Depression and incident lower limb amputations in veterans with diabetes

Lisa H. Williams, Donald R. Miller, Graeme Fincke, Jean Philippe Lafrance, Ruth Etzioni, Charles Maynard, Gregory J. Raugi, Gayle E. Reiber

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Problem: Depression is associated with a higher risk of macrovascular and microvascular complications and mortality in diabetes, but whether depression is linked to an increased risk of incident amputations is unknown. We examined the association between diagnosed depression and incident non-traumatic lower limb amputations in veterans with diabetes. Methods: This was a retrospective cohort study from 2000-2004 that included 531,973 veterans from the Diabetes Epidemiology Cohorts, a national Veterans Affairs (VA) registry with VA and Medicare data. Depression was defined by diagnostic codes or antidepressant prescriptions. Amputations were defined by diagnostic and procedural codes. We determined the HR and 95% CI for incident non-traumatic lower limb amputation by major (transtibial and above) and minor (ankle and below) subtypes, comparing veterans with and without diagnosed depression and adjusting for demographics, health care utilization, diabetes severity and comorbid medical and mental health conditions. Results: Over a mean 4.1 years of follow-up, there were 1289 major and 2541 minor amputations. Diagnosed depression was associated with an adjusted HR of 1.33 (95% CI: 1.15-1.55) for major amputations. There was no statistically significant association between depression and minor amputations (adjusted HR 1.01, 95% CI: 0.90-1.13). Conclusions: Diagnosed depression is associated with a 33% higher risk of incident major lower limb amputation in veterans with diabetes. Further study is needed to understand this relationship and to determine whether depression screening and treatment in patients with diabetes could decrease amputation rates.

Original languageEnglish (US)
Pages (from-to)175-182
Number of pages8
JournalJournal of Diabetes and Its Complications
Volume25
Issue number3
DOIs
StatePublished - May 1 2011
Externally publishedYes

Fingerprint

Veterans
Amputation
Lower Extremity
Depression
Patient Acceptance of Health Care
Medicare
Ankle
Antidepressive Agents
Prescriptions
Registries
Mental Health
Epidemiology
Cohort Studies
Retrospective Studies
Demography
Mortality

Keywords

  • Amputation
  • Depression
  • Diabetes
  • Foot ulcer
  • Veterans

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine

Cite this

Williams, L. H., Miller, D. R., Fincke, G., Lafrance, J. P., Etzioni, R., Maynard, C., ... Reiber, G. E. (2011). Depression and incident lower limb amputations in veterans with diabetes. Journal of Diabetes and Its Complications, 25(3), 175-182. https://doi.org/10.1016/j.jdiacomp.2010.07.002

Depression and incident lower limb amputations in veterans with diabetes. / Williams, Lisa H.; Miller, Donald R.; Fincke, Graeme; Lafrance, Jean Philippe; Etzioni, Ruth; Maynard, Charles; Raugi, Gregory J.; Reiber, Gayle E.

In: Journal of Diabetes and Its Complications, Vol. 25, No. 3, 01.05.2011, p. 175-182.

Research output: Contribution to journalArticle

Williams, LH, Miller, DR, Fincke, G, Lafrance, JP, Etzioni, R, Maynard, C, Raugi, GJ & Reiber, GE 2011, 'Depression and incident lower limb amputations in veterans with diabetes', Journal of Diabetes and Its Complications, vol. 25, no. 3, pp. 175-182. https://doi.org/10.1016/j.jdiacomp.2010.07.002
Williams, Lisa H. ; Miller, Donald R. ; Fincke, Graeme ; Lafrance, Jean Philippe ; Etzioni, Ruth ; Maynard, Charles ; Raugi, Gregory J. ; Reiber, Gayle E. / Depression and incident lower limb amputations in veterans with diabetes. In: Journal of Diabetes and Its Complications. 2011 ; Vol. 25, No. 3. pp. 175-182.
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