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Psychological Factors and Delayed Healing in Chronic Wounds

Cole-King, Alys MB BCh, DGM, MRCPsych, and; Harding, Keith Gordon MD, MRCGP, FRCS


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.

From the Wound Healing Research Centre, University of Wales College of Medicine, Cardiff, Wales, UK.

Address reprint requests to: Alys Cole-King, MB BCh, DGM, MRCPsych, Pwll Glass Resource Centre, Pwll Glas Road, MOLD, Flintshire, CH7 1RA, Wales, UK.

Received for publication October 5, 1999; revision received May 15, 2000.

Copyright © 2001 by American Psychosomatic Society
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