Diabetic Peripheral Neuropathy and Depressive Symptoms
The association revisited
- Loretta Vileikyte, MD, PHD123,
- Howard Leventhal, PHD3,
- Jeffrey S. Gonzalez, PHD2,
- Mark Peyrot, PHD45,
- Richard R. Rubin, PHD56,
- Jan S. Ulbrecht, MD7,
- Adam Garrow, DPM, PHD1,
- Christine Waterman, MSC1,
- Peter R. Cavanagh, PHD, DSC8 and
- Andrew J.M. Boulton, MD, FRCP12
- 1Department of Medicine, University of Manchester, Manchester, U.K.
- 2Departments of Medicine and Psychology, University of Miami, Miami, Florida
- 3Institute for Health and Department of Psychology, Rutgers University, New Brunswick, New Jersey
- 4Department of Sociology, Loyola College, Baltimore, Maryland
- 5Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
- 6Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
- 7Departments of Medicine and Biobehavioral Health, Penn State University, State College, Pennsylvania
- 8Diabetic Foot Care Program, The Cleveland Clinic, Cleveland, Ohio
- Address correspondence and reprint requests to Loretta Vileikyte, MD, PhD, Department of Medicine, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, U.K. E-mail: lvileikyte{at}med.miami.edu
Abstract
OBJECTIVE—We examined the association between severity of diabetic peripheral neuropathy and depressive symptoms and investigated the potential mediators of this association.
RESEARCH DESIGN AND METHODS—The Hospital Anxiety and Depression Scale (HADS) was used to assess depressive symptoms in 494 patients (mean age 62 years; 70% male; 72% type 2 diabetic) with diabetic neuropathy diagnosed by the Neuropathy Disability Score (NDS) and the Vibration Perception Threshold (VPT). Diabetic neuropathy symptoms, activities of daily living (ADLs), and social self-perception were measured by the neuropathy and foot ulcer–specific quality-of-life instrument, NeuroQoL; perceptions of diabetic neuropathy symptom unpredictability and the lack of effective treatment were assessed by the revised Illness Perception Questionnaire.
RESULTS—Both the NDS and VPT were significantly associated with the HADS after controlling for demographic and disease variables. Although diabetic neuropathy symptoms mediated this association, with unsteadiness being most strongly associated with HADS, the relationship between foot ulceration and depression was nonsignificant. The association between diabetic neuropathy symptoms and HADS was partially mediated by two sets of psychosocial variables: 1) perceptions of diabetic neuropathy symptom unpredictability and the lack of treatment control and 2) restrictions in ADLs and changes in social self-perception.
CONCLUSIONS—These findings establish the association between diabetic neuropathy and depressive symptoms and identify potential targets for interventions to alleviate depressive symptoms in persons affected by diabetic peripheral neuropathy.
- ADL, activity of daily living
- HADS, Hospital Anxiety and Depression Scale
- IPQ-R, revised Illness Perception Questionnaire
- NDS, Neuropathy Disability Score
- VPT, Vibration Perception Threshold
Footnotes
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A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
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- Accepted June 26, 2005.
- Received April 11, 2005.
- DIABETES CARE
