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Coping style and depression influence the healing of diabetic foot ulcers: observational and mechanistic evidence

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Coping style and depression influence the healing of diabetic foot ulcers: observational and mechanistic evidence. / Vedhara, K; Miles, JNV; Wetherell, M; Dawe, KL; Searle, AJ; Tallon, D; Cullum, N; Day, A; Dayan, CM; Drake, N; Price, P; Tarlton, J; Weinman, J; Campbell, R.

In: Diabetologia, Vol. 53, No. 8, 08.2010, p. 1590 - 1598.

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Vedhara, K, Miles, JNV, Wetherell, M, Dawe, KL, Searle, AJ, Tallon, D, Cullum, N, Day, A, Dayan, CM, Drake, N, Price, P, Tarlton, J, Weinman, J & Campbell, R 2010, 'Coping style and depression influence the healing of diabetic foot ulcers: observational and mechanistic evidence', Diabetologia, vol. 53, no. 8, pp. 1590 - 1598. https://doi.org/10.1007/s00125-010-1743-7

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Vedhara, K ; Miles, JNV ; Wetherell, M ; Dawe, KL ; Searle, AJ ; Tallon, D ; Cullum, N ; Day, A ; Dayan, CM ; Drake, N ; Price, P ; Tarlton, J ; Weinman, J ; Campbell, R. / Coping style and depression influence the healing of diabetic foot ulcers: observational and mechanistic evidence. In: Diabetologia. 2010 ; Vol. 53, No. 8. pp. 1590 - 1598.

Bibtex

@article{f85d6ac0073441e387fa23ec13cb7f4d,
title = "Coping style and depression influence the healing of diabetic foot ulcers: observational and mechanistic evidence",
abstract = "AIMS/HYPOTHESIS: Experimental evidence suggests that the healing of diabetic foot ulcers is affected by psychosocial factors such as distress. We examined this proposal in a prospective study, in which we considered the role of psychological distress and coping style in the healing of diabetic foot ulcers over a 24 week period. We also explored the role of salivary cortisol and matrix metalloproteinases (MMPs) as potential mechanisms. METHODS: For this prospective observational study we recruited 93 (68 men; mean age 60 years) patients with neuropathic or neuroischaemic diabetic foot ulcers from specialist podiatry clinics in secondary care. Clinical and demographic determinants of healing, psychological distress, coping, salivary cortisol and both MMP2 and MMP9 were assessed at baseline. Ulcers were assessed at baseline and at 6, 12 and 24 weeks post-baseline. The primary outcome was ulcer status at 24 weeks, i.e. healed vs not healed. RESULTS: After controlling for clinical and demographic determinants of healing, ulcer healing at 24 weeks was predicted by confrontation coping, but not by depression or anxiety. Patients with unhealed ulcers exhibited greater confrontation coping (model including depression: OR 0.809, 95{\%} CI 0.704-0.929, p = 0.003; model including anxiety: OR 0.810, 95{\%} CI 0.704-0.930, p = 0.003). However, change in ulcer size over the observation period was associated with depression only (p = 0.04, d = 0.31). Healed ulcers by 24 weeks were also associated with lower evening cortisol, higher precursor MMP2 and a greater cortisol awakening response. CONCLUSIONS/INTERPRETATION: Confrontation coping and depression predict ulcer healing. Our preliminary enquiry into biological mechanisms suggests that cortisol and precursor MMP2 may underlie these relationships.",
author = "K Vedhara and JNV Miles and M Wetherell and KL Dawe and AJ Searle and D Tallon and N Cullum and A Day and CM Dayan and N Drake and P Price and J Tarlton and J Weinman and R Campbell",
year = "2010",
month = "8",
doi = "10.1007/s00125-010-1743-7",
language = "English",
volume = "53",
pages = "1590 -- 1598",
journal = "Diabetologia",
issn = "0012-186X",
publisher = "Springer Berlin Heidelberg",
number = "8",

}

RIS - suitable for import to EndNote

TY - JOUR

T1 - Coping style and depression influence the healing of diabetic foot ulcers: observational and mechanistic evidence

