Analysis Of Status And Influencing Factors Of Depression In Patients With Diabetic Foot Based On The Bio-psycho-social Medical Model

Objective Based on the bio-psycho-social medical model,cross-sectional investigation and bioinformatics methods were used to investigate the current situation of depression in diabetic foot patients to analyze the social,psychological and genetic biological factors of depression in diabetic foot patients.Methods1.Patients with diabetic foot from two tertiary hospital in Qingdao and two tertiary hospitals in Tianjin were selected as the research subjects by convenience sampling method from August 2020 to January 2021.The questionnaire survey was conducted in 219 diabetic foot patients using general information questionnaire,resilience scale,social support scale and depression self-rating scale.SPSS 26.0 and Amos 25.0 software were used for data entry,statistical description and statistical analysis.Chi-square test,student t test and logistic regression analysis were used to find the influcing factors and pearson correlation analysis was used to detect the correction among type D personality,resilience,social support and depression.A structural equation model were build using Amos 25.0 software to explore the action path between the variables.2."Diabetic Foot Ulcer" and "Depression" was used as keywords in the Gene Expression Omnibus(GEO)database of the National Center for Bioinformatics(NCBI)to download the gene chip dataset of diabetic foot ulcer and depression.The dataset was analyzed with the limma package of R software to screen the differentially expressed genes.DAVID bioinformatics software was used to annotate the screened differential genes with Gene Ontology(GO),Kyoto Encyclopedia of Genes and Genomes(KEGG)functional annotation.The protein interaction network(PPI)was constructed using the String online website,and the regulatory network was constructed by Cytoscape,a biological chart visualization tool,to screen the hub genes.Results1.The depression score of diabetic foot patients was(58.88±10.07)points,138 cases were depressed,and the prevalence rate was 63.1%.Univariate analysis showed that annual income,family history of diabetes,activity restriction,Wagner classification,number of insulin injections and age had statistical significance on the incidence of depression in patients with diabetic foot(P<0.05).2.In diabetic foot patients,score of Type D personality was(21.80±8.73),score of NA(negative emotion)was(10.63±4.53),and score of SI(social inhibition)was(11.17±4.87).Score of psychological resilience was(53.56±11.67),and score of social support was(35.28±6.61).3.Correlation analysis showed that type D personality was positively correlated with depression(r=0.475,P<0.01),negatively correlated with resilience(r=-0.614,P<0.01),and negatively correlated with social support(r=-0.562,P<0.01);resilience was negatively correlated with depression(r=-0.510,P<0.01),and positively correlated with social support(r=0.653,P<0.01);social support was negatively correlated with depression(r=-0.455,P<0.01).4.Logistic regression analysis showed that type D personality(OR=2.531,95%CI: 1.224～5.233),resilience(OR=0.955,95%CI: 0.925～0.986),Wagner classification(compared to Grade 1 in this classification,Grade 2: OR=3.609,95% CI: 1.386～9.399;Grade 3: OR=6.204,95%CI: 2.234～17.230;Grade 4: OR=4.400,95%CI: 1.366～14.169;Grade 5: OR=8.876,95% CI: 0.827～95.237)entered the regression equation.5.The structural equation model showed that the total effect of type D personality on depression was 1.443,and there were three influence paths:(1)Type D personality can directly affect the depression with a direct effect of 0.844 in patients with diabetic foot,(2)Type D personality can indirectly affect depression in patients with diabetic foot by the partial mediating effect of psychological resilience with a indirect effect of0.385;(3)Type D personality indirectly affects depression of patients with diabetic foot through the chain mediating effect of social support-psychological resilience with a indirect effect of 0.214.In the total effect of type D personality on depression,the proportion of the above three pathways are 58.5%,26.7% and 14.8%.6.Bioinformatics analysis showed that a total of 195 DEGs co-expressed by DFU and depression were identified in this study,116 upregulated genes and 62 downregulated genes were detected.Co-expression gene could enrichment to 188 GO entries and two KEGG pathways,nerve-pedestal-receptor interactions and metabolic pathways of glycine,serine and threonine,respectively.The protein interaction network has a total of 191 nodes and 79 edges,and a total of 10 key genes were identified:CTSB,CDC14 A,RBM5,ICE2,FNBP4,MAP1LC3 A,SIRT1,CDC42 BPA,MMS19,PGAM1.Conclusions1.Depression in patients with diabetic foot was with a high prevalence.The main factors affecting depression in patients with diabetic foot include annual income,payment method,drinking history,family history of diabetes,activity restriction,Wagner classification,number of insulin injections and age.2.D-type personality,psychological resilience,social support and depression are all significantly correlated.The more significant the D-type personality tendency is,the higher the risk of depression,the lower the level of psychological resilience and social support.3.Type D personality can directly affect the depression of patients with diabetic foot,and it can also indirectly affect the depression of patients with diabetic foot through the partial mediating effect of psychological resilience and social support.4.Overlapping genes for diabetic foot and depression are enriched into a range of molecular processes and biological functions,CTSB,CDC14 A,RBM5,ICE2,FNBP4,MAP1LC3 A and other dysregulated genes can serve as potential genetic biological pathological factors for depressive symptoms in diabetic foot patients and may be therapeutic targets for diseases.