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Diabetologia
Published in: Diabetologia 2/2012

01-02-2012 | Article

Five-year follow-up of a cohort of people with their first diabetic foot ulcer: the persistent effect of depression on mortality

Authors: K. Winkley, H. Sallis, D. Kariyawasam, L. H. Leelarathna, T. Chalder, M. E. Edmonds, D. Stahl, K. Ismail

Published in: Diabetologia | Issue 2/2012

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Abstract

Aims/hypothesis

Depressive disorders are associated with mortality within 18 months of presentation of diabetic foot ulcers (DFU). The main aim of this study was to determine whether depressive disorder is still associated with increased mortality in people with their first foot ulcer at 5 years.

Methods

This is a 5-year follow-up of a cohort of 253 patients presenting with their first DFU. At baseline, the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) 2.1 was used to define those who met DSM-IV (Diagnostic and Statistical Manual 4th edition) criteria for depressive disorder. Cox regression analysis controlled for potential covariates: age, sex, marital status, socioeconomic status, smoking, mean HbA1c, diabetes complications and ulcer severity. The main outcome was mortality at 5 years.

Results

The prevalence of DSM-IV depressive disorder at baseline was 32.2% (n = 82). There were 92 (36.4%) deaths over the 5 years of follow-up. In the Cox regression (n = 246), after adjusting for covariates, baseline DSM-IV depressive disorder was significantly associated with a twofold increased risk of mortality for any depressive episode (HR 2.09, 95% CI 1.34, 3.25), minor (HR 1.93, 95% CI 1.00, 3.74) or major depressive disorders (HR 2.18, 95% CI 1.31, 3.65), compared with patients who were not depressed.

