Accident proneness and impulsiveness in an Italian group of burn patients

Impulsiveness and burn patients

OBJECTIVE

Impulsiveness is a tendency to act quickly based on a whim without reflection or consideration of consequences. We studied its correlations with burn variables and mental disorders among burn patients.

METHODS

Consecutive acute burn patients (N=107) admitted to the Helsinki Burn Center were assessed with the Structured Clinical Interview for DSM-IV mental disorders (SCID) at baseline and at 6 months. All patients filled out the 30-item Barratt Impulsiveness Scale (BIS-11), the most commonly administered self-report measure and a standard point of reference in research on impulsiveness.

RESULTS

The mean total score of BIS-11 was 64.5 (range 41.0-87.8, SD±6.9). There was not a significant correlation between impulsiveness and a range of characteristics of burn injury (all p-values>0.05). We found a significant correlation between some pre-burn mental disorders and impulsiveness, alcohol dependence and attentional impulsiveness (OR=1.22, p=0.022), any personality disorder and non-planning impulsiveness (OR=1.21, p=0.005), and antisocial personality disorder and motor impulsiveness (OR=1.35, p=0.043). Patients with high impulsiveness (total score >65) more often than those with low impulsiveness (≤65), had pre-burn mental disorders such as major depressive disorder (22.6% vs. 8.6%, p=0.046), alcohol dependence (46.9% vs. 25.9%, p=0.023), or other substance dependence (12.2% vs. 1.7%, p=0.028).

CONCLUSION

Impulsiveness had a significant correlation with mental disorders but not with burn-related variables. Therefore the role of impulsiveness in burn injuries should not be investigated independently without first accounting for the role of mental disorders.

Accident occurrence and functional health patterns: a pilot study of relationships in a graduate population

PURPOSE

This pilot study sought to examine the relationship between functional health patterns and accident proneness.

METHODS

A quantitative-descriptive design was employed assessing accident proneness by collecting data on the occurrence of accidents among a sample of university graduates, and examining this in relation to biographical data and information collated using the Functional Health Pattern Assessment Screening Tool (FHPAST). Data were analyzed using descriptive and inferential statistics.

FINDINGS

One FHPAST factor predicted more frequent sports accidents. Age was also shown to be a significant predictor but in a counterintuitive way, with greater age predicting less accident proneness.

CONCLUSION

The FHPAST may have a role to play in accident prediction.

IMPLICATIONS FOR NURSING PRACTICE

Functional health pattern assessment may be useful for predicting accidents.

Prevalence and co-morbidity of psychiatric disorders 1-4 years after burn

OBJECTIVE

Currently, little is known about psychiatric disorders in the period following on the first year after burn. We examined the prevalence of DSM-IV Axis I disorders in burn patients 1-4 years after burn, using a standardized structured clinical interview and comparing findings with a representative general population sample.

METHODS

Ninety patients admitted to five burn centres were assessed with the 12-month Composite International Diagnostic Interview. Results were compared to an age and gender matched nation based norm group.

RESULTS

Twelve-month prevalence for any DSM-IV study disorder was 39%. Prevalence for any after burn onset disorder was 28%. Most prevailing were major depression (10%), generalized anxiety disorder (10%), and PTSD (7%). The comorbidity-proportions for PTSD and generalized anxiety disorder where the highest. Fifty-seven percent of all burn onset disorders started within 1 year after the trauma and 21% within the next year. Burn patients had significantly higher prevalence rates for DSM-IV disorders than people from the general population sample.

CONCLUSION

Psychiatric morbidity among burn patients, 1-4 years after burn, is considerable and higher than what may be expected in the general population. A 2-year follow-up for anxiety and depression disorder is warranted.

Mental disorders among acute burn patients

OBJECTIVE

To investigate mental disorders among acute hospitalized burn patients.

METHOD

Consecutive acute adult burn patients (n=107) admitted to Helsinki Burn Centre were interviewed by an experienced psychiatrist with the Structured Clinical Interview for DSM-IV-TR for Axis I and II mental disorders assessed in three time frames (lifetime, the month prior to burn, and in acute care). Information on clinical features, psychiatric symptoms, personality traits, and burn severity (total body surface area, TBSA) was gathered.

RESULTS

The mean TBSA was 9%. Most (61%) acute burn patients had at least one lifetime Axis I or II mental disorder. Prevalences of lifetime substance-related disorders (47%), psychotic disorders (10%), and Axis II personality disorders (23%) were high. The overall prevalence of Axis I mental disorders increased significantly (Q=6.40, df=1, p=0.011) from the month prior to burn (40%) to acute care (48%). The prevalence of delirium for this period was significantly higher (0.9% vs. 13%; Q=13.00, df=1, p<0.001) in acute care.

CONCLUSIONS

Mental disorders, particularly substance use disorders, psychotic disorders, and personality disorders are common among acute burn patients before injury. These disorders may predispose to burns. Burn itself may also predispose to mental disorders, particularly delirium.

Epidemiology of burn injuries: highlighting cultural and socio-demographic aspects

Burns are devastating injuries that disproportionately affect people in developing countries, including children. In addition to a high mortality rate, survivors are burdened with life-long physical and emotional scars. The etiology and nature of burn injuries varies significantly by country, and this chapter explores the predominant causes and patterns of burn injury in both the developing and industrialized worlds. Gender differences play a significant role in the risk of burn injuries, across a spectrum with a predominance of women injured in fires from cooking and heating fuels in the developing world and industrial accidents primarily affecting men in developed nations. Children are particularly vulnerable to burn injuries, accounting for almost 50% of all burn patients in some studies. A majority of pediatric burns are scald injuries usually affecting very young children below the age of 5 years, and we discuss the behavioral patterns underlying this finding. Finally, the elderly form a rapidly increasing proportion of the population in many countries, and are often burdened with comorbidities that are likely to pose significant challenges in burn care.