Burn severity and long-term psychosocial adjustment after burn injury: The mediating role of body image dissatisfaction

Prevalence and Trend of Depression in Burn Survivors: A Single Center Cohort Study

Burn injuries are frequently disastrous catastrophes that can cause significant skin damage and frequently result in hypertrophic scarring. Recovery from burn injury includes 3 domains-medical, functional, and psychiatric. Psychological concerns affect both the quality of life and the disease recovery. This study assesses the prevalence of major depression or clinically significant symptoms of depression among patients hospitalized for acute burn injury, as well as their persistence once diagnosed. It is a prospective cohort that was studied in 1%-40% of patients with body surface area burn, where the Beck Depression Inventory was used as a depressive symptom measure. A total of 108 patients were included in the study, out of which 42 (38.8%) exhibited depressive symptoms. Type of burn did not affect the prevalence of depression, whereas total body surface area had an impact on prevalence rate. The Beck Depression Inventory score assessment during the study revealed that 8.4% of participants exhibited worsening of scores during the study period and only 3.4% showed improvement throughout the study. Patients with mild depressive symptoms at admission were likely to recover, whereas those with severe depressive symptoms were less likely to recover from the psychological state. To conclude, depression was more prevalent among burn survivors from the Indian community.

Gender differences in relation to stigmatization and depressive symptoms after burns

OBJECTIVES

The aim of this study was to investigate the moderating role of gender in the relationship between burn severity, perceived stigmatization and depressive symptoms at multiple time points postburn.

MATERIALS AND METHODS

This multi-center study included data from two cohorts. Cohort 1 consisted of 215 burn survivors, participating in a longitudinal study with measures at 3 and 12 months postburn. Cohort 2 consisted of 180 burn survivors cross-sectionally assessed at 5 - 7 years postburn. Both cohorts completed self-reported measures of perceived stigmatization and depressive symptoms. The number of acute surgeries (i.e., no surgery, 1 surgery or 2 or more surgeries) was used as indicator of burn severity. Relations between number of surgeries, depressive symptoms, and perceived stigmatization, including possible indirect effects, were evaluated with gender-specific path models.

RESULTS

In both men and women, number of surgical operations was related to higher levels of depressive symptoms and perceived stigmatization at 3 months after burn. In women, number of operations was still directly related to both constructs at 12 months after burn, which was cross-sectionally confirmed in the 5-7 years after burn cohort. In men, from 3 to 12 months after burn, depressive symptoms and perceived stigmatization were bidirectionally related, and, through these effects, number of surgeries was indirectly related to both outcomes. In the cross-sectional 5-7 years after burn cohort, number of operations was related to stigma but not to depressive symptoms of men.

CONCLUSION

Number of operations had a different effect on psychosocial adaptation of male and female burn survivors. In women, a persistent direct link from number of operations to both depressive symptoms and perceived stigmatization was found over time. In men, the effect of number of operations was most evident in the short-term, after which perceived stigmatization and depressive symptoms became interrelated. This indicates that burn severity remains a factor of significance in psychological adjustment in women, whereas in men, this significance seems to decrease over time.

Experiences of appearance conversations among young people living with a visible difference

Stigmatisation surrounding having a visible difference to the face or body may have a marked impact on how young people communicate about appearance. The aim of our study was therefore to explore the experiences of appearance conversations among young people living with a visible difference. Interviews were conducted with 32 young people (mean age 14.1 years; 67.7% girls), with a condition resulting in a visible difference (e.g., craniofacial condition or scarring). Using reflexive thematic analysis, we identified three themes. Importance of Safety and Understanding reflects the importance of feeling safe in order to be able to talk about appearance. Participants described appearance conversations as often originating in their need for emotional support or practical assistance when encountering difficulties (Conversations When in Need of Support), but appearance was also experienced as a sensitive topic that was difficult to talk about (Avoiding Appearance Conversations). Our results highlight the importance of creating spaces where young people with a visible difference feel safe to bring up the topic of appearance when in need of support. Elements that facilitate such conversations include others having knowledge about the condition and having one's feelings and experiences validated instead of minimised.

Risks of mental disorders among inpatients with burn injury: A nationwide cohort study

OBJECTIVE

This investigation identified the association between burn injuries and the risk of mental disorders in patients with no documented pre-existing psychiatric comorbidities. We also examined the relationship of injury severity and the types of injury with the likelihood of receiving new diagnoses of mental disorders.

