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Beliefs about diabetic foot ulcers may affect survival
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Survival of those with diabetic foot ulcers is independently affected by beliefs and expectations about their illness, according to recent study findings.
“We wanted to test the hypothesis that life expectancy in people with diabetic foot ulcers is shorter in patients with negative beliefs regarding their symptoms and attitudes to caring for their feet,” Kavita Vedhara, PhD, professor of health psychology, faculty of medicine and health sciences at the University of Nottingham in the United Kingdom, said in a press release.
Vedhara and colleagues evaluated data from 160 patients (mean age, 61 years) with type 1 or 2 diabetes and a foot ulcer who visited outpatient podiatry care clinics in the United Kingdom between 2002 and 2007.
Among the participants, 56 had died. The median survival period was 6.4 years, and most participants had type 2 diabetes (n = 111).
Illness beliefs were divided into categories, including identity beliefs (beliefs about the experience of physical symptoms associated with ulcers), consequence beliefs (belief that ulcers had significant consequences), timeline beliefs (belief that the ulcers would last a long time), personal control beliefs (belief there was moderate personal control over the ulcer), treatment control beliefs (belief in the effectiveness of treatment) and coherence beliefs (moderate understanding of the ulcer and belief that ulcers affect well-being).
Significant predictors of time to death were diabetes type and ischemia. In the multivariate model, predictors of time to death were ischemia (P < .0001), coherence beliefs (P = .036) and identify beliefs (P = .036); treatment control beliefs did not reach significance. Participants who were most likely to die had less ischemia, poorer understanding of their condition, perception that they experienced more symptoms and a greater belief in the effectiveness of treatment.
“Our analysis examined whether patients’ beliefs about their ulcer predicted survival, after taking into account the effects of depression and other clinical factors that might be expected to influence mortality,” Vedhara said. “We found that, although depression was not a significant predictor, patients who believed their ulcers were associated with greater symptoms died more quickly. These patients also believed that their ulcers would have more serious consequences for them, believed they would last a long time, found them distressing and believed they had little control over them. This constellation of beliefs appears to have been common in people who died more quickly in this study.” – by Amber Cox
Disclosure: Vedhara reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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Eliot LeBow, LCSW, CDE
This longitudinal research examined psychological and behavioral aspects of living with foot ulcerations and their impact on mortality rates in type 1 and type 2 diabetes. The study evaluates the correlation between illness beliefs and longevity. The research team investigated the effect of several variables that included illness beliefs, ischemia and depression impact on mortality. Significant predictors that correlated with the time of death were illness beliefs and ischemia.
Although depression didn’t seem to be a significant predictor, psychotherapeutic interventions for depression may positively impact illness beliefs, increasing life longevity. While I agree that positive illness beliefs increase patient longevity and understanding the mortality risk in patients would help create therapeutic interventions to improve survival rates, there are resources already available. However, these resources are underutilized, considering that therapeutic interventions, such as psychotherapy and certified diabetes education, improve metabolic control and compliance with diabetes self-management.
Moving forward, early assessment for depression in the endocrinologist’s, nutritionist’s and nurse’s office can be lifesaving. It isn’t of matter of suicidal ideology, but getting patients much needed support. Early referrals to mental health professionals would not only extend life after a foot ulceration diagnosis, but with the right support, may prevent foot ulcerations all together.
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