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Turner E, Robinson DM, Roaten K. Psychological Issues. Phys Med Rehabil Clin N Am 2023; 34:849-866. [PMID: 37806702 DOI: 10.1016/j.pmr.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Psychological distress is common following a burn injury, and many burn survivors have pre-morbid psychiatric illnesses including mood and trauma-related disorders, and substance and alcohol use. This article is intended to be used by all interdisciplinary health care team members to improve the identification and treatment of common psychological concerns experienced by survivors and is organized to follow the general recovery timeline.
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Affiliation(s)
- Emma Turner
- The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Suite CS6.104B, Dallas, TX 75390, USA.
| | - Diana M Robinson
- The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Suite CS6.104B, Dallas, TX 75390, USA.
| | - Kimberly Roaten
- The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Suite CS6.104B, Dallas, TX 75390, USA.
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Palackic A, Franco-Mesa C, Beck I, Nolte S, Tapking C, Panayi AC, Stolle A, Haug V, Hirche C, Kneser U, Hundeshagen G. The Impact of Facial Burns on Short- and Long-Term Quality of Life and Psychological Distress-A Prospective Matched Cohort Study. J Clin Med 2023; 12:5057. [PMID: 37568459 PMCID: PMC10419582 DOI: 10.3390/jcm12155057] [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: 06/10/2023] [Revised: 07/17/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Burn injuries are a major healthcare challenge worldwide, with up to 50% of all minor burns located on the head and neck. With this study, we sought to describe the effect of facial burns (FB) on health-related quality of life through a prospective and matched cohort study design. Patients completed the 36 Item Short Form (SF-36) and the Hospital Anxiety and Depression Scale (HADS). Results were analyzed based on the distribution of datasets. In total, 55 patients with FB and 55 age-and sex-matched candidates were recruited. The most common mechanism of thermal injury was burns from flames. The FB group scored lower in physical and psychological dimensions than the control group, both acutely and one year after injury. An analysis of each domain showed that subjects in the FB group trended toward improvements in their score after one-year post-burn in physical functioning (acute: 71.0 ± 29.2; one-year: 83.7 ± 23.9; p = 0.02) and bodily pain (acute: 58.5 ± 30.3; one-year: 77.9 ± 30.5; p = 0.01) domains. Additionally, the FB group had significanlyt higher scores for anxiety (FB: 4.8 ± 3.2; control: 2.5 ± 2.8; p = <0.002) and depression (FB: 3.9 ± 3.5; control: 2.1 ± 2.7; p = 0.01) compared to the control. In conclusion, facial burns are associated with physical and psychosocial deficits, as well as elevated levels of psychological distress.
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Affiliation(s)
- Alen Palackic
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany; (A.P.); (I.B.); (S.N.); (C.T.); (A.C.P.); (A.S.); (V.H.); (C.H.); (U.K.)
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA;
| | - Camila Franco-Mesa
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA;
| | - Inessa Beck
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany; (A.P.); (I.B.); (S.N.); (C.T.); (A.C.P.); (A.S.); (V.H.); (C.H.); (U.K.)
| | - Steffen Nolte
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany; (A.P.); (I.B.); (S.N.); (C.T.); (A.C.P.); (A.S.); (V.H.); (C.H.); (U.K.)
- Department of Otorhinolaryngology, Head and Neck Surgery, Armed Forces Hospital Ulm, 89081 Ulm, Germany
| | - Christian Tapking
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany; (A.P.); (I.B.); (S.N.); (C.T.); (A.C.P.); (A.S.); (V.H.); (C.H.); (U.K.)
| | - Adriana C. Panayi
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany; (A.P.); (I.B.); (S.N.); (C.T.); (A.C.P.); (A.S.); (V.H.); (C.H.); (U.K.)
| | - Annette Stolle
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany; (A.P.); (I.B.); (S.N.); (C.T.); (A.C.P.); (A.S.); (V.H.); (C.H.); (U.K.)
| | - Valentin Haug
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany; (A.P.); (I.B.); (S.N.); (C.T.); (A.C.P.); (A.S.); (V.H.); (C.H.); (U.K.)
| | - Christoph Hirche
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany; (A.P.); (I.B.); (S.N.); (C.T.); (A.C.P.); (A.S.); (V.H.); (C.H.); (U.K.)
