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Druery M, Das A, Warren J, Newcombe PA, Lipman J, Cameron CM. Early predictors of health-related quality of life outcomes at 12 months post-burn: ABLE study. Injury 2024; 55:111545. [PMID: 38584078 DOI: 10.1016/j.injury.2024.111545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/21/2024] [Accepted: 04/01/2024] [Indexed: 04/09/2024]
Abstract
There remains a paucity of evidence on the early predictors of long-term Health-Related Quality of Life (HRQoL) outcomes post-burn in hospitalised adults. The overall aim of this study was to identify the factors (personal, environmental, burn injury and burn treatment factors) that may predict long-term HRQoL outcomes among adult survivors of hospitalised burn injuries at 12 months post-burn. A total of 274 participants, aged 18 years or over, admitted to a single state-wide burn centre with a burn injury were recruited. Injury and burn treatment information were collected from medical records or the hospital database and surveys collected demographic and social data. HRQoL outcome data were collected at 3-, 6- and 12-months using the 12-Item Short Form Survey (SF-12 v1) and Burns Specific Health Scale-Brief (BSHS-B). Personal, environmental, burn injury and burn treatment factors were also recorded at baseline. Analyses were performed using linear and logistic regression. Among 274 participants, 71.5 % (N=196) remained enrolled in the study at 12 months post-burn. The majority of participants reported HRQoL outcomes comparable with population norms and statistically significant improvements in generic (SF-12 v1) and condition-specific (BSHS-B) outcomes over time. However, for participants with poor HRQoL outcomes at 12-months post-burn, Univariable predictors included longer hospital length of stay, unemployment at the time of injury, a diagnosed pre-injury mental health condition, inadequate pre-burn social support, intentional injury, recreational drug use pre-injury and female gender. The early multivariable predictors of insufficient HRQoL outcomes were female gender, a previously diagnosed mental health condition, unemployment, inadequate social support, intentional injury, and prolonged hospital length of stay. These results suggest potential factors that could be used to screen and burns patients for psychosocial intervention and long-term follow up.
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Affiliation(s)
| | - Arpita Das
- Jamieson Trauma Institute, Australia; Queensland University of Technology, Australia.
| | - Jacelle Warren
- Jamieson Trauma Institute, Australia; Queensland University of Technology, Australia
| | | | - Jeffrey Lipman
- The University of Queensland, Australia; Jamieson Trauma Institute, Australia
| | - Cate M Cameron
- Jamieson Trauma Institute, Australia; Queensland University of Technology, Australia
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Gesi C, Cirnigliaro G, Achilli F, Cerioli M, Cafaro R, Boscacci M, Dell’Osso B. The Impact of COVID-19 Pandemic First Wave on Healthcare Workers: A New Perspective from Qualifying PTSD Criterion A to Assessing Post-Traumatic Growth. J Clin Med 2023; 12:jcm12051862. [PMID: 36902649 PMCID: PMC10003652 DOI: 10.3390/jcm12051862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023] Open
Abstract
Post-traumatic growth (PTG) and specific traumatic events have been poorly explored in the literature focusing on post-traumatic stress disorder (PTSD) among healthcare workers (HWs) tackling the COVID-19 pandemic. In a large sample of Italian HWs, we investigated the kinds of traumatic events and whether PTG affects the risk of PTSD, along with its prevalence and features, during the first COVID-19 wave. COVID-19-related stressful events, Impact of Event Scale-Revised (IES-R) and PTG Inventory-Short Form (PTGI-SF) scores were collected through an online survey. Out of 930 HWs included in the final sample, 257 (27.6%) received a provisional PTSD diagnosis based on IES-R scores. Events referring to the overall pandemic (40%) and to a threat to a family member (31%) were reported as the most stressful events. Female sex, previous mental disorders, job seniority, unusual exposure to sufferance and experiencing a threat to one's family significantly increased the provisional PTSD diagnosis' risk, while being a physician, the availability of personal protective equipment and moderate/greater scores on the PTGI-SF spiritual change domain were found to be protective factors.
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Affiliation(s)
- Camilla Gesi
- Department of Biomedical and Clinical Sciences Luigi Sacco, Department of Psychiatry, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| | - Giovanna Cirnigliaro
- Department of Biomedical and Clinical Sciences Luigi Sacco, Department of Psychiatry, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
- Correspondence: ; Tel.: +39-0239042904
| | - Francesco Achilli
- Department of Biomedical and Clinical Sciences Luigi Sacco, Department of Psychiatry, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| | - Matteo Cerioli
- Department of Biomedical and Clinical Sciences Luigi Sacco, Department of Psychiatry, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| | - Rita Cafaro
- Department of Biomedical and Clinical Sciences Luigi Sacco, Department of Psychiatry, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| | - Maria Boscacci
- Department of Biomedical and Clinical Sciences Luigi Sacco, Department of Psychiatry, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
| | - Bernardo Dell’Osso
- Department of Biomedical and Clinical Sciences Luigi Sacco, Department of Psychiatry, ASST Fatebenefratelli-Sacco, University of Milan, 20157 Milan, Italy
- Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford Medical School, Stanford University, Stanford, CA 94305, USA
- CRC “Aldo Ravelli” for Neurotechnology & Experimental Brain Therapeutics, University of Milan, 20122 Milan, Italy
- Centro per lo Studio dei Meccanismi Molecolari alla Base delle Patologie Neuro-Psico-Geriatriche, University of Milan, 20122 Milan, Italy
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Surviving Burn Injury: Drivers of Length of Hospital Stay. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020761. [PMID: 33477442 PMCID: PMC7829802 DOI: 10.3390/ijerph18020761] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 11/17/2022]
Abstract
With a reduction in the mortality rate of burn patients, length of stay (LOS) has been increasingly adopted as an outcome measure. Some studies have attempted to identify factors that explain a burn patient’s LOS. However, few have investigated the association between LOS and a patient’s mental and socioeconomic status. There is anecdotal evidence for links between these factors; uncovering these will aid in better addressing the specific physical and emotional needs of burn patients and facilitate the planning of scarce hospital resources. Here, we employ machine learning (clustering) and statistical models (regression) to investigate whether segmentation by socioeconomic/mental status can improve the performance and interpretability of an upstream predictive model, relative to a unitary model. Although we found no significant difference in the unitary model’s performance and the segment-specific models, the interpretation of the segment-specific models reveals a reduced impact of burn severity in LOS prediction with increasing adverse socioeconomic and mental status. Furthermore, the socioeconomic segments’ models highlight an increased influence of living circumstances and source of injury on LOS. These findings suggest that in addition to ensuring that patients’ physical needs are met, management of their mental status is crucial for delivering an effective care plan.
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Increased Rate of Long-term Mortality Among Burn Survivors: A Population-based Matched Cohort Study. Ann Surg 2020; 269:1192-1199. [PMID: 31082920 DOI: 10.1097/sla.0000000000002722] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To estimate long-term mortality following major burn injury compared with matched controls. SUMMARY BACKGROUND DATA The effect of sustaining a major burn injury on long-term life expectancy is poorly understood. METHODS Using health administrative data, all adults who survived to discharge after major burn injury between 2003 and 2013 were matched to between 1 and 5 uninjured controls on age, sex, and the extent of both physical and psychological comorbidity. To account for socioeconomic factors such as residential instability and material deprivation, we also matched on marginalization index. The primary outcome was 5-year all-cause mortality, and all patients were followed until death or March 31, 2014. Cumulative mortality estimates were estimated using the Kaplan-Meier method. Cox proportional hazards modeling was used to estimate the association of burn injury with mortality. RESULTS In total, 1965 burn survivors of mean age 44 (standard deviation 17) years with median total body surface area burn of 15% [interquartile range (IQR) 5-15] were matched to 8671 controls and followed for a median 5 (IQR 2.5-8) years. Five-year mortality was significantly greater among burn survivors (11 vs 4%, P < 0.001). The hazard ratio was greatest during the first year (4.15, 95% CI 3.17-5.42), and declined each year thereafter, reaching 1.65 (95% CI 1.02-2.67) in the fifth year after discharge. Burn survivors had increased mortality related to trauma (mortality rate ratio, MRR 9.8, 95% CI 5-19) and mental illness (MRR 9.1, 95% CI 4-23). CONCLUSIONS Burn survivors have a significantly higher rate of long-term mortality than matched controls, particularly related to trauma and mental illness. Burn follow-up should be focused on injury prevention, mental healthcare, and detection and treatment of new disease.
