1 Introduction

Loss can manifest in various forms, including the death of a loved one, disability, or failure in personal or professional spheres [1]. One significant form of loss is amputation, which causes both physical and emotional pain, often leading to complex psychological experiences for the affected individuals [2-8]. Yuan et al. [9] reported that globally, the incidence and prevalence of traumatic amputation as of 2019 was 13.23 million with the number increasing gradually. Other conditions that may result into amputation include chronic conditions such as diabetes and peripheral artery disease [10, 11]. The impact of amputation can vary greatly depending on the cause. Traumatic amputations, often resulting from accidents or violence, can trigger sudden psychological responses such as shock, posttraumatic stress disorder (PTSD), and difficulties in adjusting to the loss [12]. In contrast, amputations due to medical conditions like diabetes or vascular disease are typically associated with long-term health challenges, where individuals may experience a sense of loss, frustration, or relief if the procedure prevents further health complications [13]. Congenital amputations, where individuals are born without a limb, present unique challenges related to self-image and societal acceptance, although the emotional impact tends to be more gradual [14]. For amputations caused by diseases such as cancer or infections, the emotional distress is often compounded by the uncertainty surrounding the underlying illness and grief over body loss [15].

Amputees employ a range of coping strategies to manage distress, including both adaptive and maladaptive methods that may affect their well-being [5, 16]. Positive coping strategies have been linked to better psychological adjustment, and promoting these can facilitate emotional recovery [17]. Despite the attention given to amputees' emotional experiences, the emotional impact on caregivers—who provide essential physical and emotional support during recovery—has been less thoroughly explored yet both amputees and their caregivers often experience a range of negative emotions following amputation [18]. Amputees face a range of challenges, including mobility restrictions, phantom limb sensations, and the need for prosthetic devices [3, 4, 7, 8, 19, 20], all of which necessitate ongoing care and adjustment. Caregivers often face significant emotional strain, physical exhaustion, and financial burdens, which can affect their mental health and well-being [21]. The mutual dependence between amputees and caregivers plays a crucial role in rehabilitation, and without proper support, caregivers may experience significant mental health challenges [22, 23].

The relationship between amputees and their caregivers is marked by interdependence, which supports successful rehabilitation. However, caregiving can be overwhelming, leading to the need for comprehensive support systems to address both the amputees' and caregivers' psychological and emotional needs, as caregiver well-being influences the well-being of care recipient. Unfortunately, a literature search reveal that unlike the amputees, there are no initiatives or psychosocial interventions for caregivers of amputees in Ghana. This study seeks to explore the impact of amputation on the well-being of both amputees and caregivers, focusing on the coping strategies they employ to manage potential distress associated with amputation and caregiving. This study aimed to answer the following research questions: (1) What is the impact of amputation on amputees and caregivers? (2) How do amputees and caregivers cope with the distress associated with amputation and caregiving?

2 Materials and Methods

3 Findings

3.1 Demographic Information About Study Participants

Information About Amputees: There were six males and four females. There was one participant in the age range of 18–23 years, two were aged between 23 and 28 years, one was 28–33 years, three were 33–38 years, one each for 38–43, 43–48 and 48–53. Regarding the types of amputation, seven had undergone lower leg amputation, one had arm amputation and two had foot amputation. Regarding employment status, three were unemployed, two were students, three were mechanics, one was a waitress, and one was a health worker.

Information About Caregivers: There were eight females and two males. One caregiver was aged between 18 and 23 years, three were aged between 23 and 28 years, three were between 28 and 33 years, two were between 38 and 43 years and one was aged 53 and 58 years. Regarding relations to amputees, one was a parent, one was a spouse, one was a ward, three were siblings, and four were other relatives to the amputees. Concerning the profession, two were unemployed, three were students, three were petty traders and two were health workers.

The findings of the data analyses are presented below. The experiences of amputees were compared with those of their caregivers, for a full appreciation of the discrepancies and similarities in their experiences. The themes that emerged from the data have been organised graphically in Figure 1.

4 The Impact of the Experience of Amputation

This theme explored how amputation impacted the well-being of amputees and their caregivers. For amputees, the distress they experienced included phantom limb sensation and a change in vocation, whereas, for the caregivers, their experiences included fear and economic hardship. The experience of stress was reported by both amputees and their caregivers.

5 Coping Strategies for Managing Distresses

The coping mechanisms adopted by both amputees and their caregivers following amputation were explored in this study. Findings show that whereas amputees used social distancing, social reference and social support as a means of coping with their traumatic ordeal, caregivers just encouraged themselves as a means of dealing with theirs. However, a common means of dealing with their experiences was religious coping through their belief in the power of an extraordinary being and prayers.

6 Discussion

This study explored the distress associated with amputation and the coping strategies of both amputees and their caregivers. With regard to distress, findings indicate that whereas amputees uniquely experience phantom limb sensation and loss of job, caregivers uniquely experience economic hardship and fear. Both amputees and caregivers experience stress but the sources of the stress are different. Amputees' stress resulted from adaptation to prosthetic legs, and self-alienation whereas the caregivers' stress resulted from the ‘burden’ of caregiving activities. Concerning coping strategies, amputees uniquely used social distancing, social reference and social support but caregivers just encouraged themselves, while relying on their religious beliefs. However, both amputees and caregivers use religious coping through their belief in the power of an extraordinary being and prayers.

Phantom limb sensation (PLS), which is the feeling of the presence of a lost body part, is a common experience following amputation [34, 35]. Losing one's body part is in itself traumatic, and the constant feeling that the lost body part is still present only further heightens one's state of denial and significantly impacts one's mental health. The experience of phantom limb sensation and loss of job among amputees in this present study is consistent with previous research [7, 8]. Abouammoh et al. [36] reported that physical adjustment contributed to amputees' quality of life as it places some form of restrictions on one's functional ability. Thus, if the amputee's vocation cannot accommodate these restrictions it may result in a change of vocation. The psychological implication of this is that the amputee may have to settle for a less satisfying job because of the disability.

