Perceived Stress and Cortisol Levels Predict Speed of Wound Healing in Healthy Male Adults - Essay Example

Journal Article Review: Perceived Stress and Cortisol Levels Predict Speed of Wound Healing in Healthy Male Adults By: Marcel Ebrecht, Justine Hextall, Lauren-Grace Kirtley, Alice Taylor, Mary Dyson, John Weinman                    Authored by Ebrecht, Hextall, Kirtley, Taylor, Dyson and Weinman (2003), the article entitled “Perceived Stress and Cortisol Levels Predict Speed of wound Healing in Healthy Male Adults” investigated the relationship between perceived stress and the cure of impaired cutaneous wound in humans with the use of a novel wound assessment technique. Aside from this, the investigation of the relationship between the two also considered putative mediating factors such as cortisol levels, human health behaviours and personality factors.         Previous studies conducted with regard to wound healing and stress factors, have all validated that the stress levels of an individualindeed negatively affect the rate of wound healing in both animals and humans. However, Ebrecht et al. (2003) found out that previous studies made on the topic they are investigating on failed to incorporate putative mediating factors in their research. Factors such as health-risk behaviors which include smoking, alcohol consumption, poor sleep and the inability to engage in physical exercise have always been associated with psychological distress. Hence, the abovementioned putative factors can play a special role in affecting the immune system of individuals, thus, also affect the time needed for the wound to heal. Aside from these, the authors of the research being reviewed also noted that previous studies tended to use macro photography and hydrogen peroxide foaming in their assessment of wound healing, whereas such methods of assessment only record the surface appearance of the wound and can therefore question the validity of results obtained in such manner. Consequently, they give paramount importance to other valid methods such as ultrasound scanning to determine the healing activity of wounds by looking at it deeper rather than just merely examine its surface.           In relation with the purpose of this study mentioned above, it also aims to confirm and extend all previous studies done with regard to the investigation of the relationship existing between perceived stress and wound healing. Moreover, this research also aims to incorporate new factors that had not been taken into consideration by previous studies with regard to the topic at hand.         In order to push for further investigation, the authors of the study hypothesized that the relationship between psychological distress and the impaired process of wound healing are not as important to the effects of stress-induced changes to the health behaviours of humans, thereby suppressing the immune functions of the individuals which eventually slows down the process of wound healing. The study then also employed a prospective, within-subjects design that involved the participation of twenty four participants in order to determine the influences of cortisol levels, health behaviours and personality factors on the process by which the wounds of individuals heal. Thus, according to the authors of the article, this study employed a method that aimed to test specific hypotheses of the study rather than investigate the topic at hand in an exploratory way.         The sample was consisted of twenty four participants who were either members of the staff or students that has been randomly selected from a population at Kings College London. The article reports that the mean age was 29.49 (minimum 19, maximum 59) yet failed to clarify the group’s response rate. The authors recognized that cortisol levels differ between sexes. As a result, only male participants were recruited in order to serve as respondents for this study. Furthermore, these respondents were selected using the exclusion criteria which include the following: smoking, the intake of glucocorticoid medication or acute illness and disorders. Since the sample were solely males, the findings of the research may only be appropriate to a significant aspect of the population. As a result, the researchers have significantly ailed in generalising the findings of their study to the population of healthy individuals. Another limitation of this study is related to the use of a small sample which then affects the conclusion of this study when its data are applied to the larger samples. Moreover, the researchers also failed in providing a clear explanation on why a small sample size was chosen considering the fact that this could harm the validity of the results. In contrast to other researches made, however, the researchers were able to recruit a sample that has high age variability, thereby allowing the generalization of findings to fit a broader population. In order to probe deeply into the topic at hand, the researchers have acknowledged the influence of health related behaviours of the individuals to stress. Hence, they examined the effects of health-risk behaviours (i.e. unhealthy eating habits, disturbed sleep patterns, smoking, alcohol consumption, poor sleep or lack of physical