**Background:** The COVID-19 pandemic and associated lockdowns had substantial negative socioeconomic and health consequences, including delayed healthcare access. Individuals with impaired wound healing (IWH) were particularly affected due to closure of outpatient wound clinics and postponed care. Prior research in the Netherlands showed that young adults with self-reported IWH had poorer mood, sleep, quality of life, attention, and immune fitness compared to healthy controls, and that lockdown effects were more pronounced in this group. This study aimed to confirm and extend these findings in a German cohort.
**Methods:** An online survey was conducted between mid-November 2021 and end of March 2022 among German young adults aged 18–35 years. Participants were recruited via email and printed flyers. A total of 317 individuals participated; 66 were allocated to the IWH group (based on self-reported slow-healing wounds and/or wound infections in the past year) and 251 to the control group. The IWH group had a higher proportion of women (78.8% vs. 64.5%, p=0.028). Mean age was 24.8 (SD 3.9) in the IWH group and 25.7 (SD 4.1) in controls (p=0.134). Assessments were made retrospectively for five time periods: before the pandemic (BP), first lockdown (L1, March–May 2020), first no-lockdown (NL1, summer 2020), second lockdown (L2, November 2020–May 2021), and second no-lockdown (NL2, summer 2021). Mood was assessed with validated single-item ratings (0–10 scales) for stress, anxiety, depression, fatigue, loneliness, optimism, and happiness. Quality of life and immune fitness were also rated on 0–10 scales. Attention control was measured using the 20-item Attention Control Scale (ATTS), yielding total, focusing, and shifting scores. Within-group comparisons across time used Friedman's test with Bonferroni correction (p<0.0125); between-group comparisons used Mann-Whitney U test (p<0.05).
**Key Results:** At baseline (BP), the IWH group reported significantly lower immune fitness (5.5 vs. 6.9, p<0.001), with 56.6% having reduced immune fitness vs. 24.9% in controls (p<0.001). Quality of life was also lower in the IWH group (5.8 vs. 6.8, p=0.005). Attention focusing was significantly poorer in the IWH group (20.7 vs. 22.6, p=0.007), while attention shifting did not differ (28.6 vs. 28.7, p=0.906). During lockdowns, both groups showed significant declines in mood and quality of life. For example, in the IWH group, anxiety increased from 3.9 (BP) to 5.6 (L1) and 5.6 (L2) (both p<0.001); depression increased from 3.1 to 4.3 (L1, p=0.012) and 5.0 (L2, p<0.001); loneliness increased from 2.8 to 4.7 (L1) and 5.0 (L2) (both p<0.001). Quality of life dropped from 6.3 (BP) to 4.6 (L1) and 4.5 (L2) (both p<0.001). Effects were generally more pronounced during the second lockdown. Between-group comparisons showed significantly higher stress, fatigue, anxiety, depression, and loneliness in the IWH group across most time points. For instance, during L1, stress was 5.9 (IWH) vs. 4.5 (controls, p<0.001); fatigue was 5.5 vs. 3.4 (p<0.001); anxiety was 5.6 vs. 4.1 (p<0.001); depression was 4.3 vs. 2.3 (p<0.001); loneliness was 4.7 vs. 3.1 (p<0.001). Immune fitness was significantly lower in the IWH group at all time points (all p<0.001). During no-lockdown periods, mood and quality of life generally returned to near-baseline levels, except for stress (lower during NL1) and optimism (lower during NL2).
**Clinical Implications:** This study demonstrates that young adults with self-reported impaired wound healing are a vulnerable population who experience disproportionately greater negative effects on mood, quality of life, and immune fitness during periods of healthcare disruption such as COVID-19 lockdowns. The findings suggest that this group may require targeted psychological support and prioritized wound care access during public health emergencies. The observed attention focusing deficits may also impact self-care and treatment adherence. Limitations include retrospective self-report, small convenience sample, lack of formal wound diagnosis, and inability to assess sex differences or comorbidities. Future research should examine formally diagnosed chronic wound patients, investigate causal mechanisms (e.g., delayed care, fear of COVID-19, lower mental resilience), and explore interventions to support mood and resilience in this population.