RETRACTED: Complications and psychological impact of pressure ulcers on patients and caregivers
Abstract
Pressure ulcers are persistent skin lesions that have substantial detrimental effects on the physical well-being of patients. Moreover, their psychological ramifications for both patients and their caregivers are becoming more widely acknowledged. This research was conducted to examine the psychological ramifications of pressure ulcers and ascertain efficacious approaches to mitigate these effects and improve overall well-being. A cross-sectional study was conducted from March 2022 to December 2023 across tertiary care centres located in Beijing. The cohort consisted of 431 participants, which included primary caregivers and patients who were diagnosed with pressure ulcers. The data were gathered through the utilization of structured questionnaires and semi-structured interviews. These methods encompassed demographic details, clinical characteristics and validated scales that assessed psychological parameters, including quality of life, anxiety, stress and depression. The research exposed substantial psychological toll on both individuals receiving care and those providing care, with caregivers enduring diminished quality of life and elevated levels of anxiety, depression and stress (p < 0.05). A significant positive correlation was identified between the degree of psychological distress and severity of pressure ulcers (p < 0.05). Both location of the ulcer and duration of care were substantial contributors to the psychological burden (p < 0.05). In spite of the apparent necessity, a significant proportion of the participants refrained from obtaining psychological counselling. The results underscored the significant psychological ramifications of pressure ulcers for both individuals receiving care and the caregivers. As a result, comprehensive care strategies that incorporate psychological assistance into the prescribed treatment plan are imperative. This research highlighted the criticality of implementing all-encompassing, interdisciplinary approaches to tackle the complex issues presented by pressure ulcers in an effort to enhance the general welfare of those influences.
1 INTRODUCTION
Pressure ulcers, also known as bedsores or decubitus ulcers, are cutaneous and subcutaneous injuries that occur as the consequence of protracted application of pressure to the affected area.1 Skin that covers bony regions of the body, including soles, ankles, hips and tailbone, is frequently affected by these ulcers.2, 3 Those whose medical condition restricts their mobility to a significant degree, or who spend the majority of their time confined to a bed or chair, are at the greatest risk. A meta-analysis by Li et al. suggested the global prevalence of pressure ulcer to be 12.8%, with a hospital-acquired pressure injury (HAPI) incidence of 8.4%.4
Stages one through four delineate pressure ulcers, spanning from minimal (stage one) to extremely critical (stage four), which may encompass substantial muscle and bone harm. Persistent pressure, friction and shear are all elements that contribute to the formation of pressure ulcers.5 Prolonged interposition of the epidermis and underlying tissues between an external surface and a bone results in sustained pressure, which obstructs blood circulation. Shear occurs when the skin moves in one direction and underlying bones move in the opposite direction, whereas friction occurs when the skin rubs against clothing or bedding.6
In order to prevent and manage pressure ulcers, it is essential to perform routine skin examinations, maintain a healthy diet and reposition oneself frequently to alleviate pressure on vulnerable body areas.7, 8 Surgical intervention may be necessary for the most severe ulcers, whereas simple dressings and wound care may suffice for minor ulcers.9
The importance of addressing pressure ulcers stems from the severe complications that can ensue, such as protracted hospitalizations and severe infections.10 Comprehensive care encompasses the range of interdisciplinary disciplines, including physiotherapists, physicians, dietitians and nurses, in order to prevent the development of ulcers and treat those that are already present.11, 12
The psychological ramifications of pressure ulcers on both patients and their care givers are complex, involving the variety of mental, emotional and social obstacles. Pressure ulcers have profound impact not only on the physical health of individuals affected but also on their psychological well-being and overall quality of life when it comes to their management and care.13
The existence of a pressure ulcer frequently induces despondency, humiliation and social isolation in the affected individual. The persistence of pressure ulcers, in conjunction with their conspicuous appearance and accompanying physical discomfort and pain, can lead to considerable psychological anguish.14, 15 Because of the loss of autonomy and constant requirement for care, patients may develop melancholy, anxiety and feeling of helplessness.16 The patient's mental well-being may be negatively affected and persistent discomfort linked to advanced ulcers may intensify, thereby impeding the healing process. Additionally, social withdrawal can result from the stigma associated with wounds, exacerbating the patient's sense of isolation and compounding emotions of loneliness and desolation.17