exercise) to the delayed process of wound healing. It is in line with this that the researchers met another limitation. Whilst they acknowledge smoking as one of the health risk behaviours that they seek to study, the participants were non-smokers only. However, it must be taken into consideration that this was undertaken in order to eliminate biased perceptions. Nonetheless, the researchers should have provided reasons as to why only non-smokers participated in the study when smoking is one of the major factors being investigated. The use of a number of questionnaires (i.e. Life Orientation Test, Social Support Questionnaire, Self-Esteem Scale and UCLA Loneliness Scale which were measured once, and additionally the Perceived Stress Scale, General Health Questionnaire and Health Behaviour Questionnaire which were measured thrice) was also central to this study in order to measure health risk behaviours. However, the use of these in order to determine behaviours may yield insignificant data for respondents may falsely report their true experiences. In the same manner, the researcher may also have a hard time in correlating the responses to the numerous questionnaires that measure different behaviours. Nonetheless, the success of the researchers with regard to the development of new techniques by which they could efficiently measure the progress of wound healing must be acknowledged. Through this, the researchers were able to identify the rate of healing without inflicting further damaged to the wound which could eventually affect its process.       However, after the analysis of the data, the results seem to be insignificant. As expected, all participants showed a progress in wound healing but no correlation was recorded between perceived stress measures and the progress of wound healing. Nevertheless wound healing was found to be positively correlated with the dispositional positivism. In the same manner, measured risky health behaviours also had no effect on the speed of wound healing. Cortisol responses were also not related with the questionnaires except with the general health questionnaire score which was only obtained on the day after the biopsy. Aside from this, the study also showed that there was no correlation between cortisol responses and measures of wound healing on 14 days before and 14 days after the biopsy. Nonetheless, there was a correlation between total healing progress and the cortisol response one day after the biopsy. Thus, the findings rather than extended, more or less just replicated the already known and obtained association between psychosocial stress and impaired wound healing. Health behaviours correlated with the healing progress showed that there is no association between risky health behaviours and impaired wound healing, however the data suggests that cortisol can deviate the amount of stress and consequently the rapidity of wound healing.         Due to the specificity of the methods used by the researchers, there is a little possibility that the findings can be generalised for other people who would want to investigate the relationship between the level of stress and the process by which the wound heals. Based on the discussion above, the conclusion of the researchers were to some extent very limited and does not generally concur with the main purpose of this study. Nonetheless, the findings of the study can be significant for the members of healthcare institutions as Ebrecht and her colleagues (2003) stated. Apparently, the said results would encourage the medical practitioners to at least lessen the stress levels of patients before subjecting them to surgical procedures.         However, a major knowledge gap that arose from the review of this article is the correlation between surgical processes and wound healing which has not been effectively discussed nor measured by the study conducted by Ebrecht and her colleagues (2003).         This study, despite its limitations has to be praised for its success in adhering to the ethics of research. No respondent was harmed and all processes were approved by the Guy’s Hospital Research Ethics Committee. However, several adjustments must be made in order to ensure its validity. For example, the study could have investigated the said relationships existing between the process of wound healing, perceived stress and cortisol levels by looking into other factors such as the size of wounds, a factor given importance in the study of Takahashi and his colleagues (2009) as well as in the study of Kielcolt-Glaser et al (1995). In the same manner, the researchers could also undertake other laboratory examinations by which the past medical records of the participants could be analysed in order to determine other factors that may affect the process.   References  Ebrecht, M., et al. (2003). Perceived stress and cortisol levels predict speed of wound healing in healthy male adults. Pscyhoneuroendocrinology: 29, p. 798-809.   Kielcolt-Glaser, J.K., et al. (1995). Slowing of wound healing by psychological stress. PUBMED: 346 (8984), pp.1194-1196.  Takahashi, P., et al. (2009). A Retrospective Cohort Study of Factors that Affect Healing in Long-term Care Residents with Chronic Wounds. Ostomy Wound Management: 55 (1), p. 23. Read More