Abstract
ABSTRACTObjectiveThe aim of the study was to investigate the impact of stress, illness perceptions, and behaviors on healing of venous leg ulcers.MethodsA prospective observational study of 63 individuals for 24 weeks investigated possible psychosocial predictors of healing. There were two indices of healing: rate of change in ulcer area and number of weeks to heal. Psychological variables were assessed at baseline using self-report measures (Perceived Stress Scale, Hospital Anxiety and Depression Scale, Revised Illness Perception Questionnaire, adapted Summary of Diabetes Self-Care Activities, Adherence Questionnaire, and Short-Form Health Survey).ResultsControlling for sociodemographic and clinical variables, for the 24 weeks, a slower rate of change in ulcer area was predicted by greater stress (standardized β = −0.61, p = .008), depression (standardized β = −0.51, p = .039), and holding negative perceptions or beliefs about the ulcer (standardized β = −1.4, p = .045). By 24 weeks, 69% of ulcers had closed. A more negative emotional response to the ulcer at baseline (i.e., emotional representation of the ulcer) was associated with a greater number of weeks to heal (hazard ratio [HR] = 0.63, 95% confidence interval [CI] = 0.41-0.95, p = .028). Higher educational attainment (HR = 3.22, 95% CI = 1.37–7.55, p = .007) and better adherence to compression bandaging (HR = 1.41, 95% CI = 1.06–1.88, p = .019) were associated with fewer weeks to heal. No other psychosocial variable (stress, perceptions about the ulcer, health behaviors) predicted weeks to heal.ConclusionsAlongside ulcer-related predictors, psychological and sociodemographic factors were associated with healing. Future research should explore mediating mechanisms underlying these associations and develop interventions to target these variables.
Highlights
Venous leg ulcers (VLUs) are a common, recurrent chronic wound, which increase in prevalence with age [1]
The effect size was informed by a meta-analysis of 11 studies investigating the relationship between stress and wound healing across clinical and experimental wound types [6], which estimated that stress would be responsible for 16% of the variance in the rate of healing
Few participants scored above the threshold (>7) suggestive of emotional disturbance for anxiety (30.2%) and depression (22.2%)
Summary
Venous leg ulcers (VLUs) are a common, recurrent chronic wound, which increase in prevalence with age [1] They have a significant impact on quality of life because they can be painful, malodorous, and exuding [2]. The following study addressed these limitations by using a prospective design to explore the impact of stress, IPs, and a range of behavioral factors on healing, while controlling for ulcer characteristics, comorbidity, and sociodemographic variables. It was hypothesized that psychological stress, IPs, and health behaviors would be associated with impaired healing defined as a slower rate of change in ulcer area and a greater number of weeks to heal
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