Attitude is everything! That’s what research by health psychologists suggest when it comes to people with diabetic foot ulcers. Researchers have concluded that a patient’s beliefs about their illness have a significant independent effect on their survival.
A study of 169 patients with foot ulcers, led by researchers at The University of Nottingham and carried out over five years, investigated how depression led to poorer clinical outcomes for diabetic ulcer patients. The results, published in the scientific and medical journal PLOS ONE, aim to improve the understanding of mortality risks and better inform future therapeutic treatment to improve survival.
Type 1 and type 2 diabetes are susceptible to leg and foot ulcers as a consequence of nerve damage and the narrowing of arteries connected to the feet and lower leg. Such problems with the arteries can be complicated by foot injuries that may fail to heal and subsequently develop into ulcers that may become infected and difficult to treat which can result in amputation and death.
The University of Nottingham School of Medicine, Professor Kavita Vedhara said: “We wanted to test the hypothesis that life expectancy in people with diabetic foot ulcers is shorter in patients with negative beliefs regarding their symptoms and attitudes to caring for their feet.” The researchers used data that included the type of diabetes, glucose control, how many previous ulcers the patient has had, the size and location of ulcer and infection levels. They combined that information with a patient completed survey that measured illness beliefs and depression levels.
“We found that, although depression was not a significant predictor, patients who believed their ulcers were associated with greater symptoms died more quickly.”
The same foot care advice and treatment was provided to all the patients. Information regarding survival and mortality was collected about the patients in 2011, between 4 and 9 years after they had been initially recruited for the study.
“We found that of the 160 patients for whom data on mortality were available, 104 were alive and 56 had died. The patients had an average age of 61 and most had type 2 diabetes. Most patients had had a previous ulcer and in one-third of the cohort the index ulcer was infected at the start of the study. The psychological data revealed on average low levels of depression,” Professor Vedhara said.
The scientist noted that their analysis examined whether patients’ beliefs about their ulcer predicted survival, after taking into account the effects of depression and other clinical factors that might be expected to influence mortality.
“We found that, although depression was not a significant predictor, patients who believed their ulcers were associated with greater symptoms died more quickly.”
These patients also believed that their ulcers would have more serious consequences for them, believed they would last a long time, found them distressing and believed they had little control over them. This constellation of beliefs appears to have been common in people who died more quickly in this study.”
Despite the small number of participants in the study, the results suggest that negative expectations about one’s illness, combined with other clinical factors, may influence survival in people with diabetic foot ulcers.
