Stress, illness perceptions, behaviors, and healing in venous leg ulcers: Findings from a prospective observational study

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.