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Moosavi S, Nwaka B, Akinjise I, Corbett SE, Chue P, Greenshaw AJ, Silverstone PH, Li XM, Agyapong VIO. Mental Health Effects in Primary Care Patients 18 Months After a Major Wildfire in Fort McMurray: Risk Increased by Social Demographic Issues, Clinical Antecedents, and Degree of Fire Exposure. Front Psychiatry 2019; 10:683. [PMID: 31620033 PMCID: PMC6760025 DOI: 10.3389/fpsyt.2019.00683] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 08/23/2019] [Indexed: 11/13/2022] Open
Abstract
Objectives: To assess prevalence of likely posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD) in patients attending the only out-of-hours primary care clinic in Fort McMurray some 18 months following a major fire. Methods: A quantitative cross-sectional survey was used to collect data through self-administered paper-based questionnaires to determine likely PTSD, MDD, and GAD using the PTSD Checklists for Diagnostic and Statistical Manual (DSM) 5, Patient Health Questionnaire (PHQ) 9, and GAD-7, respectively, from residents of Fort McMurray who were impacted by the wildfires. This was carried out eighteen (18) months after a major wildfire, which required the rapid evacuation of the entire city population (approximately 90,000 individuals). Results: We achieved a response rate of 48% and results from the 290 respondents showed the 1 month prevalence rate for likely PTSD was 13.6%, likely MDD was 24.8%, and likely GAD was 18.0%. Compared to self-reported prevalence rates before the wildfire (0%, 15.2%, and 14.5% respectively), these were increased for all diagnoses. After controlling for other factors in a logistic regression model, there were statistically significant associations between individuals who had likely PTSD, MDD, and GAD diagnoses and multiple socio-demographic, clinical, and exposure-related variables as follows: PTSD: History of anxiety disorder and received counselling had odds ratios (ORs) of 5.80 and 7.14, respectively. MDD: Age, witnessed the burning of homes, history of depressive disorder, and receiving low level support from friends and family had ORs of 2.08, 2.29, 4.63, and 2.5, respectively. GAD: Fearful for their lives or the lives of friends/family, history of depressive disorder, and history of anxiety disorder had ORs of 3.52, 3.04, and 2.68, respectively. There were also associations between individuals with a likely psychiatric diagnosis and those who also had likely alcohol or drug abuse/dependence. Conclusion: Our study suggests there are high prevalence rates for mental health and addiction conditions in patients attending the out-of-hours clinic 18 months after the wildfires, with significant associations between multiple variables and likely PTSD, MDD, and GAD. Further studies are needed to explore the impact of population-based mental health interventions on the long-term mental health effects of the wildfires.
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Affiliation(s)
- Shahram Moosavi
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Bernard Nwaka
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Idowu Akinjise
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sandra E. Corbett
- Department of Psychiatry, Northern Lights Regional Health Centre, Fort McMurray, AB, Canada
| | - Pierre Chue
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Andrew J. Greenshaw
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Peter H. Silverstone
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Xin-Min Li
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Vincent I. O. Agyapong
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Deeter L, Seaton M, Carrougher GJ, McMullen K, Mandell SP, Amtmann D, Gibran NS. Hospital-acquired complications alter quality of life in adult burn survivors: Report from a burn model system. Burns 2019; 45:42-47. [DOI: 10.1016/j.burns.2018.10.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 10/08/2018] [Accepted: 10/17/2018] [Indexed: 12/01/2022]
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Predictors of health-related quality of life after burn injuries: a systematic review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:160. [PMID: 29898757 PMCID: PMC6000969 DOI: 10.1186/s13054-018-2071-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/17/2018] [Indexed: 01/08/2023]
Abstract
Background Identifying predictors of health-related quality of life (HRQL) following burns is essential for optimization of rehabilitation for burn survivors. This study aimed to systematically review predictors of HRQL in burn patients. Methods Medline, Embase, Web of Science, Cochrane, CINAHL, and Google Scholar were reviewed from inception to October 2016 for studies that investigated at least one predictor of HRQL after burns. The Quality in Prognostic Studies tool was used to assess risk of bias of included studies. Results Thirty-two studies were included. Severity of burns, postburn depression, post-traumatic stress symptoms, avoidance coping, less emotional or social support, higher levels of neuroticism, and unemployment postburn were found to predict a poorer HRQL after burns in multivariable analyses. In addition, weaker predictors included female gender, pain, and a postburn substance use disorder. Risk of bias was generally low in outcome measurement and high in study attrition and study confounding. Conclusions HRQL after burns is affected by the severity of burns and the psychological response to the trauma. Both constructs provide unique information and knowledge that are necessary for optimized rehabilitation. Therefore, both physical and psychological problems require attention months to years after the burn trauma. Electronic supplementary material The online version of this article (10.1186/s13054-018-2071-4) contains supplementary material, which is available to authorized users.
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Scholten AC, Haagsma JA, Steyerberg EW, van Beeck EF, Polinder S. Assessment of pre-injury health-related quality of life: a systematic review. Popul Health Metr 2017; 15:10. [PMID: 28288648 PMCID: PMC5348891 DOI: 10.1186/s12963-017-0127-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 02/28/2017] [Indexed: 12/15/2022] Open
Abstract
Background Insight into the change from pre- to post-injury health-related quality of life (HRQL) of trauma patients is important to derive estimates of the impact of injury on HRQL. Prospectively collected pre-injury HRQL data are, however, often not available due to the difficulty to collect these data before the injury. We performed a systematic review on the current methods used to assess pre-injury health status and to estimate the change from pre- to post-injury HRQL due to an injury. Methods A systematic literature search was conducted in EMBASE, MEDLINE, and other databases. We identified studies that reported on the pre-injury HRQL of trauma patients. Articles were collated by type of injury and HRQL instrument used. Reported pre-injury HRQL scores were compared with general age- and gender-adjusted norms for the EQ-5D, SF-36, and SF-12. Results We retrieved results from 31 eligible studies, described in 41 publications. All but two studies used retrospective assessment and asked patients to recall their pre-injury HRQL, showing widely varying timings of assessments (soon after injury up to years after injury). These studies commonly applied the SF-36 (n = 13), EQ-5D (n = 9), or SF-12 (n = 3) using questionnaires (n = 14) or face-to-face interviews (n = 11). Two studies reported prospective pre-injury assessment, based on prospective longitudinal cohort studies from a sample of initially non-injured patients, and applied questionnaires using the SF-36 or SF-12. The recalled pre-injury HRQL scores of injury patients consistently exceeded age- and sex-adjusted population norms, except in a limited number of studies on injury types of higher severity (e.g., traumatic brain injury and hip fractures). All studies reported reduced post-injury HRQL compared to pre-injury HRQL. Both prospective studies reported that patients had recovered to their pre-injury levels of physical and mental health, while in all but one retrospective study patients did not regain the reported pre-injury levels of HRQL, even years after injury. Conclusions So far, primarily retrospective research has been conducted to assess pre-injury HRQL. This research shows consistently higher pre-injury HRQL scores than population norms and a recovery that lags behind that of prospective assessments, implying a systematic overestimation of the change in HRQL from pre- to post-injury due to an injury. More prospective research is necessary to examine the effect of recall bias and response shift. Researchers should be aware of the bias that may arise when pre-injury HRQL is assessed retrospectively or when population norms are applied, and should use prospectively derived HRQL scores wherever possible to estimate the impact of injury on HRQL. Electronic supplementary material The online version of this article (doi:10.1186/s12963-017-0127-3) contains supplementary material, which is available to authorized users.
