Anxiety Levels in Diabetes Mellitus Patients with Diabetic Foot Ulcers
Keywords:
Anxiety, Foot ulcers, Ulcer GradeAbstract
Unmanaged diabetes can lead to various serious complications, one of which was the occurrence of diabetic foot ulcers. When patients experienced diabetic ulcers, it triggered anxiety. The aimed of this study was to determine the anxiety levels of diabetic patients with diabetic foot ulcers. The design of this study used a descriptive quantitative design with a population of 30 inpatients in the Wijaya Kusuma ward at Dr. Soedono Hospital, Madiun. The sampling used in this study was total sampling, and the method used to measure anxiety in this study was the “Hamilton Anxiety Rating Scale” (HARS), conducted from April 29 to May 4, 2024. The results found that more than half of the patients were female, and patients with anxiety levels were entirely in the severe anxiety category, with a small portion of patients aged 51-70 years experiencing severe anxiety. The study results showed that there was mild to severe anxiety in diabetic patients with diabetic foot ulcers, which was related to factors such as age, wound severity, and patient age. With this research, it was expected that healthcare professionals, especially doctors, nurses, and also the patients' families, could provide support and motivation to the patients to prevent excessive anxiety
References
1. Misra A, Gopalan H, Jayawardena R, Hills AP, Soares M, Reza‐Albarrán AA, et al. Diabetes in developing countries. J Diabetes [Internet]. 2019 Jul 11;11(7):522–39. Available from: https://onlinelibrary.wiley.com/doi/10.1111/1753-0407.12913
2. Wang X, Yuan CX, Xu B, Yu Z. Diabetic foot ulcers: Classification, risk factors and management. World J Diabetes [Internet]. 2022 Dec 15;13(12):1049–65. Available from: https://www.wjgnet.com/1948-9358/full/v13/i12/1049.htm
3. Aljohary H, Ahmed Murad M, Alfkey R, Elgohary S. Stepping up to the Challenge: Confronting the Global Burden of Diabetic Foot Disease. In: Diabetic Foot - Advanced Methods of Management [Working Title] [Internet]. IntechOpen; 2025. Available from: https://www.intechopen.com/online-first/1221841
4. Hirpa D, Bekela T, Abdissa D. Prevalence of diabetic foot ulcer and its associated factors among diabetes patients on follow up at public hospitals in West Shewa Zone, Oromia, Ethiopia”. Int J Africa Nurs Sci [Internet]. 2023;19:100578. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2214139123000537
5. Hoerunisa R, Setiawan H, Purwati AE, Hidayat N. Pengaruh Senam Kaki Diabetik terhadap Penurunan Risiko Ulkus Diabetik pada Pasien Diabetes Melitus Tipe II. INDOGENIUS [Internet]. 2023 Jun 30;2(2):45–55. Available from: https://genius.inspira.or.id/index.php/indogenius/article/view/227
6. Muhaimin A, Rohman HF, Fauzi AK. Effect of Ergonomic Exercise on Blood Glucose Levels and Anxiety in Type 2 Diabetes Mellitus Patients. Adult Heal Nurs J. 2024;1(1):9–15.
7. Nguyen M, Wong D, Barson E, Staunton ET, Fisher CA. Psychological and Cognitive Barriers to Diabetes-Related Foot Complication Treatment: Clinicians’ Perspectives. Int J Low Extrem Wounds [Internet]. 2022 Dec 3;21(4):617–31. Available from: https://journals.sagepub.com/doi/10.1177/1534734620983181
8. Yan D, Tang T, Liu Y. The 16-year psychological journey of amputee survivors of the Wenchuan earthquake: a qualitative study. Sci Rep. 2025;15(1):1–17.
9. Alasfour L, Alboloushi A, Kirwan E, McIntosh C, MacGilchrist C, Hurst JE. Mapping the evidence to determine the influence of stress, anxiety, and depression on wound healing in patients with diabetes-related foot ulcers: A scoping review. J Tissue Viability [Internet]. 2025 Aug;34(3):100935. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0965206X2500083X
10. Elis Anggeria, Rahmaini Fitri Harahap, Kristina L Silalahi, Parida Hanum, Verawaty Fitrinelda Silaban. The effectiveness of Diabetes Self-Management Education (DSME) with self-acceptance and self-care for diabetes mellitus patients. Indian J Forensic Med Toxicol. 2022;16(3):140–4.
