Affiliation:
1. Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, U.K
2. Department of Biostatistics, Institute of Psychiatry, King's College London, London, U.K
3. Diabetic Foot Clinic, King's College Hospital, London, U.K
Abstract
OBJECTIVE—The aim was to evaluate over 18 months whether depression was associated with mortality in people with their first foot ulcer.
RESEARCH DESIGN AND METHODS—A prospective cohort design was used. Adults with their first diabetic foot ulcer were recruited from foot clinics in southeast London, U.K. At baseline, the Schedules for Clinical Assessment in Neuropsychiatry 2.1 was used to define those who met DSM (Diagnostic and Statistical Manual of Mental Disorders)-IV criteria for minor and major depressive disorders. Potential covariates were age, sex, marital status, socioeconomic status, smoking, antidepressant use, A1C, macro- and microvascular complications, and University of Texas classification–based severity and size of ulcer. The main outcome was mortality 18 months later, and A1C was the secondary outcome. The proportion who had an amputation, had recurrence, and whose ulcer had healed was recorded.
RESULTS—A total of 253 people with their first diabetic foot ulcer were recruited. The prevalence of minor and major depressive disorder was 8.1% (n = 21) and 24.1% (n = 61), respectively. There were 40 (15.8%) deaths, 36 (15.5%) amputations, and 99 (43.2%) recurrences. In the adjusted Cox regression analysis, minor and major depressive disorders were associated with an approximately threefold hazard risk for mortality compared with no depression (3.23 [95% CI 1.39–7.51] and 2.73 [1.38–5.40], respectively). There was no association between minor and major depression compared with no depression and A1C (P = 0.86 and P = 0.43, respectively).
CONCLUSIONS—One-third of people with their first diabetic foot ulcer suffer from clinical depression, and this is associated with increased mortality.
Publisher
American Diabetes Association
Subject
Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine
Reference63 articles.
1. Apelqvist J, Larsson J, Agardh C: Long-term prognosis for diabetic patients with foot ulcers. J Intern Med 233: 485–491, 1993
2. Williams D: The size of the problem: epidemiological and economic aspects of foot problems in diabetes. In The Foot in Diabetes. Boulton A, Connor H, Cavanagh P, Eds. Chichester, John Wiley, 1994, p. 15–24
3. Ramsey SD, Newton K, Blough D, McCulloch DK, Sandhu N, Reiber GE, Wagner EH: Incidence, outcomes, and cost of foot ulcers in patients with diabetes. Diabetes Care 22:382–387, 1999
4. Walters D, Gatling W, Mulle M, Hill R: The distribution and severity of diabetic foot disease: a community study with comparison to a non-diabetic group. Diabet Med 9:354–358, 1992
5. Apelqvist J, Larsson J, Agardh C: The influence of external precipitating factors and peripheral neuropathy on the development and outcome of diabetic foot ulcers. J Diabetes Complications 4:21–25, 1990
Cited by
175 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献