Assessment of depression in people with diabetes attending outpatient clinics for the treatment of foot ulcers

Background: People with diabetes and foot ulceration experience more depressed mood particularly when healing does not occur after prolonged treatment. Those who have depression and diabetes have poorer adherence to self-care and/or treatment regimes, poor glycaemic control along with a greater risk of diabetes related complications and mortality. Screening for depression has been shown to be effective to determining the severity of depression as well as the type of treatment required.

Methods: The study required participants to complete a validated self-reporting 9-item Patient Health Questionnaire (PHQ) that provides a diagnosis of mild, moderate and severe depressive syndrome and continuous severity score. Participants were classified in the depressed category if they had PHQ score ≥5. This included all participants in the mild to severe categories. Group differences were examined using chi-square for categorical variables and t-tests for continuous variables.

Results: A higher proportion of participants with depression had diabetes for >10 years compared to those without depression. Of the 60 participants, 31(51.7%) were categorised as depressed (PHQ ≥5). Of these, 15 (48%) had a prior diagnosis of depression and 16 (52%) participants had unrecognised cases of depression.

Conclusion and Clinical Relevance: This study demonstrated the prevalence of depression in people with diabetes and the often hidden impact it has in managing diabetes foot ulceration.