11. Al-Ayed M, Moosa SR, Robert AA, Al Dawish M. Anxiety, depression and their associated risk factors among patients with diabetic foot ulcer: A two center cross-sectional study in Jordan and Saudi Arabia. Diabetes Metab Syndr Clin Res Rev [Internet]. 2021 Jan;15(1):237–42. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1871402120305294
12. Baroni I, Caruso R, Dellafiore F, Ausili D, Barello S, Vangone I, et al. Self-care and type 2 diabetes mellitus (T2DM): a literature review in sex-related differences. Acta Biomed [Internet]. 2022 Aug 31;93(4):e2022277. Available from: http://www.ncbi.nlm.nih.gov/pubmed/36043961
13. Joshi RD, Dhakal CK. Predicting Type 2 Diabetes Using Logistic Regression and Machine Learning Approaches. Int J Environ Res Public Health [Internet]. 2021 Jul 9;18(14):7346. Available from: https://www.mdpi.com/1660-4601/18/14/7346
14. O’Donovan F, Capobianco L, Taylor-Bennett J, Wells A. Relationships between anxiety, depression and wound healing outcomes in adults: A systematic review and meta-analysis. Savoia F, editor. PLoS One [Internet]. 2025 May 20;20(5):e0309683. Available from: https://dx.plos.org/10.1371/journal.pone.0309683
15. Dias Â, Ferreira G, Vilaça M, Pereira MG. Quality of Life in Patients with Diabetic Foot Ulcers: A Cross-sectional Study. Adv Skin Wound Care [Internet]. 2022 Dec;35(12):661–8. Available from: https://journals.lww.com/10.1097/01.ASW.0000891864.37619.34
16. Khalid KA, Nawi AFM, Zulkifli N, Barkat MA, Hadi H. Aging and Wound Healing of the Skin: A Review of Clinical and Pathophysiological Hallmarks. Life [Internet]. 2022 Dec 19;12(12):2142. Available from: https://www.mdpi.com/2075-1729/12/12/2142
17. Li S, Wei X, Mao L, Wang X, Huang J, Yang L, et al. Prevalence and risk factors of diabetes mellitus: a community-based sectional survey. Ann Palliat Med [Internet]. 2021 Nov;10(11):11939–49. Available from: https://apm.amegroups.com/article/view/84323/html
18. Nanayakkara N, Curtis AJ, Heritier S, Gadowski AM, Pavkov ME, Kenealy T, et al. Impact of age at type 2 diabetes mellitus diagnosis on mortality and vascular complications: systematic review and meta-analyses. Diabetologia. 2021;64(2):275–87.
19. Chen Y, Wu C, Qian W. Underestimated anxiety in chronic diseases: A cross-sectional study on specific risk factors. Medicine (Baltimore) [Internet]. 2025 Mar 7;104(10):e41791. Available from: https://journals.lww.com/10.1097/MD.0000000000041791
20. Chen JQ, Chen ZH, Zheng WB, Shen XQ. Correlation of anxiety and depression with pain in patients with diabetic foot ulcers and analysis of risk factors. World J Psychiatry [Internet]. 2025 Jun 19;15(6). Available from: https://www.wjgnet.com/2220-3206/full/v15/i6/105334.htm
2. Wang X, Yuan CX, Xu B, Yu Z. Diabetic foot ulcers: Classification, risk factors and management. World J Diabetes [Internet]. 2022 Dec 15;13(12):1049–65. Available from: https://www.wjgnet.com/1948-9358/full/v13/i12/1049.htm
3. Aljohary H, Ahmed Murad M, Alfkey R, Elgohary S. Stepping up to the Challenge: Confronting the Global Burden of Diabetic Foot Disease. In: Diabetic Foot - Advanced Methods of Management [Working Title] [Internet]. IntechOpen; 2025. Available from: https://www.intechopen.com/online-first/1221841
4. Hirpa D, Bekela T, Abdissa D. Prevalence of diabetic foot ulcer and its associated factors among diabetes patients on follow up at public hospitals in West Shewa Zone, Oromia, Ethiopia”. Int J Africa Nurs Sci [Internet]. 2023;19:100578. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2214139123000537
5. Hoerunisa R, Setiawan H, Purwati AE, Hidayat N. Pengaruh Senam Kaki Diabetik terhadap Penurunan Risiko Ulkus Diabetik pada Pasien Diabetes Melitus Tipe II. INDOGENIUS [Internet]. 2023 Jun 30;2(2):45–55. Available from: https://genius.inspira.or.id/index.php/indogenius/article/view/227
6. Muhaimin A, Rohman HF, Fauzi AK. Effect of Ergonomic Exercise on Blood Glucose Levels and Anxiety in Type 2 Diabetes Mellitus Patients. Adult Heal Nurs J. 2024;1(1):9–15.
7. Nguyen M, Wong D, Barson E, Staunton ET, Fisher CA. Psychological and Cognitive Barriers to Diabetes-Related Foot Complication Treatment: Clinicians’ Perspectives. Int J Low Extrem Wounds [Internet]. 2022 Dec 3;21(4):617–31. Available from: https://journals.sagepub.com/doi/10.1177/1534734620983181
8. Yan D, Tang T, Liu Y. The 16-year psychological journey of amputee survivors of the Wenchuan earthquake: a qualitative study. Sci Rep. 2025;15(1):1–17.
