Skip to main content
Top
Published in: Journal of Foot and Ankle Research 1/2014

Open Access 01-12-2014 | Research

High levels of anxiety and depression in diabetic patients with Charcot foot

Authors: Zahra Chapman, Charles Matthew James Shuttleworth, Jörg Wolfgang Huber

Published in: Journal of Foot and Ankle Research | Issue 1/2014

Login to get access

Abstract

Background/aims

Charcot foot is a rare but devastating complication of diabetes. Little research is available on the mental health impact of Charcot foot. Aim of the study is to assess mental health in diabetes patients with Charcot foot and to investigate the moderating effects of socio-demographic factors. The severity of the problem will be statistically evaluated with the help of a reference data set.

Methods

Cross-sectional questionnaire data using the Hospital Anxiety and Depression Scale (HADS) and demographic background were collected from 50 patients with diabetes and Charcot complications (males 62%; mean age 62.2 ± 8.5 years). Statistical comparisons with a large data set of general diabetes patients acting as a point of reference were carried out.

Results

Anxiety and depression levels were high, (anxiety and depression scores 6.4 ± 4 and 6.3 ± 3.6 respectively). Females reported more severe anxiety and depression. Ethnic minorities and patients out of work reported more severe anxiety. Comparisons with published HADS data indicate that diabetes patients with Charcot foot experience more serious levels of anxiety and depression.

