Pressure Ulcers and Depression: The Psychological Impact of Wounds Protection Status
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By Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS

I have been in wound care my entire nursing career. I have been in a variety of positions, but it always involved wound management. It wasn't until recently that I became more interested in pressure ulcers than I ever thought possible. A close friend of mine, "Karla", was diagnosed with a rare condition that left her basically paralyzed from the waist down. Karla is an extremely intelligent, independent, successful young woman who woke up one day and couldn't feel her feet due to her condition. The progression of the paralysis was rapid, but luckily seemed to have stopped about waist high.

The Rapid Development of Pressure Ulcers

Karla was released from the hospital and sent home with VNA care. Her parents, who don't speak English, did not understand the instructions given that due to Karla's lack of sensation, they needed to help her reposition at least every two hours. Karla refused to ask for help and became severely depressed about her prognosis. Depression can be rooted in denial or anger about a one's circumstances which can lead to introverted behavior.1 Within a matter of a week at home, she developed bilateral stage IV heel ulcers and two stage IV sacral pressure ulcers.

When Karla went in for a neurological follow up, the nurse, who typically doesn't do skin assessments, looked at her skin because of the foul odor filling the exam room. Karla had been in complete denial about the odor and the foul drainage on the sheets at home. Her eyes were glazed over and almost removed from the discussion of reality and the severity of the wounds. Nursing Times stated that the individual with wounds can feel vulnerable and like a nuisance to others which can lead to a "sense of worthlessness and possibly depression."1

Screening Our Wound Care Patients for Depression and Anxiety

As clinicians, we discuss depression with our wound patients as well as assess their level of understanding, self awareness, and participation in their care. However, I feel that we need to better screen for depression in our patients as the correlation is very strong. Immobility we know can cause pressure ulcers, but it can also lead to social isolation and depression. It has been shown that patients who experienced depression are more likely to require rehospitalization for infection-related complications than individuals reporting less distress.2 It is also shown that patients who experienced the highest level of depression and anxiety are four times more likely to have delayed wound healing.

We can assist our patients by discussing body image, providing information to reduce uncertainty about their situation, empathizing with their anger, recommend counseling or medication if needed, and encourage discussion about the reality of the wounds while providing a supportive environment for questions.

1. Hopkins S. Psychological aspects of wound healing. Nurs Times. 2001;97(48):57-8.Available at: Accessed February 3, 2015.
2. Gouin JP, Kiecolt-glaser JK. The impact of psychological stress on wound healing: methods and mechanisms. Immunol Allergy Clin North Am. 2011;31(1):81-93.

About the Author
Lindsay (Prussman) Andronaco is board certified in wound care by the Wound Ostomy Continence Nursing Certification Board. She also is a Diplomate for the American Professional Wound Care Association. Her clinical focus is working with Diabetic Limb Salvage/Surgical/Plastic Reconstruction patients, though her interests and experience are varied and include surgical, urological and burn care, biotherapeutics and Kennedy Terminal Ulcer research. Lindsay is the 2011 recipient of the Dorland Health People's Award in the category of 'Wound Ostomy Continence nurse' and has been recognized in Case In Point Magazine as being one of the "Top People in Healthcare" for her "passionate leadership and an overall holistic approach to medicine."

Lindsay is board certified in wound care by the Wound Ostomy Continence Nursing Certification Board. She also is a Diplomate for the American Professional Wound Care Association. In 2011, Lindsay was honored with the Dorland Health People's Award in the category of 'Wound Ostomy Continence nurse.'

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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