Predictors of depressive symptoms in persons with diabetic peripheral neuropathy: a longitudinal study

Abstract

Aims/hypothesis The aim of the study was to determine whether diabetic peripheral neuropathy (DPN) is a risk factor for depressive symptoms and examine the potential mechanisms for this relationship. Methods This longitudinal study (9 and 18 month followup) of 338 DPN patients (mean age 61 years; 71% male; 73% type 2 diabetes) examined the temporal relationships between DPN severity (mean±SD; neuropathy disability score [NDS], 7.4±2.2; mean vibration perception threshold, 41.5±9.5 V), DPN somatic experiences (symptoms and foot ulceration), DPN psychosocial consequences (restrictions in activities of daily living [ADL] and social selfperception) and the Hospital Anxiety and Depression subscale measuring depressive symptoms (HADS-D; mean 4.9±3.7).Results Controlling for baseline HADS-D and demographic/disease variables, NDS at baseline significantly predicted increased HADS-D over 18 months. This association was mediated by baseline unsteadiness, which was significantly associated with increased HADS-D. Baseline ADL restrictions significantly predicted increased HADS-D and partly mediated the association between baseline unsteadiness and change in HADS-D. Increased pain, unsteadiness and ADL restrictions from baseline to 9 months each significantly predicted increased HADS-D over 18 months. Change in social self-perception from baseline to 9 months significantly predicted increased HADS-D and partly mediated the relationships of change in unsteadiness and ADL restrictions with change in HADS-D. Conclusions/interpretation These results confirm that neuropathy is a risk factor for depressive symptoms because it

Depression predicts first but not recurrent diabetic foot ulcers

“…Our previous work using standardised diagnostic criteria for neuropathy [18] demonstrated a significant association between DPN severity and increased depressive symptoms, but failed to demonstrate a relationship between past foot ulceration and either concurrent [19] or subsequent depression [20]. Consistent with our findings, recent data from a large population-based study of diabetes patients with past foot ulceration also found that these patients reported more symptoms of depression than patients without diabetes, but their level of depression symptoms did not differ from diabetes patients who had not had a foot ulcer [12].…”

“…However, it is unclear from the report whether analyses adequately controlled for potential confounding between neuropathy severity and depression; others using a larger population-based sample have failed to find this relationship [22]. As neuropathy, a well-established risk factor for foot ulceration [3], is also a risk factor for elevated depressive symptoms [19,20], this may be a major limitation of previous research.…”

Diabetic Neuropathy: A Position Statement by the American Diabetes Association

“…A longitudinal study has shown that DSPN is a risk factor for depression and the strongest symptom associated with depression was unsteadiness. Pain with DSPN may also give rise to symptoms of anxiety (143). Two research tools that can be used to assess quality of life that are neuropathy specific are the NeuroQoL (Quality of Life in Neurological Disorders) (144) and QOL-DN (Norfolk Quality of Life-Diabetic Neuropathy) instruments (145).…”

Risk Factors and Comorbidities in Diabetic Neuropathy: An Update 2015

“…Depression is an important comorbidity of DSPN [118][119][120][121]. Among neuropathic symptoms, it is pain and, primarily, postural instability (leading to gait uncertainty) that are associated with depression [119,120].…”

“…Among neuropathic symptoms, it is pain and, primarily, postural instability (leading to gait uncertainty) that are associated with depression [119,120]. In the same context, DSPN may be associated with poor quality of life [121], and painful symptoms may be linked with a reduced well-being index [122].…”