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Mapping the evidence to determine the influence of stress, anxiety, and depression on wound healing in patients with diabetes-related foot ulcers: A scoping review
Alasfour, Lujain Alboloushi, Ali Kirwan, Ellen McIntosh, Caroline MacGilchrist, Claire Hurst, Joanne E.
Alasfour, Lujain
Alboloushi, Ali
Kirwan, Ellen
McIntosh, Caroline
MacGilchrist, Claire
Hurst, Joanne E.
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Date
2025-07-04
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journal article
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Citation
Alasfour, Lujain, Alboloushi, Ali, Kirwan, Ellen, McIntosh, Caroline, MacGilchrist, Claire, & Hurst, Joanne E. (2025). Mapping the evidence to determine the influence of stress, anxiety, and depression on wound healing in patients with diabetes-related foot ulcers: A scoping review. Journal of Tissue Viability, 34(3), 100935. https://doi.org/10.1016/j.jtv.2025.100935
Abstract
Introduction
Diabetes-related foot ulcers (DFUs) are a severe complication of diabetes, affecting an estimated 6.3 % of individuals globally and significantly increasing healthcare burdens. Psychological factors such as stress, anxiety, and depression are common in DFU patients and are believed to impact wound healing through immune system disruptions and decreased self-care.
Objective
This scoping review evaluates current evidence on the influence of psychological distress on DFU healing, identifies research gaps, and underscores the importance of integrating mental health support in DFU management.
Methods
Following Joanna Briggs Institute guidelines and PRISMA-ScR reporting standards, a comprehensive literature search was conducted in MEDLINE, CINAHL, and PubMed. Studies with adult DFU patients reporting stress, anxiety, or depression and measurable wound outcomes were included.
Results
Ten studies were included, consistently demonstrating that psychological distress impairs DFU healing. Chronic stress was found to extend inflammation and weaken immune function, while anxiety and depression were associated with reduced self-care and directly impaired wound healing, further hindering recovery. These findings highlight the significant impact of psychological factors on the DFU healing process.
Conclusion
psychological distress, including stress, anxiety, and depression, may impair the healing process of diabetes-related foot ulcers (DFUs). However, the evidence is very low quality, making it difficult to draw definitive conclusions. This highlights the need for further high-quality research to clarify the role of mental health in DFU management.
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Publisher
Elsevier
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License
CC BY