Five-year follow-up of a cohort of people with their first diabetic foot ulcer: the persistent effect of depression on mortality
Open accessAbstract
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.
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Waiting more than 14 days before lower extremity revascularization is associated with a higher rate of major amputation compared with earlier revascularization (OR, 3.1; 95% CI, 1.4-6.9).
“A retrospective study of 314 patients with diabetes reported that waiting more than 14 days before lower extremity revascularization was associated with a higher rate of major amputation compared with earlier revascularization (OR, 3.1; 95% CI, 1.4-6.9[absolute rates not provided]).82”
From Diabetic Foot Ulcers (2023) · cites this paper as [82]
The Methods passages describe an analysis of depression and mortality, with amputation treated as a covariate. Searches for a revascularization delay, a 14-day threshold, 314 patients, and the stated odds ratio found no passage in our copy addressing the claimed association. (LLM, conf=0.76)
Experimental — accuracy not yet measuredDepression tied to complications raises mortality.
“Fear of complications is a major component of diabetes distress, and depression associated with complications increases mortality (123,124).”
From Psychosocial care for people with diabetes: a position statement of the American Diabetes Association (2016) · cites this paper as [123]
Fear of complications is a major part of diabetes distress.
“Fear of complications is a major component of diabetes distress, and depression associated with complications increases mortality (123,124).”
From Psychosocial care for people with diabetes: a position statement of the American Diabetes Association (2016) · cites this paper as [123]
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References 51 · Cited by 106
- Authors
- Winkley, K., Sallis, H., Kariyawasam, D., Leelarathna, L. H., Chalder, T., Edmonds, M. E., Stahl, D., & Ismail, K.
- Affiliations
- King's College London (GB)
- Guy's and St Thomas' NHS Foundation Trust (GB)
- King's College Hospital NHS Foundation Trust (GB)
- Corresponding author
- Winkley, K.
- ORCID
- Venue
- Diabetologia
- Published
- 2011-11-06
- Volume
- 55
- Issue
- 2
- Pages
- 303-310
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W1982877023
- Cited by
- 106
- References
- 51
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 3 · 2023: 8 · 2022: 8 · 2021: 6 · 2020: 8 · 2019: 13 · 2018: 5 · 2017: 7 · 2016: 6 · 2015: 5 · 2014: 7 · 2013: 9 · 2012: 8
- FWCI
- 6.29
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Bristol Research (University of Bristol) (submittedVersion)
- Funders
- Wellcome Trust
- University of Leicester
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
- Health Sciences › Medicine › Dermatology › Skin Diseases and Diabetes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- diabetic foot ulcer, depression, mortality, depressive disorders, long-term follow-up, major depressive disorder, minor depressive disorder, diabetes complications, ulcer severity, HbA1c
- MeSH terms
- Adult, Aged, Depression, Female, Follow-Up Studies, Humans, Male, Middle Aged, Risk, Smoking, Social Class, Cohort Studies, Proportional Hazards Models, Diabetic Foot, Diabetes Complications
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