METHODS

This population-based retrospective cohort study used administrative data extracted from the Taiwanese National Health Insurance Research Database (NHIRD) between 2000 and 2013. In total, 10,045 burn survivors were matched with a reference cohort of 40,180 patients without burn injuries and were followed to determine if any mental disorder was diagnosed. Patients diagnosed with mental disorders in the five years before study initiation were excluded to ensure incident diagnoses throughout the research duration. Generalized estimating equations in Cox proportional hazard regression models were used for data analysis.

RESULTS

In general, burn injury survivors have a 1.21-fold risk of being diagnosed with new mental disorders relative to patients without burn injuries. Total body surface area (TBSA) of ≧ 30% (aHR: 1.49, 95% CI: 1.36-1.63) and third- or fourth-degree burns (aHR: 1.49, 95% CI: 1.37-1.63) had a significantly greater risk of being diagnosed with mental disorders in comparison to the reference cohort. Patients TBSA 10-29% (aHR: 0.85, 95% CI: 0.77-0.93) and first- or second-degree burn victims (aHR: 0.89, 95% CI: 0.81-0.97) had relatively lower risk of mental disorders than the reference cohort.

CONCLUSION

Burn injuries were associated with an increased risk of mental disorders. Additional research in this field could elucidate this observation, especially if the inherent limitations of the NHIRD can be overcome.

'It's not meant to be for life, but it carries on': a qualitative investigation into the psychosocial needs of young retinoblastoma survivors

OBJECTIVE AND DESIGN

Retinoblastoma (Rb) is a rare childhood eye cancer, with 45% of individuals impacted by heritable disease and the remainder impacted non-heritably. The condition can leave survivors with life-long psychological and social challenges. This qualitative study examined the psychosocial needs of teenagers and young adults living beyond Rb.

SETTING

A qualitative, exploratory study was conducted using focus groups with teenagers and interviews with young adults. Participants were recruited via the Childhood Eye Cancer Trust and the two national Rb treatment centres in the UK. Reflexive thematic analysis was used to analyse data using exploratory and inductive methods.

PARTICIPANTS

32 young survivors of Rb (10 heritable, 21 non-heritable, 1 unknown; 23 unilateral, 9 bilateral) aged between 13 and 29 years (12 male, 20 female).

RESULTS

Data were rich and spanned the life course: three key themes were generated, containing eight subthemes. Theme 1 describes participants' experiences of childhood and trauma, including survivor guilt, memories from treatment and impact on personality. Theme 2 focuses on the challenges of adolescence, including the psychological impact of Rb, the impact on identity, and the sense of normality and adaptation to late effects. The third theme considered adulthood and the development of acceptance, a state of being widely considered unachievable during childhood, as well as the 'work' needed to feel supported, including seeking out information, peer support and therapeutic strategies.

CONCLUSIONS

This study provides in-depth insight into the experiences of life beyond Rb. Findings highlight the need for specific psychosocial interventions informed by codesign.

Predicting DSM-5 PTSD symptomatology 6 months to 2 years after burn: The role of early psychological risk factors

BACKGROUND

Major burn injuries may have long-term mental health consequences, such as posttraumatic stress disorder (PTSD). This study extended prior work to investigate DSM-5 PTSD symptoms at 6 months, 1 year, and 2 years post-burn as well as the contribution of two sets of early psychological risk factors to DSM-5 PTSD symptoms: Established PTSD risk factors (prior adjustment problems, past trauma, perception of life threat, peritraumatic emotions and dissociation) and theory-derived cognitive factors (negative appraisals of the trauma and its sequelae, memory disorganization, trauma-related rumination, and thought suppression).

METHOD

The current study recruited a sample of 118 adult burn patients (75.4% men, mean age 41.8, mean TBSA 18.3%) consecutively admitted to a large regional burn center in Northern Taiwan, who were assessed at 6, 12, and 24 months following their burn injury.

RESULTS

A total of 11.0%, 5.9%, and 7.6% met probable DSM-5 PTSD at 6 months, 1 year, and 2 years post-burn, respectively. The rates rose to 15.3%, 10.2%, and 11.0% using the cutoff method. After controlling for covariates, the regression model with theory-derived cognitive factors explained an additional significant 15.9%, 17.2%, and 17.7% of the variance in DSM-5 PTSD symptoms at 6 months, 1 year, and 2 years post-burn, respectively. In contrast, the regression model with established PTSD risk factors explained an additional significant 7.2%, 14.4%, and 10.5% of the variance in DSM-5 PTSD symptoms at 6 months, 1 year, and 2 years post-burn, respectively. Of all predictors, negative appraisals of intrusions was consistently and strongly predictive of DSM-5 PTSD symptomatology post-burn across time, followed by prior depression.