Conclusions/interpretation

Depression is associated with a persistent twofold increased risk of mortality in people with their first DFU at 5 years.
Literature
1.
Singh N, Armstrong DG, Lipsky BA (2005) Preventing foot ulcers in patients with diabetes. JAMA 293:217–228PubMedCrossRef
2.
Kumar S, Ashe HA, Parnell LN et al (1994) The prevalence of foot ulceration and its correlates in type 2 diabetic patients: a population-based study. Diabet Med 11:480–484PubMedCrossRef
3.
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. Diabet Med 19:377–384PubMedCrossRef
4.
Walters D, Gatling W, Mulle M, Hill R (1992) The distribution and severity of diabetic foot disease: a community study with comparison to a non-diabetic group. Diabet Med 9:354–358PubMedCrossRef
5.
Al-Mahroos F, Al-Roomi K (2007) Diabetic neuropathy, foot ulceration, peripheral vascular disease and potential risk factors among patients with diabetes in Bahrain: a nationwide primary care diabetes clinic-based patient cohort. Annals of Saudi Medicine 27:25–31PubMedCrossRef
6.
Muller IS, de Grauw WJC, van Gerwen WHEM, Bartelink ML, van den Hoogen HJM, Rutten GEHM (2002) Foot ulceration and lower limb amputation in type 2 diabetic patients in Dutch primary health care. Diabetes Care 25:570–574PubMedCrossRef
7.
Ramsey SD, Newton K, Blough D et al (1999) Incidence, outcomes, and cost of foot ulcers in patients with diabetes. Diabetes Care 22:382–387PubMedCrossRef
8.
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
9.
Iversen MM, Midthjell K, Østbye T et al (2008) History of and factors associated with diabetic foot ulcers in Norway: the Nord-Trøndelag Health Study. Scand J Public Health 36:62–68PubMedCrossRef
10.
Reiber GE, Pecoraro RE, Koepsell TD (1992) Risk factors for amputation in patients with diabetes mellitus. Ann Intern Med 117:97–105PubMed
11.
Vileikyte L (2001) Diabetic foot ulcers: a quality of life issue. Diabetes Metab Res Rev 17:246–249PubMedCrossRef
12.
Winkley K, Stahl D, Chalder T, Edmonds ME, Ismail K (2009) A prospective cohort study of quality of life in people with their first diabetic foot ulcer. J Am Podiatr Med Assoc 99:406–414PubMed
13.
Boulton AJM, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J (2005) The global burden of diabetic foot disease. Lancet 366:1719–1724PubMedCrossRef
14.
Anderson RJ, Freedland KE, Clouse RE, Lustman PJ (2001) The prevalence of co-morbid depression in adults with diabetes. Diabetes Care 6:1069–1078CrossRef
15.
Ali S, Stone M, Peters J, Davies M, Khunti K (2006) The prevalence of co-morbid depression in adults with type 2 diabetes: a systematic review and meta-analysis. Diabet Med 23:1165–1173PubMedCrossRef
16.
Ciechanowski PS, Katon WJ, Russo JE (2000) Depression and diabetes: impact of depressive symptoms on adherence, function and costs. Arch Intern Med 160:3278–3285PubMedCrossRef
17.
DeGroot M, Anderson RM, Freedland KE, Clouse RE, Lustman PJ (2001) Association of depression and diabetes complications: a meta-analysis. Psychosom Med 63:619–630
18.
Williams LH, Miller DR, Fincke G et al (2011) Depression and incident lower limb amputations in veterans with diabetes. J Diabetes Complications 25:175–182PubMedCrossRef
19.
Gonzalez JS, Peyrot M, McCarl LA et al (2008) Depression and diabetes treatment nonadherence: a meta-analysis. Diabetes Care 31:2398–2403PubMedCrossRef
20.
Lustman PJ, Anderson RJ, Freedland KE, de Groot M, Carney RM, Clouse RE (2000) Depression and poor glycemic control. A meta-analytic review of the literature. Diabetes Care 23:934–942PubMedCrossRef
21.
Ismail K, Winkley K, Stahl D, Chalder T, Edmonds M (2007) A cohort study of people with diabetes and their first foot ulcer: the role of depression on mortality. Diabetes Care 30:1473–1479PubMedCrossRef
22.
Egede LE, Nietert PJ, Zheng D (2005) Depression and all-cause and coronary mortality among adults with and without diabetes. Diabetes Care 28:1339–1345PubMedCrossRef
23.
Katon WJ, Rutter C, Simon G et al (2005) The association of comorbid depression with mortality in patients with type 2 diabetes. Diabetes Care 28:2668–2672PubMedCrossRef
24.
Zhang X, Norris SL, Gregg EW, Cheng YJ, Beckles GL, Khahn HS (2005) Depressive symptoms and mortality among persons with and without diabetes. Am J Epidemiol 161:652–660PubMedCrossRef
25.
Black SA, Markides KS, Ray LA (2003) Depression predicts increased incidence of adverse health outcomes in older Mexican Americans with type 2 diabetes. Diabetes Care 26:2822–2828PubMedCrossRef
26.
Lloyd CE, Nouwen A, Hermanns N, Pouwer F, Underwood L, Winkley K (2010) The epidemiology of diabetes and depression. In: Katon W, Maj M, Sartorius N (eds) Depression and diabetes. Wiley/Blackwell, London, pp 1–28CrossRef
