title: Depression symptoms in people with diabetes attending outpatient podiatry clinics for the treatment of foot ulcers.
abstract: BACKGROUND
  The purpose of this study was to examine the prevalence of depressive symptoms, diabetes self-management, and quality of life in people with diabetes and foot ulcers. Ulcer status, mortality and amputations were also assessed at six months follow-up.
  
  
  METHODS
  This was a cross-sectional survey of people attending outpatient podiatry clinics at a major tertiary referral hospital. Depressive symptoms were measured using the Patient Health Questionnaire (PHQ). Diabetes self-care was assessed using the Summary of Diabetes Self Care Activities (SDSCA) measure. Health-related quality of life was measured using the physical component summary score (PCS) and the mental component summary score (MCS) of the SF-12.
  
  
  RESULTS
  Of the 60 participants in the study 14 (23.3%) reported mild symptoms of depression (PHQ score 5-9) and 17 (28.3%) moderate to severe depressive symptoms (PHQ score > 9). Twenty-one (35%) met the criteria for previously recognized depression (on antidepressants and/or a diagnosis of depression in the last 12 months) and 17 (28.3%) for depression not previously recognized (PHQ > 4). Seventeen (28%) participants had been receiving antidepressant treatment for a median duration of 104 weeks (IQR 20, 494 weeks). Despite antidepressant treatment 12 participants (70.6% of those taking antidepressants) still reported moderate to severe depressive symptoms at the time of the study. Patients with PHQ scores > 4 reported poorer adherence to diabetes self-care activities including general diet, exercise, blood sugar monitoring and foot care when compared to those participants with PHQ scores < 5. No association was found between physical functioning (PCS) and depressive symptoms. Decreasing mental wellbeing (MCS) was associated with increasing depressive symptoms. At six months follow-up, there were three deaths and three amputations in participants with PHQ scores > 4 compared with no deaths and 2 amputations in participants with PHQ scores < 5. There was no association between depressive symptoms and ulcer healing or ulcer recurrence at the six-month follow-up.
  
  
  CONCLUSIONS
  This study found a high prevalence of depressive symptoms both recognized and unrecognized in people with diabetes and foot ulcers. Depressive symptoms were associated with overall poorer diabetes self-management and health-related quality of life (HRQoL). There was no association between depressive symptoms and ulcer outcomes at six-months follow-up.
authors.affiliation: University of Tasmania, School of Medicine, Private Bag 34, Hobart, TAS 7001 Tasmania Australia.
authors.forename: Sue
authors.initials: S
authors.lastname: Pearson
authors.affiliation: Southern Tasmania Area Health Service (STAH)-Podiatry, Royal Hobart Hospital, Hobart, Tasmania Australia.
authors.forename: Toni
authors.initials: T
authors.lastname: Nash
authors.affiliation: Southern Tasmania Area Health Service (STAH)-Podiatry, Royal Hobart Hospital, Hobart, Tasmania Australia.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Ireland
keywords: Antidepressants; Depressive symptoms; Diabetes self-management; Foot ulcers; PHQ-9; Quality of life