CONCLUSIONS

The results underscore the role of early cognitive risk factors in the development and persistence of DSM-5 PTSD symptomatology following burn injury.

Nitrous Oxide to Reduce Wound Care-Related Pain in Adults: A Systematic Review and Meta-Analysis

Significance: As an essential procedure, wound care comes with acute pain, which is short but high in intensity, causing patients to fear and affecting subsequent treatment. Nitrous oxide (N2O) is used to relieve pain related to wound care; however, evidence regarding its application is conflicting. Thus, this systematic review and meta-analysis was performed to evaluate the efficacy of N2O in wound care-related pain. Recent Advances: Randomized controlled trials that investigated the effect of N2O in adults undergoing wound care were systematically searched from PubMed, Embase, the Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov up to February 2023. The primary outcome was the pain score. Secondary outcomes included patients' satisfaction and side effects. Critical Issues: Through screening the 265 identified articles, seven and six studies were finally included in the systematic review and meta-analysis, respectively. Pooled analysis suggested that there was no significant difference in reducing wound care-related pain between the N2O group and the control group (mean difference [MD], -0.02, 95% confidence interval [CI], -1.46, 1.42; p = 0.98, I2 = 96%). Subgroup analyses indicated that there was a significant difference in favor of N2O for burns, not for ulcers, and N2O was superior to oxygen and similar to topical or intravenous anesthesia. There was no significant difference in patients' satisfaction or the incidence of side effects between groups. Future Directions: This review suggests that N2O might be effective for pain management in patients undergoing wound care. Caution must be taken when interpreting these results due to the high risk of biased methods in the included studies.

The effectiveness of the psychosocial empowerment program in early adjustment among adult burn survivors

BACKGROUND

Burns constitute a major global health challenge, causing not only physical trauma, but also significant psychosocial and emotional disturbances. The complexity of these injuries requires comprehensive rehabilitation programs that address both the physical and psychosocial aspects of recovery. Despite advances in medical care, there is a lack of standardized, accessible, and sustainable psychosocial interventions for burn survivors, particularly in the transition from hospital to home. This study aimed to develop and evaluate a nurse-led psychosocial empowerment intervention for early adjustment among burn survivors after hospital discharge.

METHODS

The study adopted a quasi-experimental framework. A convenient sample of 80 adult burn survivors was randomly divided into an intervention group, receiving the psychosocial empowerment program, and a control group, continuing standard care from November 2022 to May 2023. The effectiveness of the program was evaluated using various tools that measure satisfaction with appearance, coping abilities, and symptoms of post-traumatic stress disorder (PTSD). The intervention focused on enhancing resilience, self-efficacy, and adaptive coping, through targeted skill building in stress management, adaptability to coping, social reintegration, emotion regulation, and problem-solving.

RESULTS

Participants in the intervention group demonstrated significant improvements in body image satisfaction, coping abilities, and symptoms of PTSD compared to the control group.

CONCLUSIONS

The psychosocial empowerment program effectively addressed the psychosocial needs of burn survivors and enhanced their early adjustment after hospital discharge. The findings highlight the critical role of psychosocial support in the rehabilitation of burn survivors and underscore the need to integrate such interventions into standard post-discharge care. Future research should focus on the long-term effects of these interventions and their applicability in diverse settings.

PTSD and depression in adult burn patients three months postburn: The contribution of psychosocial factors

OBJECTIVE

Burn injuries can be traumatic and increase the risk of posttraumatic stress disorder (PTSD) and major depression (MDD). The current study examined the incremental contribution of established predictors of PTSD and theory-derived cognitive predictors to PTSD and depression early after burn.

METHODS

Participants were 118 adult burn patients consecutively admitted to the largest burn center in Taiwan who completed a baseline assessment, of which 101 (85.6%) were reassessed 3-month post-burn.

RESULTS

Three months after the burn, 17.8% and 17.8% of participants met probable DSM-5 PTSD and MDD, respectively. The rates rose to 24.8% and 31.7% using a cut-off of 28 on the Posttraumatic Diagnostic Scale for DSM-5 and 10 on the Patient Health Questionnaire-9, respectively. After controlling for potential confounders, the model with established predictors uniquely explained 26.0% and 16.5% of the variance of PTSD and depressive symptoms 3-month post-burn, respectively. The model with theory-derived cognitive predictors uniquely explained 17.4% and 14.4% of the variance, respectively. Posttrauma social support and thought suppression remained significant predictors of both outcomes.

