title: The diabetic person beyond a foot ulcer: healing, recurrence, and depressive symptoms.
abstract: BACKGROUND
  Several studies have shown a significant relationship between depressive symptoms and wound healing, but these studies have not assessed the effects of depressive symptoms on diabetic foot prognosis. We specifically designed our study to assess the role of depressive symptoms in healing and recurrence of diabetic foot ulcers.
  
  
  METHODS
  A consecutive series of 80 type 2 diabetic patients aged 60 years and older with foot ulcers was enrolled in a cohort observational study with a 6-month follow-up. Patients who healed within 6 months of enrollment were included in a 12-month follow-up study for assessment of ulcer recurrence. Depressive symptoms were assessed with the geriatric depression scale.
  
  
  RESULTS
  Healing was associated with a smaller ulcer area, shorter delay between ulcer onset and treatment, lower glycosylated hemoglobin, and higher ankle-brachial index. Both smoking status and Texas and Wagner scores also had a significant impact on healing. Patients who healed had significantly lower scores on the geriatric depression scale, and those with scores = 10 had a significantly higher risk of not healing at 6 months (relative risk, 3.57; 95% confidence interval, 1.05-12.2). Patients with a recurrent ulcer (59.3%) showed significantly higher total cholesterol levels, higher scores on the Greenfield index of disease severity and geriatric depression scale, and a higher prevalence of cerebrovascular disease. Depressive symptoms maintained a significant association with persistence and recurrence of ulcer even after adjustment for confounders.
  
  
  CONCLUSIONS
  Depressive symptoms are associated with impaired healing and recurrence of ulcers in elderly type 2 diabetic patients.
authors.affiliation: Geriatric Unit, Department of Critical Care Medicine and Surgery, University of Florence and Careggi Hospital, Florence, Italy. mmonami@libero.it
authors.forename: Matteo
authors.initials: M
authors.lastname: Monami
authors.forename: Rosella
authors.initials: R
authors.lastname: Longo
authors.forename: Carla Maria
authors.initials: CM
authors.lastname: Desideri
authors.forename: Giulio
authors.initials: G
authors.lastname: Masotti
authors.forename: Niccolò
authors.initials: N
authors.lastname: Marchionni
authors.forename: Edoardo
authors.initials: E
authors.lastname: Mannucci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003866:Depressive Disorder / Q000209:etiology / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology* / Q000523:psychology*; D017719:Diabetic Foot / Q000209:etiology / Q000503:physiopathology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D014945:Wound Healing / Q000502:physiology*