Conclusions

The high levels of mental health problems which were found in this study in diabetes patients with Charcot foot require recognition by researchers and clinicians. The findings imply the need to screen for mental health problems in diabetes patients with Charcot foot.
Appendix
Available only for authorised users
Literature
1.
go back to reference Jeffcoate WJ, Lima J, Nobrega L: The Charcot foot. Diabet Med. 2000, 17: 253-258. 10.1046/j.1464-5491.2000.00233.x.CrossRefPubMed Jeffcoate WJ, Lima J, Nobrega L: The Charcot foot. Diabet Med. 2000, 17: 253-258. 10.1046/j.1464-5491.2000.00233.x.CrossRefPubMed
2.
go back to reference Stanley JC, Collier AM: Charcot osteo-arthropathy. Curr Orthop. 2008, 22: 428-433. 10.1016/j.cuor.2008.08.004.CrossRef Stanley JC, Collier AM: Charcot osteo-arthropathy. Curr Orthop. 2008, 22: 428-433. 10.1016/j.cuor.2008.08.004.CrossRef
3.
go back to reference PiaggesiI A, Rizzo L, Golia F, Costi D, Baccetti F, Ciaccio S, De Gregorio S, Vignali E, Trippi D, Zampa V, Marcocci C, Del Prato S: Biochemical and ultrasound tests for early diagnosis of active neuro-osteoarthropathy (NOA) of the diabetic foot. Diabetes Res Clin Pract. 2002, 58: 1-9. 10.1016/S0168-8227(02)00097-9.CrossRef PiaggesiI A, Rizzo L, Golia F, Costi D, Baccetti F, Ciaccio S, De Gregorio S, Vignali E, Trippi D, Zampa V, Marcocci C, Del Prato S: Biochemical and ultrasound tests for early diagnosis of active neuro-osteoarthropathy (NOA) of the diabetic foot. Diabetes Res Clin Pract. 2002, 58: 1-9. 10.1016/S0168-8227(02)00097-9.CrossRef
5.
go back to reference Bevan WP, Tomlinson MP: Radiographic measures as a predictor of ulcer formation in diabetic Charcot midfoot. Foot Ankle Int. 2008, 29: 568-573. 10.3113/FAI.2008.0568.CrossRefPubMed Bevan WP, Tomlinson MP: Radiographic measures as a predictor of ulcer formation in diabetic Charcot midfoot. Foot Ankle Int. 2008, 29: 568-573. 10.3113/FAI.2008.0568.CrossRefPubMed
6.
go back to reference Schoots IG, Slim FJ, Busch-Westbroek TE, Maas M: Neuro-osteoarthropathy of the foot radiologist: friend or foe?. Semin Musculoskelet Radiol. 2008, 14: 365-376.CrossRef Schoots IG, Slim FJ, Busch-Westbroek TE, Maas M: Neuro-osteoarthropathy of the foot radiologist: friend or foe?. Semin Musculoskelet Radiol. 2008, 14: 365-376.CrossRef
7.
go back to reference James CS, Andrew MC: Charcot Osteo-arthropathy. 2008, 22: 428-433. James CS, Andrew MC: Charcot Osteo-arthropathy. 2008, 22: 428-433.
8.
go back to reference Sommer TC, Lee TH: Charcot foot: the diagnostic dilemma. Am Fam Physician. 2001, 64: 1591-1598.PubMed Sommer TC, Lee TH: Charcot foot: the diagnostic dilemma. Am Fam Physician. 2001, 64: 1591-1598.PubMed
9.
go back to reference Anderson RJ, Freedland KE, Clouse RE, Lustman PJ: The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care. 2001, 24: 1069-1078. 10.2337/diacare.24.6.1069.CrossRefPubMed Anderson RJ, Freedland KE, Clouse RE, Lustman PJ: The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care. 2001, 24: 1069-1078. 10.2337/diacare.24.6.1069.CrossRefPubMed
10.
go back to reference Ali S, Stone MA, Peters JL, Davies MJ, Khunti K: The prevalence of co-morbid depression in adults with Type 2 diabetes: a systematic review and meta-analysis. Diabet Med. 2006, 23 (11): 1165-1173. 10.1111/j.1464-5491.2006.01943.x.CrossRefPubMed Ali S, Stone MA, Peters JL, Davies MJ, Khunti K: The prevalence of co-morbid depression in adults with Type 2 diabetes: a systematic review and meta-analysis. Diabet Med. 2006, 23 (11): 1165-1173. 10.1111/j.1464-5491.2006.01943.x.CrossRefPubMed
11.
go back to reference Egede LE, Ellis C: Diabetes and depression: global perspectives. Diabetes Res Clin Pract. 2010, 87: 302-312. 10.1016/j.diabres.2010.01.024.CrossRefPubMed Egede LE, Ellis C: Diabetes and depression: global perspectives. Diabetes Res Clin Pract. 2010, 87: 302-312. 10.1016/j.diabres.2010.01.024.CrossRefPubMed
12.
