Quality of Life of Patients with Chronic Venous Ulcers and Socio-Demographic Factors

  Abstract: The aim of this study was to measure the quality of life of patients with venous ulcers and to identify associated socio-demographic factors. Methods. Thirty patients in the Angiology and Vascular Surgery Outpatients Clinic of Hospital of Faculty of Medicine in São José do Rio Preto Medical School (FAMERP), São Paulo, Brazil, participated in the investigation. Twenty-one (70%) were women and 9 (30%) were men, with ages ranging between 46 years and 72 years (mean of 56.5 years). After patients gave consent, socio-demographic data were collected and the SF-36 questionnaire was applied. The Mann-Whitney test and Spearman’s coefficient were employed in the statistical analysis. Results. The disease and the evaluated socio-demographic factors affected the quality of life of these patients. The functional capacity, pain, vitality, and physical and social aspects are better for married men compared to single or separated men. The social aspect is also better for active individuals. Conclusion. Quality of life is affected in patients with venous ulcers. Socio-demographic aspects, such as gender, marital status, and occupation may influence quality of life.

Introduction

  The venous system is, in many respects, more complex than the arterial system. A thorough understanding of the venous anatomy, pathophysiology, and available diagnostic tests is required in the management of acute and chronic venous disorders.¹ The Clinical-Etiology-Anatomy-Pathophysiology classification (CEAP) is a popular descriptive platform for chronic venous disease.² Effective venous return from the lower extremities requires the interaction of the heart, a pressure gradient, the peripheral muscle pumps of the legs, and competent venous valves.^1,2 Critical assessment of venous treatment modalities requires an understanding of the objective clinical outcome and the available instruments with which to measure quality of life (QOL).²   The principle determining factor of health-related QOL within 2 years of a diagnosis with deep vein thrombosis is the development of post-thrombotic syndrome (PTS).⁴ Patients with venous insufficiency commonly develop complications that can result in significant morbidity and occasional mortality. Venous leg ulcers, the most prevalent type of lower extremity ulcer, are the most frequent sequelae of venous insufficiency, and negatively affect the patient’s QOL.^5-7   Socio-demographic aspects, such as gender, marital status, religion, and occupation interfere in the QOL of patients with different diseases. The aim of this study was to assess the QOL of patients living from venous ulcers for more than 1 year.

Methods

  This study was approved by the Research Ethics Committee of the Medicine School in São José do Rio Preto, Brazil. Thirty patients in the Angiology and Vascular Surgery Outpatients Clinic of the Hospital of Faculty of Medicine in São José do Rio Preto Medical School (FAMERP), São Paulo, Brazil, who were diagnosed with venous ulcers, participated in the study.   All patients with venous ulcers of the lower limbs for a period exceeding 1 year were included in the study, regardless of gender, age, religion, marital status, and duration of the disease.   Exclusion criteria included refusal to participate in the study, and neurological or psychiatric diseases.   All participants submitted to a psychological evaluation with the completion of the following 2 instruments: a questionnaire about gender, age, marital status, religion, occupational status, and duration of the disease; and the SF-36 QOL questionnaire, which evaluates physical capacity, physical aspects, pain, general health state, vitality, social aspect, emotional aspect, and mental health.   The Mann-Whitney test and Spearman’s coefficient were employed in the statistical analysis with an alpha error of 5% (P < 0.05) being considered significant.

Results

  A significant correlation was identified between some evaluated domains of QOL (Table 1).   Of the 30 patients who participated in this study, 9 were working, 21 did not have a job, 17 were married, and 13 lived without partners. In respect to religion, 9 were churchgoers, and 21 did not frequent any type of church. Of the 30 participants, 21 identified themselves as Catholics, and 9 as non-Catholics.   Using the Spearman test, a correlation is seen between socio-demographic variables and elements of the SF-36 domains (Table 2).   No significant correlation was detected between employed and unemployed individuals and the evaluated domains, or between the type of church and the SF-36 domains.

Discussion

  This study shows the negative effect of venous ulcers on the QOL of patients in Brazil. Other studies have shown the socio-economic aspects evaluated (ie, marital status, occupation, and gender) also interfere with the QOL of these patients.⁸ Physical symptoms and pain most negatively affected this group of individuals, with marital status being the socio-demographic variable that most positively influenced QOL. Pain affects physical health (ie, functional capacity) and mental health (ie, emotional and social capacity). Studies affirm that pain alters the psychological balance of sufferers and can lead to a loss of self-control, sleep disorders, anxiety, and depression.^9-11   This psychological imbalance might be justified by the impact of the physical alterations caused by venous ulcers, such as the bad smell of wounds. Studies state this symptom is associated with depression and anxiety, a reduction in satisfaction in life, low self-esteem, and changes in body image.⁶ A lack of vitality correlates with mental health, as the lack of energy may be a symptom of mental disorders (ie, depression). Vitality is also associated with functional capacity, as physical limitations lead to fatigue, which, in turn, interferes in the capacity to perform day-to-day activities.   In respect to social manifestations, impairment of the following domains was identified: functional capacity, physical health, and pain. Studies affirm 67.5% of patients with venous ulcers experience social isolation.¹² This condition is associated with difficulty of movement, thereby restricting contact with other people, during periods of both leisure and work. Additionally, due to the physical manifestations of venous ulcers (eg, bad smell, secretions, and swelling) patients may experience rejection and repulsion by other people, even their own spouses. Pain also leads to negative social consequences, as it increases the limitations imposed by the disease, making contact with friends and relatives more difficult.¹³   Mental health is affected by functional capacity, as difficulty or inability to perform daily activities, and the consequences that result, have a negative impact on the psychological functioning of these individuals. Hence, they experience alterations in their mood, reduced motivation, loss of self-control, a feeling of helplessness, and a pessimistic view of the future.¹⁴ These emotions correlate to mental health as deterioration of the patient’s condition and can lead to mental disorders such as depression.¹¹   General health status is affected by functional capacity, vitality, mental health, and physical, social, and emotional aspects of the condition. Alterations in all of these domains cause the individual to negatively evaluate their state of health, which reflects as a reduction of the QOL.13 The results of this study highlighted worse mental health effects for women.   The data of this investigation did not reveal any relationship between QOL and occupational status; however, it is believed that active individuals may have a better social outlook, as work favors contact with other people, thus creating less social isolation. The lack of significance for this item may be attributed to the small sample size in this study.   Studies show that leaving work or accepting early retirement interferes with QOL due to reduced income and the high cost of treatment, and by a reduction in the pleasure attained from day-to-day activities, as this situation causes a feeling of worthlessness.¹⁵   In this study, no significant difference was seen between Catholic and non-Catholic patients. Researchers state that religiousness acts positively on mental health and is associated with psychological and spiritual growth, positive evaluations of QOL, and a reduction in symptoms suggestive of emotional problems. Moreover, religion constitutes an important source of support networks and a social integration in religious institutions.¹⁶   Married individuals presented with a better QOL compared with single and separated individuals, in respect to functional capacity, pain, vitality, and social aspects. This can be attributed to the help given by a spouse in performing daily activities, as well as to a spouse being an important source of social and emotional support.

Conclusion

  Venous ulcers affect the QOL of individuals living with them, as do socioeconomic characteristics, such as gender, marital status, and occupation.

References

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