Wounded Soles and Depressed Souls: the once and continued link between depression, foot ulcers and mortality

Congratulations to our friends at Kings College, London for yet another splendid (but depressing) piece on the links between depression, wounds, and mortality in people with diabetes.

Enjoy the abstract
Diabetologia. 2011 Nov 6. [Epub ahead of print]

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



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.


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.


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.


Depression is associated with a persistent twofold increased risk of mortality in people with their first DFU at 5 years.

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