Depression impacts prognosis of the patients with Wagner grades 3 diabetic foot ulcers

Abstract

Objective To evaluate the impact of depression on prognosis of Wagner grade 3 diabetic foot ulcer patients by a psychological assessment. Methods One hundred and sixty-eight patients suffered from Wagner grade 3 diabetic foot ulcers hospitalized in the Tianjin Metabolic Diseases Hospital from June 2010 to May 2011 were included in the study. Their psychological disorders were evaluated by a self-rating depression scale (SDS) to identify depression. Patients complicated with depression or not were divided into two groups accordingly. Unhealing rate and amputation risk of the patients in the two groups were compared using Chi-square test and logistic regression, respectively. Results Ninety-five out of 168 patients (56.5%) were identified as depression and the others (73 out of 168, 43.5%) were not. The unhealing rate of the patients complicated with depression was significantly higher than that of the patients without depression analyzed by Chi-square test (18.9% and 6.8% respectively, OR=2.779, 95%CI: 1.120-9.023). Logistic regression analysis indicated that depression was a risk factor of unhealed ulcers (OR=3.569, 95%CI: 1.220-10.442) after the factors related to prognosis of diabetic foot ulcer were adjusted step-by-step, including infection, arterial disease, age, glycosylated hemoglobin A1c and Charlson grading of complications. Healed patients were further analyzed by logistic regression analysis. Healing after amputation rate is higher among the patients complicated with depression than that of the patients without depression after the adjustment mentioned above (OR=2.793, 95%CI: 1.361-5.732). Conclusion Depression is common among patients with Wagner grade 3 diabetic foot ulcers and has adverse effects on the prognosis of the patients. It implies that identification of depressed should be a routine process for diabetic foot ulcer patients to improve wound healing and reduce amputation rate. Key words: Diabetic foot; Depression; Ulcer; Amputation