Page 36 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

Implications for Healing 9

experiencing high levels of stress are more likely to increase
their alcohol (Sillaber and Henniger 2004 ) and tobacco use
(Sinha 2008 ). A link to depression, anxiety and social isola-
tion has also been noted specifically in older adult drinkers
(Schonfeld and Dupree 1991 ). Furthermore studies have
identified a relationship between stress and increased partici-
pation in health damaging behaviours in individuals with
chronic wounds (Gouin and Kiecolt-Glaser 2011 ). This is a
concern because behaviours such as this have been shown to
impede the healing process.

Implications for Healing

The psychosocial issues described so far in this chapter are
important in part because of the implications they have for a
patient’s mental health and quality of life. However, this is
not their only relevance. A significant, negative relationship
has been found between these psychosocial problems and the
healing process. Studies have demonstrated that patients who
are anxious about their physical condition, or who feel
depressed, tend to show much slower healing rates than
patients with a more positive attitude. For example Doering
et al. ( 2005 ) found that following surgery, patients with more
depressive symptoms at discharge had more infections and
poorer wound healing than patients who reported less dis-
tress. Likewise, Cole-King and Harding ( 2001 ) showed that
patients with leg ulcers who experienced the highest levels of
depression and anxiety were four times more likely to show
delayed healing compared to individuals who reported less
distress. Furthermore, distress predicted wound healing out-
comes over and above differences in other variables such as
demographic and medical status. Research exploring mucosal
wound healing and presentation of dysphoria has also pro-
vided support for this link. Bosch et al. ( 2007 ), examined the
patients’ levels of dysphoria and rate of wound healing, dis-
covering that patients who presented with higher levels of
dysphoria were approximately 3.6 times more likely to