CONCLUSION

A sizeable subset of burn patients suffer from PTSD and depression early after burn. Social and cognitive factors are implicated in the development and recovery of post-burn psychopathology.

A meta-ethnography of developing and living with post-burn scars

INTRODUCTION

Post-burn scarring is often cosmetically unappealing and create discomfort. This makes it crucial to understand the experience of individuals living with scars which can offer insights into their recovery. This review sought to develop an in-depth understanding of living with post-burn scars.

DESIGN

A systematic review and meta-ethnography approach were employed. We utilized an interpretive approach to inductively generate codes. These codes were examined iteratively using a constant comparison strategy following which they were re-interpreted to formulate themes which formed the basis of undertaking a narrative synthesis.

RESULTS

Twenty-five studies were retained. The analytical process yielded two themes: emergence of a new identity and living with the redefined self. The experience of living with scars is entwined with the initial trauma as the scars served as a permanent reminder of the injury. Emergence of a new identity involved a process of meaning making, mourning the loss of the old self, confronting the new self, reconciling the remains of the old self with the new, rebuilding a new identity, and navigating through functional restrictions. These processes were particularly challenging for persons involved in self-immolation. Positive coping and changing one's perspective emerged as strategies to facilitate living with the redefined self.

CONCLUSION

Living with scars is a challenging process which is more difficult for persons whose injuries are due to self-immolation (act of burning oneself). The findings highlight a latent yet ongoing process towards subjective recovery. Clinicians need to be aware of the processes and incorporate these into rehabilitation programmes.

CLINICAL RELEVANCE

Burn survivors need ongoing professional support to adjust to and live with the scars. Victims of self-immolation should be considered for early psychosocial support.

Is it safe? Exploring positive and negative outcome changes following a web-based intervention for adolescents distressed by a visible difference (YP Face IT)

Despite the importance of making sure that psychological interventions are safe, research including both positive and negative effects of novel internet-delivered support is scarce. The aim of our study was to explore whether, and in what way, a new intervention for adolescents distressed by a visible difference (YP Face IT; YPF, Norwegian version) led to positive and/or negative outcome changes. Participants were 79 adolescents (62.00% girls; M_age = 13.84, SD = 1.73), with a visible difference. All had access to the YPF programme and answered questionnaires assessing social anxiety and body esteem pre- and post-intervention. Analyses included calculations of statistical as well as clinically significant and reliable changes. Results showed that fewer participants reported clinical levels of social anxiety and low body esteem after access to YPF. Results also indicated that participants who had a positive pre- to post-intervention change had lower levels of perceived self-worth pre-intervention, and spent more time on the intervention than those with a negative pre- to post change. Three participants showed a clinically significant negative and reliable change in social anxiety or body esteem from pre- to post-intervention. However, based on an examination of these participants' characteristics, preliminary findings support the safety of YPF.

Cost‐effectiveness analysis of a psychosocial web‐based intervention for adolescents distressed by a visible difference: Results from a randomized controlled trial in Norway

Adolescents with a visible difference to the face or body (e.g., due to a congenital condition, illness, or injury), may be at risk of elevated psychological distress. Young Person's Face IT (YPF), a web-based psychosocial intervention, has displayed effectiveness, but no previous study has specifically evaluated its cost-effectiveness. The aim of our study was to investigate whether YPF could be a cost-effective alternative for psychosocial support to adolescents distressed by a visible difference, relative to care-as-usual (CAU). Within the context of a randomized controlled trial in Norway, 102 participants (43% boys) were allocated to intervention (n = 55) or waiting list control group (n = 47). Mean age was 13.9 years (SD = 1.71; range 11-18), and all self-identified as experiencing distress related to a visible difference. Participants answered questionnaires including measures of health-related quality of life and social anxiety at baseline and 3-month follow-up. A health economic evaluation using the method of cost-utility analysis was performed, including quality-adjusted life-years (QALYs). Results indicated that the incremental cost-effectiveness of YPF was 63,641 Norwegian kroner per QALYs gained, which is well within the acceptability threshold in the Norwegian healthcare sector. Hence, YPF could potentially be considered a cost-effective intervention for adolescents experiencing distress related to a visible difference, but more research is needed that includes comparisons of YPF to other health- and societal resources and long-term follow-ups. Our study also constitutes an addition to research as, compared to interventions for somatic diseases, there is a lack of studies exploring the cost-effectiveness of psychological interventions.

