Psychological factors after injury: A systematic review of psychological factors influencing wound healing and a feasibility study of group-based Metacognitive Therapy for burns and plastics patients

Abstract

The biopsychosocial model of health has long recognised the interactions between biological, psychological, and social factors in determining individuals’ wellbeing. Improved understanding of the interactions between psychological and physical factors could facilitate better outcomes for patients. This thesis examines anxiety, depression and related processes involved in wound healing and the feasibility of treating psychological distress symptoms with metacognitive therapy (MCT) in burns and plastic surgery patients. Paper 1 provides a systematic review and meta-analysis examining the relationships between anxiety, depression and wound healing. Forty-seven eligible studies were identified in adults, of which twenty-three were included in the meta-analysis. The evidence for an effect of anxiety on wound healing was equivocal, with no overall significant effect of anxiety found in the meta-analyses. However, depression was associated with poorer wound healing. Depression was associated with a higher likelihood of wounds not healing, delayed healing, and increased risk of wound complications and infections. Future studies should explore the mechanism of the associations between depression and wound healing to inform clinical interventions. There is less evidence for an association with anxiety, but this may be due to fewer studies in this area. Paper 2 examined the feasibility and acceptability of delivering group based MCT in a burns and plastic surgery service. Fourteen adult outpatients were recruited and consented within four months and offered six sessions of group-MCT. Group-MCT was found to be feasible and acceptable within the service as the majority of patients attended at least four out of six sessions and completed post treatment self-report measures. These findings suggest that group-MCT is deliverable in patients that experienced mixed physical traumas. The findings can inform the design of future definitive effectiveness trials. Paper 3 provides a critical appraisal and broader context for the two previous papers. It also provides personal reflections and further detail on decisions made in the research process.

Date of Award	31 Dec 2022
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Adrian Wells (Supervisor)