title: Stress, Illness Perceptions, Behaviors, and Healing in Venous Leg Ulcers: Findings From a Prospective Observational Study.
abstract: OBJECTIVE
  The aim of the study was to investigate the impact of stress, illness perceptions, and behaviors 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 sociodemographic and clinical variables, for the 24 weeks, a slower rate of change in ulcer area was predicted by greater stress (standardized β = -0.61, p = .008), depression (standardized β = -0.51, p = .039), and holding negative perceptions or beliefs about the ulcer (standardized β = -1.4, p = .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% confidence interval [CI] = 0.41-0.95, p = .028). Higher educational attainment (HR = 3.22, 95% CI = 1.37-7.55, p = .007) and better adherence to compression bandaging (HR = 1.41, 95% CI = 1.06-1.88, p = .019) were associated with fewer weeks to heal. No other psychosocial variable (stress, perceptions about the ulcer, health behaviors) 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.
authors.affiliation: From the Institute of Pharmaceutical Science (Walburn, Weinman), Institute of Psychiatry, Psychology and Neuroscience, (Norton) King's College London; IMS Health (Hankins); School of Social and Community Medicine (Dawe), Faculty of Medicine and Dentistry (Banjoko), University of Bristol; and Division of Primary Care, School of Medicine (Vedhara), University of Nottingham, United Kingdom.
authors.forename: Jessica
authors.initials: J
authors.lastname: Walburn
authors.forename: John
authors.initials: J
authors.lastname: Weinman
authors.forename: Sam
authors.initials: S
authors.lastname: Norton
authors.forename: Matthew
authors.initials: M
authors.lastname: Hankins
authors.forename: Karen
authors.initials: K
authors.lastname: Dawe
authors.forename: Bolatito
authors.initials: B
authors.lastname: Banjoko
authors.forename: Kavita
authors.initials: K
authors.lastname: Vedhara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000523:psychology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D013315:Stress, Psychological / Q000523:psychology*; D014647:Varicose Ulcer / Q000523:psychology* / Q000628:therapy*