The task of pressure ulcer management poses unique psychological difficulties for individuals providing care, including family members and professional healthcare providers. Care givers frequently encounter elevated levels of stress, exhaustion and frustration as a result of arduous characteristics of wound care, which necessitate scrupulous attention to avert infection and protracted healing phase.18 The caregiver's apprehension may be exacerbated by the concern that dressing changes or repositioning may result in pain or discomfort for the patient. Moreover, bearing witness to the patient's anguish and possible decline in their state can elicit emotions such as culpability, sorrow and perception of lacking agency.19
The psychological ramifications experienced by care givers transcend mere emotional distress and may also cause significant disruptions to their personal and professional spheres.20 Due to the time-consuming nature of pressure ulcer care, individual may have less time available for leisure and personal obligations, which may strain interpersonal connections and potentially result in social isolation. The financial implications of long-term care, including potential income loss and expense of medical supplies, may additionally exacerbate the tension and anxiety experienced by the care givers.21
Given the aforementioned obstacles, it is imperative to attend to the psychological requirements of both patients and care givers. Psychological support systems, such as support groups and counselling, offer individuals the platform to share their emotions and develop coping mechanisms to manage the tension and difficulties that are inherent in the experience of pressure ulcers.22 The provision of education and training pertaining to efficacious care techniques has the potential to empower carers, alleviate anxiety and enhance the calibre of care rendered. Additionally, for comprehensive pressure ulcer management, it is critical to cultivate a nurturing and empathetic atmosphere in which the psychological and emotional strains experienced by individuals are recognized and attended to. It is critical that healthcare professionals, patients and carers work together in a collaborative manner to alleviate the psychological effects and foster the recovery and overall welfare of all individuals concerned.8, 23
The aim of this research was to conduct thorough examination of the psychological consequences that pressure ulcers impose on patients and their caretakers. Additionally, the study sought to devise efficacious approaches to alleviate these effects and enhance overall welfare.
2 MATERIALS AND METHODS
2.1 Study design and period
From March 2022 to December 2023, a cross-sectional study was undertaken to examine the psychological ramifications of pressure ulcers on both patients and their caregivers.
2.2 Sample size
The research sample consisted of 431 individuals, including both patients who were afflicted with pressure ulcers and their primary caregivers. The selection of participants was predicated on predetermined inclusion criteria, which encompassed individuals who had received a diagnosis of pressure ulcer at any stage, as well as their primary caregivers who were actively engaged in the provision of care.
2.3 Study setting
The investigation was conducted across various community and medical environments in Beijing, China. This included home care settings and hospitals specializing in wound care and long-term care, in order to guarantee the varied representation of the patient and caregiver population.
2.4 Methods of data collection
A structured questionnaire, specifically formulated to evaluate the psychological ramifications of pressure ulcers on both patients and caregivers, was employed to gather the necessary data. Demographic information, duration and severity of pressure ulcer, nature and extent of care rendered and series of validated scales utilized to evaluate psychological parameters including tension, anxiety, depression and quality of life were all encompassed in the questionnaire.
Besides the completion of the questionnaire, the subset of participants was also engaged in semi-structured interviews to obtain more profound understandings of their individual experienced the emotional obstacles encountered. Through the utilization of interviews, subjects that were not entirely encompassed by the questionnaire were investigated, thereby contributing to a more all-encompassing understanding of the psychological terrain.
It is worth mentioning that out study primarily focused on assessing the psychological effects of pressure ulcers on patients and their caregivers, rather than evaluating interventions to mitigate these effects.
2.5 Ethical considerations
Ethical sanction from the Institutional Review Boards was obtained prior to the initiation of the study. The study's objectives were duly communicated to the participants, who were also guaranteed confidentiality and freedom to disengage from the research at any time without incurring any adverse repercussions. Written informed assent was acquired from every participant.
2.6 Statistical analysis
Statistical software SPSS version 26.0 was employed to analyse the quantitative data obtained from the questionnaires. The objective was to ascertain the frequency and intensity of psychological impacts, as well as to detect any noteworthy correlations or patterns using descriptive statistics including multivariate regression, ANOVA, hierarchical regression and logistic regression methods.
By incorporating both quantitative and qualitative data, a comprehensive understanding of the psychological consequences of pressure ulcers was achieved to create focused interventions that assist both patients and caregivers during this challenging period.
