Depression prevalence in people with diabetes and foot ulcers attending podiatry outpatient clinics

Aims: Diabetic foot ulcers are one of the most common and costly complications of diabetes occurring in between 15 and 25% of diabetics. Comorbid depression has been associated with delays in healing and a threefold increased risk of mortality within 18 months of presenting with a first foot ulcer. This paper presents the results of a pilot study of depression prevalence in these patients.

Methods: Data was collected from 60 people with diabetes and foot ulcers attending outpatient podiatry clinics. Depression was measured using the Patient Health Questionnaire (PHQ) and defined as a score > 4. Patients were classified as having previously recognised depression if they were currently on antidepressants for depression and/or had been told by a doctor or other health care professional in the prior 12 months they had depression. The classification for unrecognised depression included participants who did not meet the criteria for recognised depression but had a PHQ score > 4.

Results: The prevalence of depression was 51.7%. Twenty-one participants (35%) had previously recognised depression and 17 (28.3%) unrecognised depression. Participants with unrecognised depression compared to those with recognised depression were more likely to live alone (23.5% vs. 4.8% respectively). Proportionally more participants with recognised depression reported moderate to severe depression compared to those with unrecognised depression (57.1% vs. 29.4%, p = <0.001). Of those with previously recognised depression, 17 (81%) were on antidepressants. The median duration of antidepressant treatment was 104 weeks (IQR 20 and 494 weeks). Forty-six percent of of these participants had been on antidepressants for more than two years and 23.1% for more than 10 years. The majority of participants of antidepressants had seen a general practitioner and a diabetes nurse educator in the last 12 months. Fewer visits to mental health clinicians (psychiatrist, psychologists and mental health nurses) were reported. Despite antidepressant treatment 70.6% scored in the moderate to severe range for depression on the PHQ.

Conclusion: This study shows a high prevalence of depression in these “high-risk” patients that is often undetected and untreated. Screening for depression and the provision of a case manager would be beneficial in these patients.