A cross-sectional study of depression and self-care in patients with type 2 diabetes with and without foot ulcers.

Depression has been recognized as a risk factor for foot ulceration in persons with diabetes mellitus. Using convenience sampling methods, a cross-sectional study was conducted among persons with type 2 diabetes treated in a diabetic foot clinic in Sao Paulo, Brazil between February 2010 and December 2011. One hundred (100) patients (average age 62 years, range 38 to 83 years), 50 with a foot ulcer and 50 at risk for developing a foot ulcer, participated. Symptoms of depression were assessed using the Beck Depression Inventory (BDI), where scores increase with severity; and patients were interviewed about foot self-care behaviors. Average BDI scores among patients with an ulcer were higher (mean 20.37; range 1 to 42) than those of patients that had not developed a foot ulcer (mean 15.70; range 2 to 49) (P = 0.030). Self-care behavior was not significantly different between the two groups. Severe depression (P = 0.049, OR= 6.56 95% CI 1.01-42.58) and male gender (P <0.001, OR=14.87 95% CI 3.83-57.82) were associated with the presence of a foot ulcer. Despite reported adequate self-care behaviors, patients with an ulcer had more symptoms of depression than patients who were at risk for developing a foot ulcer. Studies examining cause-and-effect relationships between these observations and the potential role of depression interventions are needed. The results of this and other studies suggest depression screening is important in patients with diabetes mellitus and foot ulcers.