Top

Published in:

01-07-2009 | Article

Predictors of depressive symptoms in persons with diabetic peripheral neuropathy: a longitudinal study

Authors: L. Vileikyte, M. Peyrot, J. S. Gonzalez, R. R. Rubin, A. P. Garrow, D. Stickings, C. Waterman, J. S. Ulbrecht, P. R. Cavanagh, A. J. M. Boulton

Published in: Diabetologia | Issue 7/2009

Abstract

Aims/hypothesis

The aim of the study was to determine whether diabetic peripheral neuropathy (DPN) is a risk factor for depressive symptoms and examine the potential mechanisms for this relationship.

Methods

This longitudinal study (9 and 18 month follow-up) of 338 DPN patients (mean age 61 years; 71% male; 73% type 2 diabetes) examined the temporal relationships between DPN severity (mean ± SD; neuropathy disability score [NDS], 7.4 ± 2.2; mean vibration perception threshold, 41.5 ± 9.5 V), DPN somatic experiences (symptoms and foot ulceration), DPN psychosocial consequences (restrictions in activities of daily living [ADL] and social self-perception) and the Hospital Anxiety and Depression subscale measuring depressive symptoms (HADS-D; mean 4.9 ± 3.7).

Results

Controlling for baseline HADS-D and demographic/disease variables, NDS at baseline significantly predicted increased HADS-D over 18 months. This association was mediated by baseline unsteadiness, which was significantly associated with increased HADS-D. Baseline ADL restrictions significantly predicted increased HADS-D and partly mediated the association between baseline unsteadiness and change in HADS-D. Increased pain, unsteadiness and ADL restrictions from baseline to 9 months each significantly predicted increased HADS-D over 18 months. Change in social self-perception from baseline to 9 months significantly predicted increased HADS-D and partly mediated the relationships of change in unsteadiness and ADL restrictions with change in HADS-D.

Conclusions/interpretation

These results confirm that neuropathy is a risk factor for depressive symptoms because it generates pain and unsteadiness. Unsteadiness is the symptom with the strongest association with depression, and is linked to depressive symptoms by perceptions of diminished self-worth as a result of inability to perform social roles.

Boulton AJM, Malik RA, Arezzo J, Sosenko JM (2004) Diabetic neuropathy: technical review. Diabetes Care 27:1458–1487PubMedCrossRef

Resnick HE, Stansberry KB, Harris TB et al (2002) Diabetes, peripheral neuropathy, and old age disability. Muscle Nerve 25:43–50PubMedCrossRef

Resnick HE, Vinik AI, Schwartz AV et al (2000) Independent effects of peripheral nerve dysfunction on lower-extremity physical function in old age: the Women's Health and Aging Study. Diabetes Care 23:1642–1647PubMedCrossRef

Vileikyte L, Peyrot M, Bundy CE et al (2003) The development and validation of a neuropathic symptom and foot ulcer-specific quality of life instrument. Diabetes Care 26:2549–2555PubMedCrossRef

Reiber GE, Vileikyte L, Boyko EJ et al (1999) Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings. Diabetes Care 22:157–162PubMedCrossRef

Pecoraro R, Reiber GE, Burgess EM (1990) Pathways to diabetic limb amputation. Diabetes Care 13:513–521PubMedCrossRef

Winocour PH, Main CJ, Medlicott G, Anderson DC (1990) A psychometric evaluation of adult patients with type I (insulin-dependent) diabetes mellitus: prevalence of psychological dysfunction and relationship to demographic variables, metabolic control and complications. Diabetes Res 14:171–176PubMed

Viinamäki H, Niskanen L, Uusitupa M (1995) Mental well-being in people with non-insulin-dependent diabetes. Acta Psychiatr Scand 92:392–397PubMedCrossRef

Geringer ES, Perlmuter LC, Stern TA, Nathan DM (1988) Depressive symptoms and diabetic neuropathy: a complex relationship. J Geriatr Psychiatry Neurol 1:11–15PubMedCrossRef

10.

