Stress, Illness Perceptions, Behaviors, and Healing in Venous Leg Ulcers: Findings From a Prospective Observational Study. Issue 5 (June 2017)

• Record Type: Journal Article
• Authors: Walburn, Jessica; Weinman, John; Norton, Sam; Hankins, Matthew; Dawe, Karen; Banjoko, Bolatito; Vedhara, Kavita
• Is Part Of: Psychosomatic medicine. Volume 79:Issue 5(2017)
• Publication Date: 2017-06
• Subjects: adherence -- depression -- educational attainment -- illness perceptions -- stress -- wound healing -- AQ = Adherence Questionnaire -- HADS = The Hospital Anxiety and Depression Scale -- HBQ = Health Behaviour Questionnaire -- HR = hazard ratio -- HRQoL = health-related quality of life -- IPQ-R = Illness Perception Questionnaire-Revised -- IPs = illness perceptions -- IQR = interquartile range -- M = mean -- MCS = Mental Component Summary -- PCS = Physical Component Summary -- PSS = The Perceived Stress Scale -- SD = standard deviation -- SRM = Self-Regulatory Model -- VLU = venous leg ulcer; Medicine, Psychosomatic -- Periodicals; 616.0805
• DOI: 10.1097/PSY.0000000000000436
• Languages: English
• ISSNs: 0033-3174

Abstract

ABSTRACT: Objective: The aim of the study was to investigate the impact of stress, illness perceptions, and behaviors on healing of venous leg ulcers. Methods: A 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). Results: Controlling 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. Conclusions: Alongside 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.