go back to reference World Health Organization (WHO): Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res. 2004, 13: 93-121. 10.1002/mpr.168.CrossRef World Health Organization (WHO): Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res. 2004, 13: 93-121. 10.1002/mpr.168.CrossRef
13.
go back to reference Lin EH, Korff MV, Alonso J: Mental disorders among persons with diabetes results from the World Mental Health Surveys. J Psychosom Res. 2008, 65: 571-580. 10.1016/j.jpsychores.2008.06.007.CrossRefPubMedPubMedCentral Lin EH, Korff MV, Alonso J: Mental disorders among persons with diabetes results from the World Mental Health Surveys. J Psychosom Res. 2008, 65: 571-580. 10.1016/j.jpsychores.2008.06.007.CrossRefPubMedPubMedCentral
14.
go back to reference Lustman PJ, Anderson RJ, Freedland KE, De Groot M, Carney RM, Clouse RE: Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care. 2000, 23: 934-942. 10.2337/diacare.23.7.934.CrossRefPubMed Lustman PJ, Anderson RJ, Freedland KE, De Groot M, Carney RM, Clouse RE: Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care. 2000, 23: 934-942. 10.2337/diacare.23.7.934.CrossRefPubMed
15.
go back to reference Williams LH, Rutter CM, Katon WJ, Reiber GE, Ciechanowski P, Heckbert SR, Lin EH, Ludman EJ, Oliver MM, Young BA, Von Korff M: Depression and incident diabetic foot ulcers: a prospective cohort study. Am J Med. 2010, 123: 748-754. 10.1016/j.amjmed.2010.01.023.CrossRefPubMedPubMedCentral Williams LH, Rutter CM, Katon WJ, Reiber GE, Ciechanowski P, Heckbert SR, Lin EH, Ludman EJ, Oliver MM, Young BA, Von Korff M: Depression and incident diabetic foot ulcers: a prospective cohort study. Am J Med. 2010, 123: 748-754. 10.1016/j.amjmed.2010.01.023.CrossRefPubMedPubMedCentral
16.
go back to reference Williams LH, Miller DR, Fincke G, Lafrance JP, Etzioni R, Maynard C, Raugi GJ, Reiber GE: Depression and incident lower limb amputations in veterans with diabetes. J Diabetes Complications. 2011, 25: 175-182. 10.1016/j.jdiacomp.2010.07.002.CrossRefPubMed Williams LH, Miller DR, Fincke G, Lafrance JP, Etzioni R, Maynard C, Raugi GJ, Reiber GE: Depression and incident lower limb amputations in veterans with diabetes. J Diabetes Complications. 2011, 25: 175-182. 10.1016/j.jdiacomp.2010.07.002.CrossRefPubMed
17.
go back to reference Ismail K, Winkley K, Stahl D, Chalder T, Edmonds M: A cohort study of people with diabetes and their first foot ulcer: the role of depression on mortality. Diabetes Care. 2007, 30: 1473-1479. 10.2337/dc06-2313.CrossRefPubMed Ismail K, Winkley K, Stahl D, Chalder T, Edmonds M: A cohort study of people with diabetes and their first foot ulcer: the role of depression on mortality. Diabetes Care. 2007, 30: 1473-1479. 10.2337/dc06-2313.CrossRefPubMed
18.
go back to reference Carrington AL, Mawdsley SK, Morley M, Kincey J, Boulton AJ: Psychological status of diabetic people with or without lower limb disability. Diabetes Res Clin Pract. 1996, 32: 19-25. 10.1016/0168-8227(96)01198-9.CrossRefPubMed Carrington AL, Mawdsley SK, Morley M, Kincey J, Boulton AJ: Psychological status of diabetic people with or without lower limb disability. Diabetes Res Clin Pract. 1996, 32: 19-25. 10.1016/0168-8227(96)01198-9.CrossRefPubMed
19.
go back to reference DiMatteo MR, Lepper HS, Croghan TW: Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000, 160: 2101-2107. 10.1001/archinte.160.14.2101.CrossRefPubMed DiMatteo MR, Lepper HS, Croghan TW: Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000, 160: 2101-2107. 10.1001/archinte.160.14.2101.CrossRefPubMed
20.
go back to reference Willrich A, Pinzur M, McNeil M, Juknelis D, Lavery L: Health related quality of life, cognitive function, and depression in diabetic patients with foot ulcer or amputation. A preliminary study. Foot Ankle Int. 2005, 26: 28-34. Willrich A, Pinzur M, McNeil M, Juknelis D, Lavery L: Health related quality of life, cognitive function, and depression in diabetic patients with foot ulcer or amputation. A preliminary study. Foot Ankle Int. 2005, 26: 28-34.
