title: The association between history of diabetic foot ulcer, perceived health and psychological distress: the Nord-Trøndelag Health Study.
abstract: BACKGROUND
  While the adverse impact of a history of a foot ulcer on physical health among persons with diabetes is well known, little is known about the association between foot ulcer, perceived health and psychological distress. Results from various studies are difficult to compare as different study designs, samples and/or different questionnaires have been used. The aim of this study was to compare levels of anxiety and depression, psychological well-being and perceived health between persons with diabetes, with or without a history of foot ulcer, and persons without diabetes in a large study of community-dwelling individuals.
  
  
  METHODS
  This study included 65,126 persons, of whom 63,632 did not have diabetes, 1,339 had diabetes without a history of foot ulcer and 155 had diabetes and a history of foot ulcer. Levels of anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS). Psychological well-being was measured on a four-item scale, and perceived health was measured with a one-item question. We investigated whether levels of anxiety, depression, psychological well-being and perceived health were different in the three study groups using multiple regression models controlling for demographic factors, body mass index, smoking and cardiovascular conditions. Separate multivariate analyses comparing the two diabetes samples were additionally adjusted for diabetes-specific variables.
  
  
  RESULTS
  A history of foot ulcer was significantly associated with more depressive symptoms, poorer psychological well-being and poorer perceived health compared to participants without diabetes. In multivariate analyses, perceived health and psychological well-being were significantly poorer among those with a history of foot ulcer compared to those without diabetes. Among persons with diabetes, perceived health was significantly worse among those with a history of foot ulcer. After multivariate adjustment, levels of anxiety and depression and psychological well-being did not differ between the two diabetes groups.
  
  
  CONCLUSIONS
  Perceived health and psychological well-being were significantly poorer among participants with diabetes and a history of foot ulcer compared to those without diabetes. Among people with diabetes, a history of foot ulcer had significant negative impact on perceived health but did not independently contribute to psychological distress.
authors.affiliation: Faculty of Health and Social Sciences, Bergen University College, PO Box 7030, 5020 Bergen, Norway. miv@hib.no
authors.forename: Marjolein M
authors.initials: MM
authors.lastname: Iversen
authors.forename: Kristian
authors.initials: K
authors.lastname: Midthjell
authors.forename: Grethe S
authors.initials: GS
authors.lastname: Tell
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Moum
authors.forename: Truls
authors.initials: T
authors.lastname: Ostbye
authors.forename: Monica W
authors.initials: MW
authors.lastname: Nortvedt
authors.forename: Sverre
authors.initials: S
authors.lastname: Uhlving
authors.forename: Berit R
authors.initials: BR
authors.lastname: Hanestad
references.citation: Qual Life Res. 1998 May;7(4):365-72
references.pmid: 9610220
references.citation: Br J Psychiatry. 2001 Dec;179:540-4
references.pmid: 11731359
references.citation: J Health Soc Behav. 1997 Mar;38(1):21-37
references.pmid: 9097506
references.citation: Diabetes Care. 2004 Apr;27(4):914-20
references.pmid: 15047648
references.citation: Diabetes Care. 2007 Jun;30(6):1473-9
references.pmid: 17363754
references.citation: Lancet. 2007 Sep 8;370(9590):851-8
references.pmid: 17826170
references.citation: Diabetes Care. 2003 Sep;26(9):2549-55
references.pmid: 12941717
references.citation: Scand J Public Health. 2008 Jan;36(1):62-8
references.pmid: 18426786
references.citation: Qual Life Res. 2007 Mar;16(2):179-89
references.pmid: 17091370
references.citation: Foot Ankle Int. 2006 Apr;27(4):274-80
references.pmid: 16624217
references.citation: J Diabetes Complications. 2000 Sep-Oct;14(5):235-41
references.pmid: 11113684
references.citation: Diabetologia. 2005 Sep;48(9):1906-10
references.pmid: 15995846
references.citation: Int J Epidemiol. 1996 Apr;25(2):259-65
references.pmid: 9119550
references.citation: Diabetologia. 2009 Jul;52(7):1265-73
references.pmid: 19399473
references.citation: Psychol Med. 1990 Aug;20(3):635-46
references.pmid: 2236373
references.citation: Diabetes Metab Res Rev. 1999 May-Jun;15(3):205-18
references.pmid: 10441043
references.citation: Diabetes Res Clin Pract. 1996 Apr;32(1-2):19-25
references.pmid: 8803478
references.citation: J Psychosom Res. 2002 Feb;52(2):69-77
references.pmid: 11832252
references.citation: Diabetes Metab Res Rev. 2000 Sep-Oct;16 Suppl 1:S75-83
references.pmid: 11054894
references.citation: Diabetes Care. 2005 Oct;28(10):2378-83
references.pmid: 16186266
references.citation: Diabetes Care. 2001 Jun;24(6):1069-78
references.pmid: 11375373
references.citation: Scand J Soc Med. 1995 Sep;23(3):179-88
references.pmid: 8602488
references.citation: Psychosom Med. 2001 Jul-Aug;63(4):619-30
references.pmid: 11485116
references.citation: JAMA. 2005 Jan 12;293(2):217-28
references.pmid: 15644549
references.citation: Res Nurs Health. 2008 Jun;31(3):226-37
references.pmid: 18481252
references.citation: J Diabetes Complications. 2005 Nov-Dec;19(6):319-27
references.pmid: 16260348
references.citation: J Am Podiatr Med Assoc. 2008 Mar-Apr;98(2):130-6
references.pmid: 18347122
references.citation: Diabetes Care. 2008 Jan;31(1):105-7
references.pmid: 17934145
references.citation: Disabil Rehabil. 2001 May 20;23(8):336-40
references.pmid: 11374523