9. Alasfour L, Alboloushi A, Kirwan E, McIntosh C, MacGilchrist C, Hurst JE. Mapping the evidence to determine the influence of stress, anxiety, and depression on wound healing in patients with diabetes-related foot ulcers: A scoping review. J Tissue Viability [Internet]. 2025 Aug;34(3):100935. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0965206X2500083X
10. Elis Anggeria, Rahmaini Fitri Harahap, Kristina L Silalahi, Parida Hanum, Verawaty Fitrinelda Silaban. The effectiveness of Diabetes Self-Management Education (DSME) with self-acceptance and self-care for diabetes mellitus patients. Indian J Forensic Med Toxicol. 2022;16(3):140–4.
11. Al-Ayed M, Moosa SR, Robert AA, Al Dawish M. Anxiety, depression and their associated risk factors among patients with diabetic foot ulcer: A two center cross-sectional study in Jordan and Saudi Arabia. Diabetes Metab Syndr Clin Res Rev [Internet]. 2021 Jan;15(1):237–42. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1871402120305294
12. Baroni I, Caruso R, Dellafiore F, Ausili D, Barello S, Vangone I, et al. Self-care and type 2 diabetes mellitus (T2DM): a literature review in sex-related differences. Acta Biomed [Internet]. 2022 Aug 31;93(4):e2022277. Available from: http://www.ncbi.nlm.nih.gov/pubmed/36043961
13. Joshi RD, Dhakal CK. Predicting Type 2 Diabetes Using Logistic Regression and Machine Learning Approaches. Int J Environ Res Public Health [Internet]. 2021 Jul 9;18(14):7346. Available from: https://www.mdpi.com/1660-4601/18/14/7346
14. O’Donovan F, Capobianco L, Taylor-Bennett J, Wells A. Relationships between anxiety, depression and wound healing outcomes in adults: A systematic review and meta-analysis. Savoia F, editor. PLoS One [Internet]. 2025 May 20;20(5):e0309683. Available from: https://dx.plos.org/10.1371/journal.pone.0309683
15. Dias Â, Ferreira G, Vilaça M, Pereira MG. Quality of Life in Patients with Diabetic Foot Ulcers: A Cross-sectional Study. Adv Skin Wound Care [Internet]. 2022 Dec;35(12):661–8. Available from: https://journals.lww.com/10.1097/01.ASW.0000891864.37619.34
16. Khalid KA, Nawi AFM, Zulkifli N, Barkat MA, Hadi H. Aging and Wound Healing of the Skin: A Review of Clinical and Pathophysiological Hallmarks. Life [Internet]. 2022 Dec 19;12(12):2142. Available from: https://www.mdpi.com/2075-1729/12/12/2142
17. Li S, Wei X, Mao L, Wang X, Huang J, Yang L, et al. Prevalence and risk factors of diabetes mellitus: a community-based sectional survey. Ann Palliat Med [Internet]. 2021 Nov;10(11):11939–49. Available from: https://apm.amegroups.com/article/view/84323/html
18. Nanayakkara N, Curtis AJ, Heritier S, Gadowski AM, Pavkov ME, Kenealy T, et al. Impact of age at type 2 diabetes mellitus diagnosis on mortality and vascular complications: systematic review and meta-analyses. Diabetologia. 2021;64(2):275–87.
19. Chen Y, Wu C, Qian W. Underestimated anxiety in chronic diseases: A cross-sectional study on specific risk factors. Medicine (Baltimore) [Internet]. 2025 Mar 7;104(10):e41791. Available from: https://journals.lww.com/10.1097/MD.0000000000041791
20. Chen JQ, Chen ZH, Zheng WB, Shen XQ. Correlation of anxiety and depression with pain in patients with diabetic foot ulcers and analysis of risk factors. World J Psychiatry [Internet]. 2025 Jun 19;15(6). Available from: https://www.wjgnet.com/2220-3206/full/v15/i6/105334.htm
Downloads
Published
2025-10-28
How to Cite
Abiddin, A., Aldila Setiawan, & Tri Cahyo Sepdianto. (2025). Anxiety Levels in Diabetes Mellitus Patients with Diabetic Foot Ulcers. Health Access Journal, 2(3), 136–142. Retrieved from https://ojs.poltekkes-malang.ac.id/HAJ/article/view/5925
Issue
Section
Article
License
Copyright (c) 2025 Andi Abiddin, Aldila Setiawan, Tri Cahyo Sepdianto
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
-fococlipping-standard.png)