21.
go back to reference Tennvall GR, Apelqvist J: Health-related quality of life in patients with diabetes mellitus and foot ulcers. J Diabetes Complications. 2000, 14: 235-241. 10.1016/S1056-8727(00)00133-1.CrossRef Tennvall GR, Apelqvist J: Health-related quality of life in patients with diabetes mellitus and foot ulcers. J Diabetes Complications. 2000, 14: 235-241. 10.1016/S1056-8727(00)00133-1.CrossRef
22.
go back to reference Ribu L, Birkeland K, Hanestad BR, Moum T, Rustoen T: A longitudinal study of patients with diabetes and foot ulcers and their health-related quality of life: wound healing and quality-of-life changes. J Diabetes Complications. 2008, 22: 400-407. 10.1016/j.jdiacomp.2007.06.006.CrossRefPubMed Ribu L, Birkeland K, Hanestad BR, Moum T, Rustoen T: A longitudinal study of patients with diabetes and foot ulcers and their health-related quality of life: wound healing and quality-of-life changes. J Diabetes Complications. 2008, 22: 400-407. 10.1016/j.jdiacomp.2007.06.006.CrossRefPubMed
23.
go back to reference Vedhara K, Beattie A, Metcalfe C, Roche S, Weinman J, Cullum N, Price P, Dayan C, Cooper AR, Campbell R, Chalder T: Development and preliminary evaluation of a psychosocial intervention for modifying psychosocial risk factors associated with foot re-ulceration in diabetes. Behav Res Ther. 2012, 50: 323-332. 10.1016/j.brat.2012.02.013.CrossRefPubMed Vedhara K, Beattie A, Metcalfe C, Roche S, Weinman J, Cullum N, Price P, Dayan C, Cooper AR, Campbell R, Chalder T: Development and preliminary evaluation of a psychosocial intervention for modifying psychosocial risk factors associated with foot re-ulceration in diabetes. Behav Res Ther. 2012, 50: 323-332. 10.1016/j.brat.2012.02.013.CrossRefPubMed
25.
go back to reference Zigmond AS, Snaith RP: The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983, 67: 361-370. 10.1111/j.1600-0447.1983.tb09716.x.CrossRefPubMed Zigmond AS, Snaith RP: The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983, 67: 361-370. 10.1111/j.1600-0447.1983.tb09716.x.CrossRefPubMed
26.
go back to reference Collins MM, Corcoran P, Perry IJ: Anxiety and depression symptoms in patients with diabetes. Diabet Med. 2009, 26: 153-161. 10.1111/j.1464-5491.2008.02648.x.CrossRefPubMed Collins MM, Corcoran P, Perry IJ: Anxiety and depression symptoms in patients with diabetes. Diabet Med. 2009, 26: 153-161. 10.1111/j.1464-5491.2008.02648.x.CrossRefPubMed
27.
go back to reference Jenkins R, Bebbington P, Brugha T, Farrell M, Gill B, Lewis G, Meltzer H, Petticrew M: The national psychiatric morbidity surveys of great Britain–strategy and methods. Int Rev Psychiatry. 1997, 15 (1–2): 5-13. Jenkins R, Bebbington P, Brugha T, Farrell M, Gill B, Lewis G, Meltzer H, Petticrew M: The national psychiatric morbidity surveys of great Britain–strategy and methods. Int Rev Psychiatry. 1997, 15 (1–2): 5-13.
28.
go back to reference McManus S, Meltzer H, Brugha T, Bebbington P, Jenkins R: Adult Psychiatric Morbidity in England, 2007. Results of a Household Survey. 2009, Leicester: National Centre for Social Research and the Department of Health Sciences, University of Leicester McManus S, Meltzer H, Brugha T, Bebbington P, Jenkins R: Adult Psychiatric Morbidity in England, 2007. Results of a Household Survey. 2009, Leicester: National Centre for Social Research and the Department of Health Sciences, University of Leicester
29.
go back to reference Twist K, Stahl D, Amiel SA, Thomas S, Winkley K, Ismail K: Comparison of depressive symptoms in type 2 diabetes using a two-stage survey design. Psychosom Med. 2013, 75 (8): 791-797. 10.1097/PSY.0b013e3182a2b108.CrossRefPubMed Twist K, Stahl D, Amiel SA, Thomas S, Winkley K, Ismail K: Comparison of depressive symptoms in type 2 diabetes using a two-stage survey design. Psychosom Med. 2013, 75 (8): 791-797. 10.1097/PSY.0b013e3182a2b108.CrossRefPubMed
30.