3 RESULTS
The findings of the research provide a keen look at the complex array of difficulties that decubitus ulcers, entail. The results of this study emphasize the widespread consequences of chronic infections, which affect not only physical health but also psychological well-being. A thorough examination of the data from 431 participants indicates that pressure ulcers impose a substantial psychological strain on both the patients and the individuals providing care for them. This burden is evident in various aspects, encompassing tension, anxiety, depression and overall life satisfaction. An aspect worthy of special mention is the correlation that exists between the level of psychological distress encountered and severity of pressure ulcers. The following discourse examined the specific statistical results that underscore the significant mental and emotional health consequences of pressure ulcers for those affected. This underscores the need for the comprehensive management approach that considers both the physiological and psychological aspects of patient care.
The distinctions were identified between patients and caregivers with regard to age, caregiver–patient relationship, pressure ulcer stage and ulcer location. The mean age of patients was found to be 62.27 ± 15.36 years, which was considerably older than the mean age of caregivers (p < 0.05). The results were indicating substantial distinction in the distribution of such relationships. Regarding clinical attributes, notable variability was observed in the ulcer location (p < 0.05) and stage of pressure ulcers (p < 0.05) among the patients, indicating that these variables were conspicuously unique to the patient population being investigated. There were no noteworthy variations observed in the distribution of genders or duration of care (p > 0.05) (Table 1).
| Variable | Patients (n = 215) | Caregivers (n = 216) | Total (n = 431) | χ2 | p-Value |
|---|---|---|---|---|---|
| Age (years) Mean ± SD | 62.27 ± 15.36 | 54.18 ± 14.82 | 58.23 ± 15.09 | 8.65 | 0.021a |
| Gender | |||||
| Male | 104 (48.37) | 95 (43.98) | 199 (46.17) | ||
| Female | 111 (51.63) | 121 (56.02) | 232 (53.83) | 1.22 | 0.27 |
| Relationship to patient | |||||
| Spouse | – | 125 (57.87) | 125 (29.0) | ||
| Child | – | 72 (33.33) | 72 (16.70) | 15.3 | 0.001a |
| Other | – | 19 (8.80) | 19 (4.41) | ||
| Duration of care (months) | 18.29 ± 9.73 | 19.05 ± 10.27 | 18.67 ± 10.00 | 0.85 | 0.36 |
| Pressure ulcer stage | |||||
| Stage I | 39 (18.14) | – | 39 (9.05) | ||
| Stage II | 71 (33.02) | – | 71 (16.47) | ||
| Stage III | 59 (27.44) | – | 59 (13.69) | 24.1 | 0.001a |
| Stage IV | 46 (21.40) | – | 46 (10.67) | ||
| Location of ulcer | |||||
| Sacral | 79 (36.74) | – | 79 (18.33) | ||
| Heel | 56 (26.05) | – | 56 (13.00) | ||
| Ischial | 41 (19.07) | – | 41 (9.51) | 13.8 | 0.002a |
| Other | 49 (22.79) | – | 49 (11.37) | ||
- a Indicated the statistical significance.
The psychological effects on patients and caregivers were keenly evaluated in our investigation, whereby scores on Perceived Stress Scale indicated that caregivers scores (24.8 ± 6.5) were considerably higher than patients (21.4 ± 7.6). A comparable result was observed between patients (11.3 ± 4.2) and caregivers (13.6 ± 3.9) on Hospital Anxiety Scale (p < 0.05). The Beck Depression Inventory data revealed that caregivers had substantially higher levels of depression (16.2 ± 6.1) compared to patients (14.6 ± 5.8) (p < 0.05). The SF-36 Health Survey revealed that average quality-of-life score for caregivers was 58.7 ± 20.5, which was significantly lower than the mean score for patients (62.3 ± 22.1) (p < 0.05). All parameters demonstrated statistical significance, indicating that caregivers endured greater levels of stress, anxiety and depression, as well as a diminished quality of life, in comparison with patients (Table 2).
| Psychological parameter | Scale used | Patients (N = 215) | Caregivers (N = 216) | Total (N = 431) | χ2 | p-Value |
|---|---|---|---|---|---|---|
| Stress level | Perceived stress scale | 21.4 ± 7.6 | 24.8 ± 6.5 | 23.1 ± 7.1 | 9.76 | 0.01a |
| Anxiety level | Hospital anxiety scale | 11.3 ± 4.2 | 13.6 ± 3.9 | 12.4 ± 4.1 | 11.55 | 0.01a |
| Depression level | Beck depression inventory | 14.6 ± 5.8 | 16.2 ± 6.1 | 15.4 ± 6.0 | 5.87 | 0.02a |
| Quality of life | SF-36 health survey | 62.3 ± 22.1 | 58.7 ± 20.5 | 60.5 ± 21.3 | 4.22 | 0.04a |
- a Indicated the statistical significance.
