Investigating the Effect of Bromelain Capsules on Stress, Anxiety and Depression in Patients with Diabetic Foot Ulcers
DOI:
https://doi.org/10.25159/2520-5293/16707Keywords:
depression, bromelain, diabetic foot ulcer, stress, anxiety, nursing educationAbstract
Depression and stress are common among individuals with diabetic foot ulcers. The purpose of this study was to find whether bromelain can alleviate these symptoms. This single blind, two-group clinical trial study was conducted in 2023. Eighty people with diabetic foot ulcers in specialised wound clinics of Tehran University of Medical Sciences were selected and randomly assigned to the test and control groups. The test group received capsules containing 500mg of bromelain twice a day for four weeks, and the control group received the same amount and number of placebos. After the intervention, the DASS-21 was completed again by the participants. The mean scores of depression, anxiety and stress of people with diabetic foot ulcers in the test group before taking bromelain were 16.02 ± 1.44, 11.62 ± 1.25 and 13.65 ± 1.81 respectively. After the intervention, they were 10.45 ± 1.44, 7.25 ± 1.17 and 10.80 ±1.72 respectively. The mean of this index in the control group before the intervention was 15.50 ± 3.25, 11.55 ± 3.43 and 13.22 ± 3.33. After the intervention, it reached 15.15 ± 1.87, 12.22 ± 2.15 and 13.17 ± 2.34. There was a statistically significant difference between the mean indices of depression (p=0.00), anxiety (p=-0.02) and stress (p˂0.001) in the test group before and after the intervention. However, this difference in the control group was not significant (p ≥ 0.05). The core of caring for patients with chronic diseases involves using safe and low-complication treatment methods. The study findings show that bromelain capsules can effectively alleviate depression, anxiety and stress. Therefore, it is recommended that healthcare providers, especially nurses, consider using bromelain for patients with diabetes and other acute and chronic diseases.
References
Abbasnezhad, F., S. Zare, M. Razzaghi, R. Karjou, Z. Karjou, E. A. Rad, and S. Zadehmodarres. 2022. “Effective combination therapy with human amniotic membrane mesenchymal stem cells and low-level laser therapy in wound healing in animal models.” Journal of Lasers in Medical Sciences 13. https://doi.org/10.34172/jlms.2022.72
Amiri, S., S. Dastghaib, M. Ahmadi, P. Mehrbod, F. Khadem, H. Behrouj, M.-R. Aghanoori, F. Machaj, M. Ghamsari, and J. Rosik. 2020. “Betulin and its derivatives as novel compounds with different pharmacological effects.” Biotechnology Advances 38: 107409. https://doi.org/10.1016/j.biotechadv.2019.06.008
Antony, M. M., P. J. Bieling, B. J. Cox, M. W. Enns, and R. P. Swinson. 1998. “Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample.” Psychological Assessment 10(2): 176. https://doi.org/10.1037/1040-3590.10.2.176
Asadi, S., M. S. Gholami, F. Siassi, M. Qorbani, and G. Sotoudeh. 2020. “Beneficial effects of nano-curcumin supplement on depression and anxiety in diabetic patients with peripheral neuropathy: A randomized, double-blind, placebo-controlled clinical trial.” Phytotherapy Research 34(4): 896–903. https://doi.org/10.1002/ptr.6571
Bakare, A. O., and B. V. Owoyele. 2021. “Bromelain reduced pro-inflammatory mediators as a common pathway that mediate antinociceptive and anti-anxiety effects in sciatic nerve ligated Wistar rats.” Scientific Reports 11(1): 289. https://doi.org/10.1038/s41598-020-79421-9
