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A cohort study of people with diabetes and their first foot ulcer: the role of depression on mortality

¹Department of Psychological Medicine, Institute of Psychiatry, King's College London, Weston Education Centre, 10 Cutcombe Road, London, SE5 9RJ
²Department of Biostatistics, Institute of Psychiatry, King's College London, De Crespigny Park, London, SE5 8AZ
³Diabetic Foot Clinic, King's College Hospital, London, Bessemer Road, London SE5 9RS

khalida.ismail{at}iop.kcl.ac.uk

ABSTRACT

Objective: The aim was to evaluate whether depression was associated with mortality in people with their first foot ulcer over 18 months.

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, UK. At baseline the Schedules for Clinical Assessment in Neuropsychiatry 2.1 was used to define those who met Diagnostic and Statistical Manual for Mental Disorders--IV criteria for minor and major depressive disorders. Potential covariates were age, sex, marital status, socioeconomic status, smoking, antidepressants, glycated hemoglobin (A1c), macro- and microvascular complications, University of Texas severity and size of ulcer. The main outcome was mortality 18 months later; A1c was the secondary outcome. The proportion who had an amputation, recurrence and whose ulcer healed was recorded.

Results: 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 around three-fold hazard risk for mortality (3.23, 95% confidence interval 1.39 to 7.5 and 2.73, 95% confidence interval 1.38 to 5.40) compared to no depression respectively. There was no association between minor and major depression compared to no depression and A1c (p=0.86 and p=0.43 respectively).

Conclusions: A third of people with their first diabetic foot ulcer suffer from clinical depression and this is associated with increased mortality.

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