- Department of Plastic, Hand and Reconstructive Microsurgery, Hand Trauma and Replantation Center (FESSH), BG Klinik Frankfurt am Main gGmbH, Academic Teaching Hospital of Goethe-University of Frankfurt, 60629 Frankfurt am Main, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany; (A.P.); (I.B.); (S.N.); (C.T.); (A.C.P.); (A.S.); (V.H.); (C.H.); (U.K.)
| | - Gabriel Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany; (A.P.); (I.B.); (S.N.); (C.T.); (A.C.P.); (A.S.); (V.H.); (C.H.); (U.K.)
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Gallagher MW, Long LJ, Phillips CA. Hope, optimism, self‐efficacy, and posttraumatic stress disorder: A meta‐analytic review of the protective effects of positive expectancies. J Clin Psychol 2019; 76:329-355. [DOI: 10.1002/jclp.22882] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Matthew W. Gallagher
- Department of Psychology, Texas Institute for Measurement, Evaluation, and StatisticsUniversity of HoustonHouston Texas
| | - Laura J. Long
- Department of Psychology, Texas Institute for Measurement, Evaluation, and StatisticsUniversity of HoustonHouston Texas
| | - Colleen A. Phillips
- Department of Psychology, Texas Institute for Measurement, Evaluation, and StatisticsUniversity of HoustonHouston Texas
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McAleavey AA, Wyka K, Peskin M, Difede J. Physical, functional, and psychosocial recovery from burn injury are related and their relationship changes over time: A Burn Model System study. Burns 2018; 44:793-799. [DOI: 10.1016/j.burns.2017.12.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/12/2017] [Accepted: 12/17/2017] [Indexed: 11/29/2022]
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Spronk I, Legemate C, Oen I, van Loey N, Polinder S, van Baar M. Health related quality of life in adults after burn injuries: A systematic review. PLoS One 2018; 13:e0197507. [PMID: 29795616 PMCID: PMC5967732 DOI: 10.1371/journal.pone.0197507] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 05/03/2018] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Measurement of health-related quality of life (HRQL) is essential to qualify the subjective burden of burns in survivors. We performed a systematic review of HRQL studies in adult burn patients to evaluate study design, instruments used, methodological quality, and recovery patterns. METHODS A systematic review was performed. Relevant databases were searched from the earliest record until October 2016. Studies examining HRQL in adults after burn injuries were included. Risk of bias was scored using the Quality in Prognostic Studies tool. RESULTS Twenty different HRQL instruments were used among the 94 included studies. The Burn Specific Health Scale-Brief (BSHS-B) (46%), the Short Form-36 (SF-36) (42%) and the EuroQol questionnaire (EQ-5D) (9%) were most often applied. Most domains, both mentally and physically orientated, were affected shortly after burns but improved over time. The lowest scores were reported for the domains 'work' and 'heat sensitivity' (BSHS-B), 'bodily pain', 'physical role limitations' (SF-36), and 'pain/discomfort' (EQ-5D) in the short-term and for 'work' and 'heat sensitivity', 'emotional functioning' (SF-36), 'physical functioning' and 'pain/discomfort' in the long-term. Risk of bias was generally low in outcome measurement and high in study attrition. CONCLUSION Consensus on preferred validated methodologies of HRQL measurement in burn patients would facilitate comparability across studies, resulting in improved insights in recovery patterns and better estimates of HRQL after burns. We recommend to develop a guideline on the measurement of HRQL in burns. Five domains representing a variety of topics had low scores in the long-term and require special attention in the aftermath of burns.
