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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

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


Jessica Walburn

John Weinman

Sam Norton

Matthew Hankins

Karen Dawe

Bolatito Banjoko

Kavita Vedhara


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.

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
Keywords Stress; Illness Perceptions; Behaviours; Healing; Venous Leg Ulcers
Public URL
Publisher URL,_Illness_Perceptions,_Behaviours_and.98865.aspx


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