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Wasiak J, Lee SJ, Paul E, Shen A, Tan H, Cleland H, Gabbe B. Female patients display poorer burn-specific quality of life 12 months after a burn injury. Injury 2017; 48:87-93. [PMID: 27476885 DOI: 10.1016/j.injury.2016.07.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 07/11/2016] [Accepted: 07/20/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Although gender differences in morbidity and mortality have been measured in patients with moderate to severe burn injury, little attention has been directed at gender effects on health-related quality of life (HRQoL) following burn injury. The current study was therefore conducted to prospectively measure changes in HRQoL for males and females in a sample of burn patients. METHODS A total of 114 adults who received treatment at a statewide burns service for a sustained burns injury participated in this study. Instruments measuring generic health status (Short Form 36 Medical Outcomes Survey version 2), burn-specific HRQoL (Burns Specific Health Scale-Brief), psychological distress (Kessler Psychological Distress Scale) and alcohol use (Alcohol Use Disorders Identification Tool) were prospectively measured at 3, 6 and 12 months post-burn. RESULTS In the 12 months post-injury, female patients showed overall poorer physical (p=0.01) and mental health status (p<0.001), greater psychological distress (p<0.001), and greater difficulty with aspects of burn-specific HRQoL: body image (p<0.001), affect (p<0.001), interpersonal functioning (p=0.005), heat sensitivity (p=0.01) and treatment regime (p=0.01). While significant interaction effects suggested that female patients had more improvement in difficulties with treatment regime (p=0.007), female patients continued to report greater difficulty with multiple aspects of physical and psychosocial health status 12 months post-injury. CONCLUSION Even though demographic variables, injury characteristics and burn care interventions were similar across genders, following burn injury female patients reported greater impairments in generic and burn-specific HRQoL along with psychological morbidity, when compared to male patients. Urgent clinical and research attention utilising an evidence-based research framework, which incorporates the use of larger sample sizes, the use of validated instruments to measure appropriate outcomes, and a commitment to monitoring long-term care, can only improve burn-care.
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Affiliation(s)
- J Wasiak
- Victorian Adult Burns Service, The Alfred, Melbourne, Australia; Epworth Hospital, Richmond, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - S J Lee
- Monash Alfred Psychiatry Research Centre, The Alfred and Central Clinical School Monash University, Melbourne, Australia
| | - E Paul
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Clinical Haematology Department, The Alfred, Melbourne, Australia
| | - A Shen
- Victorian Adult Burns Service, The Alfred, Melbourne, Australia
| | - H Tan
- Victorian Adult Burns Service, The Alfred, Melbourne, Australia
| | - H Cleland
- Victorian Adult Burns Service, The Alfred, Melbourne, Australia
| | - B Gabbe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Kornhaber R, Wilson A, Abu-Qamar M, McLean L, Vandervord J. Inpatient peer support for adult burn survivors—A valuable resource: A phenomenological analysis of the Australian experience. Burns 2015; 41:110-7. [DOI: 10.1016/j.burns.2014.05.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 05/03/2014] [Accepted: 05/06/2014] [Indexed: 11/29/2022]
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Sareen J. Posttraumatic stress disorder in adults: impact, comorbidity, risk factors, and treatment. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:460-7. [PMID: 25565692 PMCID: PMC4168808 DOI: 10.1177/070674371405900902] [Citation(s) in RCA: 205] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 05/01/2014] [Indexed: 01/19/2023]
Abstract
During the last 30 years, there has been a substantial increase in the study of posttraumatic stress disorder (PTSD). Several high-profile traumatic events, such as the wars in Afghanistan and Iraq, and the terrorist attacks of September 11 on the World Trade Center, have led to a greater public interest in the risk and protective factors for PTSD. In this In Review paper, I discuss some of the important advances in PTSD. The paper provides a concise review of the evolution of PTSD diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, impact of PTSD in the community, an overview of the established risk factors for developing PTSD, and assessment and treatment. Throughout the paper, controversies and clinical implications are discussed.
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Affiliation(s)
- Jitender Sareen
- Professor of Psychiatry, Psychology, and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
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Oster C, Sveen J. The psychiatric sequelae of burn injury. Gen Hosp Psychiatry 2014; 36:516-22. [PMID: 24953259 DOI: 10.1016/j.genhosppsych.2014.05.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/24/2014] [Accepted: 05/08/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To examine factors predicting psychiatric morbidity, taking into account the full range of psychiatric disorders before and after burn injury. METHODS A cohort of 107 patients consecutively admitted to a Swedish national burn center was examined for lifetime psychiatric morbidity, as well as 94 patients at 1 year postinjury. Sixty-seven individuals, some from that same cohort, were interviewed at 2 to 7years postinjury. The predictive effects of psychiatric history, personality and other risk factors for psychiatric morbidity following burn were evaluated with multiple regression analyses. RESULTS The prevalence of having a psychiatric disorder preburn was 57%. One year postinjury 19% had minor or major depression and 23% had subsyndromal or full posttraumatic stress disorder. At 2 to 7years, 31% fulfilled the criteria for a psychiatric disorder. The strongest contributing factors were a history of psychiatric morbidity and neuroticism. CONCLUSIONS Two-thirds of the patients had a lifetime psychiatric disorder, and one-third had a psychiatric diagnosis 2 to 7years postburn. Mental health problems can have a major impact on daily life and functional abilities. Thus, identification and treatment of a range of psychiatric disorders, taking into account preburn psychiatric disorders and personality, is important for optimal adjustment after burn.
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Affiliation(s)
- Caisa Oster
- Department of Neuroscience Psychiatry, Uppsala University, SE-751 85 Uppsala, Sweden
| | - Josefin Sveen
- Department of Neuroscience Psychiatry, Uppsala University, SE-751 85 Uppsala, Sweden.
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Ekeblad F, Gerdin B, Öster C. Impact of personality disorders on health-related quality of life one year after burn injury. Disabil Rehabil 2014; 37:534-40. [PMID: 24963942 DOI: 10.3109/09638288.2014.933898] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Personality disorders (PDs) are associated with significant distress, disability, and cause great difficulties in life. PDs have been suggested to influence adaptation after major burns, but the potential relationship has not been fully elucidated. This study aimed to describe the prevalence of PDs in 107 patients with major burn injury, and to identify the impact of PDs on perceived patient outcome assessed as health-related quality of life (HRQoL) one year after burn. METHODS One burn-specific instrument (Burn Specific Health Scale-Brief (BSHS-B)) and two generic instruments (EuroQol Five Dimensions and Short Form 36 Health Survey) were used, and Psychiatric Axis I and II disorders were assessed one year post burn. RESULTS This study identified an above normal prevalence of PDs among individuals afflicted by burn, and participants with PD had a significantly larger lifetime burden of Axis I disorders compared to participants without PD. Participants with PDs scored significantly lower than those without PD in the BSHS-B domain Skin involvement, and the effect of having a PD was related to the subscale Treatment regimens. There was no relationship between the presence of PD and generic HRQoL. CONCLUSIONS An implication of these observations is that special rehabilitation efforts including more tailored interventions must be offered to these patients to ensure that the obstacles they perceive to caring for themselves in this respect are eliminated. IMPLICATIONS FOR REHABILITATION This study identified an above normal prevalence of PDs among individuals afflicted by burn and these individuals reported poor burn-specific health-related quality of life. The identification of difficulties with compliance and endurance regarding daily skin care may cause negative consequences for optimal rehabilitation and underscore the importance of offering more tailored interventions in rehabilitation. Inflexible behavioral patterns related to the PD diagnosis imply the need for communication strategies by the rehabilitation team, which include flexibility, creativity, and diplomacy. There is a need for further research focusing on identifying the factors that facilitate the individual's own ability to take action and have control.
