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22-11-2011 | Diabetes | Article

Depression increases mortality risk in patients with diabetic foot ulcers


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MedWire News: Depression is a persistent risk factor for mortality in people with their first diabetic foot ulcer, study findings show.

The association between depression and risk for mortality remains highly significant even 5 years after patients present with their first diabetic foot ulcer, say Kirsty Winkley (King's College, London, UK) and colleagues.

The findings, published in the journal Diabetologia, come from a 3.5-year continuation of the team's earlier 18-month follow-up of 253 patients who presented with their first ulcer (baseline ulcer) between October 2001 and February 2003.

"One limitation of our original study is that the effect of depression on mortality at 18 months of follow-up may have reflected the early stages of adjustment to the sudden onset of disability," writes the team. "This would be expected to disappear over time, especially if the ulcer heals and the patient gradually adjusts."

At baseline, the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) was used to determine the presence of minor or major depressive disorder among the patients, as defined by the Diagnostic and Statistical Manual 4th edition criteria.

During the first 18 months of follow-up, 21 (12.3%) of 171 people without depression and 21 (25.6%) of 82 people with depression died.

After 5 years of follow-up, 24 (22.7%) of the 150 people without depression and 16 (26.2%) of the 61 patients with depression died.

After adjusting for covariates, baseline depressive status was associated with an approximate two-fold increased risk for mortality over the full 5 years.

The presence of minor and major depressive disorders were both associated with an increased risk for death, at hazard ratios of 1.92 and 2.18, respectively, compared with no depression.

The authors say there were no significant differences in risk between the initial 18-month period of follow-up and the subsequent 3.5-year period.

"The presence of an ulcer should alert clinicians for early screening of depression," says the team.

"Further research should concentrate on rapid identification and treatment of depression in people with diabetes, and further investigation into whether treating patients who are depressed with foot ulcers improves adverse outcomes," conclude Winkley et al.

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By Sally Robertson