Psychological Stress Impairs Wound Healing

     "Numerous studies show that stress is associated with increased mortality & morbidity across a range of conditions and many studies highlight the impact of stress upon specific markers of immune functioning, but few have been able to connect the 'micro' immune changes with 'macro' changes in disease outcomes. The recent utilization of wound healing as a primary outcome measure enables researchers to bridge this gap and investigate the impact of stress on an objective, concrete, and clinically relevant outcome, where the immune system plays a significant role. Research investigating the determinants of wound healing has traditionally focused on clinical and biomedical factors (i.e., size of wound, dressing type, extent of pathology) associated with speed of healing. However, recently the potential impact of psychosocial factors, including psychological stress, has been investigated. The objective of this review was therefore to systematically identify and synthesize existing knowledge about the relationship between psychological stress and wound healing.

     The results reveal a robust negative relationship whereby stress is associated with impairment of healing and dysregulation of biomarkers associated with wound healing and this is broadly consistent across a variety of clinical and experimental, acute and chronic wound types in cutaneous and mucosal tissue. The relationship was evident across different conceptualizations and measures of stress. The size of the relationship between stress and wound healing estimated by this analysis is r=−0.42, classified as a medium effect size, suggesting that it may be of significance clinically as well as statistically. The extent of its impact indicates that it could be considered alongside other accepted factors affecting healing such as age, diabetes, and nutrition."

       Walburn J. et al. Psychological stress and wound healing in humans: a systematic review and meta-analysis. J Psychosom Res 2009; 67(3): 253-71.

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