Risk profile in patients with foot ulcers – a bio-psycho-social model

Objective: To examine psycho-somatic and psycho-social differences – especially mental disorders, self-compassion and self-harm behaviors – in patients with and without foot ulcers.

Research design and methods: 154 patients of the Department of Internal Medicine were divided into two homogenous groups (n=47). The Composite International Diagnostic Interview was used to assess mental disorders according to Diagnostic and Statistical Manual of Psychiatric disorders, 4^th edition. Different questionnaires were used to measure self-compassion, self-harm behaviors, quality of life and depressive symptoms. Finally blood values were assessed.

Results: Patients with foot ulcers exhibited reduced compliance in health related behaviors. They visited less often their practitioners and/or psychotherapists. Patient history revealed a highly significant increase in harmful drinking behavior. The score for anxiety disorders is significantly reduced. They presented lower levels for education and income. No significant differences between patients with and without foot ulcers were found for glycosylated haemoglobin, body mass index, smoking, direct self-harm behavior, self-compassion or in disavowing problems.

Conclusions: The diabetic foot ulcer is a somatic problem with influence of psychological and social factors. The key finding of our study suggests that a history of increased alcohol consumption is an important risk factor for patients with diabetes to get a foot ulcer. Early psychotherapy in patients with this risk profile could support the medical treatment by psycho-education, enhancement of adequate conflict resolution strategies and perception of body sentiences and emotions. This will have positive effects on depressive symptoms, quality of life and coping with diabetes, neuro-/angiopathy and the foot ulcer.