Depression and anxiety symptoms are underestimated risk factors for postoperative prognosis in patients with Type 2 diabetes and peripheral artery disease undergoing partial foot amputation: Results from a prospective cohort study

Objective: The aim of this study was to evaluate the prevalence and impact of depression and anxiety symptoms on post -operative prognosis and 1 -year all -cause mortality in a large unique cohort of patients with Type 2 diabetes (T2D) and peripheral artery disease (PAD) after partial foot amputation (PFA). Methods: Prospective cohort study with 1 -year follow-up of 785 consecutive patients (mean age 60.9 +/- 9.1 years; 64.1% males) with T2D and PAD after PFA. Depressive symptoms were assessed by Patient Health Questionnaire9 (PHQ-9) and anxiety symptoms by Hamilton Anxiety Rating Scale (HARS). We used multivariable Cox proportional hazard models to examine the association of depression and anxiety with all -cause mortality. Results: One-year all -cause mortality was 16.9% ( n = 133). 331 (42.1%) patients had PHQ-9 score >= 10 indicating major depressive disorder. After adjusting for confounders, PHQ-9 score >= 10 was associated with an increased risk of 1 -year all -cause mortality (HR = 1.68 (95%CI[1.16 -2.44], p = 0.006). Depression dimensions of negative self -feeling and suicidal ideations were independently associated with 1 -year mortality (HR = 1.26 (95%CI[1.24 -1.55], p = 0.029 and HR = 2.37 (95%CI[1.89 -2.96], p < 0.001, respectively). Compared to no depression, severe depressive symptoms (cut-off >= 20) were associated with increased all -cause mortality (HR = 3.9 (95%CI [1.48 -10.29], p = 0.006). Compared to no anxiety, severe anxiety symptoms (cut-off >30) were associated with increased 1 -year mortality (HR = 2.25(95%CI [1.26 -4.05], p = 0.006). Conclusion: Depressive symptoms and severe anxiety have shown independently increased risk of 1 -year all -cause mortality in patients with T2D and PAD requiring PFA. Our results indicate that screening for anxiety and depression should be considered under these circumstances to identify patients at increased risk to allow appropriate intervention.