Research projects
- Psychological and behavioural predictors of wound healing in diabetic foot ulcers
- Intervention studies
- Psychosocial and behavioural correlates of health and disease
- Identifying pathways through which stress leads to ill-health
Psychological and behavioural predictors of wound healing in diabetic foot ulcers
Experimental studies have demonstrated that psychological stress, (e.g. in students during examinations) can delay the healing of experimentally induced wounds.
But, does stress influence the rate of healing in naturally occurring wounds?
Diabetic foot ulcers are a common feature of diabetes and are characterised by slow healing rates. These wounds therefore place a huge burden on both the patients and the health service.
This programme of work seeks:
- To explore the roles of psychological and behavioural factors in the healing rates of diabetic foot ulcers
- To examine the contributions of the health beliefs of patients and health care professionals in influencing emotional and behavioural responses to foot ulceration
This information will then be used to create a range of psychological and behavioural interventions to improve healing rates.
Intervention studies
The group has been involved in several projects aimed at improving health through psychological and behavioural interventions.
Stress management
Caring for a spouse with chronic illness is a continual source of stress and has been associated with poorer immune functioning and increased rates of illness. These effects are more detrimental in older adults who are already at increased risk due to age-related deteriorations in immune efficiency. Previous research from this group has demonstrated that elderly caregivers report greater levels of stress and have reduced responses to standard influenza vaccinations.
A follow-up study aimed to reduce levels of stress and stress-related immune impairment in elderly caregivers. A stress-management intervention was designed to address the specific needs of elderly caregivers (e.g., teach relaxation and cognitive restructuring of the stressful events associated with caregiving). Those elderly caregivers who took part in the intervention reported reduced levels of stress and demonstrated greater responses to an influenza vaccine. This study demonstrates that reducing the stress associated with caregiving for an elderly spouse can improve immune system efficacy and therefore increase protection against infectious disease.
Emotional disclosure
Unresolved personal trauma can lead to states of biological and psychological tension resulting in over-activation of the sympathetic nervous and endocrine systems. Over-activation of these systems has been associated with dysregulation of the immune system and increases in disease symptoms. Inhibited trauma and associated tension can be released through the process of emotional disclosure. This process involves writing or talking about personally traumatic events for short periods of time (e.g. 20 minutes) over a period of several days.
Emotional disclosure in patients with rheumatoid arthritis
Disclosure was beneficial for those patients who were able to fully resolve their trauma through the process of writing. These patients showed improvements in physical and mental health in the two months following the intervention.
Future work
Further investigation of the intervention is now being conducted to find out who benefits most and why. In addition, the intervention is being developed for other chronic disease groups (e.g. breast cancer patients).
Psychosocial and behavioural correlates of health and disease
Behavioural interventions
Research suggests that the successful management of chronic disease may be dependent on the patients’ social environment, in particular, the role of significant others. An exploration the illness beliefs of patients with type 2 diabetes and their partners in relation to the patients’ adaptation and self-management of the condition was conducted. Patients and their partners generally share similar representations of diabetes. In addition, partners’ illness beliefs were influential in the extent of patients’ self-management behaviours. These findings suggest the potential role of significant others in behavioural interventions to improve the management of ‘lifestyle’ diseases such as type 2 diabetes.
Psychosocial predictors of risk
Presently a patient's risk of foot ulceration is assessed entirely according to clinical characteristics (e.g. presence of neuropathy) as recommended by recently published NICE Guidelines. However, there is some evidence that men have a much higher incidence of ulceration than women, and that inadequate foot self-care is associated with ulceration. To date there has been almost no research into these issues. This research project is therefore designed to examine whether specific patient characteristics confer an increased risk of ulceration over a 12-months period.
This project therefore aims to investigate the role of gender, knowledge and other psychosocial factors in relation to foot self-care behaviours and ulcer risk status in patients with type 2 diabetes. Furthermore, to investigate whether any of these factors prospectively predict change in risk status at 12 months.
Methods
- Semi-structured interviews to explore possible gender differences in relation to attitudes to diabetes, foot self-care, health beliefs and other psychosocial factors.
- Baseline quantitative data: Survey of 200+ patients with type 2 diabetes, who do not currently have a foot ulcer. Findings from the qualitative work will inform the design of a questionnaire. All participants will furthermore receive an ulcer risk assessment according to NICE Guidelines.
- Follow-up at 12 months: Repeat of ulcer risk assessment.
Potential implications of the project
If specific psychosocial variables and behaviours assessed at baseline are found to predict change in ulcer risk status at follow-up such findings will be of importance for prevention. The findings from this project could potentially inform a patient education intervention.
Identifying pathways through which stress leads to ill-health
Stress causes dysregulation of the endocrine, nervous and immune systems. Observing these systems under experimental conditions can reveal why some people are more susceptible to the adverse physiological effects of stress than others. However, the stressors that have been previously used to assess these effects are limited in terms of their safety, ease of administration or an inability to activate all systems (e.g. hypothalamic-pituitary-adrenal axis and sympathetic nervous system) involved in the human stress response.
We have developed a novel method of inducing acute stress in the lab. Our test involves the inhalation of a mixture of 35% carbon dioxide and 65% oxygen. The test is safe, reliable and stimulates all of the key systems involved in the stress response.
This stressor technique is currently being used to:
- Assess individual and situational influences on stress responses in newly qualified Drs.
- Explore the role of HPA and sympathetic dysregulation in disease processes (e.g., depression, IBS).
- Assess vaccination responses in students during examination stress.