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Depressive Symptoms Predict Mucosal Wound Healing

From the College of Dentistry (J.A.B., C.G.E., P.T.M.), University of Illinois at Chicago, Chicago, Illinois; School of Sport and Exercise Sciences (J.A.B.), University of Birmingham, Birmingham, UK; Department of Psychology (J.T.C.), University of Chicago, Chicago, Illinois; and Institute for Behavioral Medicine Research (J.A.B., C.G.E., P.T.M.), Ohio State University, Columbus, Ohio.

Address correspondence and reprint requests to Phillip T. Marucha, University of Illinois at Chicago, College of Dentistry, Department of Periodontics (MC 859), 801 S. Paulina St., Chicago, IL 60612. E-mail: marucha{at}uic.edu

Objective: There is mounting evidence that psychosocial stress can delay wound healing, but this literature almost exclusively pertains to dermal wound healing. Many surgical procedures involve damage to mucosal tissues and the time course and the role of repair processes, such as inflammation, in the healing of these tissues are markedly different from those in dermal healing. Feelings of depression and social isolation are common among surgical patients, and the present study therefore investigated if these factors predict the rate of mucosal wound healing.

Methods: Undergraduate students were invited to participate in the study if they reported high or low levels of loneliness or depressive symptoms, corresponding to the upper or lower quintile of their peer group. The UCLA loneliness scale and the Beck Depression Inventory [short form] were used for this screening. A sample of 193 healthy young adults (age range 18–31 years) received a 3.5-mm circular wound on the oral hard palate, under local anesthesia. Healing was monitored by daily videographs of the wound.

Results: The median healing rate was 7 days. High dysphoric participants were, however, more likely to heal slower than this median healing rate (odds ratio 3.57 (1.58–8.07); p < .001). This association remained robust after correction for a broad range of demographic and behavioral variables, including gender, age, ethnicity, and health behaviors. High dysphoric individuals also exhibited significantly larger average wound sizes from day 2 post wounding onward. Loneliness and diurnal cortisol secretion (measured over 5 days) were unrelated to healing.

Conclusion: Depressive symptoms predict the rate of mucosal wound healing in healthy young adults. We discuss potential pathways that warrant further investigation.

Key Words: wound healing • surgical recovery • mucosa • inflammation • loneliness • depression • stress

Abbreviations: HPA = hypothalamic-pituitary-adrenal; BDI-sf = Beck Depression Inventory short form; UCLA-R = Revised UCLA Loneliness Scale; OR = odds ratio; AUC = area under the curve.

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