ASSESSMENT OF ANXIETY LEVELS IN PATIENTS WITH PURULENT-NECROTIC COMPLICATIONS OF DIABETIC FOOT SYNDROME

Abstract. Introduction. Assessment of anxiety levels in patients with purulent-necrotic complications of diabetic foot syndrome (DFS) is an important component of a comprehensive approach to treatment and rehabilitation, reflecting aspects of quality of life. The presence of severe complications, such as infections and tissue necrosis, in patients with DFS causes significant emotional stress. It should be emphasized separately that the negative impact on the psychological state of the high probability of lower limb amputation is significant. These aspects of the course of the disease increase the feeling of uncertainty about the effectiveness of treatment and further functional independence. Aim. To identify the dynamics of anxiety levels in patients with purulent-necrotic complications of diabetic foot syndrome (DFS), who used a half-shoe and a plaster splint for foot offloading during inpatient treatment. Materials and Methods. All operated patients had stage 3 or 4 of the pathological process in the foot according to the Meggitt-Wagner classification and the neuroischemic form of DFS. The first group included 29 patients who used a half-shoe for foot offloading. The second group consisted of 27 patients who used a plaster splint. The assessment of anxiety levels in patients with purulent-necrotic complications of DFS was conducted on the 1st and 14th postoperative days using the Generalized Anxiety Disorder-7 (GAD-7) questionnaire and the Hospital Anxiety and Depression Scale (HADS). Results and Discussion. In the first group, where patients used the half-shoe, the GAD-7 anxiety level indicated mild anxiety in 20 patients, moderate anxiety in 8 patients, and severe anxiety in 1 patient. In the second group, mild anxiety was found in 13 patients, moderate anxiety in 10 patients, and severe anxiety in 4 patients. The HADS scale showed subclinical anxiety in 10 patients of the first group and clinical anxiety in 2 patients. In the second group, these indicators were significantly higher: subclinical anxiety was observed in 11 patients, and clinical anxiety in 5 patients. On the 14th postoperative day, some improvement in anxiety and depression indicators was noted in both groups. The anxiety level according to GAD-7 in patients who used the half-shoe: mild anxiety was found in 23 patients, and moderate anxiety in 6 patients. In the second group of patients, where a plaster splint was used for offloading, mild anxiety was found in 17 patients, and moderate anxiety in 10 patients. The anxiety level according to HADS showed that the number of patients with subclinical anxiety in the second group remained higher (11 vs. 6 in the first group), which confirms the significant influence of stress factors on the emotional state of patients with purulent-necrotic complications of DFS. Conclusions. A comprehensive approach to treating patients with purulent-necrotic complications of DFS should consider both physical and psychological conditions. On day 1, the anxiety level in the half-shoe group was (7.8±1.3) points according to GAD-7 and (7.4±0.8) points according to HADS, whereas in the plaster splint group, the GAD-7 score was higher — (9.7±1.4) points, and the HADS score was (8.6±0.7) points. On day 14, in the first group, these scores decreased to (6.1±0.8) points (a 21.8% reduction) for GAD-7 and 5.7±0.4 points (a 23% reduction) for HADS, while in the second group, the reduction was 18.6% for GAD-7 ((7.9±1.3) points) and 19.8% for HADS ((6.9±0.5) points). Thus, patients who used a plaster splint for foot offloading showed worse anxiety levels compared to the group using the half-shoe, including the dynamics of these indicators on the 14th day.