title: Diabetic peripheral neuropathy and depressive symptoms: the association revisited.
abstract: OBJECTIVE
  We examined the association between severity of diabetic peripheral neuropathy and depressive symptoms and investigated the potential mediators of this association.
  
  
  METHODS
  The Hospital Anxiety and Depression Scale (HADS) was used to assess depressive symptoms in 494 patients (mean age 62 years; 70% male; 72% type 2 diabetic) with diabetic neuropathy diagnosed by the Neuropathy Disability Score (NDS) and the Vibration Perception Threshold (VPT). Diabetic neuropathy symptoms, activities of daily living (ADLs), and social self-perception were measured by the neuropathy and foot ulcer-specific quality-of-life instrument, NeuroQoL; perceptions of diabetic neuropathy symptom unpredictability and the lack of effective treatment were assessed by the revised Illness Perception Questionnaire.
  
  
  RESULTS
  Both the NDS and VPT were significantly associated with the HADS after controlling for demographic and disease variables. Although diabetic neuropathy symptoms mediated this association, with unsteadiness being most strongly associated with HADS, the relationship between foot ulceration and depression was nonsignificant. The association between diabetic neuropathy symptoms and HADS was partially mediated by two sets of psychosocial variables: 1) perceptions of diabetic neuropathy symptom unpredictability and the lack of treatment control and 2) restrictions in ADLs and changes in social self-perception.
  
  
  CONCLUSIONS
  These findings establish the association between diabetic neuropathy and depressive symptoms and identify potential targets for interventions to alleviate depressive symptoms in persons affected by diabetic peripheral neuropathy.
authors.affiliation: Department of Medicine, University of Manchester, UK. lvileikyte@med.miami.edu
authors.forename: Loretta
authors.initials: L
authors.lastname: Vileikyte
authors.forename: Howard
authors.initials: H
authors.lastname: Leventhal
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Gonzalez
authors.forename: Mark
authors.initials: M
authors.lastname: Peyrot
authors.forename: Richard R
authors.initials: RR
authors.lastname: Rubin
authors.forename: Jan S
authors.initials: JS
authors.lastname: Ulbrecht
authors.forename: Adam
authors.initials: A
authors.lastname: Garrow
authors.forename: Christine
authors.initials: C
authors.lastname: Waterman
authors.forename: Peter R
authors.initials: PR
authors.lastname: Cavanagh
authors.forename: Andrew J M
authors.initials: AJ
authors.lastname: Boulton
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D003863:Depression / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology*; D003929:Diabetic Neuropathies / Q000150:complications* / Q000523:psychology*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012649:Self Concept; D012803:Sick Role; D012919:Social Behavior