Proceedings of the 2021 American Burn Association State and Future of Burn Science Meeting

Periodically, the American Burn Association (ABA) has convened a State of the Science meeting on various topics representing multiple disciplines within burn care and research. In 2021 at the request of the ABA President, meeting development was guided by the ABA's Burn Science Advisory Panel (BSAP) and a subgroup of meeting chairs. The goal of the meeting was to produce both an evaluation of the current literature and ongoing studies, and to produce a research agenda and/or define subject matter-relevant next steps to advance the field(s). Members of the BSAP defined the topics to be addressed and subsequently solicited for nominations of expert speakers and topic leaders from the ABA's Research Committee. Current background literature for each topic was compiled by the meeting chairs and the library then enhanced by the invited topic and breakout discussion leaders. The meeting was held in New Orleans, LA on November 2nd and 3rd and was formatted to allow for 12 different topics, each with two subtopics, to be addressed. Topic leaders provided a brief overview of each topic to approximately 100 attendees, followed by expert-lead breakout sessions for each topic that allowed for focused discussion among subject matter experts and interested participants. The breakout and topic group leaders worked with the participants to determine research needs and associated next steps including white papers, reviews and in some cases collaborative grant proposals. Here, summaries from each topic area will be presented to highlight the main foci of discussion and associated conclusions.

Examining the perceived stress and body image in burn patients: A cross-sectional study

This study aimed to examine the perceived stress and body image in burn patients and the relationship between these two variables. This is a descriptive and cross-sectional study. The study included total of 144 patients who had burn injuries, received treatment in a research and training hospital and were scheduled to be discharged. The data were collected prospectively by the researchers, using descriptive methods, Kruskal Wallis test, paired samples t test, and Pearson's correlation analysis. Of the patients, 59% were between the ages of 18 and 35 years, 68.1% were male, 65.3% had second-degree burns, 77.1% had burn surfaces ranging between 10% and 20% of their body, and 54.9% had autograft surgery. The burn patients aged 51 years and over had higher perceived stress than younger patients, and the difference between them was statistically significant (P < 0.05). As the percentage of burn surface increased, the perceived stress increased, and the perceived body image weakened (P < 0.05). The burn patients with autograft surgery had lower perceived stress and higher perceived body image than those without autograft surgery, and the difference between them was statistically significant (P < 0.01). This study found an inverse relationship between perceived stress and body image in burn patients, which was affected by the percentage of burn surface and autograft surgery. Relevant interventions are suggested to increase perceived body image in burn patients and reduce their perceived stress.

"Through the fire and flames, we carry on:" Art Therapy Small N Feasibility Study with Adult Burn Patients in an Acute Care Setting

This study aimed to investigate the feasibility of facilitating four sessions of art therapy intervention with a primary focus on implementation and acceptability. The exploratory aim was on assessing the impact of art therapy on self-reported outcomes on anxiety and mood among 5 individuals (aged 18+ years) hospitalized for burn injuries and to understand their perceptions of engagement with art therapy. A convergent mixed methods small N design was adopted wherein both quantitative and qualitative data are gathered and then integrated, and an individual served as his/her own control when assessed before and after art therapy. Anxiety was assessed using Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety short-form of the emotional distress bank, and mood was assessed using the Positive and Negative Affect Schedule (PANAS). There was a statistically significant decrease in anxiety scores and negative mood scale. Positive mood scale scores tended to improve after art therapy though were not statistically significant. Thematic analysis of qualitative data indicates that art therapy improves a) symptom management, b) facilitates emotional expression and c) insight, d) brings out symbolic and metaphorical representations, and e) allows tactile and sensory exploration of art media. This study demonstrated that art therapy can be successfully implemented with acute burn patients and can have promising psychosocial benefits. More research in needed to determine the impact and effectiveness of art therapy with burn patients, in ways that is meaningful to the patients.

Body image dissatisfaction and experimental pressure pain sensitivity in a cohort of 13-year-old adolescents

OBJECTIVE

We aimed to quantify the associations between body image (dis)satisfaction and pressure pain thresholds in adolescents, using data from Generation XXI, a population-based cohort study in Portugal.

METHODS

We assessed 1785 13-year old adolescents cross-sectionally. Body image satisfaction was measured using the Children's Figure Rating Scale. Pain detection and tolerance thresholds were assessed using cuff pressure algometry. We quantified the associations between body image categories (satisfied, prefers slightly thinner, prefers much thinner, and prefers heavier) and pain detection and tolerance thresholds using linear and logistic regression for continuous and binary (odds of achieving the highest distribution quarter) outcomes, respectively. Models were adjusted to pubertal stage and body mass index.

