02 Aug 2010 14:03:00.000
People suffering from diabetes-related foot ulcers show different rates of healing according to the way they cope and their psychological state of mind, according to new research by a health psychologist at The University of Nottingham.
The large study published in the journal Diabetologia this month has shown that the way patients cope with the condition and their levels of depression, affect how the wound heals or worsens.
The work by Professor Kavita Vedhara from the University’s Institute of Work, Health and Organisations, has sparked a follow-on project to develop psychological treatments to reduce depression in sufferers and help them cope more effectively with this debilitating and potentially life-threatening condition.
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Foot ulcers are open sores which form when a minor skin injury fails to heal because of microvascular and metabolic dysfunction caused by diabetes. Up to fifteen per cent of people with diabetes, both Type 1 and Type 2, develop foot or leg ulcers with many suffering depression and poorer quality of life as a result.
The increased morbidity and mortality caused by the condition are estimated to cost UK health services £220 million per year. The costs are exacerbated by slow healing rates with two thirds of ulcers remaining unhealed after 20 weeks of treatment. The five year amputation and death rates among patients are 19 per cent and 44 per cent respectively. Ulcers account for around four out of five lower leg amputations and half of diabetes-related hospital admissions.
During the five-year study 93 patients (68 men and 25 women) with diabetic foot ulcers were recruited from specialist podiatry clinics across the UK. Clinical and demographic determinants of healing; psychological distress, coping style and levels of cortisol (a stress hormone) in saliva were assessed and recorded at the start of a 24 week monitoring period. The size of each patient’s ulcer was also measured at the start, and then at 6, 12 and 24 weeks to record the extent of healing or otherwise of the ulcer.
The results of the research showed that the likelihood of the ulcer healing over a 24 week period was predicted by how individual’s coped. Surprisingly perhaps, patients who showed a ‘confrontational’ way of coping (a style characterised by a desire to take control) with the ulcer and its treatment were less likely to have a healed ulcer at the end of the 24 week period.
Professor Vedhara said: ”My colleagues and I believe that this confrontational approach may, inadvertently, be unhelpful in this context because these ulcers take a long time to heal. As a result, individuals with confrontational coping may experience distress and frustration because their attempts to take control do not result in rapid improvements.”
A secondary analysis of each patient examined the relationship of psycho-social factors with the change in the size of the ulcer over the observation period. Whereas the first analysis showed that only confrontation coping, not anxiety or depression, was a significant predictor of healing, the second showed that depression was a significant predictor in how the size of the ulcer changed over time, with patients with clinical depression showing smaller changes in ulcer size over time i.e., they showed less improvement or healing.
The £500,000 research project was funded by the Medical Research Council. A second project is under way thanks to a £230,000 grant from the National Institute for Health Research. This will develop and pilot a psychological intervention to reduce the risk of ulcers recurring in patients with a history of diabetic ulcers.
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Notes to editors: The research has appeared in the July 18 advance online publication of Nature.
The University of Nottingham is ranked in the UK's Top 10 and the World's Top 100 universities by the Shanghai Jiao Tong (SJTU) and the Times Higher Education-QS World University Rankings.
More than 90 per cent of research at The University of Nottingham is of international quality, according to RAE 2008, with almost 60 per cent of all research defined as ‘world-leading’ or ‘internationally excellent’. Research Fortnight analysis of RAE 2008 ranks the University 7th in the UK by research power. In 27 subject areas, the University features in the UK Top Ten, with 14 of those in the Top Five.
The University provides innovative and top quality teaching, undertakes world-changing research, and attracts talented staff and students from 150 nations. Described by The Times as Britain's “only truly global university”, it has invested continuously in award-winning campuses in the United Kingdom, China and Malaysia. Twice since 2003 its research and teaching academics have won Nobel Prizes. The University has won the Queen's Award for Enterprise in both 2006 (International Trade) and 2007 (Innovation — School of Pharmacy), and was named ‘Entrepreneurial University of the Year’ at the Times Higher Education Awards 2008.
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More information is available from Professor Kavita Vedhara on +44 (0)115 823 2209 firstname.lastname@example.org