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

Walburn, Jessica; Weinman, John; Norton, Sam; Hankins, Matthew; Dawe, Karen; Banjoko, Bolatito; Vedhara, Kavita

Abstract

Objective: To investigate the impact of stress, illness perceptions and behaviours 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 socio-demographic and clinical variables, over the 24 weeks a slower rate of change in ulcer area was predicted by greater stress (standardised beta =-0.61, p=0.008); depression (standardised beta =-0.51, p=0.039); holding negative perceptions or beliefs about the ulcer (standardised beta =-1.4, p=0.045). 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% CI 0.41 - 0.95, p=0.028]. Higher educational attainment (HR= 3.22, 95% CI 1.37 - 7.55, p=0.007) and better adherence to compression bandaging (HR= 1.41 95% CI 1.06 - 1.88, p=0.019) were associated with fewer weeks to heal. No other psychosocial variable (stress; perceptions about the ulcer; health behaviours) 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.

Citation

Walburn, J., Weinman, J., Norton, S., Hankins, M., Dawe, K., Banjoko, B., & Vedhara, K. (2017). Stress, illness perceptions, behaviours and healing in venous leg ulcers: findings from a prospective observational study. Psychosomatic Medicine, 79(5), https://doi.org/10.1097/PSY.0000000000000436

• Journal Article Type: Article
• Acceptance Date: Nov 28, 2016
• Online Publication Date: Dec 9, 2016
• Publication Date: Jun 1, 2017
• Deposit Date: May 3, 2017
• Publicly Available Date: May 3, 2017
• Journal: Psychosomatic Medicine
• Print ISSN: 0033-3174
• Electronic ISSN: 1534-7796
• Publisher: Lippincott, Williams & Wilkins
• Peer Reviewed: Peer Reviewed
• Volume: 79
• Issue: 5
• DOI: https://doi.org/10.1097/PSY.0000000000000436
• Keywords: Stress; Illness Perceptions; Behaviours; Healing; Venous Leg Ulcers
• Public URL: https://nottingham-repository.worktribe.com/output/968888
• Publisher URL: http://journals.lww.com/psychosomaticmedicine/Abstract/publishahead/Stress,_Illness_Perceptions,_Behaviours_and.98865.aspx