RESULTS

Adolescents who desired a heavier silhouette had lower pressure pain tolerance thresholds when compared to those who were satisfied (linear regression coefficient: -3.95; 95% confidence interval: -6.68, -1.21), which was more precise in boys (-3.51; -7.17, -0.08). Those adolescents also had lower odds of achieving the highest quarter of pressure pain tolerance threshold (odds ratio: 0.66; 0.48, 0.90), especially girls (0.58; 0.35, 0.98). Adolescents who desired much thinner silhouettes had lower odds of achieving the highest quarter of pressure pain tolerance (0.68; 0.46, 1.00), and this was clearer in girls (0.66; 0.48, 0.90). Pain detection thresholds did not show robust associations with body image dissatisfaction.

CONCLUSION

Our study suggests an association between satisfaction with one's silhouette and pain tolerance in adolescents from the general population, arguing for an integrated approach to the assessment of body image and pain sensitivity.

The cultural adaptation and validation of Turkish version of the satisfaction with appearance scale (SWAP-TR)

AIM

The aim of this study was to translate, culturally adapt and validate the Satisfaction with Appearance Scale (SWAP) into Turkish to be used in the context of pediatric burn care.

METHOD

This methodological study was conducted in two stages as Language Adaptation and Psychometric study. In the first stage, the Turkish scale was obtained after expert translations. A pilot study was conducted. After back-translation, and the scale was finalized. In the second stage, the scale was administered to 145 children with burns. Body Appreciation Scale for Children (BASC) was applied to the same group for correlation analysis with the scale.

RESULTS

A structure explaining 65.98 % of the total variance was obtained. Cronbach's alpha values in the range of 0.995-1000 were quite reliable. A statistically significant correlation was determined between the test and retest applications for all the items (0.99-1.00) in the positive direction (p < 0.001). There is a linear negative moderate correlation between BASC scores and the scores of the SWAP-TR scale (r = -0.621 p<0.001). The dissatisfaction scores of children with face, hand and leg burns are significantly higher than the other groups.

CONCLUSIONS

SWAP-TR is a reliable and valid instrument for use in a Turkish speaking children with burns. It is recommended to study the validity of this scale in other age groups with burns in Turkey.

Unveiling the Association between Body Image Dissatisfaction and Dental Anxiety

Background: Increased demands for invasive and non-invasive treatments related to body image disturbances are seen worldwide. These demands may be related to body image dissatisfaction. No study to date investigated the relationship between body image dissatisfaction and dental anxiety (namely, anticipatory dental anxiety and treatment dental anxiety) among a non-clinical population. The current study aims to unveil such relationships. Methods: Dentally anxious people may choose to ‘cope’ with their anxiety via unnecessary invasive procedures related to their body image dissatisfaction. In the current study, 553 individuals completed an online survey assessing their dental anxiety, dental neglect, and body image via self-report questionnaires. Results: Body image dissatisfaction was significantly correlated with dental anxiety. In contrast to previous studies, dental neglect was negatively associated with dental anxiety. Additionally, no link was found between body image dissatisfaction and dental neglect. Conclusions: The current study highlights the importance of addressing these factors prior to invasive procedures.

The relation between satisfaction with appearance and race and ethnicity: A National Institute on Disability, Independent Living, and Rehabilitation Research burn model system study

Research supports that people of color in the U.S. have poorer outcomes after burn injury compared to White individuals. The current study sought to explore burn health disparities by testing the relationship between racial and ethnic minority status, a proxy for systemic discrimination due to race and ethnicity, with two key constructs linked to functional outcomes, satisfaction with appearance and social community integration. Participants included 1318 burn survivors from the Burn Model System National Database (mean age = 40.2, SD = 12.7). Participants completed measures of satisfaction with appearance and social community integration at baseline, 6-, 12-, and 24-months after burn injury. Linear regressions revealed that racial and ethnic minority status significantly related to lower satisfaction with appearance and social community integration compared to White individuals at all time points. In addition, satisfaction with appearance continued to significantly relate to greater social community integration even while accounting for race and ethnicity, age, sex, burn size, and physical disability at 6-, 12-, and 24-month time points. Overall, the study supports that racial and ethnic minority burn survivors report greater dissatisfaction with their appearance and lower social community reintegration after burn injury.