Gore M, Brandenburg NA, Dukes E, Hoffman DL, Tai KS, Stacey B (2005) Pain severity in diabetic peripheral neuropathy is associated with patient functioning, symptom levels of anxiety and depressive symptoms, and sleep. J Pain Symptom Manage 30:374–385PubMedCrossRef

11.

de Groot M, Anderson R, Freedland KE, Clouse RE, Lustman PJ (2001) Association of depressive symptoms and diabetes complications: a meta-analysis. Psychosom Med 63:619–630PubMed

12.

Davies M, Brophy S, Williams R, Taylor A (2006) The prevalence, severity, and impact of painful diabetic peripheral neuropathy in type 2 diabetes. Diabetes Care 29:1518–1522PubMedCrossRef

13.

Dyck PJ, Kratz KM, Karnes JL et al (1993) The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population-based cohort: the Rochester Diabetic Neuropathy Study. Neurology 43:817–824PubMed

14.

Bruce DG, Davis WA, Davis TM (2005) Longitudinal predictors of reduced mobility and physical disability in patients with type 2 diabetes: the Fremantle Diabetes Study. Diabetes Care 28:2441–2447PubMedCrossRef

15.

Von Korff M, Katon W, Lin EH et al (2005) Potentially modifiable factors associated with disability among people with diabetes. Psychosom Med 67:233–240CrossRef

16.

Von Korff M, Katon W, Lin EH et al (2005) Work disability among individuals with diabetes. Diabetes Care 28:1326–1332CrossRef

17.

Simon GE, Katon WJ, Lin EH et al (2005) Diabetes complications and depressive symptoms as predictors of health service costs. Gen Hosp Psych 27:344–351CrossRef

18.

Williamson GM (1998) The central role of restricted normal activities in adjustment to illness and disability: a model of depressed affect. Rehab Psychol 43:327–347CrossRef

19.

Pouwer F, Beekman AT, Nijpels G et al (2003) Rates and risks for co-morbid depressive symptoms in patients with type 2 diabetes mellitus: results from a community-based study. Diabetologia 46:892–898PubMedCrossRef

20.

Heidrich SM, Forsthoff CA, Ward SE (1994) Psychological adjustment in adults with cancer: the self as mediator. Health Psychol 13:346–353PubMedCrossRef

21.

Dyeson TB (2000) Burden self-image: a mediating variable of depressive symptoms among chronically ill care recipients. J Gerontol Soc Work 33:17–33CrossRef

22.

Leventhal H, Meyer D, Nerenz D (1980) The common sense representation of illness danger. In: Rachman S (ed) Contributions to medical psychology, vol 2. Pergamon, New York, pp 7–30

23.

Vileikyte L, Leventhal H, Gonzalez JS et al (2005) Diabetic peripheral neuropathy and depressive symptoms: the association revisited. Diabetes Care 28:2378–2383PubMedCrossRef

24.

Young MJ, Boulton AJM, Macleod AF, Williams DRR, Sonksen PH (1993) A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population. Diabetologia 36:150–154PubMedCrossRef

25.

Zigmond AS, Snaith RP (1983) The hospital anxiety and depressive symptoms rating scale. Acta Psychiatr Scand 67:361–370PubMedCrossRef

26.

Schafer JL, Graham JW (2002) Missing data: our view of the state of the art. Psychol Methods 7:147–177PubMedCrossRef

27.

Muthén LK, Muthén BO (1998) Mplus user’s guide. Muthen & Muthen, Los Angeles

28.

Baron RM, Kenny DA (1986) The moderator/mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 51:1173–1182PubMedCrossRef

29.

Sobel ME (1982) Asymptotic intervals for indirect effects in structural equation models. In: Leinhart S (ed) Sociological methodology. Jossey Bass, San Francisco, pp 290–312

30.