AU - Vedhara, K

AU - Miles, JNV

AU - Wetherell, M

AU - Dawe, KL

AU - Searle, AJ

AU - Tallon, D

AU - Cullum, N

AU - Day, A

AU - Dayan, CM

AU - Drake, N

AU - Price, P

AU - Tarlton, J

AU - Weinman, J

AU - Campbell, R

PY - 2010/8

Y1 - 2010/8

N2 - AIMS/HYPOTHESIS: Experimental evidence suggests that the healing of diabetic foot ulcers is affected by psychosocial factors such as distress. We examined this proposal in a prospective study, in which we considered the role of psychological distress and coping style in the healing of diabetic foot ulcers over a 24 week period. We also explored the role of salivary cortisol and matrix metalloproteinases (MMPs) as potential mechanisms. METHODS: For this prospective observational study we recruited 93 (68 men; mean age 60 years) patients with neuropathic or neuroischaemic diabetic foot ulcers from specialist podiatry clinics in secondary care. Clinical and demographic determinants of healing, psychological distress, coping, salivary cortisol and both MMP2 and MMP9 were assessed at baseline. Ulcers were assessed at baseline and at 6, 12 and 24 weeks post-baseline. The primary outcome was ulcer status at 24 weeks, i.e. healed vs not healed. RESULTS: After controlling for clinical and demographic determinants of healing, ulcer healing at 24 weeks was predicted by confrontation coping, but not by depression or anxiety. Patients with unhealed ulcers exhibited greater confrontation coping (model including depression: OR 0.809, 95% CI 0.704-0.929, p = 0.003; model including anxiety: OR 0.810, 95% CI 0.704-0.930, p = 0.003). However, change in ulcer size over the observation period was associated with depression only (p = 0.04, d = 0.31). Healed ulcers by 24 weeks were also associated with lower evening cortisol, higher precursor MMP2 and a greater cortisol awakening response. CONCLUSIONS/INTERPRETATION: Confrontation coping and depression predict ulcer healing. Our preliminary enquiry into biological mechanisms suggests that cortisol and precursor MMP2 may underlie these relationships.

AB - AIMS/HYPOTHESIS: Experimental evidence suggests that the healing of diabetic foot ulcers is affected by psychosocial factors such as distress. We examined this proposal in a prospective study, in which we considered the role of psychological distress and coping style in the healing of diabetic foot ulcers over a 24 week period. We also explored the role of salivary cortisol and matrix metalloproteinases (MMPs) as potential mechanisms. METHODS: For this prospective observational study we recruited 93 (68 men; mean age 60 years) patients with neuropathic or neuroischaemic diabetic foot ulcers from specialist podiatry clinics in secondary care. Clinical and demographic determinants of healing, psychological distress, coping, salivary cortisol and both MMP2 and MMP9 were assessed at baseline. Ulcers were assessed at baseline and at 6, 12 and 24 weeks post-baseline. The primary outcome was ulcer status at 24 weeks, i.e. healed vs not healed. RESULTS: After controlling for clinical and demographic determinants of healing, ulcer healing at 24 weeks was predicted by confrontation coping, but not by depression or anxiety. Patients with unhealed ulcers exhibited greater confrontation coping (model including depression: OR 0.809, 95% CI 0.704-0.929, p = 0.003; model including anxiety: OR 0.810, 95% CI 0.704-0.930, p = 0.003). However, change in ulcer size over the observation period was associated with depression only (p = 0.04, d = 0.31). Healed ulcers by 24 weeks were also associated with lower evening cortisol, higher precursor MMP2 and a greater cortisol awakening response. CONCLUSIONS/INTERPRETATION: Confrontation coping and depression predict ulcer healing. Our preliminary enquiry into biological mechanisms suggests that cortisol and precursor MMP2 may underlie these relationships.

UR - http://www.scopus.com/inward/record.url?eid=2-s2.0-77955516959&partnerID=8YFLogxK

U2 - 10.1007/s00125-010-1743-7

DO - 10.1007/s00125-010-1743-7

M3 - Article

VL - 53

SP - 1590

EP - 1598

JO - Diabetologia

JF - Diabetologia

SN - 0012-186X

IS - 8

ER -