Bazrafshan, M.-R., M. Jokar, N. Shokrpour, and H. Delam. 2020. “The effect of lavender herbal tea on the anxiety and depression of the elderly: a randomized clinical trial.” Complementary Therapies in Medicine 50: 102393. https://doi.org/10.1016/j.ctim.2020.102393
Belal, A., M. S. Elballal, A. A. Al-Karmalawy, A. H. Hassan, E. J. Roh, M. M. Ghoneim, M. A. Ali, A. J. Obaidullah, J. M. Alotaibi, and S. Shaaban. 2024. “Exploring the sedative properties of natural molecules from hop cones (Humulus lupulus) as promising natural anxiolytics through GABA receptors and the human serotonin transporter.” Frontiers in Chemistry 12: 1425485. https://doi.org/10.3389/fchem.2024.1425485
Chakraborty, A. J., S. Mitra, T. E. Tallei, A. M. Tareq, F. Nainu, D. Cicia, K. Dhama, T. B. Emran, J. Simal-Gandara, and R. Capasso. 2021. “Bromelain a potential bioactive compound: a comprehensive overview from a pharmacological perspective.” Life 11(4): 317. https://doi.org/10.3390/life11040317
Engidaw, N. A., A. D. Wubetu, and E. A. Basha. 2020. “Prevalence of depression and its associated factors among patients with diabetes mellitus at Tirunesh-Beijing general hospital, Addis Ababa, Ethiopia.” BMC Public Health 20: 1–7. https://doi.org/10.1186/s12889-020-8360-2
Fereidooni, G. J., F. Ghofranipour, and F. Zarei. 2024. “Interplay of self-care, self-efficacy, and health deviation self-care requisites: a study on type 2 diabetes patients through the lens of Orem’s self-care theory.” BMC Primary Care 25(1): 48. https://doi.org/10.1186/s12875-024-02276-w
Ghazizadeh, J., S. Hamedeyazdan, M. Torbati, F. Farajdokht, A. Fakhari, J. Mahmoudi, M. Araj‐khodaei, and S. Sadigh‐Eteghad. 2020. “Melissa officinalis L. hydro‐alcoholic extract inhibits anxiety and depression through prevention of central oxidative stress and apoptosis.” Experimental Physiology 105(4): 707–720. https://doi.org/10.1113/EP088254
Hazar, N., M. Jokar, N. Namavari, S. Hosseini, and V. Rahmanian. 2024. “An updated systematic review and Meta-analysis of the prevalence of type 2 diabetes in Iran, 1996–2023.” Frontiers in Public Health 12: 1322072. https://doi.org/10.3389/fpubh.2024.1322072
Kenda, M., N. Kočevar Glavač, M. Nagy, and M. Sollner Dolenc. 2022. “Medicinal plants used for anxiety, depression, or stress treatment: An update.” Molecules 27(18): 6021. https://doi.org/10.3390/molecules27186021
Kumar, V., H. Dureja, and V. Garg. 2023. “Traditional use, phytochemistry and pharmacology of Ananas comosus (L.) Merr.(Family Bromeliaceae): An update.” Current Nutrition & Food Science 19(4): 428–441. https://doi.org/10.2174/1573401318666220509140201
Lin, M., D. Xiang, X. Chen, and H. Huo. 2019. “Role of characteristic components of Humulus lupulus in promoting human health.” Journal of Agricultural and Food Chemistry 67(30): 8291–8302. https://doi.org/10.1021/acs.jafc.9b03780
Lovibond, P. F., and S. H. Lovibond. 1995. “The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories.” Behaviour Research and Therapy 33(3): 335–343. https://doi.org/10.1016/0005-7967(94)00075-U
McDermott, K., M. Fang, A. J. Boulton, E. Selvin, and C. W. Hicks. 2023. “Etiology, epidemiology, and disparities in the burden of diabetic foot ulcers.” Diabetes Care 46(1): 209–221. https://doi.org/10.2337/dci22-0043
Mirsamiyazdi, N., F. Jafaripour, H. Taqvaeinasab, L. Masoudiyekta, R. Amiri, S. Azarbad, and Z. Komeilifar. 2021. “The relationship between health literacy and health promoting behaviors in patients with type 2 diabetes.” Journal of Health Literacy 6(3): 24–31.