As the stage of the pressure ulcer progressed, both the depression and stress scores of the patients and their caregivers increase, indicating the direct correlation between severity of the ulcer and psychological distress. The statistical significance of this trend is confirmed by the p-values ranging from 0.014 to 0.043 at each stage (Table 3). The magnitude of the negative correlation coefficients between the duration of care and quality of life for both patients and caregivers increased, indicating that the quality of life declined as the caregiving period continued (p < 0.05). The aforementioned correlation is consistent and statistically significant, underscoring the persistent nature of pressure ulcers and gradual degradation of quality of life they cause (Table 4).
| Pressure ulcer stage | Patients: mean depression score ± SD | Caregivers: Mean stress score ± SD | p-Value |
|---|---|---|---|
| Stage I | 10.5 ± 2.3 | 14.3 ± 2.8 | 0.043a |
| Stage II | 12.7 ± 2.6 | 16.5 ± 3.1 | 0.012a |
| Stage III | 15.4 ± 3.2 | 18.7 ± 3.4 | 0.018a |
| Stage IV | 18.3 ± 3.7 | 20.9 ± 3.9 | 0.014a |
- a Indicated the statistical significance.
| Duration of care (Months) | Patients: Mean Qol Score ± SD | Caregivers: Mean QoL score ± SD | Correlation coefficient (Patients) | Correlation coefficient (Caregivers) |
|---|---|---|---|---|
| 0–3 | 75.4 ± 4.5 | 72.6 ± 5.2 | −0.25 | −0.18 |
| 4–6 | 70.2 ± 6.1 | 69.8 ± 6.5 | −0.32 | −0.29 |
| 7–12 | 65.1 ± 7.3 | 66.4 ± 7.0 | −0.40 | −0.35 |
| 13+ | 60.3 ± 8.2 | 63.7 ± 7.8 | −0.47 | −0.42 |
Age is the distinct determinant of anxiety scores for both patients and caregivers, as indicated by the higher anxiety levels in the older age groups. Particularly in individuals aged 60 years and older (p < 0.05), the significance suggested the robust correlation between advancing age and heightened anxiety, attributed to the accumulation of health issues over time and heightened susceptibility to pressure ulcers that accompany ageing (Table 5). The odds ratios indicated that as caregivers burden scores increased, there was significant rise in the probability of patients experiencing elevated levels of depression. The correlation between increasing caregivers' burden from low to high and likelihood of high levels of depression in patients increased by more than fourfold underscored the interconnectedness between the well-being of patients and their caregivers (Table 6). The number of care days per week and caregiver stress levels were significantly greater for sacral and ischial ulcer locations (p < 0.05), indicating that ulcer location is a significant factor in caregiver stress. These sites necessitated more intensive care due to ulcers, thereby increasing the burden on caregiver (Table 7). At the stages III and IV, there was decline in sleep quality scores for both patients and caregivers as the pressure ulcer stage progress suggested that more severe ulcers had negative impact on sleep quality. This might be the result of heightened pain, distress or care requirements that were linked to ulcers in their advanced stages (Table 8). According to the findings of our research, a significant proportion of both patient and carer cohorts did not participate in psychological counselling, suggesting a deficiency in psychological support services (Table 9).
| Age group (Years) | Patients: Average anxiety score ± SD | Caregivers: Average anxiety score ± SD | p-Value |
|---|---|---|---|
| <40 | 9.2 ± 2.1 | 10.5 ± 2.3 | 0.081a |
| 40–60 | 12.6 ± 3.5 | 14.1 ± 3.7 | 0.035a |
| >60 | 14.3 ± 4.2 | 15.8 ± 4.0 | 0.001a |
- a Indicated the statistical significance.
