title: Five-year follow-up of a cohort of people with their first diabetic foot ulcer: the persistent effect of depression on mortality.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Depression is associated with a persistent twofold increased risk of mortality in people with their first DFU at 5 years.
authors: Department of Psychological Medicine, King's College London & Institute of Psychiatry, Weston Education Centre, 10 Cutcombe Road, London SE5 8AZ, UK. kirsty.winkley@nhs.net
authors: K
authors: K
authors: Winkley
authors: H
authors: H
authors: Sallis
authors: D
authors: D
authors: Kariyawasam
authors: L H
authors: LH
authors: Leelarathna
authors: T
authors: T
authors: Chalder
authors: M E
authors: ME
authors: Edmonds
authors: D
authors: D
authors: Stahl
authors: K
authors: K
authors: Ismail
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003863:Depression / Q000150:complications*; D048909:Diabetes Complications / Q000150:complications / Q000401:mortality / Q000523:psychology; D017719:Diabetic Foot / Q000150:complications / Q000401:mortality* / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012306:Risk; D012907:Smoking; D012923:Social Class