The Impact of Psychological Stress on Wound Healing: A Clinical Nursing Perspective

Background: Psychological stress, a complex subjective experience, triggers neuroendocrine and immune responses that can disrupt homeostasis. A growing body of evidence indicates that stress negatively impacts health, including tissue repair processes, suggesting a significant link between psychological state and physiological healing. Aim: This article synthesizes clinical and experimental research to examine the impact of psychological stress on wound healing and discusses the implications for nursing practice. Methods: The review integrates findings from animal models (e.g., restraint stress in rodents) and human studies, including observational clinical research and interventional studies (e.g., caregiver stress, examination stress). It analyzes how stress is assessed and explores its effects through immunological and neuroendocrine pathways. Results: Both acute and chronic psychological stress consistently delay wound healing. Mechanisms involve hypothalamic-pituitary-adrenal (HPA) axis activation, leading to elevated glucocorticoids (e.g., cortisol), which suppress pro-inflammatory cytokines (e.g., IL-1β), impair immune cell recruitment, and dysregulate matrix metalloproteinase activity. Stress is associated with higher infection rates and slower closure in both acute (surgical, experimental) and chronic wounds (e.g., leg ulcers). Maladaptive behaviors (poor sleep, nutrition) further compound these effects. Conclusion: Psychological stress is a significant, modifiable factor that impairs wound healing through defined biological pathways. This underscores the necessity of integrating psychological assessment and stress-reduction strategies into holistic wound management.