Smedstad LM, Vaglum P, Moum T, Kvien TK (1997) The relationship between psychological distress and traditional clinical variables: a 2 year prospective study of 216 patients with early rheumatoid arthritis. Br J Rheumatol 36:1304–1311PubMedCrossRef

31.

Dickens C, McGowan L, Clark-Carter D, Creed F (2002) Depressive symptoms in rheumatoid arthritis: a systematic review of the literature with meta-analysis. Psychosom Med 64:52–60PubMed

32.

Lindenberger EC, Landefeld CS, Sands LP et al (2003) Unsteadiness reported by older hospitalized patients predicts functional decline. J Am Geriatr Soc 51:621–626PubMedCrossRef

33.

McKee KJ, Orbell S, Austin CA et al (2002) Fear of falling, falls efficacy, and health outcomes in older people following hip fracture. Disabil Rehabil 24:327–333PubMedCrossRef

34.

Ismail K, Winkley K, Stahl D et al (2007) A cohort study of people with diabetes and their first foot ulcer: the role of depressive symptoms on mortality. Diabetes Care 30:1473–1479PubMedCrossRef

35.

Simson U, Nawarotzky U, Porck W et al (2008) Depression, anxiety, quality of life and type D pattern among inpatients suffering from diabetic foot syndrome. Psychother Psychosom Med Psychol 58:44–50PubMedCrossRef

36.

Abbott CA, Carrington AL, Ashe H et al (2002) The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort. Diabetic Med 19:377–384PubMedCrossRef

37.

Abbott CA, Garrow AP, Carrington AL et al (2005) Foot ulcer risk is lower in South-Asian and African-Caribbean compared with European diabetic patients in the U.K.: the North-West diabetes foot care study. Diabetes Care 28:1869–1875PubMedCrossRef

38.

Max MB, Culnane M, Schafer SC et al (1987) Amitriptyline relieves diabetic neuropathy pain in patients with normal or depressed mood. Neurology 37:589–596PubMed

39.

Ciechanowski PS, Katon WJ, Russo JE, Hirsch IB (2003) The relationship of depressive symptoms to symptom reporting, self-care and glucose control in diabetes. Gen Hosp Psych 25:246–252CrossRef

40.

Ludman EA, Katon W, Russo J et al (2004) Depressive symptoms and diabetes symptom burden. Gen Hosp Psych 26:430–436CrossRef

Title: Predictors of depressive symptoms in persons with diabetic peripheral neuropathy: a longitudinal study
Authors: L. Vileikyte
M. Peyrot
J. S. Gonzalez
R. R. Rubin
A. P. Garrow
D. Stickings
C. Waterman
J. S. Ulbrecht
P. R. Cavanagh
A. J. M. Boulton
Publication date: 01-07-2009
Publisher: Springer-Verlag
Published in: Diabetologia / Issue 7/2009
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-009-1363-2

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Predictors of depressive symptoms in persons with diabetic peripheral neuropathy: a longitudinal study

Abstract

Aims/hypothesis

Methods

Results

Conclusions/interpretation

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Aims/hypothesis

Methods

Results

Conclusions/interpretation

Please log in to get access to this content

Other articles of this Issue 7/2009

The type 1 diabetes protective HLA DQB1*0602 allele is less frequent in gestational diabetes mellitus

Risk of type 2 diabetes among individuals with high and low glomerular filtration rates

Relationship between glyco-oxidation, antioxidant status and microalbuminuria in type 2 diabetic patients

Apolipoprotein E deficiency abrogates insulin resistance in a mouse model of type 2 diabetes mellitus

Prevention of spontaneous immune-mediated diabetes development in the LEW.1AR1-iddm rat by selective CD8+ T cell transfer is associated with a cytokine shift in the pancreas-draining lymph nodes

Combined analysis of 19 common validated type 2 diabetes susceptibility gene variants shows moderate discriminative value and no evidence of gene–gene interaction

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page