Lower-leg symptoms in peripheral arterial disease are associated with anxiety, depression, and anhedonia

Smolderen, Kim G.; Hoeks, Sanne E.; Pedersen, Susanne S.; Domburg, Ron T. van; Liefde, Inge I. de; Poldermans, Don

doi:10.1177/1358863x09104658

Cited by 65 publications

(62 citation statements)

References 34 publications

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“…Cross-sectional studies in patients with peripheral arterial disease have shown that decreased lower extremity functioning by 6-minute walk test20,21 and increased self-reported rest pain24 are associated with depressive symptoms, although the directionality of these associations is not clear. A prospective study showed an association between baseline diabetic peripheral neuropathy severity and depressive symptoms 18 months later, and this relationship was partially mediated by the symptoms of pain and unsteadiness 25…”

Section: Discussionmentioning

confidence: 99%

Depression and Incident Diabetic Foot Ulcers: A Prospective Cohort Study

Williams

Rutter

Katon

et al. 2010

The American Journal of Medicine

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Objective-To test whether depression is associated with an increased risk of incident diabetic foot ulcers. Methods-The Pathways EpidemiologicStudy is a population-based prospective cohort study of 4839 patients with diabetes in [2000][2001][2002][2003][2004][2005][2006][2007]. The present analysis included 3474 adults with type 2 diabetes and no prior diabetic foot ulcers or amputations. Mean follow-up was 4.1 years. Major and minor depression assessed by the Patient Health Questionnaire-9 (PHQ-9) were the exposures of interest. The outcome of interest was incident diabetic foot ulcers. We computed the hazard ratio (HR) and 95% CI for incident diabetic foot ulcers, comparing patients with major and minor depression to those without depression and adjusting for sociodemographic characteristics, medical comorbidity, glycosylated hemoglobin (HbA 1c ), diabetes duration, insulin use, number of diabetes complications, body mass index, smoking status, and foot self-care. Sensitivity analyses Please address requests for reprints to Dr. Lisa H. Williams at 125 16 th Ave E, mail stop CSB-5, Seattle, WA 98112. The authors have no relevant financial interests to disclose. All authors had access to the data and a role in writing the manuscript.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptAm J Med. Author manuscript; available in PMC 2011 August 1. Results-Compared to patients without depression, patients with major depression by PHQ-9 had a two-fold increase in the risk of incident diabetic foot ulcers (adjusted HR 2.00, 95% CI: 1.24, 3.25). There was no statistically significant association between minor depression by PHQ-9 and incident diabetic foot ulcers (adjusted HR 1.37, 95% CI: 0.77, 2.44).Conclusion-Major depression by PHQ-9 is associated with a two-fold higher risk of incident diabetic foot ulcers. Future studies of this association should include better measures of peripheral neuropathy and peripheral arterial disease, which are possible confounders and/or mediators. Keywordsdiabetes; depression; foot ulcers; complications Among individuals with diabetes, depression is common and associated with multiple adverse outcomes. Depressive symptoms were associated with a higher risk of developing self-reported macrovascular and microvascular complications in a large study of older Hispanic Americans with type 2 diabetes. 1 Mild to severe depressive symptoms were associated with the development of retinopathy 2 and proteinuria 3 in younger African American adults with type 1 diabetes. In addition, several studies in patients with type ...

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Section: Discussionmentioning

confidence: 99%

Depression and Incident Diabetic Foot Ulcers: A Prospective Cohort Study

Williams

Rutter

Katon

et al. 2010

The American Journal of Medicine

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“…Criterion scores of ≥ 8 for the depression subscale denote clinically relevant symptoms of depression. 26–27 …”

Section: Methodsmentioning

confidence: 99%

Gender Differences in Health Status and Adverse Outcomes Among Patients With Peripheral Arterial Disease

Dreyer¹,

Zitteren

Beltrame

et al. 2015

JAHA

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BackgroundFew studies have examined gender differences in health status and cardiovascular outcomes in patients with peripheral artery disease (PAD). This study assessed (1) self‐reported health status at PAD diagnosis and 12‐months later, and explored (2) whether outcomes in women with PAD differ with regard to long‐term major adverse events.Methods and ResultsA total of 816 patients (285 women) with PAD were enrolled from 2 vascular clinics in the Netherlands. Baseline clinical data and subsequent adverse events were recorded and patients completed the Short Form‐12 (SF‐12, Physical Component Score [PCS] and Mental Component Score [MCS]) upon PAD diagnosis and 12‐months later. Women had similar ages and clinical characteristics, but poorer socio‐economic status and more depressive symptoms at initial diagnosis, as compared with men. Women also had poorer physical (PCS: 37±10 versus 40±10, P=0.004) and mental (MCS: 47±12 versus 49±11, P=0.005) health status at the time of presentation. At 12‐months, women still reported a poorer overall PCS score (41±12 versus 46±11, P=0.006) and MCS score (42±14 versus 49±12, P=0.002). Female gender was an independent determinant of a poorer baseline and 12‐month PCS and MCS scores. However, there were no significant differences by gender on either mortality (unadjusted hazard ratio [HR]=0.93, 95% CI 0.60;1.44, P=0.74) or major adverse events (unadjusted HR=0.90, 95% CI 0.63;1.29, P=0.57), after a median follow‐up of 3.2 years.ConclusionsWomen's physical and mental health status is compromised both at initial PAD diagnosis and at 12‐month follow‐up, despite experiencing a similar magnitude of change in their health scores throughout the first 12‐months after diagnosis.

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“…Patients with PAD have markedly reduced health- related quality of life and higher prevalence of depression which is largely related to leg symptoms 23,24. Diminished physical activity in daily life predicts higher overall mortality in PAD 25,26.…”

Section: Functional Disability In Padmentioning

confidence: 99%