title: Alcohol consumption and other psycho-social conditions as important factors in the development of diabetic foot ulcers.
abstract: OBJECTIVE
  To characterize bio-psycho-social factors, particularly mental disorders and self-harm behaviour, associated with the development of diabetic foot ulcers.
  
  
  METHODS
  Two groups of diabetic patients with and without foot ulcers (n=47 in each group) with similar sex, age and diabetes duration were assessed for mental disorders using the Composite International Diagnostic Interview. Self-harm behaviour, quality of life, depressive symptoms and self-compassion were rated using different standard questionnaires.
  
  
  RESULTS
  Patients from the ulcer group visited their practitioners and/or psychotherapists less frequently in the last 12 months than patients in the control group 0 vs. 13%; P=0.026). The ulcer group patients had a history of increased alcohol consumption (43 vs. 19%; P=0.025), lower levels of education (8 vs. 10 grades; P=0.014) and income (1190 vs. 1535 €/month; P=0.039). Additionally, they were less likely to be diagnosed with anxiety disorders (11 vs. 32%; P=0.022). No significant differences in glycated haemoglobin, body mass index, smoking and direct self-harm behaviour were identified.
  
  
  CONCLUSIONS
  Patients with foot ulcers tend to exhibit lower health-conscious behaviour, particularly higher lifetime alcohol consumption, lower utilization of medical services and less general anxiety. Practitioners should be aware of these behaviours, since early detection of diabetes patients at psycho-social risk and consecutive psychological intervention may be an effective preventive strategy in avoiding the development of foot ulcers.
authors.affiliation: Department of Internal Medicine III, Medical Faculty Carl Gustav Carus, Technical University of Dresden, Fetscherstrasse 74, Dresden, Germany. nicole.altenburg@uniklinikum-dresden.de
authors.forename: N
authors.initials: N
authors.lastname: Altenburg
authors.forename: P
authors.initials: P
authors.lastname: Joraschky
authors.forename: A
authors.initials: A
authors.lastname: Barthel
authors.forename: A
authors.initials: A
authors.lastname: Bittner
authors.forename: K
authors.initials: K
authors.lastname: Pöhlmann
authors.forename: H
authors.initials: H
authors.lastname: Rietzsch
authors.forename: S
authors.initials: S
authors.lastname: Fischer
authors.forename: G
authors.initials: G
authors.lastname: Mennicken
authors.forename: C
authors.initials: C
authors.lastname: Koehler
authors.forename: S R
authors.initials: SR
authors.lastname: Bornstein
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects* / Q000523:psychology; D000671:Amputation, Surgical / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology / Q000523:psychology; D017719:Diabetic Foot / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D003929:Diabetic Neuropathies / Q000150:complications / Q000503:physiopathology / Q000523:psychology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data; D012307:Risk Factors; D012648:Self Care / Q000523:psychology*; D011795:Surveys and Questionnaires