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Psychological Factors and Delayed Healing in Chronic Wounds

From the Wound Healing Research Centre, University of Wales College of Medicine, Cardiff, Wales, UK.

Address reprint requests to: Alys Cole-King, MB BCh, DGM, MRCPsych, Pwll Glass Resource Centre, Pwll Glas Road, MOLD, Flintshire, CH7 1RA, Wales, UK.

OBJECTIVE: Studies have shown that stress can delay the healing of experimental punch biopsy wounds. This study examined the relationship between the healing of natural wounds and anxiety and depression.

METHODS: Fifty-three subjects (31 women and 22 men) were studied. Wound healing was rated using a five-point Likert scale. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HAD), a well-validated psychometric questionnaire. Psychological and clinical wound assessments were each conducted with raters and subjects blinded to the results of the other assessment.

RESULTS: Delayed healing was associated with a higher mean HAD score (p = .0348). Higher HAD anxiety and depression scores (indicating "caseness") were also associated with delayed healing (p = .0476 and p = .0311, respectively). Patients scoring in the top 50% of total HAD scores were four times more likely to have delayed healing than those scoring in the bottom 50% (confidence interval = 1.06–15.08).

CONCLUSIONS: The relationship between healing of chronic wounds and anxiety and depression as measured by the HAD was statistically significant. Further research in the form of a longitudinal study and/or an interventional study is proposed.

Key Words: delayed wound healing • depression • anxiety.

Abbreviations: CI = confidence interval; HAD = Hospital Anxiety and Depression Scale; IL = interleukin.

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