“…There is contradictory evidence, however, that has found no significant differences by etiology in levels of depression (Rybarczyk et al, 1995;Rybarczyk et al, 1992;Singh, Hunter, & Philip, 2007), quality of life and adjustment to amputation (Rybarczyk et al, 1995;Unwin et al, 2009), psychiatric symptoms (Shukla, Sahu, Tripathi, & Gupta, 1982), sexual activity (Williamson & Walters, 1996), and likelihood of returning to work (Fisher, Hanspal, & Marks, 2003). In contrast to the Rybarczyk et al (2010) chapter, an earlier review by Horgan and MacLachlan (2004) highlighted findings from seven of the above studies that found no differences in psychosocial outcomes by etiology, and concluded that the existing evidence suggests that cause of amputation is not related to adjustment to limb loss. Two of the key studies that have found differences by etiology (Cavanagh et al, 2006;Darnall et al, 2005) were unavailable at the time that the Horgan and MacLachlan (2004) paper was published.…”