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Affiliation(s)
- Frida Ekeblad
- Department of Neuroscience Psychiatry, Uppsala University , Uppsala , Sweden and
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Zhang LJ, Cao J, Feng P, Huang J, Lu J, Lu XY, Xia ZF. Influencing factors of the quality of life in Chinese burn patients: Investigation with adapted Chinese version of the BSHS-B. Burns 2013; 40:731-6. [PMID: 24280529 DOI: 10.1016/j.burns.2013.09.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 09/01/2013] [Accepted: 09/22/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The study aims to evaluate the quality of life (QOL) in burn patients in China and find out principal influencing factors, so as to provide evidence for interventions. METHODS A total of 271 burn patients in three major burn units in China were asked to fill in the adapted Chinese version (ACV) of the Burn Specific Health Scale-Brief (ACV BSHS-B) in order to seek out the principal influencing factors in combination with a self-designed demographic and disease condition questionnaire. Multivariable linear regression was used to analyse the principal influencing factors. RESULTS The findings showed that there were seven principal influencing factors for the overall ACV BSHS-B score. They were: percent total body surface area (TBSA) burned (with the standardised regression coefficient being -0.594), burn area of lower limber (0.241), itch level (-0.227), pain level (-0.220), gender (0.217), mechanical ventilation (0.216) and hand deformity (-0.141). CONCLUSION QOL decreased in burn patients to different degrees depending on the intensity of burns. With a better understanding of influencing factors of burn patients' QOL, the medical and nursing staff can take specific countermeasures to help patients gain a higher QOL.
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Affiliation(s)
- Ling-Juan Zhang
- Nursing Department, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Jie Cao
- Anesthesiology Department, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Ping Feng
- Burn Center, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Juan Huang
- Nursing Department, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Jian Lu
- Department of Medical Statistics, Second Military Medical University, Shanghai 200433, China
| | - Xiao-Ying Lu
- Nursing Department, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Zhao-Fan Xia
- Burn Center, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
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15
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Öster C, Willebrand M, Ekselius L. Burn-specific health 2 years to 7 years after burn injury. J Trauma Acute Care Surg 2013; 74:1119-24; discussion 1124. [PMID: 23511154 DOI: 10.1097/ta.0b013e318283cca0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Knowledge concerning the pattern of recovery and predictors of burn-specific health years after burn injury is limited, and these factors were therefore assessed with a disease-specific instrument, the Burn Specific Health Scale-Brief. METHODS Consecutive adult burn patients were prospectively included during hospitalization and assessed at 3, 6, and 12 months as well as at 2 years to 7 years (4.6 years on average) after burn. Data concerning injury characteristics, sociodemographic variables, psychiatric disorders, and burn-specific health were obtained. RESULTS Burn-specific health improved over time, from 6 months to the final assessment after burn. At 2 years to 7 years after burn, most problems were reported in the subscales heat sensitivity, body image, and work. The regression analyses revealed that length of stay, any preburn psychiatric disorder, major depression, and posttraumatic stress disorder 12 months after burn were predictors of long-term burn-specific health in the affect and relations domain, whereas time since injury, length of stay, and major depression 12 months after burn predicted outcome in the skin involvement domain. Predictors for the subscale work were length of stay, working at the time of injury, and posttraumatic stress disorder at 12 months. CONCLUSION This study underscores that significant improvement in postburn health can be expected even later than 2 years after injury. Furthermore, the results imply that both preburn factors and factors identified 1 year after burn have impact on burn-specific health after several years. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Caisa Öster
- Department of Neuroscience Psychiatry, Uppsala University, Uppsala, Sweden.
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16
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Long term health-related quality of life after burns is strongly dependent on pre-existing disease and psychosocial issues and less due to the burn itself. Burns 2013; 39:229-35. [DOI: 10.1016/j.burns.2012.11.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 11/22/2012] [Accepted: 11/26/2012] [Indexed: 11/21/2022]
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17
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Jewett LR, Hudson M, Malcarne VL, Baron M, Thombs BD. Sociodemographic and disease correlates of body image distress among patients with systemic sclerosis. PLoS One 2012; 7:e33281. [PMID: 22457749 PMCID: PMC3311623 DOI: 10.1371/journal.pone.0033281] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 02/13/2012] [Indexed: 11/24/2022] Open
Abstract
Background Body image concerns are infrequently studied in systemic sclerosis (SSc), even though significant visible disfigurement is common. The objective of this study was to identify sociodemographic and disease-related correlates of dissatisfaction with appearance and social discomfort among people with SSc. Methods SSc patients came from the 15-center Canadian Scleroderma Research Group Registry. Sociodemographic information was based on patient self-report. Disease characteristics were obtained via physician examinations. The Brief-SWAP was used to assess dissatisfaction with appearance and social discomfort. Structural equation models were conducted with MPlus to determine the relationship of dissatisfaction with appearance and social discomfort with age, sex, education, marital status, race/ethnicity, disease duration, skin involvement, telangiectasias, skin pigmentation changes, and hand contractures. Results A total of 489 SSc patients (432 female, 57 male) were included. Extent of skin involvement was significantly associated with both dissatisfaction with appearance and social discomfort (standardized regression coefficients = 0.02, p = 0.001; 0.02, p = 0.020, respectively), as was skin involvement in the face (0.18, p = 0.016; 0.23, p = 0.006, respectively). Greater social discomfort was robustly associated with younger age (−0.017, p<0.001) and upper-body telangiectasias (0.32, p = 0.021). Dissatisfaction with appearance was associated with hand contractures (0.07, p = 0.036). Conclusion This study found that dissatisfaction with appearance and social discomfort were associated with numerous disfiguring characteristics of SSc, in addition to age. These results underline that there are multiple factors contributing to body image distress in SSc, as well as the need to attend to both disease and social contexts in understanding the impact of disfigurement among patients.
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Affiliation(s)
- Lisa R. Jewett
- Department of Psychiatry, McGill University, Montréal, Québec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Marie Hudson
- Department of Medicine, McGill University, Montréal, Québec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Division of Rheumatology, Jewish General Hospital, Montréal, Québec, Canada
| | - Vanessa L. Malcarne
- Department of Psychology, San Diego State University, San Diego, California, United States of America
| | - Murray Baron
- Department of Medicine, McGill University, Montréal, Québec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Division of Rheumatology, Jewish General Hospital, Montréal, Québec, Canada
| | - Brett D. Thombs
- Department of Psychiatry, McGill University, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Québec, Canada
- Department of Medicine, McGill University, Montréal, Québec, Canada
- School of Nursing, McGill University, Montréal, Québec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Division of Rheumatology, Jewish General Hospital, Montréal, Québec, Canada
- Department of Psychiatry, Jewish General Hospital, Montréal, Québec, Canada
- * E-mail:
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18
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Low AJF, Dyster-Aas J, Willebrand M, Ekselius L, Gerdin B. Psychiatric morbidity predicts perceived burn-specific health 1 year after a burn. Gen Hosp Psychiatry 2012; 34:146-52. [PMID: 22266132 DOI: 10.1016/j.genhosppsych.2011.12.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 12/08/2011] [Accepted: 12/12/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Individual factors such as gender, age, coping and personality traits and injury-related factors such as injury severity have been implicated as risk factors for poor perceived health after burns. As psychiatric morbidity is common in individuals who sustain burns, the aim of this study was to examine the effect of preinjury psychiatric problems on perceived health after injury. METHOD A total of 85 consecutive patients treated at a national burn center were prospectively assessed: the patients were interviewed during acute care with the Structured Clinical Interview for DSM-IV Axis I Disorders. One year after injury, perceived health was assessed with the Burn-Specific Health Scale-Brief (BSHS-B). Multiple regression analyses were used to evaluate the predictive effect of preinjury psychiatric history on perceived postinjury health. RESULTS Psychiatric morbidity, especially mood disorders, affected outcome for six of the nine BSHS-B subscales, with the covariates mainly being the length of hospital stay and total burn size. CONCLUSION The results show that a history of preinjury psychiatric disorders, especially during the year before the burn, affects perceived outcome regarding both physical and psychological aspects of health 1 year after injury and that it is a risk factor for worse perceived outcome.