Caregivers' experience of economic hardship supports the findings of Ae-Ngibise et al. [37] and Volker [38] who reported that caregivers experienced various degrees of financial burden resulting from taking care of the needs of their relatives who may also be experiencing financial problems resulting from the disability from amputation. Generally, amputees experience some level of financial difficulty because of high medical costs and job loss [39, 40]. Further, any form of amputation restricts the individual in the type of jobs they can engage. Thus, amputees only look for jobs that can accommodate their deficits and provide them with financial assistance, yet most of these jobs are low-paying. Given amputees' financial constraint due to their handicap, caregivers often go beyond providing psychological and physical care to the extent of supporting amputees financially which only places a strain on their finances [41]. The experience of fear in the caregivers resulted from their shared experience of trauma associated with amputation which tends to trigger traumatic stress in caregivers [42, 43]. Traumatic stress in turn is associated with increased anxiety [44]. This traumatic experience is usually not anticipated and the new realisation of the relative's ordeal and the burden they have to bear creates fear and panic, symptomatic of anxiety.

Our finding that amputees were stressed from having to go through the daily routine of adjusting to their prosthetic devices and make use of it despite the discomfort- is corroborated by previous works that evidence the burden of prosthesis adjustment [41]. The use of the prosthesis has implications for body image and mental health because getting used to a technological device to assume the role of primary organ does not come with ease. Therefore, it is not surprising that amputees report body image distress and associated posttraumatic stress disorder [8, 36].

Unlike the amputees, caregivers' stress was associated with caregiving role. There is much evidence to suggest that the burden of care among caregivers of amputees is high [41, 45-48]. This is because caregivers make major life adjustments such as changing daily routine and prior roles, taking on new responsibilities, and/or cancelling plans to accommodate their new role with little or no social support [45, 48].

The use of social distancing, social reference and social support by amputees is at variance with the findings of Garafalo [49] and Kashani et al. [50] who reported that amputees make use of excessive alcohol consumption and drugs as a means of dealing with their distress. However, it was not surprising that amputees avoided larger communal interactions after amputation. Charlton and Thompson [51] explain that when an event is carefully placed in the past, distancing is more easily adopted. When the cause of one's amputation is as a result of a traumatic event and one is focusing on healing from such experience, a typical response will be to avoid communications surrounding that experience. Thus, it can be argued this is more likely to be achieved when one engages less with people of the larger community and potential reminders. Another possible reason could be that the amputee wants to avoid the pity glances from the larger community. Further, some amputees compared their situation to other people whose conditions were worse than theirs, and that made them feel better about their condition. This is a similar concept in downward comparison, which is a coping mechanism used to reduce the psychological impact of negative life events [52]. In downward comparison, one arranges comparison in such a way that the outcome of the comparison is more favourable to the self than the other [52]. Regardless of the seemingly negative connotative of this coping mechanism, it presents a dimension of hope to the self or the individual. It gives one hope that if the ‘other’ whose situation appears to be worse than the ‘self’ is surviving, then life is worth living and the ‘self’ could find reasons not to give up. Evidence suggests that amputees make use of social support as a way of dealing with their ordeal [16, 53]. In this study, amputees relied greatly on the love and care of relatives, loved ones and friends for support in dealing with their ordeal. Thus, social support is a form of collective coping mechanism, which affords an individual the opportunity to solicit for comfort from members of their in-group in distressing events [54]. This finding reinforces the idea that Africans are collective in nature [55].

The use of self-support by caregivers, whereby caregivers relied on no one but themselves for strength, is an interesting finding, that supports Ae-Ngibise et al.'s (2015) and Costa et al.'s (2020) finding on lack of social support for caregivers. Despite the emotional stressors they must deal with, their only form of support was religious support and prayers [56]. Caregivers do not make use of collective coping perhaps because they feel that cannot rely on anyone but themselves to be strong for the amputee. Literature has established that in the case of amputation, attention is concentrated on the amputees to the neglect of the caregivers [38, 57, 58]. Thus, this finding shows that caregivers are neglected to deal with their distress following amputation.

Religious coping, in the form of belief in the power of God and prayers, was used by both caregivers and amputees in this present study. This finding corroborates the results of Ae-Ngibise et al.'s (2015) and Livneh et al.'s (2000) study that reported that amputees and caregivers use spirituality and religious prayers as a means of coping with their ordeal. Further, this finding is consistent with evidence of studies that suggest that Ghanaians are highly religious [59] and are more inclined to use religious coping when faced with distress [60-63]. Religious coping provides them with the courage to face their predicament and increases their faith in God as one who cures and heals diseases in the body [60]. Thus, in an uncontrollable situation such as amputation where there seem to be limitations in human capabilities, religious coping seems ideal.

Author Contributions

Esther Ohenewa: conceptualisation, investigation, writing–original draft, methodology, writing–review and editing, formal analysis, project administration, data curation, resources. Joana Salifu Yendork: conceptualisation, investigation, writing–original draft, methodology, writing–review and editing, formal analysis, supervision. Benjamin Amponsah: conceptualisation, investigation, writing–original draft, methodology, writing–review and editing, formal analysis, supervision. Frances Emily Owusu-Ansah: methodology, writing–review and editing, formal analysis, supervision.

Ethics Statement

The researchers obtained ethical clearance from the Ethics Committee for Humanities (ECH: 016/16–17) at the University of Ghana, Legon, prior the commencement of the study.

Conflicts of Interest

The authors declare no conflicts of interest.