Impact of depression, anxiety, inflammatory factors, and stress levels on treatment outcomes in patients with chronic trauma

Abstract

This editorial discusses a recent article published by Li et al in 2024, which highlights a critical yet underexplored dimension of chronic wound care: The impact of psychological factors such as depression and anxiety on treatment outcomes. With the increasing prevalence of chronic wounds in China, driven by population aging, traffic accidents, and chronic diseases, chronic wounds have emerged as a significant public health concern. They not only pose serious threats to individual health but also impose considerable social and economic burdens on healthcare systems. Against this backdrop, the study by Li et al aimed to explore how psychological distress affects the management and recovery of patients with chronic wounds. In their research, chronic wound patients were meticulously evaluated for depression and anxiety using validated psychological assessment scales and blood biomarkers. The findings reveal a stark reality: Individuals with severe depression and anxiety exhibit markedly lower treatment adherence, slower recovery rates, and diminished post-treatment quality of life. These psychological challenges hinder patients’ active engagement with their care plans and may directly impede physiological healing processes. Importantly, the study underscored that factors such as wound size, anxiety, and depression significantly influence therapeutic outcomes in chronic wound patients. This insight calls for a more holistic approach to wound care, where addressing psychological well-being becomes an integral component of treatment protocols. As such, the study highlighted the necessity of early identification and targeted intervention for depression and anxiety in chronic wound patients. By prioritizing psychological support alongside medical treatment, healthcare providers can enhance therapeutic efficacy and improve patients’ long-term quality of life. This integrative approach can not only optimize clinical outcomes but also alleviate the broader societal and economic impact of chronic wounds.

Key Words: Chronic trauma; Depression; Anxiety; Therapeutic outcomes; Editorial

Core Tip: With the development of technology and society, the incidence of chronic wounds is on the rise. At present, chronic wounds have become a common clinical problem that affects health and causes economic burden. What patients with chronic trauma experience is not only physical pain, but also psychological problems such as depression and anxiety, as well as changes in inflammatory factors and stress levels in peripheral blood. These factors are intertwined and jointly affect the whole process of treatment. Nowadays, with the continuous progress in the medical field, our treatment and care for chronic trauma patients should not only be limited to the repair of physical injury, but also should deeply explore the impact of their comprehensive psychological and physiological conditions on the treatment results.

INTRODUCTION

With advancements in technology and societal changes, coupled with the aging population, the incidence of chronic wounds is steadily increasing[1]. Chronic wounds have become a prevalent clinical challenge, posing significant threats to individual health while placing a considerable economic burden on healthcare systems[2]. In light of ongoing progress in the medical field, our approach to treating chronic trauma patients must extend beyond the mere repair of physical injuries. A deeper understanding of how psychological and physiological factors interact to influence treatment outcomes is essential. Patients with chronic wounds endure not only physical pain but also profound psychological challenges such as depression and anxiety, accompanied by alterations in inflammatory markers and stress levels in peripheral blood. These intertwined factors collectively shape the trajectory of treatment and recovery[3,4].

RELEVANT FACTORS AND COUNTERMEASURES

Chronic trauma, as its name implies, refers to persistent physical injuries that are challenging to heal swiftly. Such conditions may arise from severe accidents, complications of chronic diseases, or prolonged exposure to adverse living environments. Beyond the physical pain, these injuries often impose a profound psychological burden on patients[4,5]. Depression and anxiety are particularly prevalent among individuals with chronic trauma[4-6]. Confronted with reduced physical functionality, diminished quality of life, and uncertainty about their future, many patients experience feelings of helplessness and hopelessness, which can spiral into clinical depression. Anxiety, on the other hand, often stems from fears of trauma recurrence, poor treatment outcomes, or disruptions to social life. This psychological distress is far from being an isolated issue, and it significantly undermines patients’ motivation and adherence to treatment. A patient struggling with depression and anxiety may lose the drive to engage actively in their care, disregard medical advice, or even lose hope for recovery, which can severely compromise treatment outcomes. In their study, Li et al[3] retrospectively analyzed the clinical data of 110 patients with chronic wounds, revealing that anxiety and depression are critical factors influencing recovery outcomes in these patients.