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Affiliation(s)
- Aili J F Low
- Department of Surgical Sciences, Plastic and Maxillofacial Surgery, Burn Center, Uppsala University Hospital, 75185 Uppsala, Sweden.
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19
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Liang CY, Wang HJ, Yao KP, Pan HH, Wang KY. Predictors of health-care needs in discharged burn patients. Burns 2011; 38:172-9. [PMID: 22078805 DOI: 10.1016/j.burns.2011.09.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 06/15/2011] [Accepted: 09/08/2011] [Indexed: 11/25/2022]
Abstract
Patients' health-care needs are an important issue, but have not been studied in the burn field. The aims of this study were to explore discharged burn patients' health-care needs and related factors. This cross-sectional study used convenience sampling and four questionnaires, including basic information, Mental Status Inventory, Burn Patients' Social Support and Burn Patients' Healthcare Needs for data collection. There were 93 adults, injured on average 45% of total body surface area, who completed the study. Results indicated that the level of psychosocial care needs were higher than physiological needs. The level of physiological care needs changed over time, but psychosocial needs did not change. Self-reported psychosocial needs and physiological care needs correlated with each other. The multiple regressions showed that the most important predictors of overall health-care needs were numbers of visible scarred areas, time since discharge and previous psychiatric history. The findings revealed the burn patients provided clinically useful information and supported further evaluation in the area of care needs for burn patients.
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Affiliation(s)
- C Y Liang
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
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20
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Öster C, Ekselius L. Return to work after burn—A prospective study. Burns 2011; 37:1117-24. [DOI: 10.1016/j.burns.2011.05.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 05/27/2011] [Accepted: 05/31/2011] [Indexed: 10/18/2022]
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21
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Return to work after burn injury: burn-injured individuals' perception of barriers and facilitators. J Burn Care Res 2010; 31:540-50. [PMID: 20616648 DOI: 10.1097/bcr.0b013e3181e4d692] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of this study was to explore burn-injured individuals' perception of factors seen as facilitators or barriers in the process of returning to work after a severe burn injury. Semistructured interviews were prospectively conducted with 39 former burn injury patients, admitted to the Uppsala Burn Center between March 2000 and March 2007. The participants were employed or studying at the time of injury and were interviewed on average 4.6 years after the burn. The interview data were analyzed with qualitative content analysis. Factors acknowledged by the participants as facilitators and barriers to return to work (RTW) were identified and sorted into five categories: the Individual, Social Life, Health Care and Rehabilitation, the Workplace, and Social Welfare Agencies. Facilitators were perceived to a great extent as individual characteristics, such as own ability to take action, setting up goals in rehabilitation, having willpower, being persistent, and learning to live with impairments. The possibility of getting modified work tasks or a change of workplace, when having physical or psychological impairments, was also seen as facilitating factors. Some barriers experienced as delaying RTW were difficulties when ceasing pain medication, limited knowledge of wound care at primary health care facilities, lack of individualized rehabilitation plans, and lack of psychological support during rehabilitation. Former burn injury patients emphasized psychological resources and capabilities as facilitators in the RTW process. The need in rehabilitation for a coordinator and for assessment of work capacity, and not solely a focus on impairments, is discussed.
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22
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Palmu R, Suominen K, Vuola J, Isometsä E. Mental disorders among acute burn patients. Burns 2010; 36:1072-9. [PMID: 20483541 DOI: 10.1016/j.burns.2010.04.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 04/01/2010] [Accepted: 04/08/2010] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- Raimo Palmu
- Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland.
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23
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Pre-existing psychiatric disorders, psychological reactions to stress and the recovery of burn survivors. Burns 2010; 36:183-91. [DOI: 10.1016/j.burns.2009.08.008] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Revised: 07/08/2009] [Accepted: 08/21/2009] [Indexed: 11/22/2022]
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24
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McKibben JBA, Ekselius L, Girasek DC, Gould NF, Holzer C, Rosenberg M, Dissanaike S, Gielen AC. Epidemiology of burn injuries II: psychiatric and behavioural perspectives. Int Rev Psychiatry 2009; 21:512-21. [PMID: 19919204 DOI: 10.3109/09540260903343794] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Modern technological advances have decreased the incidence and severity of burn injuries, and medical care improvements of burn injuries have significantly increased survival rates, particularly in developed countries. Still, fire-related burn injuries are responsible for 300,000 deaths and 10 million disability-adjusted life years lost annually worldwide. The extent to which psychiatric and behavioural factors contribute to the incidence and outcomes of these tragedies has not been systematically documented, and the available data is often insufficient to reach definitive conclusions. Accordingly, this article reviews the evidence of psychiatric and behavioural risk factors and prevention opportunities for burn injuries worldwide. Psychiatric prevalence rates and risk factors for burn injuries, prevalence and risks associated with 'intentional' burn injuries (self-immolation, assault, and child maltreatment), and prevention activities targeting the general population and those with known psychiatric and behavioural risk factors are discussed. These issues are substantially interwoven with many co-occurring risk factors. While success in teasing apart the roles and contributions of these factors rests upon improving the methodology employed in future research, the nature of this entanglement increases the likelihood that successful interventions in one problem area will reap benefits in others.
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Affiliation(s)
- Jodi B A McKibben
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814-4799, USA.
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25
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Major Depression and Posttraumatic Stress Disorder Symptoms Following Severe Burn Injury in Relation to Lifetime Psychiatric Morbidity. ACTA ACUST UNITED AC 2008; 64:1349-56. [DOI: 10.1097/ta.0b013e318047e005] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Affiliation(s)
- Patricia Blakeney
- University of Texas Medical Branch and Shriners Hospitals for Children, Galveston Burn Hospital, Galveston, TX, USA
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27
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Kaufman MS, Graham CC, Lezotte D, Fauerbach JA, Gabriel V, Engrav LH, Esselman P. Burns as a result of assault: associated risk factors, injury characteristics, and outcomes. J Burn Care Res 2007; 28:21-8; discussion 29. [PMID: 17211196 DOI: 10.1097/bcr.0b013e31802c896f] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to identify specific premorbid factors and injury characteristics associated with intentional burn injuries and to compare outcomes for individuals injured by assault and those with unintentional injuries. Participants sustaining major burns from May 1994 to August 2005 and consenting to a multisite, prospective, longitudinal outcome study were included. Etiology of the injury was classified as intentional (i.e., assault) or unintentional. Subjects <18 years old or with self-inflicted burns were excluded. Statistical analysis was performed with t-tests, chi2 tests, and analysis of variance. Eighty patients sustained intentional burn injuries and 1982 subjects sustained nonintentional burn injuries. Compared to patients with nonintentional burns, those with burns related to assault were more likely to be female, black, and unemployed and to have higher rates of premorbid substance use. Between the groups, there were no significant differences in preinjury living situation, education level, history of psychiatric treatment, or hospital length of stay. The intentional-burn group had larger burns and a greater in-hospital mortality rate, and these patients were less likely to be discharged to home. They also demonstrated significantly greater levels of psychological distress during the acute hospitalization but not at follow-up. Understanding the unique characteristics and needs of patients with intentional burn injuries is important because these individuals are less likely to have a steady income and more likely to rely on community social services. Affordable and accessible community-based health services are necessary in order to improve their outcomes.
