Depressive symptoms in patients with wounds: A cross-sectional study

Depression slows wound healing in patients with chronic wounds. The prevalence of depressive symptoms differs in the literature and the current understandings of factors related to depression in patients with wounds have been limited. To investigate the prevalence of depressive symptoms and the associated factors in patients with wounds, we performed this retrospective study in which depressive symptoms were evaluated with the Patient Health Questionnaire 9-item (PHQ-9). Valid PHQ-9 scores were collected from 222 patients (112 males and 110 females; age: 64.1 ± 15.8) out of 260 consecutive patients evaluated at an outpatient physical therapy wound clinic during 2012-2015. The proportion of patients with minimal to severe depressive symptoms was 81.5% [80.8% in patients with venous leg ulcers (VLUs) and 82.0% in non-VLUs]; 22.1% patients with wounds had scored positive for depression (moderate to severe depressive symptoms). Specific proportions of positive depression screening were 26.6% in patients with VLUs and 18.8% in non-VLU patients, and 14.1 and 40.0% in patients with wounds <90 and ≥ 90 days as of initial examination, respectively. PHQ-9 scores were significantly decreased from 5.85 ± 6.01 at initial examination to 3.42 ± 4.35 at last visit (p < 0.001). The odds of a positive depression screening was 3.20 (95% CI = [1.49, 6.87]) in patients with wounds ≥ 90 days (vs. < 90 days) and 2.53 (95% CI = [1.26, 5.08]) in patients with pain related to the wounds (vs. without pain), after patients' age, gender, and race were controlled for. No difference was found in proportions of positive depression screening between VLUs and other wound diagnoses. Depressive symptoms were common in patients with wounds, especially in patients with wounds ≥90 days and with pain related to the wounds at initial examination. Therefore, clinicians should take into consideration patients' mental status upon management of wounds.