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Affiliation(s)
- Inge Spronk
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
- Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Catherine Legemate
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, VU University Medical Centre, Amsterdam, the Netherlands
| | - Irma Oen
- Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands
| | - Nancy van Loey
- Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, the Netherlands
- Utrecht University, Department of Clinical Psychology, Utrecht, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Margriet van Baar
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands
- Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands
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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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Fidel-Kinori SG, Eiroa-Orosa FJ, Giannoni-Pastor A, Tasqué-Cebrián R, Arguello JM, Casas M. The Fenix II study: A longitudinal study of psychopathology among burn patients. Burns 2016; 42:1201-11. [DOI: 10.1016/j.burns.2016.01.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 01/20/2016] [Accepted: 01/22/2016] [Indexed: 11/30/2022]
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Caltran MP, Freitas NO, Dantas RAS, Farina JA, Rossi LA. Satisfaction With Appearance Scale-SWAP: Adaptation and validation for Brazilian burn victims. Burns 2016; 42:1331-9. [PMID: 27143340 DOI: 10.1016/j.burns.2016.03.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 03/10/2016] [Accepted: 03/30/2016] [Indexed: 11/28/2022]
Abstract
AIM Methodological study that aimed to adapt the Satisfaction with Appearance Scale (SWAP) into Brazilian Portuguese language and to assess the validity, the reliability and the dimensionality of the adapted version in a sample of Brazilian burn victims. METHODS We carried out the adaptation process according to the international literature. Construct validity was assessed by correlating the adapted version of SWAP scores with depression (Beck Depression Index), self-esteem (Rosenberg Self-Esteem Scale), health-related quality of Life (Short Form Health Survey-36) and health status of burn victims (Burn Specific Health Scale-Revised), and with gender, total body surface area burned, and visibility of the scars. We tested dimensionality using Exploratory Factor Analysis (EFA) and the reliability by means of Cronbach's alpha. RESULTS Participants were 106 adult burned patients. The correlations between the Brazilian version of the SWAP scores and the correlated construct measures varied from moderate to strong (r=.30-.77). The participants who perceived their burn sequelae was visible reported being more dissatisfied with their body image than the participants who answered that their scars would not be visible (p<.001). Cronbach's alpha for the adapted version was 0.88 and the item-total correlation varied from moderate to strong (r=.35-.73). The EFA resulted in three factors with a total explained variance percentage of 63.2%. CONCLUSION The Brazilian version of the SWAP was valid and reliable for use with Brazilian burn victims.
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Affiliation(s)
- Marina P Caltran
- Master of Nursing in Science at University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, SP, Brazil.
| | - Noélle O Freitas
- Interunit Doctoral Program in Nursing, University of São Paulo School of Nursing and University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, SP, Brazil.
| | - Rosana A S Dantas
- University of São Paulo at Ribeirão Preto College of Nursing, Brazil.
| | | | - Lidia A Rossi
- University of São Paulo at Ribeirão Preto College of Nursing, Brazil.
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Eiroa-Orosa FJ, Giannoni-Pastor A, Fidel-Kinori SG, Argüello JM. Substance use and misuse in burn patients: Testing the classical hypotheses of the interaction between post-traumatic symptomatology and substance use. J Addict Dis 2015; 35:194-204. [DOI: 10.1080/10550887.2015.1127717] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Despite the numerous multidisciplinary services burn centers provide, a number of challenges to obtaining optimal outcomes exist. The goal of this study was to overcome the barriers to effective burn rehabilitation by utilizing an expanded care coordinator (ECC) to supplement the existing outpatient services. In this between-group, single-blind, randomized, controlled trial, the control group (n = 41) received standard outpatient care and the experimental group (n = 40) received additional services provided by the ECC, including telephone calls at set intervals (24 hours postdischarge, 2, 4, 8, 12 weeks postdischarge and 5, 7, 9 months postdischarge). The ECC was trained in motivational interviewing, crisis intervention, and solution-focused counseling. He assisted patients before and after each clinic visit, coordinated outpatient services in their geographic area (physical and occupational therapy, counseling, primary care provider referrals, etc.), and helped develop problem-solving approaches to accomplish individualized goals. Outcome measures included patient identified goals utilizing the goal attainment scale, the urn-specific health scale-brief, the Short Form 12, a patient satisfaction survey, and a return to work survey. The average subject age was 43 years (SD = 16.9) with a mean TBSA of 19% (SD = 18.8). The average length of hospitalization was 36 days (SD = 42.9). The patient and injury characteristics were similar between the study groups. For the experimental group, 33% completed seven calls, with 23% completing all the eight calls. All were assessed using general linear models and were adjusted for sex, age, length of hospitalization, urban vs rural area of residence, %TBSA burn, and ethnicity. There was no difference between the control and experimental groups for any of the outcome measures at either 6 or 12 months postburn. No differences in outcomes between the groups were found. All participants appreciated the individualized goal setting process that was used as an outcome measure and this may have accounted for the similar outcomes in both the groups. (The measure may have been more of an intervention, thus contributing to the strength of the control group.) Although most patients with burn injuries may not need an intervention that is this intensive, a subset of patients at higher risk or with more severe injuries may benefit from more intensive and personalized services. Future research should examine the benefits of individual goal setting processes for all the patients and also attempt to identify those patients most at risk for poorer outcomes and therefore, likely to benefit of more intensive personalized services.