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Affiliation(s)
- Marla S Kaufman
- Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, Washington 98104, USA
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28
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Wallis H, Renneberg B, Ripper S, Germann G, Wind G, Jester A. Emotional Distress and Psychosocial Resources in Patients Recovering From Severe Burn Injury. J Burn Care Res 2006; 27:734-41. [PMID: 16998408 DOI: 10.1097/01.bcr.0000238094.33426.0d] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Emotional distress as well as psychosocial resources in 55 patients with burn injuries was assessed during acute and follow-up treatment. Results showed significantly greater values of emotional distress among patients when compared with norms of the general population. As well as higher levels of general psychopathology, particularly prevalent were anxiety, depression, and posttraumatic symptoms. However, patients also reported high levels of resources such as general optimism, self-efficacy, and perceived social support. Within the sample, no significant correlation between severity of emotional distress and severity of burn injury was found. By psychological assessments a subgroup of highly distressed patients was identified. These patients were highly emotionally distressed while having objective injury severity comparable with the other patients in the sample. Reactions to burn accidents vary individually. The results demonstrate the importance of routine screenings of psychological symptoms. An early identification of patients at-risk allows for tailored psychotherapeutic interventions and can thus help to improve quality of life and general well-being of burn patients on a long-term basis.
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Affiliation(s)
- Hanna Wallis
- Department for Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany
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29
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Sliwa JA, Heinemann A, Semik P. Inpatient Rehabilitation Following Burn Injury: Patient Demographics and Functional Outcomes. Arch Phys Med Rehabil 2005; 86:1920-3. [PMID: 16213231 DOI: 10.1016/j.apmr.2005.04.024] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2004] [Revised: 04/14/2005] [Accepted: 04/21/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To identify demographic characteristics of burn patients referred for inpatient rehabilitation, the benefits of rehabilitation in this population, and factors that influence functional outcome. DESIGN Retrospective chart review. SETTING Free-standing rehabilitation hospital. PARTICIPANTS Patients (N=129) admitted for inpatient rehabilitation after a burn injury. INTERVENTION Comprehensive inpatient rehabilitation. MAIN OUTCOME MEASURES Demographic data and the FIM instrument on admission and discharge for all patients. RESULTS Linear measures of functional status derived by Rasch analysis of the FIM showed significant improvements from admission to discharge for all patients. There was no correlation between total body surface area (TBSA), premorbid psychiatric alcohol or drug abuse history, and change between admission and discharge FIM score. There was a significant correlation between TBSA burn and age and between TBSA and length of stay. CONCLUSIONS Burn patients referred for inpatient rehabilitation are either older or have large TBSA burns. All patients made significant functional improvements and consequently inpatient rehabilitation can be considered an important component of care after a burn injury.
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Affiliation(s)
- James A Sliwa
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine and Rehabilitation Institute of Chicago, Chicago, IL, USA
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30
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Tarrier N, Gregg L, Edwards J, Dunn K. The influence of pre-existing psychiatric illness on recovery in burn injury patients: the impact of psychosis and depression. Burns 2005; 31:45-9. [PMID: 15639364 DOI: 10.1016/j.burns.2004.06.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2004] [Indexed: 11/30/2022]
Abstract
We hypothesised that patients with a co-morbid psychiatric illness would show poorer outcomes in recovery from their burn injury compared to patients with equivalent burn injury but without a pre-existing psychiatric illness. A secondary aim was to investigate the effect of self-inflicted burn injury. Consecutive admissions (n = 190) to a burns inpatient unit were screened for the existence of a formal pre-burn psychiatric disorder. Nine patients suffering from psychosis and eight suffering from depression were matched with 18 and 15 patients, respectively not suffering a pre-burn psychiatric disorder on gender, age, burn severity, type, depth and location. Patients with a pre-burn psychiatric diagnosis spent significantly longer in hospital, spent more time in care until discharged from outreach and their burn injuries took longer to heal than matched burn injury patients without a pre-existing psychiatric illness. Time in hospital and to wound healing were significantly greater in psychotic patients compared to their controls but not between depressed patients and their matched controls. Both psychotic and depressed patients had significantly more surgery than their matched controls. Patients whose burn was self-inflicted spent significantly longer in hospital and their wounds took longer to heal. Patients with pre-existing psychiatric conditions, especially psychosis, and those with self-inflicted injuries are associated with difficulties in clinical management and higher economic cost yet staff receive very little specialist training in their management.
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Affiliation(s)
- Nicholas Tarrier
- Academic Division of Clinical Psychology, University of Manchester, Education and Research Building, Wythenshawe Hospital, Manchester M23 9LT, UK.
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31
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Dyster-Aas J, Kildal M, Willebrand M, Gerdin B, Ekselius L. Work status and burn specific health after work-related burn injury. Burns 2005; 30:839-42. [PMID: 15555799 DOI: 10.1016/j.burns.2004.05.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2004] [Indexed: 10/26/2022]
Abstract
UNLABELLED Work status is a valid indicator of post burn health. There is limited information on this issue after work-related burn injury. AIM To investigate long-term health- and work status after work-related burns. METHOD Eighty-six former patients treated for severe work-related burn injuries an average of 9.0 years previous to follow-up were questioned about their present work status. They were also assessed with the Burn Specific Health Scale-Brief (BSHS-B) and a pain scale adopted from the abbreviated Burn Specific Health Scale. RESULTS At follow-up 71 (83%) of the former patients were working, nine (10%) were on sick leave or had a disability pension, and six (7%) were unemployed. Those who were not working reported a poorer outcome in three of the BSHS-B psychosocial domains (Body Image, Affect and Interpersonal Relationships) and in two of the BSHS-B physical domains (Treatment Regimens and Work). They also reported significantly more pain. CONCLUSION Only a small group of former patients with work-related accidents were not working in the sample studied after a long follow-up period. The unemployed reported more pain and worse perceived health, particularly in psychosocial domains.
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Affiliation(s)
- Johan Dyster-Aas
- Department of Neuroscience, Psychiatry, Uppsala University Hospital, SE-75185 Uppsala, Sweden
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32
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Fauerbach JA, Lezotte D, Hills RA, Cromes GF, Kowalske K, de Lateur BJ, Goodwin CW, Blakeney P, Herndon DN, Wiechman SA, Engrav LH, Patterson DR. Burden of Burn: A Norm-Based Inquiry into the Influence of Burn Size and Distress on Recovery of Physical and Psychosocial Function. ACTA ACUST UNITED AC 2005; 26:21-32. [PMID: 15640730 DOI: 10.1097/01.bcr.0000150216.87940.ac] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This prospective, longitudinal study examined the influence of baseline physical and psychological burden on serial assessments of health-related quality of life among adults with major burns from three regional burn centers (n = 162). Physical burden groups were defined by % TBSA burned: <10%, 10% to 30%, or >30%. Psychological burden groups were defined by in-hospital distress using the Brief Symptom Inventory Global Severity Index T-score with scores of < 63 or > or = 63. Analyses compared groups across level of burden and with published normative data. Assessments reflected health and function (Short Form 36) during the month before burn, at discharge, and at 6 and 12 months after burn. Physical functioning was significantly more impaired and the rate of physical recovery slower among those with either large physical burden or large psychological burden. Notably, psychosocial functioning also was more impaired and the rate of psychosocial recovery slower among those with greater psychological burden. These results suggest that, in addition to aggressive wound closure, interventions that reduce in-hospital distress may accelerate both physical and psychosocial recovery.
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Affiliation(s)
- James A Fauerbach
- Johns Hopkins University School of Medicine, c/o Baltimore Regional Burn Center, 4940 Eastern Avenue, Baltimore, MD 21224, USA
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33
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Sheridan RL, Tompkins RG. What's new in burns and metabolism. J Am Coll Surg 2004; 198:243-63. [PMID: 14759783 DOI: 10.1016/j.jamcollsurg.2003.11.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2003] [Accepted: 11/10/2003] [Indexed: 12/31/2022]
Affiliation(s)
- Robert L Sheridan
- Burn Surgery Service, Shriners Hospital for Children, 51 Blossom Street, Boston, MA 02114, USA
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34
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Kildal M, Willebrand M, Andersson G, Gerdin B, Ekselius L. Personality Characteristics and Perceived Health Problems After Burn Injury. ACTA ACUST UNITED AC 2004; 25:228-35. [PMID: 15273462 DOI: 10.1097/01.bcr.0000126295.84815.df] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The relationship between personality traits and the perceived outcome of burn injury 1 to 18 years (mean, 9.2 years) after severe burn injury was evaluated in 166 individuals treated at the Uppsala Burn Unit. The perceived outcome was measured with the Burn Specific Health Scale-Brief (BSHS-B) and was related to personality traits evaluated by means of the Swedish universities Scales of Personality. After controlling for age at inquiry, time since injury, burn area, and sex, a stepwise logistic regression analysis revealed an association between the Swedish universities Scales of Personality domain Neuroticism and Bad outcome in all BSHS-B domains, both psychosocial and physical, and Insufficient outcome in the domains Work, Body image, Affect, and BSHS-B total score. The neurotic traits Somatic trait anxiety, Psychic trait anxiety, Stress susceptibility, Embitterment, and Mistrust each or in different combinations explained the observed relationships. The data suggest that personality is related to health status because it is perceived a long time after severe burn injury and that its effect is not confined only to psychological but also to physical aspects of life.