go back to reference Fabrin J, Larsen K, Holstein PE: Long-term follow-up in diabetic Charcot feet with spontaneous onset. Diabetes Care. 2000, 23: 796-800. 10.2337/diacare.23.6.796.CrossRefPubMed Fabrin J, Larsen K, Holstein PE: Long-term follow-up in diabetic Charcot feet with spontaneous onset. Diabetes Care. 2000, 23: 796-800. 10.2337/diacare.23.6.796.CrossRefPubMed
31.
go back to reference Kessler RC, Ustün TB: The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res. 2004, 13: 93-121. 10.1002/mpr.168.CrossRefPubMed Kessler RC, Ustün TB: The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res. 2004, 13: 93-121. 10.1002/mpr.168.CrossRefPubMed
32.
go back to reference Oyibo SO, Jude EB, Tarawneh I, Nguyen HC, Harkless LB, Boulton AJ: A comparison of two diabetic foot ulcer classification systems: the Wagner and the University of Texas. Diabetes Care. 2001, 24: 84-88. 10.2337/diacare.24.1.84.CrossRefPubMed Oyibo SO, Jude EB, Tarawneh I, Nguyen HC, Harkless LB, Boulton AJ: A comparison of two diabetic foot ulcer classification systems: the Wagner and the University of Texas. Diabetes Care. 2001, 24: 84-88. 10.2337/diacare.24.1.84.CrossRefPubMed
33.
go back to reference Sochocki MP, Verity S, Atherton PJ, Huntington JL, Sloan JA, Embil JM, Trepman E: Health related quality of life in patients with Charcot arthropathy of the foot and ankle. J Foot Ankle Surg. 2008, 1: 11-15. 10.1186/1757-1146-1-11.CrossRef Sochocki MP, Verity S, Atherton PJ, Huntington JL, Sloan JA, Embil JM, Trepman E: Health related quality of life in patients with Charcot arthropathy of the foot and ankle. J Foot Ankle Surg. 2008, 1: 11-15. 10.1186/1757-1146-1-11.CrossRef
34.
go back to reference Pakarinen TK, Laine HJ, Maenpaa H, Mattila P, Lahtela J: Long-term outcome and quality of life in patients with Charcot foot. J Foot Ankle Surg. 2009, 4: 187-191.CrossRef Pakarinen TK, Laine HJ, Maenpaa H, Mattila P, Lahtela J: Long-term outcome and quality of life in patients with Charcot foot. J Foot Ankle Surg. 2009, 4: 187-191.CrossRef
35.
go back to reference Simon U, Nawarotzky U, Friese G, Porck W, Schottenfeld-Naor Y, Hahn S, Scherbaum WA, Kruse J: Psychotherapy intervention to reduce depressive symptoms in patients with diabetic foot syndrome. Diabet Med. 2008, 25: 206-212. 10.1111/j.1464-5491.2007.02370.x.CrossRef Simon U, Nawarotzky U, Friese G, Porck W, Schottenfeld-Naor Y, Hahn S, Scherbaum WA, Kruse J: Psychotherapy intervention to reduce depressive symptoms in patients with diabetic foot syndrome. Diabet Med. 2008, 25: 206-212. 10.1111/j.1464-5491.2007.02370.x.CrossRef
36.
go back to reference Gyani A, Shafran R, Layard R, Clark DM: Enhancing recovery rates: lessons from year one of IAPT. Behav Res Ther. 2013, 5 (9): 597-606.CrossRef Gyani A, Shafran R, Layard R, Clark DM: Enhancing recovery rates: lessons from year one of IAPT. Behav Res Ther. 2013, 5 (9): 597-606.CrossRef
37.
go back to reference Huber JW, Drescher U, Asimakopoulou K: Depression in Type 2 diabetes. Prim Care Diabetes. 2009, 11: 281-285. Huber JW, Drescher U, Asimakopoulou K: Depression in Type 2 diabetes. Prim Care Diabetes. 2009, 11: 281-285.
38.
go back to reference González EL, Johansson S, Wallander MA, Rodríguez LA: Trends in the prevalence and incidence of diabetes in the UK: 1996-2005. J Epidemiol Community Health. 2009, 63: 332-336. 10.1136/jech.2008.080382.CrossRefPubMed González EL, Johansson S, Wallander MA, Rodríguez LA: Trends in the prevalence and incidence of diabetes in the UK: 1996-2005. J Epidemiol Community Health. 2009, 63: 332-336. 10.1136/jech.2008.080382.CrossRefPubMed
Metadata
Title
High levels of anxiety and depression in diabetic patients with Charcot foot
Authors
Zahra Chapman
Charles Matthew James Shuttleworth
Jörg Wolfgang Huber
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Journal of Foot and Ankle Research / Issue 1/2014
Electronic ISSN: 1757-1146
DOI
https://doi.org/10.1186/1757-1146-7-22

Other articles of this Issue 1/2014

Journal of Foot and Ankle Research 1/2014 Go to the issue