| Objective:to explore the risk factors of the diabetic foot patients with depression and the influence of peer education for the diabetic foot patients with depression.Methods:The inpatients,from the department of podiatry of our hospital between May,2012 and March,2014,as the objective of the research,were finished all the relevant examination and collected the general data,including the name,gender,age,the duration of diabetes and diabetic foot,smoking and alcohol history,BMI and so on,in a week after admitted.Besides,meantime,the evaluation of complications and comorbidities were also performed.According to whether the patients with depression by Self-rating depression scale,Social Support Rate Scale,Activity of daily living scale,Patients were divided into two groups:depression group and non-depression group,and compared the difference between the two groups as well as analyzed the risk factors of the diabetic foot patients with depression.Based on the depression group,the patients,who conformed to the inclusion criteria and be willing to take part in intervention and observation,were divided into two group again:psychological intervention group(group A)and psychological intervention and peer education group(group B).Based on the diabetic foot standard treatment for both groups,the group A still accepted the psychological intervention,on the other hand,the group B accepted both psychological intervention and peer education,both for 12 weeks.Then take a comparison and evaluation on the results before and after intervention for both groups.The patients,whose diabetic foot ulcer became recovery and discharged from hospital during the experiment,should finish the regular clinical follow-up according to the expected intervention for the whole project.Results:1.In this study,542 patients were included,and according to whether the patients with depression,patients were divided into depression group(n=296,54.6%)and non-depression group(n=246,45.4%).Furthermore,73 patients(24.7%/13.5%)were mild depression,138 patients(46.6%/25.5%)moderate depression,85 patients(28.7%/15.7%)severe in the depression group.The age?marital status?heart function grade of NYHA?diabetic retinopathy and the status of diabetic foot ulcer are the risk factors the diabetic foot patients with depression by means of binary non-conditional Logistic regression analysis.And age:75-79 years old(OR=4.045,95%CI:1.927-8.298)?greater than 80 years old(OR=9.061,95%CI:2.429-33.805),DR(in?-? periods(OR=1.723,95%CI:1.097-2.708),heart function grade of NYHA:the first level(OR=3.332,95%CI:1.833-6.057)?the second level(OR=4.042,95%CI:2.104-7.767),the third level(OR=2.961,95%CI:1.735-5.055),the status of diabetic foot ulcer:multiple ulcers in single foot(OR=2.772,95%CI:1.698-4.524).Body mass index,total cholesterol,high density lipoprotein cholesterol were the protective factors for the diabetic foot patients with depression.2.52 patients who conformed to the inclusion criteria and be willing to take part in intervention and observation were divided into group A and group B in random way.Both groups were 26 patients.But during the experiment,in the group A,there were two patients being transferred to another hospital for amputation because of their severe conditions,and one patient discharged from hospital for his diabetic foot ulcer recovery and failed to finish the clinic follow-up.Finally,the group A had 23 patents and the group B had 26 patients.using the SDS and VAS to compare and evaluate the results before and after intervention for both groups,the group A:SDS(56.96 ±5.03 vs 62.39 ±5.34,t--6.297,p<0.001,VAS(z=-3.858,p=0.001);the B group:SDS(52.84±4.25 vs 63.37±4.34,t=-11.250,p<0.001),VAS(z=-2.269,p=0.023);the difference has statistically significant(p<0.05).The comparison between group A and group B indicated that:SDS(56.96±5.03 vs 52.84±4.25,t=3.214,p=0.002,VAS(z=-2.144,p=0.032),the difference has statistically significant(p<0.05).Conclusion:Diabetic foot was one of complications of diabetes,which could results in disability and death.The people who were diagnosed with diabetic foot were easy to suffer from depression mood for ulcer not easy to heal,a long time for inpatient,bad living level,and a big economic burden and so on.In this study,542 patients were included,and according to whether the patients with depression patients were divided into depression group(n=296,54.6%)and non-depression group(n=246,45.4%).1.univariate analysis indicated that:the higher proportion of female,age of elderly,bad marital status,long disease course,the number of complications,serious retinopathy,a bad cardiac function,a bad ability of daily living,multiple ulcer in single foot or both feet,and the history of amputation of depression group than non-depression group.the difference has statistically significant(P<0.05).However,GFR,BMI,TC,HDL and the scores of social support of depression group was inferior to the non-depression group.the difference has statistically significant(P<0.05).2.(1)Multivariate analysis showed that:the risk factors for the diabetic foot patients with depression wasthe age,marital status,cardiac function,DR,foot ulcers.(2)SSRS is the protective factor for the patients with depression.(3)The patients who had a higher BMI,TC,HDL was not easier to deprssion.3.Psychological intervention could improve the SDS scores of the patient with depression.And with SDS scores declined,the VAS scores also decreased,the ratio of unbearable pain also decreased.Besides,psychological intervention combined with peer education could bring more improvement of the SDS and VAS scores.4.The treatment for diabetic foot should be a multidisciplinary team treatment in early stage;it can shorten the healing time,improve the wound healing rates,and decrease the rates of amputation.So for diabetic foot patients,we should not only take routine treatments,but also cope with their psychological problems,which conformed to modern medical model.It can enhance the patients' confidence more effectively,remove their mental confusion,improve the medication adherence and promote the healing rate of diabetic foot. |
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