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Coping with burns: the role of coping self-efficacy in the recovery from traumatic stress following burn injuries. J Behav Med 2015; 38:642-51. [PMID: 25851608 PMCID: PMC4496529 DOI: 10.1007/s10865-015-9638-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 03/20/2015] [Indexed: 12/24/2022]
Abstract
We conducted a three-wave prospective study among patients with burns (N = 178) to examine the prospective influence of coping self-efficacy (CSE) perceptions on trajectories of posttraumatic stress symptoms in the first 12 months after burn injuries. Using linear growth curve modeling, we corrected for demographics, the number of surgeries during initial admittance, trait coping styles, and changing levels of health-related quality of life. CSE during initial admission was by far the strongest predictor of both initial PTSD symptoms and degree of symptom change with higher CSE levels associated with lower initial symptoms and a steeper decline of symptoms over time. Of the other variables only avoidant coping was associated with higher initial symptom levels, and only emotional expression associated with greater rate of recovery. Current findings suggest that CSE plays a pivotal role in recovery from posttraumatic stress after a burn injury, even when the role of burn-related impairments is taken into consideration. Implications of findings are discussed.
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Cakir U, Terzi R, Abaci F, Aker T. The prevalence of post-traumatic stress disorder in patients with burn injuries, and their quality of life. Int J Psychiatry Clin Pract 2015; 19:56-9. [PMID: 25363198 DOI: 10.3109/13651501.2014.981545] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the prevalence of post-traumatic stress disorder (PTSD) in patients with burn injuries undergoing physical therapy, and to evaluate their quality of life. METHODS A total of 21 patients who underwent physical therapy for burn injuries between October 2012 and December 2012, in the Physical Therapy and Rehabilitation outpatient clinic of a Training and Research Hospital, were included in the study. The sociodemographic form for data collection, the Clinician- Administered PTSD Scale (CAPS) for the diagnosis of PTSD, and the Short Form 36 (SF-36) Health Survey for the assessment of the quality of life, were used. RESULTS Eight patients (38.1%) had PTSD. These patients had poor physical functioning, and indicated a lower rate of role functioning-physical, vitality, and role functioning-social, compared to those without PTSD. However, it did not reach statistical significance. The physical functioning related to the quality of life was statistically significantly lower in the patients with contracture. CONCLUSIONS PTSD seems to be an important health issue in patients with burn injuries. Clinicians who attempt to tailor treatment interventions should keep in mind that these patients require psychosocial rehabilitation, as well as physical therapy.