Peripheral blood inflammatory factors play a critical role in the progression and recovery of chronic trauma patients. Following injury, the immune system responds by releasing a variety of inflammatory mediators to combat infection and initiate tissue repair and remodeling[7,8]. While this acute inflammatory response is essential for healing, in cases of chronic trauma, the inflammatory process often becomes dysregulated, resulting in persistent inflammation. Chronic inflammation is a defining characteristic of metabolic disorders and age-related diseases[7]. Prolonged elevation of inflammatory factors not only impedes wound healing but can also provoke systemic inflammatory responses, placing additional strain on the body. Furthermore, excessive production of these mediators can interact with the nervous system, intensifying symptoms of depression and anxiety. This creates a detrimental cycle in which psychological distress and chronic inflammation mutually reinforce each other, complicating treatment efforts and delaying recovery.

Stress levels are another critical factor influencing the treatment outcomes of chronic trauma patients[5]. Prolonged exposure to traumatic stress often triggers excessive production of stress hormones such as cortisol. While the short-term elevation of these hormones is beneficial, mobilizing the body’s energy to manage trauma, sustained high levels can have detrimental effects. Over time, chronic stress damages the immune system, disrupts cardiovascular function, and undermines the body’s overall physiological balance. These hormonal shifts extend beyond physical health, influencing numerous aspects of mental and physiological well-being[9]. Elevated stress levels exacerbate the psychological strain experienced by patients, deepening the emotional scars of trauma and impairing their ability to recover fully. This heightened psychological burden creates additional barriers to treatment, ultimately hindering recovery and complicating therapeutic outcomes.

Faced with these multifaceted challenges, how can we improve the treatment of chronic trauma patients? First, healthcare teams must prioritize the assessment and intervention of patients’ psychological conditions. Regular use of validated psychological assessment tools, such as the Self-Rating Depression Scale and the Self-Rating Anxiety Scale, can facilitate the timely identification of psychological issues. Once detected, appropriate psychological support and therapy should be provided. Psychotherapeutic approaches, such as cognitive behavioral therapy and supportive psychotherapy, can help patients reframe negative thought patterns and build resilience, empowering them with the confidence to cope with adversity. When necessary, pharmacological interventions, including antidepressants and anxiolytics, can be employed to alleviate symptoms effectively[4,5].

In parallel, routine monitoring of peripheral blood inflammatory factors and stress levels should be integrated into the treatment protocols for chronic trauma patients[8]. Regular testing allows clinicians to evaluate the patient’s inflammatory and stress status in real time, enabling precise adjustments to treatment plans. For instance, in cases of elevated inflammatory markers, anti-inflammatory medications or targeted immunomodulatory therapies may be considered. For patients experiencing heightened stress levels, interventions such as psychological counseling, relaxation training, and stress management programs can help mitigate their stress responses. In more severe cases, medications may be required to regulate the secretion of stress hormones.

In addition, the comprehensive treatment model of multidisciplinary collaboration is an inevitable choice to improve the treatment effect of chronic trauma patients. This model should include surgeons, rehabilitation therapists, psychologists, dietitians, and professionals from many other areas[2,6]. Surgeons are responsible for trauma repair and surgical treatment, rehabilitation therapists develop personalized rehabilitation training plans to help patients recover their physical functions, psychologists pay attention to patients’ psychological needs and provide psychological support and treatment, and nutritionists develop reasonable diet plans and provide nutritional support according to patients’ physical conditions. All disciplines work closely together to develop a comprehensive and systematic treatment plan for patients.

Finally, the establishment of social support systems is essential for the recovery of patients with chronic trauma[1,2]. Families, friends, and all sectors of society should give patients full care and understanding, so that they feel warm and supported[1]. At the same time, the government and social organizations can help patients reduce their burden, reintegrate into society, and improve their quality of life by providing financial assistance, rehabilitation facilities, and employment support. It should be emphasized that it is very important for patients to recover psychologically and become an integral part of society[2].

CONCLUSION

In conclusion, the treatment of chronic trauma patients is an intricate and multifaceted challenge, requiring comprehensive attention to factors such as depression, anxiety, peripheral blood inflammatory responses, and stress levels. Only through an integrated and holistic approach to care can patients overcome their suffering, reclaim both physical and mental well-being, and return to a fulfilling life. This endeavor is not only a cornerstone of modern medicine but also a societal responsibility. Together, we can create a brighter future for individuals living with chronic trauma.