Page 100 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

74 Chapter 3. Stress

approximately 40 % longer (an average of 3 days) to heal.
Additionally, indicating the possibility of one immunological
mechanism, during the stress period, production of interleu-
kin- 1 beta declined significantly (68 %). Moreover, Ebrecht
et al. ( 2004 ) examined the relationship between perceived
stress and wound healing. After receiving a 4 mm biopsy
wound, participants were monitored using ultrasound scan-
ning. The Perceived Stress Scale (PSS; Cohen et al. 1983 ) and
the General Health Questionnaire (GHQ-12; Goldberg
1992 ) were also administered to participants in order to
account for stress and health behaviours. Finally, cortisol
assessments were conducted on participant’s saliva samples.
It was discovered that as PSS and GHQ-12 scores increased,
speed of wound healing decreased. Additionally, cortisol
assessments from the morning following the biopsy nega-
tively correlated with speed of wound healing. It was con-
cluded that the implications of perceived stress are quite
substantial in wound healing.
Other research has explored psychological stress in more
ecologically valid studies. For example, biopsy wounds have
been administered to 13 women caring for relatives with
Alzheimer’s disease and a control group in order to assess
wound healing (Kiecolt-Glaser et al. 1995 ). In addition to the
completion of the PSS at the time of biopsy and 1 week later,
wounds were photographed and assessed using hydrogen
peroxide. Findings highlighted the negative associated
between stress and wound healing with caregivers reporting
more stress and their wounds taking approximated 9 days
longer to heal. Hence, it is apparent from the above study
that in addition to stressful experiences, chronic stress can
significantly impact upon a patient’s wound healing. This,
and the previous studies, are influential in providing clini-
cians with a foundation to the importance of the relationship
between stress and wound healing. However, in order to
apply such understanding to the complex nature of wound
care, it is also essential to explore this stress-wound relation-
ship in relation to patients with naturally occurring chronic
wounds.