The impact of depression on healing outcomes in people with diabetes-related foot ulcers: A systematic review

This systematic review examined the impact of depression on healing outcomes among people with diabetes-related foot ulcers (DFUs). A comprehensive search of MEDLINE, APA PsycINFO, CINAHL, Embase, and The Cochrane Library was conducted from inception (1976) to 11 March 2024 to identify eligible studies. The Mixed Methods Appraisal Tool (MMAT) was used to assess study quality, and a narrative synthesis was conducted. We identified 1403 articles, of which 11 were included in the final analysis and included a total of 1392 participants with DFUs. The included studies used diagnostic interviews and screening tools to assess depression, and healing outcomes were described as healed ulcer, change in ulcer size, and/or changes in ulcer severity classification tool scores. Of the 11 studies, five studies (45.5 %) found that there was a significant negative impact (or association) of depression on healing outcomes of DFUs. On the other hand, six studies (54.5 %) showed there was no significant impact or association. Three studies were considered high quality, four studies medium quality, and four studies low quality. Depression may have a significant negative impact on healing outcomes in people with DFUs. However, the existing evidence is still unclear, and further high-quality studies are needed to investigate this impact.