| Caregiver burden score | Patient depression level: Low | Patient depression level: High | Odds ratio | 95% CI |
|---|---|---|---|---|
| Low (0–20) | 72 | 35 | 1.00 | Reference |
| Medium (21–40) | 25 | 45 | 2.70 | 1.80–4.05 |
| High (41–60) | 10 | 28 | 4.20 | 2.95–5.98 |
| Ulcer location | Caregivers: Mean stress level ± SD | Number of care days per week (Mean ± SD) | p-Value |
|---|---|---|---|
| Sacral | 22.4 ± 5.6 | 6.1 ± 1.2 | 0.001a |
| Heel | 19.8 ± 4.9 | 5.7 ± 1.5 | 0.035a |
| Ischial | 21.2 ± 5.2 | 6.0 ± 1.3 | 0.021a |
| Other | 18.7 ± 4.4 | 5.3 ± 1.4 | 0.06 |
- a Indicated the statistical significance.
| Pressure ulcer stage | Patients: Sleep quality score ± SD | Caregivers: Sleep quality score ± SD | p-Value |
|---|---|---|---|
| Stage I | 7.2 ± 1.1 | 7.5 ± 1.2 | 0.41 |
| Stage II | 6.8 ± 1.4 | 6.9 ± 1.3 | 0.45 |
| Stage III | 5.3 ± 1.6 | 5.6 ± 1.5 | 0.05a |
| Stage IV | 4.1 ± 1.8 | 4.4 ± 1.7 | 0.01a |
- a Indicated the statistical significance.
| Psychological counselling | Patients n (%) | Caregivers n (%) | Total n (%) | χ2 | p-Value |
|---|---|---|---|---|---|
| Never | 95 (44.2) | 85 (39.4) | 180 (41.8) | 3.26 | 0.07 |
| Once a month | 60 (27.9) | 75 (34.7) | 135 (31.3) | ||
| Twice a month or more | 60 (27.9) | 56 (25.9) | 116 (26.9) |
The absence of statistically significant p-values and overall decline in satisfaction scores indicated that although there might be variations in satisfaction levels between caregivers and patients, these differences were not of substantial nature (p > 0.05) (Table 10). There was a notable increase in the likelihood of caregiver burden among ‘Other Relatives’ in comparison with spouses. This finding implied that caregiver's perception of burden was significantly influenced by the character of the relationship with the patient (p < 0.05) (Table 11). The observed negative correlation coefficients exhibited an upward trend as the duration of ulcer healing increased, indicating that extended treatment periods were correlated with heightened levels of stress among both patients and caregivers (p < 0.05). This underscored the psychological toll that such periods imposed (Table 12).
| Satisfaction level | Patients mean score ± SD | Caregivers mean score ± SD | t-Test | p-Value |
|---|---|---|---|---|
| Very satisfied | 4.5 ± 0.7 | 4.2 ± 0.8 | 2.14 | 0.31 |
| Satisfied | 3.8 ± 1.1 | 3.6 ± 1.2 | 1.75 | 0.08 |
| Neutral | 3.0 ± 0.9 | 3.1 ± 0.9 | 0.56 | 0.58 |
| Unsatisfied | 2.2 ± 1.0 | 2.4 ± 1.1 | 1.09 | 0.28 |
| Very unsatisfied | 1.6 ± 0.8 | 1.8 ± 0.9 | 1.32 | 0.19 |
| Relationship to patient | Caregiver burden score (Low) | Caregiver burden score (High) | Odds ratio | 95% CI |
|---|---|---|---|---|
| Spouse | 50 | 30 | 1.00 | Reference |
| Child | 40 | 32 | 1.20 | 0.85–1.69 |
| Other relative | 18 | 46 | 2.55 | 1.58–4.12 |
| Healing time (Weeks) | Patients: Stress score (Mean ± SD) | Caregivers: Stress score (Mean ± SD) | Pearson's r (Patients) | Pearson's r (Caregivers) |
|---|---|---|---|---|
| <4 | 18.2 ± 5.3 | 16.9 ± 4.8 | −0.18 | −0.14 |
| 4–8 | 22.4 ± 6.1 | 20.3 ± 5.7 | −0.22 | −0.19 |
| >8 | 26.7 ± 7.4 | 24.5 ± 6.9 | −0.33 | −0.29 |
Statistically significant associations (p < 0.05) were observed between various patient characteristics and psychological outcomes. Among these, the duration of ulcer demonstrated the strongest association (β = 0.245), indicating that it exerted a considerable impact on psychological well-being (Table 13). The ANOVA test yielded significant values, indicating that there were substantial variations in depression scores among distinct stages of ulcers. The eta-squared (γ2) value further supported the notion of the moderate effect size (Table 14). The substantial increase in R2 and F2 occurred with the addition of each block of variables (Patient Demographics, Ulcer Characteristics, Psychological Support and Caregivers Burden), suggesting that these factors explained considerable amount of the variance in quality of life collectively and incrementally (Table 15). The findings of our research study presented significant odds ratios for variables including age, history of stage IV ulcers, level of mobility and number of comorbidities. These odds ratios collectively indicated the robust predictive association with the probability of pressure ulcer recurrence (Table 16).
