SCIENCE, PRACTICE AND EDUCATION tially protective aspects of mental health were also FUTURE RESEARCH not examined; for example, a US study found that n Personality disorders, depression and diabetes- emotional expression, that is, actively communicat- related distress are prevalent in people attending ing about emotional experiences with others, was specialist podiatry/diabetes clinics, but the positively related to self-care behaviours (including variables measured here do not necessarily FSC). 56 Finally, only three questions from the BIPQ predict foot self-care. were used to allow comparison with a study from the UK, 33 and this limits interpretation. n Future research should seek to identify specific psychological risk factors for DFU and foot self- Additional investigations were undertaken looking care in diabetes, as this could facilitate the at DFU and insulin use. Apart from experiencing design of interventions that improve both more physical symptoms of diabetes, there were no physical and mental health outcomes for patients statistically significant differences in the psychology with diabetes. questionnaire results in participants with DFU ver- sus those without DFU; however, the number in the Key messages DFU group was relatively small. It should be empha- n It is established that medical factors such as being sised that these findings are exploratory in nature overweight and a longer duration of diabetes and, while worthy of further of investigation with a confer a significant risk of diabetic foot ulcer. larger sample, no definitive conclusions can be drawn at the moment. n Mood difficulties and personality disorders were common features in patients presenting to diabetic IMPLICATIONS FOR CLINICAL PRACTICE specialist clinics, and they may require additional n It is clear from our study that psychological interventions. difficulties are a significant feature of many patients presenting with DFU; consequently, n Psychological variables were not identified as pathways to mental health care, where required, conferring an increased risk for foot ulcers or poor are important for patients attending specialist foot self-care. podiatry/diabetes clinics. n The relationship between psychological factors n We suggest exploring the idea of routinely and diabetic foot self-care remains to be screening all patients for diabetes-related distress elucidated. m and depression. Where required, patients could be provided psychoeducational information and the possibility for an onward referral to local community or online mental health services. REFERENCES 1. Hunter CM. Understanding diabetes and the role of psychology in its prevention and treatment. Am Psychol 2016; 71(7):515–25. 2. Armstrong DG, Boulton AJM, Bus SA. Diabetic foot ulcers and their recurrence. NEJM 2017; 376(24):2367–75. 3. Peters EJG, Lipsky BA, Senneville É, Abbas ZG, Aragón-Sánchez J, Diggle M, et al. Interventions in the management of infection in the foot in diabetes: A systematic review. Diabetes Metab Res Rev 2020; 36(S1):e3282. 4. Crawford F, Nicolson DJ, Amanna AE, Martin A, Gupta S, Leese GP, et al. Preventing foot ulceration in diabetes: Systematic review and meta-analyses of RCT data. Diabetologia 2020; 63(1):49–64. 5. Robinson H, Norton S, Jarrett P, Broadbent E. The effects of psychological interventions on wound healing: A systematic review of randomized trials. Br J Health Psychol 2017; 22(4):805–35. 6. Broadbent E, Koschwanez HE. The psychology of wound healing. Curr Opin Psychiatry 2012; 25(2):135–40. 7. Ahmad Sharoni SK, Minhat HS, Mohd Zulkefli NA, Baharom A. Health education programmes to improve foot self-care practices and foot problems among older people with diabetes: A systematic review. Int J Older People Nurs 2016; 11(3):214–39. 8. van Netten JJ, Price PE, Lavery LA, Monteiro-Soares M, Rasmusson A, Jubiz Y, et al. Prevention of foot ulcers in the at-risk patient with diabetes: A systematic review. Diabetes Metab Res Rev 2016; 32(Suppl. 1):84–98. 9. Rezende Neta DS, Vilarouca da Silva AR, Freitas da Silva GR. Adesão das pessoas com diabetes mellitus ao autocuidado com os pés. Rev Bras Enferm 2015; 68(1):111–6. 10. Bus SA, van Netten JJ. A shift in priority in diabetic foot care and research: 75% of foot ulcers are preventable. Diabetes Metab Res Rev 2016; 32(1):195–200. 11.Čukić I, Mõttus R, Realo A, Allik J. Elucidating the links between personality traits and diabetes mellitus: Examining the role of facets, assessment methods, and selected mediators. Pers Indiv Differ 2016; 94(Supple- ment C):377–82. 12. Keuroghlian AS, Frankenburg FR, Zanarini MC. The relationship of chronic medical illnesses, poor health-related lifestyle choices, and health care utilization to recovery status in borderline patients over a decade of prospective follow-up. J Psychiatr Res 2013; 47(10):1499–506. JOURNAL OF WOUND MANAGEMENT 53 OFFICIAL JOURNAL OF THE EUROPEAN WOUND MANAGEMENT ASSOCIATION
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