Coping style and depression influence the healing of diabetic foot ulcers: observational and mechanistic evidence

Vedhara, K., Miles, J. N. V., Wetherell, M. A., Dawe, K., Searle, A., Tallon, D., Cullum, N., Day, A., Dayan, C., Drake, N., Price, P., Tarlton, J., Weinman, J. and Campbell, R. (2010) Coping style and depression influence the healing of diabetic foot ulcers: observational and mechanistic evidence. Diabetologia, 53 8: 1590-1598. doi:10.1007/s00125-010-1743-7


Author Vedhara, K.
Miles, J. N. V.
Wetherell, M. A.
Dawe, K.
Searle, A.
Tallon, D.
Cullum, N.
Day, A.
Dayan, C.
Drake, N.
Price, P.
Tarlton, J.
Weinman, J.
Campbell, R.
Title Coping style and depression influence the healing of diabetic foot ulcers: observational and mechanistic evidence
Journal name Diabetologia   Check publisher's open access policy
ISSN 0012-186X
1432-0428
Publication date 2010-08-01
Sub-type Article (original research)
DOI 10.1007/s00125-010-1743-7
Open Access Status
Volume 53
Issue 8
Start page 1590
End page 1598
Total pages 9
Place of publication Heidelberg, Germany
Publisher Springer
Language eng
Formatted abstract
Aims/hypothesis
Experimental evidence suggests that the healing of diabetic foot ulcers is affected by psychosocial factors such as distress. We examined this proposal in a prospective study, in which we considered the role of psychological distress and coping style in the healing of diabetic foot ulcers over a 24 week period. We also explored the role of salivary cortisol and matrix metalloproteinases (MMPs) as potential mechanisms.

Methods

For this prospective observational study we recruited 93 (68 men; mean age 60 years) patients with neuropathic or neuroischaemic diabetic foot ulcers from specialist podiatry clinics in secondary care. Clinical and demographic determinants of healing, psychological distress, coping, salivary cortisol and both MMP2 and MMP9 were assessed at baseline. Ulcers were assessed at baseline and at 6, 12 and 24 weeks post-baseline. The primary outcome was ulcer status at 24 weeks, i.e. healed vs not healed.

Results
After controlling for clinical and demographic determinants of healing, ulcer healing at 24 weeks was predicted by confrontation coping, but not by depression or anxiety. Patients with unhealed ulcers exhibited greater confrontation coping (model including depression: OR 0.809, 95% CI 0.704–0.929, p = 0.003; model including anxiety: OR 0.810, 95% CI 0.704–0.930, p = 0.003). However, change in ulcer size over the observation period was associated with depression only (p = 0.04, d = 0.31). Healed ulcers by 24 weeks were also associated with lower evening cortisol, higher precursor MMP2 and a greater cortisol awakening response.

Conclusions/interpretation

Confrontation coping and depression predict ulcer healing. Our preliminary enquiry into biological mechanisms suggests that cortisol and precursor MMP2 may underlie these relationships.
Keyword Coping
Cortisol
Depression
Diabetic foot ulcers
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Nursing, Midwifery and Social Work Publications
 
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Created: Wed, 21 May 2014, 21:04:43 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work