Ismail Khalida, Winkley Kirsty, Stahl Daniel, Chalder Trudie, Edmonds Michael
Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK.
Diabetes Care. 2007 Jun;30(6):1473-9. doi: 10.2337/dc06-2313. Epub 2007 Mar 15.
The aim was to evaluate over 18 months whether depression was associated with mortality in people with their first foot ulcer.
A prospective cohort design was used. Adults with their first diabetic foot ulcer were recruited from foot clinics in southeast London, U.K. At baseline, the Schedules for Clinical Assessment in Neuropsychiatry 2.1 was used to define those who met DSM (Diagnostic and Statistical Manual of Mental Disorders)-IV criteria for minor and major depressive disorders. Potential covariates were age, sex, marital status, socioeconomic status, smoking, antidepressant use, A1C, macro- and microvascular complications, and University of Texas classification-based severity and size of ulcer. The main outcome was mortality 18 months later, and A1C was the secondary outcome. The proportion who had an amputation, had recurrence, and whose ulcer had healed was recorded.
A total of 253 people with their first diabetic foot ulcer were recruited. The prevalence of minor and major depressive disorder was 8.1% (n = 21) and 24.1% (n = 61), respectively. There were 40 (15.8%) deaths, 36 (15.5%) amputations, and 99 (43.2%) recurrences. In the adjusted Cox regression analysis, minor and major depressive disorders were associated with an approximately threefold hazard risk for mortality compared with no depression (3.23 [95% CI 1.39-7.51] and 2.73 [1.38-5.40], respectively). There was no association between minor and major depression compared with no depression and A1C (P = 0.86 and P = 0.43, respectively).
One-third of people with their first diabetic foot ulcer suffer from clinical depression, and this is associated with increased mortality.
旨在评估在超过18个月的时间里，抑郁症是否与首次发生足部溃疡的患者的死亡率相关。
采用前瞻性队列设计。从英国伦敦东南部的足部诊所招募首次发生糖尿病足溃疡的成年人。在基线时，使用神经精神病学临床评估量表2.1来定义符合《精神疾病诊断与统计手册》（DSM）-IV标准的轻度和重度抑郁症患者。潜在的协变量包括年龄、性别、婚姻状况、社会经济地位、吸烟情况、抗抑郁药使用情况、糖化血红蛋白（A1C）、大血管和微血管并发症，以及基于德克萨斯大学分类法的溃疡严重程度和大小。主要结局是18个月后的死亡率，A1C是次要结局。记录截肢、复发以及溃疡愈合的患者比例。
共招募了253例首次发生糖尿病足溃疡的患者。轻度和重度抑郁症的患病率分别为8.1%（n = 21）和24.1%（n = 61）。有40例（15.8%）死亡，36例（15.5%）截肢，99例（43.2%）复发。在调整后的Cox回归分析中，与无抑郁症相比，轻度和重度抑郁症与死亡的风险比约为三倍（分别为3.23 [95%可信区间1.39 - 7.51]和2.73 [1.38 - 5.40]）。与无抑郁症相比，轻度和重度抑郁症与A1C之间无关联（P分别为0.86和0.43）。
三分之一首次发生糖尿病足溃疡的患者患有临床抑郁症，且这与死亡率增加相关。
