title: Mental health issues associated with foot complications of diabetes mellitus.
abstract: BACKGROUND
  The purpose of this study was to evaluate the effect of foot problems on mental health in diabetic patients and their caregivers.
  
  
  METHODS
  Diabetic patients (47 patients with and 49 patients without foot problems), and 21 caregivers of patients with foot problems, completed outcome surveys. Foot problems included ulcers (41 patients [87%]), osteomyelitis (9 patients [19%]), and Charcot foot (8 patients [17%]).
  
  
  RESULTS
  In contrast with diabetic patients having no foot problems, diabetic patients with foot problems had, on average, significantly greater symptoms of diabetes (Diabetes Symptom Checklist-2 score), greater depression symptoms (Hospital Anxiety and Depression Scale [HADS]-Depression score), worse health-related quality of life (Medical Outcome Study Short Form 36 [SF-36]: Physical Component Summary score and 6 of 8 subscales), greater pain (Short-Form McGill Pain Questionnaire), and greater suicidal behavior (Suicidal Behaviors Questionnaire-Revised). There were no significant differences in alcohol use (mean Alcohol Use Disorder Identification Test score), anxiety (HADS-Anxiety score), or SF-36 Mental Component Summary score between patients with and without foot problems. Caregivers had marked caregiver burden (average Montgomery Caregiver Burden Assessment score) and frequently had mild to moderate depression and anxiety.
  
  
  CONCLUSIONS
  Foot problems are significantly associated with mental health symptoms in diabetic patients and caregivers. This may affect treatment in the foot clinic, outcome, and quality of life.
authors: Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors: Christopher
authors: C
authors: Hoban
authors: Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.
authors: Jitender
authors: J
authors: Sareen
authors: Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.
authors: Christine A
authors: CA
authors: Henriksen
authors: Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada.
authors: Lorraine
authors: L
authors: Kuzyk
authors: Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada; Section of Infectious Diseases, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: jembil@hsc.mb.ca.
authors: John M
authors: JM
authors: Embil
authors: Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada.
authors: Elly
authors: E
authors: Trepman
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety; D017028:Caregivers / Q000523:psychology*; D017281:Cost of Illness; D003863:Depression; D017719:Diabetic Foot / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011788:Quality of Life; D055815:Young Adult
keywords: Charcot; Osteomyelitis; Outcomes; Quality of life; Ulcer