title: Is depression a risk factor for diabetic foot ulcers? 11-years follow-up of the Nord-Trøndelag Health Study (HUNT).
abstract: OBJECTIVE
  To prospectively examine whether depressive symptoms increase the risk of diabetes and a diabetic foot ulcer.
  
  
  METHODS
  The Nord-Trøndelag Health Study (HUNT) is a community-based longitudinal study. The Hospital Anxiety and Depression Scale (HADS-D subscale) assessed depressive symptoms. We followed individuals with complete HADS-D data from HUNT2 (1995-97) and assessed whether they reported diabetes with or without a history of diabetic foot ulcer (DFU) in HUNT3 (2006-08) (n=36,031). Logistic regression was used to investigate the effect of depressive symptoms on subsequent development of diabetes and of DFU.
  
  
  RESULTS
  Unadjusted odds for reporting diabetes at follow-up was higher among individuals who reported a HADS-D score≥8 at baseline (OR 1.30 95% CI, 1.07-1.57) than among those reporting a lower score. After adjusting for age, gender and BMI, this association was no longer significant. The odds of developing a DFU was almost two-fold (OR=1.95 95% CI, 1.02-3.74) for those reporting a HADS-D score of 8-10, and 3-fold (OR=3.06 95% CI, 1.24-7.54) for HADS-D scores≥11, compared to HADS-D scores<8, after adjusting for age, gender and serum glucose.
  
  
  CONCLUSIONS
  Symptoms of depression at baseline are associated with an increased risk of a diabetic foot ulcer in a dose response manner during this 11-year follow-up.
authors.affiliation: Faculty of Health and Social Sciences, Bergen University College, PO Box 7030, N-5020 Bergen, Norway; Department of Endocrinology, Stavanger University Hospital, PO Box 8100, 4068 Stavanger, Norway. Electronic address: marjolein.iversen@hib.no.
authors.forename: Marjolein M
authors.initials: MM
authors.lastname: Iversen
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, PO Box 7800, 5020 Bergen, Norway.
authors.forename: Grethe S
authors.initials: GS
authors.lastname: Tell
authors.affiliation: Faculty of Health and Social Sciences, Bergen University College, PO Box 7030, N-5020 Bergen, Norway.
authors.forename: Birgitte
authors.initials: B
authors.lastname: Espehaug
authors.affiliation: The HUNT Research Center, Norwegian University of Science and Technology, Forskningsveien 2, 7600 Levanger, Norway.
authors.forename: Kristian
authors.initials: K
authors.lastname: Midthjell
authors.affiliation: Faculty of Health and Social Sciences, Bergen University College, PO Box 7030, N-5020 Bergen, Norway.
authors.forename: Marit
authors.initials: M
authors.lastname: Graue
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, PO Box 7800, 5020 Bergen, Norway.
authors.forename: Berit
authors.initials: B
authors.lastname: Rokne
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, PO Box 7800, 5020 Bergen, Norway.
authors.forename: Line Iden
authors.initials: LI
authors.lastname: Berge
authors.affiliation: Duke Global Health Institute, Duke University, Box 90519 Durham, NC 27708, USA.
authors.forename: Truls
authors.initials: T
authors.lastname: Østbye
mesh_terms: D017677:Age Distribution; D015331:Cohort Studies; D016001:Confidence Intervals; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology*; D017719:Diabetic Foot / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests; D009664:Norway; D016017:Odds Ratio; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013997:Time Factors; D014945:Wound Healing / Q000502:physiology
keywords: Cohort study; Depression; Diabetes; Foot ulcer; Norway; Risk factor