Page 150 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

Diabetic Foot Ulcer (DFU) 125

In this study, it was found that almost all of the patients
reported negative implications on their social roles and activi-
ties. However, in addition to this, patients described how such
restrictions led to significant and prolonged periods of clinical
depression, to the point where the patient pleaded with clini-
cians to have an amputation. Such consequences of living with
a foot ulcer can be detrimental to both the quality of life and
well-being of patients (as we will see later in the book), con-
tinuing the vicious circle of reduced wound healing. Hence, it
is essential that clinicians are aware of not only the physical
and social implications, but also the psychological and emo-
tional toll such illnesses have. In effect, clinicians must adopt
multi-faceted treatment regimes in order to assess patients
and provide the most effective treatment and delivery of care.
Importantly, psychological morbidity is increased in those
with diabetes and DFU by at least two-fold (Anderson et al.
2001 ; Ali et al. 2006 ; Carrington et al. 1996 ). Both depres-
sion and anxiety have been reported in those with DFU
(Ali et al. 2006 ) and these can lead to significant issues with
self-care. For example, there may be a general neglect in
those with depression. Anxiety itself can manifest in range of
disorders including generalised anxiety disorders, obsessive-
compulsive disorders, PTSD and panic disorders (Lin et al.
2008 ). Williams et al. ( 2010 ) reported that depression in those
with type 2 diabetes was associated with twice the rate of
a first DFU and, furthermore, a higher rate of amputation
(Williams et al. 2011 ). Additionally, depression in first DFU is
associated with a two-fold increase of mortality over 5 years
(Ismail et al. 2007 ). This psychological comorbidity, particu-
larly depression, can lead to additional risks on patients with
diabetes and diabetic foot ulcers resulting in poorer self-care
and poorer outcomes (Lustman et al. 2000 ). In contrast, in
those with anxiety it has been argued that its link with self-
care and clinical outcomes are less clear: dependent on the
nature of the anxiety problem, poorer or even enhanced self-
care many emerge (DiMatteo et al. 2000 ).
It is not just psychological distress that may lead to
impairment in healing. Vedhara et al. ( 2010 ) reported that
ineffective coping with the DFU delayed healing with their