Mapping the evidence to determine the influence of stress, anxiety, and depression on wound healing in patients with diabetes-related foot ulcers: A scoping review

Introduction: Diabetes-related foot ulcers (DFUs) are a severe complication of diabetes, affecting an estimated 6.3 % of individuals globally and significantly increasing healthcare burdens. Psychological factors such as stress, anxiety, and depression are common in DFU patients and are believed to impact wound healing through immune system disruptions and decreased self-care. Objective: This scoping review evaluates current evidence on the influence of psychological distress on DFU healing, identifies research gaps, and underscores the importance of integrating mental health support in DFU management. Methods: Following Joanna Briggs Institute guidelines and PRISMA-ScR reporting standards, a comprehensive literature search was conducted in MEDLINE, CINAHL, and PubMed. Studies with adult DFU patients reporting stress, anxiety, or depression and measurable wound outcomes were included. Results: Ten studies were included, consistently demonstrating that psychological distress impairs DFU healing. Chronic stress was found to extend inflammation and weaken immune function, while anxiety and depression were associated with reduced self-care and directly impaired wound healing, further hindering recovery. These findings highlight the significant impact of psychological factors on the DFU healing process. Conclusion: psychological distress, including stress, anxiety, and depression, may impair the healing process of diabetes-related foot ulcers (DFUs). However, the evidence is very low quality, making it difficult to draw definitive conclusions. This highlights the need for further high-quality research to clarify the role of mental health in DFU management.