Moghaddam, A., F. Saed, P. Dibajnia, and J. Zangeneh. 2008. “A preliminary validation of the depression, anxiety and stress scales (DASS) in non-clinical sample.” Clinical Psychology and Personality 6(2): 23–38.
Nayeri, N. D., N. Samadi, N. Mehrnoush, I. Allahyari, F. Bezaatpour, and M. NaseriAsl. 2020. “Experiences of nurses within a nurse-led multidisciplinary approach in providing care for patients with diabetic foot ulcer.” Journal of Family Medicine and Primary Care 9(6): 3136–3141. https://doi.org/10.4103/jfmpc.jfmpc_1008_19
Oliveira, A. C. d., D. d. M. Rocha, S. M. G. Bezerra, E. M. L. R. Andrade, A. M. R. d. Santos, and L. T. Nogueira. 2019. “Quality of life of people with chronic wounds.” Acta Paulista de Enfermagem 32: 194–201. https://doi.org/10.1590/1982-0194201900027
Pickering, D., A. Blaszczynski, and S. M. Gainsbury. 2021. “Development and psychometric evaluation of the Recovery Index for Gambling Disorder (RIGD).” Psychology of Addictive Behaviors 35(4): 472. https://doi.org/10.1037/adb0000676
Rahmannia, M., M. J. Ghapanchian, S. Bagheri-kelayeh, S. B. Nejad, A. Etedali, S. Rajabalipour, H. Pourmontaseri, S. Orandi, A. H. Shiri, and N. Deravi. 2022. “Ginkgo biloba leaves extract for the treatment of anxiety, stress, and depression.” Bulletin of Integrative Psychiatry (2). https://doi.org/10.36219/BPI.2022.2.05
Safari, M., A. Asadi, N. Aryaeian, H. F. Huseini, F. Shidfar, S. Jazayeri, M. Malek, A. F. Hosseini, and Z. Hamidi. 2023. “The effects of Melissa officinalis on depression and anxiety in type 2 diabetes patients with depression: a randomized double-blinded placebo-controlled clinical trial.” BMC Complementary Medicine and Therapies 23(1): 140. https://doi.org/10.1186/s12906-023-03978-x
Sharaf, A., and P. Muthayya. 2022. “Microbial profile of burn wounds managed with enzymatic debridement using bromelain-based agent, NexoBrid®.” Burns 48(7): 1618–1625. https://doi.org/10.1016/j.burns.2021.12.004
Varilla, C., M. Marcone, L. Paiva, and J. Baptista. 2021. “Bromelain, a group of pineapple proteolytic complex enzymes (Ananas comosus) and their possible therapeutic and clinical effects. A summary.” Foods 10(10): 2249. https://doi.org/10.3390/foods10102249
Wang, Y., J. Wang, S. Y. Tao, Z. Liang, R. Xie, N. n. Liu, R. Deng, Y. Zhang, D. Deng, and G. Jiang. 2024. “Mitochondrial damage‐associated molecular patterns: A new insight into metabolic inflammation in type 2 diabetes mellitus.” Diabetes/Metabolism Research and Reviews 40(2): e3733. https://doi.org/10.1002/dmrr.3733
Woon, L. S.-C., H. B. Sidi, A. Ravindran, P. J. Gosse, R. L. Mainland, E. S. Kaunismaa, N. H. Hatta, P. Arnawati, A. Y. Zulkifli, and N. Mustafa. 2020. “Depression, anxiety, and associated factors in patients with diabetes: evidence from the anxiety, depression, and personality traits in diabetes mellitus (ADAPT-DM) study.” BMC Psychiatry 20: 1–14. https://doi.org/10.1186/s12888-020-02615-y
Zuraikat, F. M., R. A. Wood, R. Barragán, and M.-P. St-Onge. 2021. “Sleep and diet: mounting evidence of a cyclical relationship.” Annual Review of Nutrition 41: 309–332. https://doi.org/10.1146/annurev-nutr-120420-021719