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Affiliation(s)
- Ugur Cakir
- Department of Psychiatry, Abant Izzet Baysal University School of Medicine , Bolu , Turkey
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The Treatment of Posttraumatic Stress Disorder and Related Psychosocial Consequences of Burn Injury. J Burn Care Res 2015; 36:184-92. [DOI: 10.1097/bcr.0000000000000177] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Long-term posttraumatic stress symptoms vary inversely with early opiate dosing in children recovering from serious burns. J Trauma Acute Care Surg 2014; 76:828-32. [DOI: 10.1097/ta.0b013e3182ab111c] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Szczechowicz J, Lewandowski J, Sikorski J. Polish adaptation and validation of burn specific health scale - brief. Burns 2014; 40:1013-8. [PMID: 24556075 DOI: 10.1016/j.burns.2013.11.026] [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] [Received: 06/09/2013] [Revised: 11/27/2013] [Accepted: 11/29/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Burn Specific Health Scale - Brief is a well-described, specific tool to assess health condition (quality of life) of burnt patients. This project was aimed at creating a Polish adaptation and validation of the Burn Specific Health Scale - Brief. METHOD Adaptation of the tool was performed in two stages. The first stage involved translation, back translation, evaluation by a panel of judges and a pre-test of the tool. The second stage consisted of surveying 202 burned patients. Those data were used to conduct a psychometric analysis. Reliability was checked by determining the Cronbach's α internal consistency coefficient and conducting the test-retest procedure (ICC). Content validity was evaluated by a panel of judges. Criterion validity was determined using SF-36. Construct validity was determined using known-groups validation. RESULTS Reliability of the tool, determined using the internal consistency coefficient (Cronbach's α=0.94) and the test-retest procedure (ICC=0.89), proved to be high. Criterion validity, determined using the relationship of results of comparable BSHS-B and SF-36 subscales, obtained a satisfactory level with a correlation of r=0.55-0.89 (p<0.01). Analysis of inter-group differences showed that patients who stayed at a hospital for more than 10 days (p=0.002), patients after surgical intervention (p=0.018), patients with a burn larger than 19% of the TBSA (p=0.01) and patients with 3rd degree burns (p=0.001) have much poorer results than the rest of the subjects. DISCUSSION The Polish version of BSHS-B is a reliable and valid tool for assessing quality of life of burned patients. It may be used to plan the burn treatment process and evaluate its outcomes.
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Affiliation(s)
- Julia Szczechowicz
- University School of Physical Education in Poznan, Department of Locomotor System Rehabilitation, Poland.
| | - Jacek Lewandowski
- University School of Physical Education in Poznan, Department of Locomotor System Rehabilitation, Poland
| | - Jerzy Sikorski
- University of Medical Science in Poznań, Department of Trauma Surgery, Burns and Plastic Surgery, Poland; Burn Treatment Unit of the General Surgery and Multiple Organ Injury Ward of the J. Struś Multi-Specialist City Hospital in Poznań, Poland
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Assunção FFO, Dantas RAS, Ciol MA, Gonçalves N, Farina JA, Rossi LA. Reliability and validity of the body image quality of life inventory: Version for Brazilian burn victims. Res Nurs Health 2013; 36:299-310. [DOI: 10.1002/nur.21538] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2013] [Indexed: 11/09/2022]
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Rauch SAM, Defever E, Oetting S, Graham-Bermann SA, Seng JS. Optimism, Coping, and Posttraumatic Stress Severity in Women in the Childbearing Year. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2013; 5:77-83. [PMID: 25664143 DOI: 10.1037/a0022214] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PTSD symptoms in pregnancy may cause adverse effects on both mother and infant child. Identifying and addressing PTSD in pregnancy may help to alleviate the impact of PTSD on pregnancy. Optimism has been examined as a protective factor in the development of PTSD; however no study to date has looked at the relationship between optimism and PTSD in pregnant women. The current study examined the role of optimism on PTSD symptom severity, coping and somatization among women in the childbearing year. We examined data from 1581 completed interviews with nulliparous, pregnant women from the first wave telephone interview conducted as part of a longitudinal outcomes study, "Psychobiology of PTSD & Adverse Outcomes of Childbearing" (NIH NR008767; common name "the STACY project"). Four trauma exposure group cohorts (PTSD-positive, trauma-positive, non-exposed, and partial PTSD) were differentiated and two coping variables (active and avoidant) were examined. The relationships between demographics, trauma exposure groups, optimism and PTSD were examined. In addition, we examined the impact of these factors on coping and somatization. In general, the PTSD-positive group reported significantly less optimism than the trauma-positive and non-exposed groups. SES and number of reported traumas contributed to PTSD severity, as well as optimism. For those women reporting more optimism, they reported more use of active coping, less engagement in avoidant coping, and less somatization.
