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

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

Research output: Contribution to journalArticle (Academic Journal)peer-review

54 Citations (Scopus)

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 HbA(1c), 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.

Original languageEnglish
Pages (from-to)303-10
Number of pages8
JournalDiabetologia
Volume55
Issue number2
DOIs
Publication statusPublished - Feb 2012

Keywords

  • Adult
  • Aged
  • Cohort Studies
  • Depression
  • Diabetes Complications
  • Diabetic Foot
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Risk
  • Smoking
  • Social Class

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