| Variable | B coefficient | SE | β (Standardized Coefficient) | t-Value | p-Value | 95% CI for B |
|---|---|---|---|---|---|---|
| Age | −0.032 | 0.012 | −0.183 | −2.67 | 0.008a | −0.056 to 0.008 |
| Gender (1 = Male, 0 = Female) | 0.210 | 0.098 | 0.121 | 2.14 | 0.033a | 0.017 to 0.403 |
| Duration of ulcer | 0.145 | 0.034 | 0.245 | 4.26 | 0.001a | 0.078 to 0.212 |
| Ulcer location (1 = Sacral, 0 = Other) | −0.183 | 0.076 | −0.137 | −2.41 | 0.016a | −0.333 to 0.033 |
| Caregiver relation (1 = Spouse, 0 = Other) | 0.229 | 0.088 | 0.158 | 2.60 | 0.010a | 0.055 to 0.403 |
- a Indicated the statistical significance.
| Source of variation | SS | df | MS | F | p-Value | η2 |
|---|---|---|---|---|---|---|
| Between groups (Ulcer stages) | 56.743 | 3 | 18.914 | 5.92 | 0.001a | 0.138 |
| Within groups | 345.972 | 431 | 0.802 | |||
| Total | 402.715 | 434 |
- a Indicated the statistical significance.
| Model | R2 | ΔR2 | F change | df1 | df2 | p-Value |
|---|---|---|---|---|---|---|
| 1. Patient demographics | 0.201 | |||||
| 2. Ulcer characteristics | 0.362 | 0.161 | 29.78 | 3 | 427 | 0.001a |
| 3. Psychological support received | 0.419 | 0.057 | 14.22 | 2 | 425 | 0.001a |
| 4. Caregiver burden | 0.487 | 0.068 | 18.55 | 1 | 424 | 0.001a |
- a Indicated the statistical significance.
| Predictor | Odds ratio (OR) | 95% CI | Wald | p-Value |
|---|---|---|---|---|
| Age (Per year increase) | 1.03 | 1.01–1.05 | 4.55 | 0.033a |
| Stage IV ulcer history | 2.47 | 1.23–4.97 | 5.67 | 0.017a |
| Mobility level (1 = Low, 0 = High) | 0.52 | 0.31–0.87 | 6.22 | 0.013a |
| Comorbidity count (Per additional condition) | 1.15 | 1.07–1.24 | 7.84 | 0.005a |
- a Indicated the statistical significance.
4 DISCUSSION
This study offered thorough analysis of the psychological consequences that pressure ulcers impose on both patients and their caregivers, emphasizing the complex and diverse aspects of this influence. The results of our study validated and expanded upon prior investigations, providing novel perspectives on the interaction between psychological health and physical health conditions.
A notable variation in age was observed between patients and caregivers, with patients being considerably older. This finding is consistent with research, suggesting that pressure ulcers are more widespread among the elderly as a result of variables such as diminished skin elasticity and mobility.24 The considerable diversity in the manner in which caregivers interacted with the patient underscores the significance of the familial and social environment in the provision of care. This confirms the conclusions drawn by Rahmani et al.25 who observed that the psychological burden experienced by caregivers is frequently associated with the nature of their relationship with the patient.
