Relationship between Depression, Quality of Life and Foot Ulcer Healing Rates in Type
2 Diabetic (T2D) Patients
A thesis submitted in fulfilment of the requirements for the degree of Master of
Science
Andrew Peter Steel
B.Sc The University of Melbourne
B.P&O (Hons) LaTrobe University
College of Science, Engineering and Health
School of Health and Biomedical Sciences
RMIT University
January
2019
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Declaration
I certify that except where due acknowledgement has been made, the work is that of the author
alone; the work has not been submitted previously, in whole or in part, to qualify for any other
academic award; the content of the thesis is the result of work which has been carried out since
the official commencement date of the approved research program; any editorial work, paid or
unpaid, carried out by a third party is acknowledged; and, ethics procedures and guidelines
have been followed.
I acknowledge the support I have received for my research through the provision of an
Australian Government Research Training Program Scholarship.
Andrew Peter Steel
19/01/2019
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Acknowledgements
I would like to acknowledge the support of The Northern Hospital Podiatry and Orthotics
department, and The Northern Hospital for a research grant to complete this study. I would
also like to acknowledge A. Prof John Reece for his initial assistance in the early stages of
this research as well as Dr Anne-Marie Daw, and most recently for their guidance Dr Mirella
Di Benedetto and Dr Russell Conduit.
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Table of Contents
List of Tables ........................................................................................................................... vii
List of Abbreviations .............................................................................................................. viii
Publications ............................................................................................................................. viii
Abstract ...................................................................................................................................... 9
Chapter I: Introduction ............................................................................................................. 10
1.1 Thesis Overview ............................................................................................................. 10
1.2 Background of Study ...................................................................................................... 11
1.3 Rationale of the Study .................................................................................................... 13
1.4 Aims of Research ........................................................................................................... 15
1.5 Scope and Significance of the Study .............................................................................. 15
Chapter II: Literature Review .................................................................................................. 17
2.1 Introduction .................................................................................................................... 17
2.2 T2D, Foot Ulcers and their Management ....................................................................... 17
2.3 Aetiopathogenesis .......................................................................................................... 22
2.4 Neuropathy ..................................................................................................................... 22
2.5 Neuroarthropathy ........................................................................................................... 23
2.6 Depression and Diabetes ................................................................................................ 24
2.7 Biological Relationship .................................................................................................. 27
2.8 Depression and Diabetes Self-Care ................................................................................ 28
2.9 Identification & Treatment of Foot Ulcers ..................................................................... 29
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2.10 Screening for Depression in People with T2D ............................................................. 32
2.11 Measuring Depression in People with T2D ................................................................. 34
2.12 Quality of Life and Diabetic Foot Ulcers ..................................................................... 36
2.12.1 The Social Aspect .................................................................................................. 37
2.12.2 The Psychological Aspect ..................................................................................... 38
2.12.3 The Physical Aspect .............................................................................................. 39
2.14 Depression and Diabetic Foot Ulcers ........................................................................... 39
2.15 Research Gap and Theoretical Research Model .......................................................... 41
2.16 Research Hypotheses.................................................................................................... 42
Chapter III: Methodology ........................................................................................................ 43
3.1 Introduction .................................................................................................................... 43
3.2 Research Purpose and Design ........................................................................................ 43
3.3 Study Population Sample ............................................................................................... 44
3.3.1 Sample ..................................................................................................................... 44
3.3.2 Sampling Technique ................................................................................................ 45
3.4 Materials ......................................................................................................................... 45
3.4.1 Data Collection Instruments .................................................................................... 45
3.5 Study Approach .............................................................................................................. 49
3.6 Ethical Considerations.................................................................................................... 50
3.7 Data Analysis ................................................................................................................. 50
Chapter IV: Results .................................................................................................................. 52