Jessica Walburn
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
Authors
John Weinman
Sam Norton
Matthew Hankins
Karen Dawe
Bolatito Banjoko
Kavita Vedhara
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.
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 |
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