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Affiliation(s)
- Morten Kildal
- Burn Unit, the Department of Plastic Surgery, Uppsala University, Uppsala, Sweden
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Patterson DR, Finch CP, Wiechman SA, Bonsack R, Gibran N, Heimbach D. Premorbid Mental Health Status of Adult Burn Patients: Comparison with a Normative Sample. ACTA ACUST UNITED AC 2003; 24:347-50. [PMID: 14501409 DOI: 10.1097/01.bcr.0000086070.91033.7f] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The presence of psychiatric problems in burn patients has been found to have an impact on their burn care and long-term adjustment. This study investigated rates of previous mental health symptoms in a sample of 199 hospitalized burn patients screened for previous psychiatric diagnoses. Patients were instructed to fill out a questionnaire about their mental health functioning on the Rand Inventory for the month preceding their burn injury. Scores compared with a national normative sample on the Rand Mental Health Inventory revealed that burn patients scored higher on psychological distress, anxiety, depression, and loss of behavioral and emotional control. These results reflect other studies in the literature, indicating that burn patients are premorbidly more psychologically vulnerable than the general population, a factor that likely contributes to many of them sustaining their injuries.
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Affiliation(s)
- David R Patterson
- University of Washington School of Medicine, Harborview Medical Center, Seattle, 98104-2499, USA
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Willebrand M, Andersson G, Kildal M, Ekselius L. Exploration of coping patterns in burned adults: cluster analysis of the coping with burns questionnaire (CBQ). Burns 2002; 28:549-54. [PMID: 12220912 DOI: 10.1016/s0305-4179(02)00064-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of this study was to investigate coping patterns, health status and personality traits in burned adults. Subjects were 161 burn patients treated at the Uppsala University Hospital between 1980 and 1995. Measures were the coping with burns questionnaire (CBQ), the burn specific health scale-brief (BSHS-B) and the Swedish universities scales of personality (SSP). The CBQ was subjected to a K-means cluster analysis and three clusters were derived: extensive, adaptive, and avoidant copers. Extensive copers used the most coping and took an intermediate role regarding health status and the personality trait of neuroticism. Adaptive copers preferred the strategies emotional support and optimism/problem solving, and had the highest health status ratings. Avoidant copers preferred the strategy avoidance and reported the lowest use of emotional support and optimism/problem solving. They had the lowest health status ratings and the highest ratings on neuroticism and aggressiveness. The clusters did not differ in severity of injury or time since injury. In conclusion, coping patterns can be discerned among burn patients, and those individuals preferring avoidance and lacking other coping options displayed more maladaptive traits and poorer health status years after the burn.
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Affiliation(s)
- M Willebrand
- Department of Neuroscience, Psychiatry, Uppsala University Hospital, Sweden.
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Stoddard FJ, Sheridan RL, Saxe GN, King BS, King BH, Chedekel DS, Schnitzer JJ, Martyn JAJ. Treatment of pain in acutely burned children. THE JOURNAL OF BURN CARE & REHABILITATION 2002; 23:135-56. [PMID: 11882804 DOI: 10.1097/00004630-200203000-00012] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The child with burns suffers severe pain at the time of the burn and during subsequent treatment and rehabilitation. Pain has adverse physiological and emotional effects, and research suggests that pain management is an important factor in better outcomes. There is increasing understanding of the private experience of pain, and how children benefit from honest preparation for procedures. Developmentally appropriate and culturally sensitive pain assessment, pain relief, and reevaluation have improved, becoming essential in treatment. Pharmacological treatment is primary, strengthened by new concepts from neurobiology, clinical science, and the introduction of more effective drugs with fewer adverse side effects and less toxicity. Empirical evaluation of various hypnotic, cognitive, behavioral, and sensory treatment methods is advancing. Multidisciplinary assessment helps to integrate psychological and pharmacological pain-relieving interventions to reduce emotional and mental stress, and family stress as well. Optimal care encourages burn teams to integrate pain guidelines into protocols and critical pathways for improved care.
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Abstract
Clinical experience and burn survivor testimony show that the experience of being burned can be associated with catastrophic stress and lead to drastic permanent body image changes from scarring and limb-function loss. Close relatives, if not killed in the fire, often also experience clinically significant bystander stress. Closeness of relationships may be lost, and self-image may suffer. Property damage and loss of crucial resources may be associated with fires. Although many burns result from accidents, most result from preventable causes associated with psychiatric disorders, which include mood disorders, psychoses, cognitive disorders, and substance-use disorders. Burns then result from: Deliberate self-harm Impaired judgment and poor coordination associated with substance intoxication Risk-taking behavior Poor supervision of children and impaired elderly persons Careless handling of flammable materials. Many clinical syndromes, such as delirium, ASD, acute psychosis, suicidality, and pain need to be addressed by the consulting psychiatrist to facilitate surgical treatment of the burn injury. Other psychiatric disorders, such as PTSD, major depression, and adjustment disorder, need to be treated to expedite long-term adjustment. Hospital length of stay and RTW/RTS are major outcome variables. The psychiatry consultant can positively affect both variables substantially using both pharmacologic and psychosocial measures. The important role of psychiatric issues both before and after burn injury support the need for more consistent and comprehensive medical insurance coverage for psychiatric consultation to burn units and clinics. Burn Support Groups are an invaluable asset.
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Affiliation(s)
- Sunny T Ilechukwu
- Medical Psychiatry Clinical Research Division, Department of Psychiatry and Behavioral Neuroscience, Wayne State University, Detroit, Michigan, USA.
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Fauerbach JA, Lawrence JW, Bryant AG, Smith JH. The relationship of ambivalent coping to depression symptoms and adjustment. Rehabil Psychol 2002. [DOI: 10.1037/0090-5550.47.4.387] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Affiliation(s)
- Mimmie Willebrand
- Department of Neuroscience Psychiatry, Uppsala University Hospital, Sweden
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Fauerbach JA, Engrav L, Kowalske K, Brych S, Bryant A, Lawrence J, Li G, Munster A, de Lateur B. Barriers to employment among working-aged patients with major burn injury. THE JOURNAL OF BURN CARE & REHABILITATION 2001; 22:26-34. [PMID: 11227681 DOI: 10.1097/00004630-200101000-00007] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to examine the prevalence of preexisting and burn-related impairments and to describe their association with preburn employment status. Data gathered during the acute hospitalization were analyzed on a consecutive series of burn patients aged 16 to 64 years (N = 770) enrolled in a prospective, longitudinal, multicenter study. Patients who were unemployed before the injury were more likely than those who were employed to report being alcohol-dependent (36 vs 18%), abusing other drugs (22 vs 10%), having received psychiatric treatment in the past year (21 vs 6%), and having preexisting physical disability (23 vs 3%); all were significant at P < .001). Of the unemployed patients who received toxicologic screening at admission, 49% tested positive for alcohol and 39% positive for other drugs, percentages that were significantly higher than 26 and 31%, respectively, for the employed. With adjustment for age, sex, race, and education, variables that were most predictive of preinjury unemployment status were preexisting physical disability (odds ratio, 51.0; 95% confidence interval, 7.7-336.9) and being alcohol-positive at admission (odds ratio, 2.8; 95% confidence interval, 1.2-6.8). Unemployed and employed patients also differed significantly in injury patterns and clinical outcomes, with inhalation injury and psychiatric distress being more prevalent among the unemployed and both hand burns and hand surgery among the employed. The greater prevalence of preexisting impairments among survivors who were unemployed before the injury helps explain why preburn employment status is such a powerful determinant of postburn work outcomes, and suggests the need to include psychosocial services in a program of comprehensive rehabilitation.
