Psychological factors and delayed healing in chronic wounds

OBJECTIVE: Studies have shown that stress can delay the healing of experimental punch biopsy wounds. This study examined the relationship between the healing of natural wounds and anxiety and depression. METHODS: Fifty-three subjects (31 women and 22 men) were studied. Wound healing was rated using a five-point Likert scale. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HAD), a well-validated psychometric questionnaire. Psychological and clinical wound assessments were each conducted with raters and subjects blinded to the results of the other assessment. RESULTS: Delayed healing was associated with a higher mean HAD score (p = .0348). Higher HAD anxiety and depression scores (indicating "caseness") were also associated with delayed healing (p = .0476 and p = .0311, respectively). Patients scoring in the top 50% of total HAD scores were four times more likely to have delayed healing than those scoring in the bottom 50% (confidence interval = 1.06-15.08). CONCLUSIONS: The relationship between healing of chronic wounds and anxiety and depression as measured by the HAD was statistically significant. Further research in the form of a longitudinal study and/or an interventional study is proposed.