J Foot Ankle Res. 2026 Sep;19(3):e70208. doi: 10.1002/jfa2.70208.
ABSTRACT
INTRODUCTION: There is close association between experience of diabetes-tissue complications and depression/psychological distress. Our aim was to describe the results of prospective screening for anxiety/depression in a high-risk multidisciplinary foot hospital clinic where people present with diabetes foot ulceration.
METHODS: Fifty patients attending our podiatry clinic participated in this study. All had active foot ulceration. The scales completed were GAD-7 for anxiety/PHQ-9 for depression plus 2-specific diabetes distress scale items (16 + 2 questions). Spearman's rho(ρ) was utilised for correlational analysis due to the skewed distributions of variables. Medical history was obtained from primary and secondary care electronic health records. Inclusion criteria were type 1 or 2 diabetes and active foot ulceration.
RESULTS: Eight patients were diagnosed with type 1 diabetes and 42 with type 2 diabetes. Mean (standard deviation) (sd) age of the study population was 65.4 (12.9) years (n = 50) of which 86.7% were men. Median time since diagnosis was 14.5 (3.1) years. 42% of the patients had CKD (estimated GFR < 60 mL/min/1.73 m2). Median (IQR) for PHQ-9 was 9 (3-16) and GAD-7 was 4 (0.5-9.0) (mild-moderate median scores for both). The median (IQR) of number of comorbidities was 8.3 (3.9); number of separate drugs was 10.5 (4.1). Depression/anxiety scores correlated highly positively with each other (Spearman's rho 0.791, p < 0.001) and with the diabetes distress score. Age was significantly and inversely correlated with anxiety (rho -0.472, p = 0.017) and depression (rho -0.250, p = 0.040). The PHQ-9 questionnaire score for depression was higher in people taking more individual pharmacological agents (0.490, p = 0.001) and in people with a higher HbA1c (rho 0.421, p = 0.007) and correlated with the total of the 2 diabetes distress score items (rho 0.456, p = 0.006). Ulcer healed status at 12 weeks was not associated with any questionnaire score. Insulin treatment was associated with higher PHQ-9 score.
CONCLUSION: In this prospective study, we found a high correlation between depression/anxiety symptoms and diabetes foot ulceration, both recognised and unrecognised (until assessment). Both depression and anxiety symptoms declined with age. Higher depression scores associated with a higher current HbA1c and with greater number of prescribed medications.
PMID:42755053 | DOI:10.1002/jfa2.70208