ASSESSMENT OF DEPRESSIVE SYMPTOMS

PEOPLE WITH DIABETIC FOOT ULCER

DJOKO PRIYONO
BACKGROUND

• Ulcers of the lower limbs are common in patients with

circulatory system and diabetes mellitus.
• Estimated that 15% of patients with diabetes mellitus
will develop at least one foot injury throughout their
lives
• Research has been developed to identify the best treatment.
However, there is a need to understand the complex process of
healing, as well as the biopsychosocial aspects purporting to
these individuals.
• People living with a difficult-to-heal wound, with the risk of having the limb
amputated, experience feelings such as fear,, helplessness, frustration and
isolation.
• Foot ulcers have a significant impact on quality of life. For example, loss of
mobility associated with foot ulcers affect a patient’s ability to perform
simple everyday tasks and participate in leisure activities.
• Several studies have shown that patients with diabetic foot
ulcers were more depressed and had poor quality of life
• Depression is considered one of the ten leading causes of
disability worldwide, limiting physical, social and
personal skills.
• Depression is underdiagnosed and undertreated.
• Around 50-60% cases of depression are not detected. Often depressed
patients do not receive adequate and specific treatment.
• Foot injuries in patients with diabetes can influence significantly
their daily lives and may have consequences, such as
psychosocial disorders, including depression.
• This study aimed to evaluate the intensity and degree of
depression and the depressive symptoms presented by diabetic
patients with foot injury.
METHODS

• Descriptive study. Seventy patients with diabetes melitus and foot ulcers
were enrolled. All were treated in the outpatient Kitamura Wound Clinic,
Pontianak, West Kalimantan, Indonesia.

• We included patients with type 1 or 2 diabetes, with foot ulcer and age
over 18 years. Patients who had physical and mental conditions that
prevented them from responding to the questions were excluded.
• Data were collected during the period from April 2018 to Juni 2018. We
used an instrument to collect data that had socio-demographic and clinical
information. The instrument used to assess depression was the Beck
Depression Assessment inventory

• 21 categories. Each category consists of a series of four different degrees

of intensity of manifestation (0-3 points), totaling 63 points.
• In this study, we considered the following scores: <9
corresponding to no or minimal depression; 10-18, mild to
moderate depression; 19-29, moderate to severe depression; 30
to 63, severe depression.
 RESULT
• Classification of symptoms of depression in diabetic patients with foot ulcer by the Beck
questionnaire

Classification of depressive symptoms N % Valid % Accumulated

%
Minimal or none 18 25,7 25,7 25,7
61,4
Mild 25 35,7 35,7 91,4
Moderate 21 30,0 30,0 100,0
Severe 6 8,6 8,6
Total 70 100,0 100,0
35,7% of patients had mild depression and 30,0% moderate
depression.
RESPONSES OF BECK DEPRESSION INVENTORY FOR DEPRESSIVE
SYMPTOMS IN PATIENTS WITH DIABETIC FOOT ULCER
Occurence of depressive Answer % of cases Occurence of
symptoms depressive
symptoms
Less Satisfied 53 6,27 75,71
Sadness 52 6,15 74,28
Fatigue 51 6,04 72,86
Disqualification for Work 50 5,92 71,43
Somatic preoccupation 50 5,92 71,43
Loss of Libido 50 5,92 71,43

It can be seen in table 2 that 53 (75,71%) patients had symptoms of depression: Less
Satisfied; 52 (74,28%) Sadness; 51 (72,86) Fatigue; 50 (71,43%) patients had a
Disqualification for Work, Somatic Preoccupation and Loss of Libido.
 DEMOGRAPHIC DATA
Variabel N % Valid Gender n % Valid %
Age Interval %
18-25 1 1,4 1,4 Male 35 50,0 50,0
26-35 2 2,9 2,9 Female 35 50,0 50,0
36-45 7 10,0 10,0 Total 70 100 100
46-55 23 32,9 32,9 Education n % Valid
56-65 24 34,3 34,3 %
>65 13 18,6 18,6 Elementary School 23 32,86 32,86
Total 70 100 100 Junior High School 13 18,57 18,57
Senior High School 22 31,43 31,43
Diploma 1 1,43 1,43
Table displays that 24 (34,3%) patients were aged Bachelor 6 8,57 8,57
between 56 and 65 years, 23 (32,9%) patients were aged Master 5 7,14 7,14
between 46-55 years Total 70 100 100

35 (50%) patients were male and female; 23 (32,86%)

patients were elementary school and 22 (31,43)
patients were senior high school.
DISTRIBUTION OF DIABETIC WITH FOOT ULCERS
ACCORDING TO CLINICAL DATA

Varibel N % Valid %
Smoking
Yes 18 25,7 25,7
No 52 74,3 74,3
Total 70 100 100

It can be seen in table that 52 (74,3%) patients were no smokers

 DISTRIBUTION OF DIABETIC WITH FOOT ULCERS ACCORDING TO
DATA RELATED TO THE WOUND

Variables N % Valid % Time With N % Valid %

Size of Ulcer
lesion Up to 6 Months 65 92,86 92,86
1 to 5 cm 40 57,1 57,1
7 Months to 1 year 2 2,86 2,86
6 to 10 cm 20 28,6 28,6
Above 1 Year 3 4,28 4,28
Above 11 cm 10 14,3 14,3
Relapse N % Valid % In table it can be seen that 40 (57,1%) had a size 1 to 5
Yes 42 60,0 60,0 cm; 65 (92,86%) patients lived with the wound Up to 6
No 28 40,0 40,0 Months; and 42 (60%) had ulcer recurrence.
DISCUSION

• Living with the condition of having a wound imposes a number

of changes in people’s lives. The family and the health team are
not prepared to cope with, and understand all aspects involving
this problem.
• In this study, most patients had mild and moderate depression.
The depressive symptoms that showed were: Less Satisfied,
Sadness and Fatigue. Studies indicate that one third of diabetics
who develop foot ulcer suffer from depression.
• In this study, most patients had a wound up to 6 month and and relapsing
wounds. The person with an ulcer should be helped to understand that
the injury does not constitute a restriction on social life, but needs to be
seen as a new condition that requires adaptation.

• Whereas it is difficult to adapt to any change, the help of a professional is

necessary so that the patient feels supported and motivated to seek aid
• Through the assessment of depression inventory of Beck, the
results showed that diabetic patients with foot ulcers had
varying degrees of depressive symptoms.
• This research reinforces the need to redirect the health care of
patients with wounds, seeking to identify emotional disorders
among these patients and propose preventive measures.
• Future studies should be conducted in order for the sample
size to be increased and the magnitude of possible changes in
the emotional aspects and their consequences for patients with
wounds understood.
•THANKS