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Affiliation(s)
- J A Fauerbach
- Baltimore Regional Burn Center, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Maryland 21224, USA
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Fauerbach JA, Lawrence JW, Schmidt CW, Munster AM, Costa PT. Personality predictors of injury-related posttraumatic stress disorder. J Nerv Ment Dis 2000; 188:510-7. [PMID: 10972570 DOI: 10.1097/00005053-200008000-00006] [Citation(s) in RCA: 136] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This longitudinal, cohort study examined the effect of personality traits on the emergence of posttraumatic stress disorder (PTSD) in a recently traumatized, civilian, mixed-gender sample with significant injuries. Burn survivors (N = 70) were administered the NEO-Personality Inventory (NEO-PI) and the Structured Clinical Interview for DSM III-R (SCID) at hospital discharge and readministered the SCID 4 and 12 months later. Overall, the sample of burn survivors scored significantly higher on neuroticism and extraversion and lower on openness, agreeableness, and conscientiousness relative to a normative national sample. Furthermore, multivariate analysis of variance revealed that PTSD symptom severity groups (i.e., single symptom, multiple symptoms, subthreshold PTSD, PTSD) were differentially related to neuroticism and extraversion. Planned comparisons indicated that neuroticism was higher and extraversion was lower in those who developed PTSD compared with those who did not develop PTSD.
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Affiliation(s)
- J A Fauerbach
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Baltimore, Maryland 21224, USA
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Fauerbach JA, Heinberg LJ, Lawrence JW, Munster AM, Palombo DA, Richter D, Spence RJ, Stevens SS, Ware L, Muehlberger T. Effect of early body image dissatisfaction on subsequent psychological and physical adjustment after disfiguring injury. Psychosom Med 2000; 62:576-82. [PMID: 10949104 DOI: 10.1097/00006842-200007000-00017] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The impact of body image dissatisfaction on quality of life after severe burn injury was investigated after controlling for other determinants of outcome (i.e., injury, distress, and preburn quality of life). METHODS The postburn quality of life (2-months postdischarge) of groups with and without body image dissatisfaction was studied after controlling for preburn quality of life (measured 2-3 days postadmission). The patient population (N = 86) was 77.9% men, had an average total body surface area burned of 17.02%, and average full-thickness burn of 6.09%. Forty percent had facial injuries, 68.6% required surgery, most were injured by flame (39.5%), and 76.8% were employed. RESULTS Multivariate analysis of covariance (covarying preburn level of Mental quality of life, facial injury, and size of burn) contrasting body image dissatisfaction groups found significantly lower psychosocial adjustment at 2-month follow-up in those with greater body image dissatisfaction (multivariate F = 3.61; p<.01). A second MANCOVA (covarying the preburn level of Physical quality of life and both facial injury and size of burn) found significantly lower physical functioning at 2-month follow-up in those with greater body image dissatisfaction (multivariate F = 2.78; p < .03). Adding two more covariates (depression and posttrauma distress) eliminated the effect of body image dissatisfaction on postburn Physical but not Mental adjustment. CONCLUSIONS Body image dissatisfaction affects quality of life after severe burn injury. Distress moderates this impact on aspects of physical but not psychosocial health.
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Affiliation(s)
- J A Fauerbach
- Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA.
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Morton R, Gleason O, Yates W. Psychiatric effects of anabolic steroids after burn injuries. PSYCHOSOMATICS 2000; 41:66-8. [PMID: 10665271 DOI: 10.1016/s0033-3182(00)71176-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- R Morton
- Department of Psychiatry, University of Oklahoma Health Sciences Center, Tulsa 74137, USA
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Fauerbach JA, Lawrence JW, Munster AM, Palombo DA, Richter D. Prolonged adjustment difficulties among those with acute posttrauma distress following burn injury. J Behav Med 1999; 22:359-78. [PMID: 10495968 DOI: 10.1023/a:1018726103302] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study examined the impact of mild to moderate symptoms of in-hospital posttrauma distress (PTD) following severe burn injury on quality of life (QOL) at 2-month follow-up after controlling for preburn QOL, injury severity, and state Negative Affectivity (depression, body image dissatisfaction) and dispositional optimism-pessimism. Participants' (n = 86) self-report established PTD and non-PTD groups (median split on Davidson Trauma Scale). After covarying preburn level of psychosocial QOL, PTD groups differed on psychosocial functioning at follow-up. This effect remained after covarying injury severity, state NA, dispositional optimism-pessimism, and preburn Mental domain QOL. PTD groups also differed significantly on physical functioning at follow-up after covarying preburn physical functional status. This effect was removed by controlling preburn Physical domain QOL and either injury severity or state NA and dispositional optimism-pessimism. Therefore, PTD is related to significant impairments in the physical and psychosocial adjustment of survivors of severe burns regardless of pretrauma level of adjustment. Injury severity and state NA and dispositional optimism-pessimism moderate the impact of PTD on physical but not psychosocial adjustment.
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Affiliation(s)
- J A Fauerbach
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Fauerbach JA, Lawrence J, Haythornthwaite J, Richter D, McGuire M, Schmidt C, Munster A. Preburn psychiatric history affects posttrauma morbidity. PSYCHOSOMATICS 1997; 38:374-85. [PMID: 9217408 DOI: 10.1016/s0033-3182(97)71445-2] [Citation(s) in RCA: 114] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A sample of inpatient, burn-injured adults (N = 95) were assessed upon discharge, and 4 and 12 months later with a structured interview and DSM-III-R criteria. The prevalence of disorder in this sample was contrasted with published data on a representative national community-dwelling comparison group in the National Comorbidity Study. The prevalence of lifetime affective, alcohol, and substance use disorders was significantly higher, and lifetime anxiety disorders significantly lower, in the burn-injured sample. The 12-month postburn prevalences of alcohol, and substance use disorders were significantly greater in the burn-injured sample. The risk of postburn disorder was significantly greater for the subjects who had a preburn history of affective, alcohol, or substance use disorder. The risk for developing posttraumatic stress disorder (PTSD) was elevated in the subjects with a preburn affective disorder but not preburn anxiety disorder. Finally, postburn PTSD was associated with a greater length of stay, and greater preburn comorbidity predicted preburn employment status and tended to lengthen hospitalization.
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Affiliation(s)
- J A Fauerbach
- Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA
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Lawrence JW, Fauerbach J, Munster A. Early avoidance of traumatic stimuli predicts chronicity of intrusive thoughts following burn injury. Behav Res Ther 1996; 34:643-6. [PMID: 8870290 DOI: 10.1016/0005-7967(96)00019-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The role of avoidance behavior in perpetuating the experience of intrusive thoughts among burn survivors was investigated. The Impact of Events Scale (IES), which has subscales that measure the frequency of intrusive thoughts and avoidance behavior, was administered to burn survivors (n = 23) upon discharge and four months later. Both avoidance behavior and intrusive thoughts at discharge were significantly related to experiencing intrusive thoughts at four months (r = 0.59, P < 0.003, r = 0.45, P < 0.03, respectively). In a hierarchical regression analysis controlling for intrusive thoughts at discharge, avoidance behavior continued to significantly predict intrusive thoughts at four months [B = 0.43, t(20) = 2.9, P < 0.009]. Limitations of the study and implications for treatment are discussed.
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Affiliation(s)
- J W Lawrence
- Johns Hopkins University School of Medicine, Baltimore Regional Burn Center, Johns Hopkins Bayview Medical Center, MD 21224, USA
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