Relationship between resilience and depression in individuals with diabetic foot ulcers: a longitudinal study

Diabetic foot ulcers (DFU) are a serious complication of diabetes, and depression is an important factor in predicting the deterioration of the physical and mental health of those with this condition. However, research on the relationship between depression and mental resilience in these patients is limited. The study aimed to examine depression trends and the longitudinal association between resilience and depression in adults with diabetic foot ulcers.

A longitudinal survey of patients with diabetic foot ulcers was conducted four times: 1 week after acute hospitalization and 1, 3, and 6 months post-discharge. Demographic and clinical data were obtained through participant self-reports and medical records at baseline. The sample included 223 adults (63.7% men and 36.3% women) with a mean age of 64.74 years (standard deviation = 11.25) who completed the Connor-Davidson Resilience Scale and Patient Health Questionnaire-9. The statistical analysis comprised analysis of variance, t-tests analyses, Pearson's correlation, Generalized estimation equation and cross-lagged model .

The depression scores decreased from baseline to 6 months post-discharge. Generalized estimation equation was used to analyze changing trends in depression (a downward trend from T0 to T6) and resilience (an upward trend from T0 to T6). Multivariable linear regression model indicated that resilience may predict depression at all time points. The cross-lagged model analysis demonstrated that temporary fluctuations in depression during treatment do not effectively predict changes in resilience in patients with diabetic foot. In contrast, over a six-month time span, resilience showed a sustained, significant and substantial negative prediction of later depression.

Depression and resilience change with disease progression in participants with diabetic foot ulcers. During treatment, resilience may be a positive psychological resource and protect against depressive symptom caused by DFU. The findings provide insights for optimizing measures to mitigate negative emotions among these patients.