Screening for Depression and Anxiety in People With Diabetes and a Foot Ulcer in the Podiatry Clinic.

Authors

Emma Fletcher, Matthew Allen, Andrew Sharpe, Muneeb Ibad, Mathilde Mordaunt, Rosie Callen, Andy Gorman, Heather Schofield, Edward Jude, Adam Robinson, Reena Patel, Sheena Thayyil, Hermione Price, Edward Gee, Boris Mankovsky, George Dunn, Michael Edmonds, Neil Reeves, Adrian Heald

Published in

Journal of foot and ankle research. Volume 19. Issue 3. Pages e70208.

Abstract

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.
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.
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.
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
Bibliographic data and abstract were imported from PubMed on 18 Sep 2026.

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