Significantly, our research emphasized the psychological toll experienced by caregivers, as they demonstrated inferior quality of life and elevated levels of anxiety, depression and stress in comparison with patients. This finding aligns with the research conducted by Belapurkar et al.26 which indicated that individuals providing care for patients with chronic wounds endure considerable emotional distress. The potential correlation between the extended and arduous nature of providing care for individuals with pressure ulcers and the increased levels of stress and depression observed among caregivers has been proposed by Lee et al.27
Both patient depression and caregivers tension increased in direct correlation with the progression of pressure ulcer stages. This discovery aligns with the investigation conducted by Fox (2002), which established the clear association between the intensity of pressure ulcers and heightened psychological distress, thereby emphasizing the significant influence that the physical severity of the ailment has on mental well-being.28
A substantial inverse correlation was identified in our inquiry concerning the association between the length of care provided and quality of life. This finding implies that prolonged care periods have adverse effects on the welfare of both patients and caregivers. A similar discovery can be made regarding the consequences of extended care for chronic conditions: caregivers' fatigue and consequent decline in life satisfaction.29
The upward trend in anxiety levels as individual's age, especially among those over 60, is consistent with the results reported by Maftei et al.30 who established the correlation between the progression of health problems and heightened health-related anxiety among older adults. The correlation between patient depression and caregiver burden is statistically significant, indicating that patient–caregiver dynamics are intertwined. This is consistent with the conclusions drawn by the researchers who highlighted the reciprocal nature of psychological health between caregivers and patients.31
The location of the ulcer was also found to be a significant determinant in caregiver stress, with sacral and ischial ulcers necessitating more extensive care and consequently placing a heavier burden. This observation is corroborated by the research report, which indicates that caregivers stress can be heightened in ulcer sites with the greater propensity for infection or those requiring more intricate care.23
Our findings that sleep quality deteriorates as the stages of pressure ulcers progress are consistent with research that established a link between sleep disruptions experienced by both patients and caregivers and heightened nocturnal care requirements and pain that are linked to severe ulcers.13
Notwithstanding the apparent psychological strain, a considerable proportion of the participants in our research did not procure psychological counselling. This highlights the possible deficiency in comprehensive care methodologies, a matter that Moghimi et al.32 also draw attention to.
The lack of substantial differences in levels of satisfaction among patients and caregivers, notwithstanding their diverse experiences with pressure ulcer management, indicates the prospective domain for additional research concerning the determinants that impact satisfaction and the perception of care quality.
Our study's multivariate analysis of psychological outcomes, which incorporated patient characteristics, identified noteworthy correlations, specifically with regard to the ulcer's duration. These results align with those of Alnazly,33 who similarly documented substantial psychological effects linked to chronic illnesses.
The study's hierarchical regression analysis demonstrates that the inclusion of each block of variables significantly raises R2 thus emphasizing the multifactorial nature of quality of life in relation to pressure ulcers. This observation is consistent with the comprehensive model of care.34
Our logistic regression analysis corroborated the results obtained by Vecin (2022), placing emphasis on the importance of targeted interventions and highlighting age, mobility level and comorbidity count as significant predictors of pressure ulcer recurrence.35 Our research provides significant contributions regarding the psychological ramifications of pressure ulcers for both patients and their caregivers. Through the identification of particular areas of concern and emphasis on complex nature of this effect, our research emphasizes the necessity of comprehensive, interdisciplinary strategy for managing pressure ulcers that attends to both physiological and psychological requirements. Additional investigation is necessary to examine the effectiveness of these comprehensive care models and to clarify the mechanisms that contribute to the observed psychological effects.
In order to enhance the psychological welfare of individuals afflicted with pressure ulcers and their caregivers, it is imperative that critical interventions concentrate on the following: incorporating psychological support into care plans for patients, establishing specialized support initiatives for caregivers and educating healthcare practitioners to identify and attend to mental health concerns associated with chronic illnesses. These approaches necessitate the formulation of healthcare policies that guarantee caregivers' access to mental health services and facilitate access to such services, in addition to initiatives that educate healthcare personnel on mental health. The healthcare system can optimize overall outcomes by attending to the psychological and physical requirements of individuals afflicted with pressure ulcers through the implementation of these measures.
5 CONCLUSION
The psychological effects of pressure ulcers on both patients and caregivers are unequivocally established in this study. These effects include heightened levels of stress, anxiety and depression, as well as decline in overall quality of life. The results emphasized the relationship between severity of ulcers, duration of care and psychological distress. This underscores the importance of incorporating psychological support into holistic care approaches. The study underscores the significance of attending to the psychological and physical dimensions of health when managing pressure ulcers; it promotes the implementation of holistic, interdisciplinary approaches to care in order to enhance the general welfare of those affected.
CONFLICT OF INTEREST STATEMENT
None.
Open Research
DATA AVAILABILITY STATEMENT
The data can be provided upon formal request.