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Affiliation(s)
- Sheila A M Rauch
- Research Service, VA Ann Arbor Healthcare System ; Department of Psychiatry, University of Michigan Medical School
| | - Erin Defever
- Department of Psychiatry, University of Michigan Medical School
| | - Stephanie Oetting
- Office of Institutional Research and Effectiveness, St. Francis University
| | | | - Julia S Seng
- Institute for Research on Women and Gender, University of Michigan ; School of Nursing, University of Michigan
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Gonçalves N, Echevarría-Guanilo ME, Carvalho FDLD, Miasso AI, Rossi LA. Biopsychosocial factors that interfere in the rehabilitation of burn victims: integrative literature review. Rev Lat Am Enfermagem 2011. [DOI: 10.1590/s0104-11692011000300023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This study aimed to identify the biopsychosocial factors that influence the rehabilitation of burn victims, through an integrative literature review, from January 1987 to January 2007. Articles were searched in databases Scielo, Pubmed and Lilacs, resulting in 982 articles, of which 45 were selected, after the analysis and categorization processes. Most studies were descriptive and qualitative. The most frequently associated factors to the rehabilitation process were: mental health state before the accident, coping strategies and family support, besides the severity of the burn and the total body surface area burned. The quality of the selected studies, most classified as evidence level VI, shows the scarce production of strong evidences in this knowledge area, which needs more investment, considering the important implications of the sequelae of burns in the social reintegration of these people.
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Affiliation(s)
- Natália Gonçalves
- Universidade de São Paulo, Brazil; Conselho Nacional de Desenvolvimento Científico e Tecnológico
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Ying WL, Pertrini MA, Xin LL. Gender differences in the quality of life and coping patterns after discharge in patients recovering from burns in China. J Res Nurs 2010. [DOI: 10.1177/1744987110379301] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to investigate gender differences in quality of life and coping patterns after discharge for patients with burns in China. Cross-sectional survey research design and purposive sampling were used in this study, for which 92 subjects, including 56 males and 36 females, were recruited from a medical centre in central China. Quality of life was measured by the burn-specific health scale-brief (BSHS-B) and coping patterns were measured with the coping with burns questionnaire (CBQ), while demographic data was collected using a demographic questionnaire. An independent t-test and bivariate correlate were employed to analyse the data. The study results showed significant differences in quality of life between genders and coping patterns. There was a statistically significant gender difference in the sub-domain of the BSHS-B score for affect and relations, p < 0.05, and for coping patterns: emotion support, p < 0.05. The findings indicated that optimism/problem solving, revolution/adjustment and avoidance were the most commonly used coping patterns for males and females. The rank orders were same. The study indicated that women are more sensitive to relationships with family after discharge and tend to exhibit depressive symptoms. For women, emotional support is more important than it is for men. A number of significant positive and negative correlations were found among the variables.
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Affiliation(s)
- Wang Lin Ying
- Teacher, ShaoXin University, China
- Doctor, The First Teaching Hospital of Jiang Xi Medical College, China
| | - Marcia A. Pertrini
- Professor, Wuhan University, China
- Doctor, The First Teaching Hospital of Jiang Xi Medical College, China
| | - Liao Li Xin
- Doctor, The First Teaching Hospital of Jiang Xi Medical College, China
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Abstract
Burn injuries and their subsequent treatment cause one of the most excruciating forms of pain imaginable. The psychological aspects of burn injury have been researched in different parts of the world, producing different outcomes. Studies have shown that greater levels of acute pain are associated with negative long-term psychological effects such as acute stress disorder, depression, suicidal ideation, and post-traumatic stress disorder for as long as 2 years after the initial burn injury. The concept of allostatic load is presented as a potential explanation for the relationship between acute pain and subsequent psychological outcomes. A biopsychosocial model is also presented as a means of obtaining better inpatient pain management and helping to mediate this relationship.
