Mental health issues associated with foot complications of diabetes mellitus

• Foot problems may affect mental health in diabetic patients and their caregivers.
• Foot problems were associated with greater symptoms of diabetes and depression.
• Patients with diabetic foot problems had worse health-related quality of life.
• Caregivers had marked caregiver burden and mild to moderate depression and anxiety.
• Mental health symptoms in diabetic patients may affect treatment in the foot clinic.

BackgroundThe purpose of this study was to evaluate the effect of foot problems on mental health in diabetic patients and their caregivers.MethodsDiabetic patients (47 patients with and 49 patients without foot problems), and 21 caregivers of patients with foot problems, completed outcome surveys. Foot problems included ulcers (41 patients [87%]), osteomyelitis (9 patients [19%]), and Charcot foot (8 patients [17%]).ResultsIn contrast with diabetic patients having no foot problems, diabetic patients with foot problems had, on average, significantly greater symptoms of diabetes (Diabetes Symptom Checklist-2 score), greater depression symptoms (Hospital Anxiety and Depression Scale [HADS]-Depression score), worse health-related quality of life (Medical Outcome Study Short Form 36 [SF-36]: Physical Component Summary score and 6 of 8 subscales), greater pain (Short-Form McGill Pain Questionnaire), and greater suicidal behavior (Suicidal Behaviors Questionnaire-Revised). There were no significant differences in alcohol use (mean Alcohol Use Disorder Identification Test score), anxiety (HADS-Anxiety score), or SF-36 Mental Component Summary score between patients with and without foot problems. Caregivers had marked caregiver burden (average Montgomery Caregiver Burden Assessment score) and frequently had mild to moderate depression and anxiety.ConclusionsFoot problems are significantly associated with mental health symptoms in diabetic patients and caregivers. This may affect treatment in the foot clinic, outcome, and quality of life.