as contribute to rethink clinical protocols of evaluation and follow-up of this population. However, the importance of continuing studies with this population is recognizable, since, even with the knowledge and study of the predictor variables of obesity, it doesn't prevent, in this process, there is a propensity to contract pathologies, such are the changes in the life of these subjects. A psychosocial evaluation of these patients would be important, as well as a rationale of the entire process for the therapeutic success of these subjects and the study of all the variables of the individual for more individualized and robust results and plans

Prevalence of Personality Disorders in Adults with Binge-Eating Disorder – a Systematic Review and Bayesian Meta-analysis

Binge eating disorder (BED) is a complex mental health problem entailing high risk for obesity, overweight, and other psychiatric disorders. However, there is still unclear evidence of the prevalence of personality disorders (PDs) in BED patients. We conducted a systematic review and a Bayesian meta‐analysis for studies examining the prevalence of any PD in adult BED patients. Data sources included PubMed, Cochrane library, EBSCO, PsycINFO, and Science Direct. A Bayesian meta‐analysis was conducted to estimate effect sizes for the prevalence of any PD in BED patients. Twenty eligible articles were examined with a total of 2945 BED patients. Borderline personality disorder and “Cluster C” PD, particularly obsessive‐compulsive and avoidant PD, were the most frequent PD found in BED patients. BED diagnosis was associated with 28% probability of a comorbid diagnosis of any PD (0.279, 95%CrI: [0.22, 0.34]), with high levels of between‐study heterogeneity (τ = 0.61, 95% CrI [0.40, 0.90]). Sensitivity analysis suggested effect sizes ranging from 0.27 to 0.28. The high comorbidity of PDs in BED patients draws attention to the potential complexity of BED clinical presentations, including those that might also be comorbid with obesity. Clinical practice should address this complexity to improve care for BED and obesity patients

Is perceived social support more important than visual acuity for clinical depression and anxiety in patients with age-related macular degeneration and diabetic retinopathy?

Objective: To investigate whether visual acuity has the same importance as a factor of depression and anxiety comparing with other psychological variables, particularly perceived social support, in patients diagnosed with age-related eye diseases, with and without low vision. Design: Observational cross-sectional study. Setting: Patients attending outpatient appointments at the department of ophthalmology of a general hospital in Portugal. Subjects: Patients with age-related macular degeneration and patients with diabetic retinopathy attending routine hospital appointments were recruited for this study. Measures: Anxiety and depression were measured using the hospital anxiety and depression scale and perceived social support using the multidimensional scale of perceived social support. Visual acuity was measured with ETDRS charts. Results: Of the 71 patients, 53 (75%) were diagnosed with diabetic retinopathy, 37 (52%) were female and age (mean ± SD) was 69 ± 12 years. Acuity in the better seeing eye was 0.41 ± 0.33 logMAR. The mean anxiety score was 4.38 ± 3.82 and depression 4.41 ± 3.39. Clinically significant levels of anxiety were found in 21% ( n = 15) of the participants and depression in 18%(n = 13). The total social support score was 5.29 ± 0.61. Significant multivariate regression models were found for anxiety (R² = 0.21, P = 0.016) and for depression (R² = 0.32, P < 0.0001). Social support was independently associated with levels of anxiety and with levels of depression. Gender was independently associated with levels of anxiety. Conclusion: This study suggests that patients’ perceived social support might be more important than visual acuity as a factor of clinical depression and anxiety in a sample of age-related eye disease patients

From self-awareness to self-identification with visual impairment: a qualitative study with working age adults at a rehabilitation setting

Objective: To explore the experience of vision loss, focusing on working age patients’ self-awareness of impairment and self-identification with the impairment. Design: A cross-sectional and qualitative study, using semi-structured interviews. Setting: A specialized rehabilitation centre and a low vision unit at a public hospital. Participants: A convenience sample of 38 patients between the ages of 20 and 65, with sight loss caused by a serious ophthalmological condition acquired after the age of 18, and doing their rehabilitation. Main outcome measures: A semi-structured interview, addressing three core areas: the emotional impact of vision loss; adjustment; and social support. Interviews were transcribed, coded and analysed by two independent researchers. Results: Seven themes emerged from interviews. Changes in patients’ identity, achievement and future life projection arose as being the main transformations caused by vision loss. Self-awareness of impairment appeared associated with the patients’ first contact with their loss, while self-identification with the impairment arose connected with the later embodiment process of the vision loss. Conclusions: Patients’ self-awareness and self-perceptions of impairment appear to be two important milestones in the adjustment process to vision loss. Their assessment and monitoring over the rehabilitation period might help to promote impairment acceptance and rehabilitation outcomes

Beyond the body image: A qualitative study on how adults experience lower limb amputation

Objective: To explore adults’ experiences of lower limb amputation, focusing on the changes in self-identity related to the impairment. Design: A cross-sectional and qualitative study, using semi-structured interviews. Interviews were transcribed, coded and analysed by two independent researchers. Setting: A rehabilitation medicine service from a general public hospital. Participants: A convenience sample of 42 patients with lower limb amputation performed after the age of 18 and followed up in the physical medicine and rehabilitation department of a general hospital. Main outcome measures: A semi-structured interview, addressing three core areas: the emotional impact of amputation; the adjustment process; and the relation with the external resources. Results: Eight themes emerged from interviews: reactions and feelings about becoming amputee; changes in own life; problems in well-being; relation with the prosthesis; self-perceptions; aims related to the rehabilitation and future plans; relation with the rehabilitation; and perceived social support. These results supported a theoretical model for the self-identity changes related to limb loss. Conclusions: The self-identity changes after a lower limb amputation appear beyond the patient’s body image and functioning, affecting the patient’s awareness of the impairment, biographical self and any future projections