27.
Lustman PJ, Griffith LS, Freedland KE, Clouse RE (1997) The course of major depression in diabetes. Gen Hosp Psychiatry 19:138–143PubMedCrossRef
28.
WHO (1999) Definition, diagnosis and classification of diabetes mellitus and its complications. Report of a WHO Consultation. World Health Organization, Geneva
29.
ONS (2000) Office of National Statistics. ONS standard occupational classification 2000. Volume 1: Structure and description of unit groups. Volume 2: The coding index. Stationery Office, London
30.
Saunders J, Aasland O, Babor TF, de la Fuete JR, Grant M (1993) Development of the Alcohol Use Disorders Test (AUDIT): WHO collaborative project on the early detection of persons with harmful alcohol consumption. Addiction 88:791–804PubMedCrossRef
31.
Rajbhandari S, Harris N, Sutton M et al (1999) Digital imaging: an accurate and easy method of measuring foot ulcers. Diabet Med 16:339–342PubMedCrossRef
32.
Armstrong DG, Lavery LA, Harkless LB (1998) Validation of a diabetic wound classification system. Diabetes Care 21:855–859PubMedCrossRef
33.
WHO (1997) SCAN: Schedules for Clinical Assessment in Neuropsychiatry. Version 2.1. World Health Organization, Geneva
34.
Rijinders C, van der Berg J, Hodiamont P et al (2000) Psychometric properties of the schedules for clinical assessment in neuropsychiatry (SCAN-2.1). Social Psychiatry & Epidemiology 35:348–352CrossRef
35.
Cleves M (2004) Introduction to survival analysis using STATA. Stata Corp., Texas
36.
Jeffcoate WJ, Chipchase SY, Ince P, Game FL (2006) Assessing the outcome of the management of diabetic foot ulcers using ulcer-related and person-related measures. Diabetes Care 29:1784–1787PubMedCrossRef
37.
Winkley K, Stahl D, Chalder T, Edmonds M, Ismail K (2007) Risk factors associated with adverse outcomes in a population-based prospective cohort study of people with their first diabetic foot ulcer. J Diabetes Complications 21:341–349PubMedCrossRef
38.
Monami M, Longo R, Desideri CM, Masotti G, Marchionni N, Mannucci E (2008) The diabetic person beyond a foot ulcer: healing, recurrence, and depressive symptoms. J Am Podiatr Med Assoc 98:130–136PubMed
39.
Williams LH, Rutter CM, Katon WJ et al (2010) Depression and incident diabetic foot ulcers: a prospective cohort study. Am J Med 123:748–754.e743PubMedCrossRef
40.
Gonzalez J, Vileikyte L, Ulbrecht J et al (2010) Depression predicts first but not recurrent diabetic foot ulcers. Diabetologia 53:2241–2248PubMedCrossRef
41.
Lin EHB, Katon W, von Korff M et al (2004) Relationship of depression and diabetes self-care, medication adherence, and preventive care. Diabetes Care 27:2154–2160PubMedCrossRef
42.
Carney RM, Freedland KE, Miller GE, Jaffe AS (2002) Depression as a risk factor for cardiac mortality and morbidity: a review of potential mechanisms. J Psychosom Res 53:897–902PubMedCrossRef
43.
Musselman DL, Tomer A, Manatunga AK et al (1996) Exaggerated platelet reactivity in major depression. Am J Psychiatry 153:1313–1317PubMed
44.
Owen B, Eccleston D, Ferrier I, Young H (2001) Raised levels of plasma interleukin-1 beta in major and postviral depression. Acta Psychiatr Scand 103:226–228PubMedCrossRef
45.
Suarez E, Krishnan R, Lewis J (2003) The relation of severity of depressive symptoms to monocyte-associated proinflammatory cytokines and chemokines in apparently healthy men. Psychosom Med 65:362–368PubMedCrossRef
46.
Harris T, Borsanyi S, Messari S et al (2000) Morning cortisol as a risk factor for subsequent major depressive disorder in adult women. Br J Psychiatry 177:505–510PubMedCrossRef
47.
Pariante CM, Lightman SL (2008) The HPA axis in major depression: classical theories and new developments. Trends Neurosci 31:464–468PubMedCrossRef
48.
van der Feltz-Cornelis CM, Nuyen J, Stoop C et al (2010) Effect of interventions for major depressive disorder and significant depressive symptoms in patients with diabetes mellitus: a systematic review and meta-analysis. Gen Hosp Psychiatry 32:380–395PubMedCrossRef
49.
Simson U, Nawarotzky U, Friese G et al (2008) Psychotherapy intervention to reduce depressive symptoms in patients with diabetic foot syndrome. Diabet Med 25:206–212PubMedCrossRef
Metadata
Title
Five-year follow-up of a cohort of people with their first diabetic foot ulcer: the persistent effect of depression on mortality
Authors
K. Winkley
H. Sallis
D. Kariyawasam
L. H. Leelarathna
T. Chalder
M. E. Edmonds
D. Stahl
K. Ismail
Publication date
01-02-2012
Publisher
Springer-Verlag
Published in
Diabetologia / Issue 2/2012
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI
https://doi.org/10.1007/s00125-011-2359-2

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