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Affiliation(s)
- P. K. Dalal
- Department of Psychiatry, C.S.M. Medical University, Lucknow, Uttar Pradesh, India
| | - Rahul Saha
- Department of Psychiatry, C.S.M. Medical University, Lucknow, Uttar Pradesh, India
| | - Manu Agarwal
- Department of Psychiatry, C.S.M. Medical University, Lucknow, Uttar Pradesh, India
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The impact of personality and coping on the development of depressive symptoms in adult burns survivors. Burns 2010; 36:29-37. [DOI: 10.1016/j.burns.2009.06.202] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 06/02/2009] [Accepted: 06/24/2009] [Indexed: 11/19/2022]
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Posttraumatic Stress Disorder and Pain Impact Functioning and Disability After Major Burn Injury. J Burn Care Res 2010; 31:13-25. [DOI: 10.1097/bcr.0b013e3181cb8cc8] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Difede J, Cukor J, Lee F, Yurt R. Treatments for common psychiatric conditions among adults during acute, rehabilitation, and reintegration phases. Int Rev Psychiatry 2009; 21:559-69. [PMID: 19919209 DOI: 10.3109/09540260903344081] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Common and pernicious adult psychiatric disorders consequent to burn injury include post-traumatic stress disorder (PTSD), major depressive disorder (MDD), and new-onset substance abuse disorder. Diagnosing and treating these disorders is complicated by the complex psychosocial issues associated with burns including grief, pain, role impairment, disfigurement, dysfunction, stigma, as well as financial and legal issues. Additionally, pre-morbid psychiatric and neurological illnesses are risk factors for burns, adding to the challenge of diagnosis and treatment. This article will focus on the diagnosis and treatment of PTSD and MDD consequent to burn trauma, as these are the major psychiatric outcomes, addressing the attendant psychosocial problems as threads in this post-trauma tapestry.
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Affiliation(s)
- Joann Difede
- Department of Psychiatry, Weill Medical College of Cornell University, New York 10065, USA.
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Klinge K, Chamberlain DJ, Redden M, King L. Psychological adjustments made by postburn injury patients: an integrative literature review. J Adv Nurs 2009; 65:2274-92. [DOI: 10.1111/j.1365-2648.2009.05138.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Falder S, Browne A, Edgar D, Staples E, Fong J, Rea S, Wood F. Core outcomes for adult burn survivors: A clinical overview. Burns 2009; 35:618-41. [PMID: 19111399 DOI: 10.1016/j.burns.2008.09.002] [Citation(s) in RCA: 156] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2004] [Accepted: 09/02/2008] [Indexed: 11/25/2022]
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Using QMethodology to Identify Reasons for Distress in Burn Survivors Postdischarge. J Burn Care Res 2009; 30:83-91. [DOI: 10.1097/bcr.0b013e3181921f42] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ferreira E, Dantas RAS, Rossi LA, Ciol MA. The cultural adaptation and validation of the "Burn Specific Health Scale-Revised" (BSHS-R): version for Brazilian burn victims. Burns 2008; 34:994-1001. [PMID: 18375073 DOI: 10.1016/j.burns.2007.12.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Accepted: 12/07/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND The Burns Specific Health Scale-Revised (BSHS-R) is of easy application, can be self-administered, and it is considered a good scale to evaluate various important life aspects of burn victims. OBJECTIVES To translate and culturally adapt the BSHS-R into the Brazilian-Portuguese language and to evaluate the internal consistency and convergent validity of the translated BSHS-R. METHODS The cultural adaptation of the BSHS-R included translation and back-translation, discussions with professionals and patients to ensure conceptual equivalence, semantic evaluation, and pre-test of the instrument. The Final Brazilian-Portuguese Version (FBPV) of the BSHS-R was tested on a group of 115 burn patients for internal consistency and validity of construct (using the Rosenberg Self-Esteem Scale (RSES) and the Beck Depression Inventory (BDI)). RESULTS All values of Cronbach's alpha were greater than .8, demonstrating that the internal consistency of the FBPV was very high. Self-esteem was highly correlated with affect and body image (r=.59, p<.001), and with interpersonal relationships (r=.51, p<.001). Correlations between the domains of the FBPV and the BDI were all negative but larger in magnitude than the correlations with RSES. Depression was highly correlated with affect and body image (r=-.77, p<.001), and with interpersonal relationships (r=-.67, p<.001). CONCLUSIONS The results showed that the adapted version of the BSHS-R into Brazilian-Portuguese fulfills the validity and reliability criteria required from an instrument of health status assessment for burn patients.
