Depression, Anxiety and Sexual Dysfunction in Patients with Diabetes Mellitus With and Without Foot Ulcer

Abstract

Introduction: Anxiety and depression are both associated with increased morbidity in diabetic population, especially those afflicted with foot ulcer, whereas Erectile Dysfunction (“ED”) and Female Sexual Dysfunction (“FSD”) are amongst the common complication found in diabetes. This study aimed to determine the prevalence of anxiety and depression as primary outcome and sexual dysfunction (“SD”) as a secondary outcome in diabetic patients with and without foot ulcer (“DFU”). Methods: A cross-sectional study was conducted in Hospital Raja Permaisuri Bainun Ipoh, Perak, where 164 diabetic patients were recruited for the purpose of this study. Hospital Anxiety and Depression Scale (“HADS”) were utilised to measure anxiety and depression. International Index for Erectile Function 5 (“IIEF-5”) and the Malay version of Female Sexual Function Index (“MVFSFI”) were used to detect SD. Simple and multiple logistic regressions were referred to in order to evaluate the factors associated with anxiety, depression and SD. Results: In the group with foot ulcer, 36.8% had depressive and anxiety risk respectively compared to without the foot ulcer, 37.5% and 38.5% respectively. Male gender (AOR=6.3,p=0.002,95%CI 1.975, 20.205) and having lower education status (AOR=6.0,p=0.018,95%CI1.36,26.59,) was associated with foot ulcer. High prevalence of SD found in foot ulcer group (52.6%,p=0.006). Those with depression (OR=4.421,95% CI 1.08,18.16,p=0.039) and male gender (OR=18.42,p<0.01,95%CI5.5,-61.62) predicts present of SD. Conclusion: Depression and anxiety prevalent were similar for both with and without diabetic foot ulcer. Several significant predictor factors were identified for DFU group, for anxiety and depression risk and for SD in a diabetes patient. Further studies are required to establish the directional nature of this relationship.

Quality of Life in Patients with Diabetic Foot Ulcers: A Cross-sectional Study

“…The existing literature is unanimous in reporting depression and anxiety as important variables that compromise QoL in these patients. 14,22 However, the present study showed how depression and anxiety together were associated with worse QoL and its domains using a specific DFUQoL scale. Overall, the results confirmed H1 and H2.…”

“…According to Alrub et al, 23 patients with DFUs report low DFUQoL because psychological distress is related to delayed healing and, consequently, long-term care, increasing the impact of DFU on day-to-day activities. The existing literature is unanimous in reporting depression and anxiety as important variables that compromise QoL in these patients 14,22 . However, the present study showed how depression and anxiety together were associated with worse QoL and its domains using a specific DFUQoL scale.…”

“…Specifically, 32% of patients with DFU showed signs and symptoms of major depressive disorder 14 . Depression doubles the risk of mortality in patients with DM and is significantly associated with treatment nonadherence 22,25 …”

“…20 Ultimately, illness representations influence QoL and predict survival in both patients with DM and DFU. 21 According to Husin et al, 22 DFU healing may be impacted by psychological distress, because depression and anxiety have an impact on the body's metabolism. Thus, psychological distress may delay the progression of healing and is associated with long-term care needs and low QoL.…”

“…14 Depression doubles the risk of mortality in patients with DM and is significantly associated with treatment nonadherence. 22,25 Moreover, DFU is associated with a loss of QoL and autonomy as a result of disability. 23 Compared with patients with DM and the general population, patients with DFU report worse QoL, especially regarding physical health.…”