ArticleBJGP open2025
Psychological determinants of health-related quality of life in primary care patients with diabetic foot ulcers: a
Article in BJGP open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDiabetic foot ulcers (DFUs) significantly impair health-related quality of life (HRQoL). While clinical predictors are well established, the contribution of psychological factors, particularly in primary care, remains underexplored.
aimTo examine the sociodemographic, clinical, and psychological determinants of HRQoL in individuals with DFUs to inform development of psychologically informed interventions. DESIGN &
settingCross-sectional study conducted between April and October 2022 in primary care settings in Singapore.
methodA total of 186 patients with DFUs completed validated measures, including psychological variables (for example, the Diabetes Distress Scale and Brief Illness Perception Questionnaire) and Wound-QoL, which uses a questionnaire to assess quality of life in body, psyche, and everyday life domains. Hierarchical multiple regression analyses evaluated the contribution of psychological variables to HRQoL.
resultsPsychological burden dominated, with psyche HRQoL impaired in 57% of participants (mean = 2.0), outpacing everyday life (38%; mean = 1.3) and body domains (24%; mean = 0.8). In hierarchical models, psychological variables - together with sociodemographic and clinical factors - explained 29.8% of the variance in body HRQoL, with interpersonal distress and threat perceptions emerging as significant predictors. A similar model accounted for 31.8% of the variance in psyche HRQoL, with female sex, emotional burden, and threat perceptions as key predictors. Everyday life HRQoL was significantly associated with HbA1c, independence in daily activities, emotional burden, and threat perceptions, with the full model explaining 33.7% of the variance.
conclusionPsychological factors significantly contributed to reduced HRQoL in primary care patients with DFUs. Routine screening and targeted, psychologically informed support - particularly for females, those with poor glycaemic control, or limited functional independence - are essential to improve outcomes.
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