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Affiliation(s)
- Eneas Ferreira
- Head Nurse at the Burn Unit, Clinical Hospital of Ribeirão Preto, University of São Paulo, Campus of Ribeirão Preto, Brazil
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Acute stress disorder and posttraumatic stress disorder: a prospective study of prevalence, course, and predictors in a sample with major burn injuries. J Burn Care Res 2008; 29:22-35. [PMID: 18182894 DOI: 10.1097/bcr.0b013e31815f59c4] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This is one of the largest prospective studies of patients with major burn injuries to use psychometrically sound methods to track and predict posttraumatic stress disorder (PTSD) across 2 years after burn. The principal objectives were to investigate the utility of self-report measures in detecting acute stress disorder (ASD) and PTSD, and in tracking and predicting PTSD. Participants were adult patients admitted for treatment of a major burn injury. The Stanford Acute Stress Reaction Questionnaire (SASRQ) was used to assess ASD symptomatology at discharge (n = 178), and the Davidson Trauma Scale was used to assess PTSD symptoms at scheduled follow-ups at 1 (n = 151), 6 (n = 111), 12 (n = 105), and 24 (n = 71) months after burn. The prevalence of in-hospital ASD was 23.6%, and 35.1, 33.3, 28.6, and 25.4% of the participants met PTSD criteria at 1, 6, 12, and 24 months, respectively. Clinically significant and reliable change in PTSD symptomatology during the 24 months was uncommon. SASRQ diagnostic cutoff and total scores each robustly predicted PTSD at the first three follow-ups and all four follow-ups, respectively. A SASRQ empirically derived cutoff score (> or =40) yielded moderate-high sensitivities (0.67-0.71) and specificities (0.75-0.80), and predicted PTSD at each follow-up. In conclusion, ASD and PTSD are prevalent following major burn injuries, ASD symptomatology can reliably predict PTSD up to 24 months later, and, once established, PTSD usually persists. Research is needed to determine whether early recognition and treatment of persons with in-hospital ASD can improve long-term outcomes.
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Fauerbach JA, Pruzinsky T, Saxe GN. Psychological Health and Function After Burn Injury: Setting Research Priorities. J Burn Care Res 2007; 28:587-92. [PMID: 17514031 DOI: 10.1097/bcr.0b013e318093e470] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- James A Fauerbach
- Johns Hopkins Burn Center, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224, USA
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Fauerbach JA, McKibben J, Bienvenu OJ, Magyar-Russell G, Smith MT, Holavanahalli R, Patterson DR, Wiechman SA, Blakeney P, Lezotte D. Psychological distress after major burn injury. Psychosom Med 2007; 69:473-82. [PMID: 17585064 PMCID: PMC5788166 DOI: 10.1097/psy.0b013e31806bf393] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To track the prevalence and stability of clinically significant psychological distress and to identify potentially modifiable in-hospital symptoms predictive of long-term distress (physical, psychological, and social impairment). METHOD We obtained data from the Burn Model Systems project, a prospective, multisite, cohort study of major burn injury survivors. The Brief Symptom Inventory (BSI) was used to assess symptoms in-hospital (n = 1232) and at 6 (n = 790), 12 (n = 645), and 24 (n = 433) months post burn. Distress was examined dimensionally (BSI's Global Severity Index (GSI)) and categorically (groups formed by dichotomizing GSI: T score > or =63). Attrition was unrelated to in-hospital GSI score. RESULTS Significant in-hospital psychological distress occurred in 34% of the patients, and clinically significant and reliable change in symptom severity by follow-up visits occurred infrequently. Principal components analysis of in-hospital distress symptoms demonstrated "alienation" and "anxiety" factors that robustly predicted distress at 6, 12, and 24 months, controlling for correlates of baseline distress. CONCLUSIONS This is the largest prospective, multisite, cohort study of patients with major burn injury. We found that clinically significant in-hospital psychological distress was common and tends to persist. Two structural components of in-hospital distress seemed particularly predictive of long-term distress. Research is needed to determine if early recognition and treatment of patients with in-hospital psychological distress can improve long-term outcomes.
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Affiliation(s)
- James A Fauerbach
- Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
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35
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Lu MK, Lin YS, Chou P, Tung TH. Post-traumatic stress disorder after severe burn in southern Taiwan. Burns 2007; 33:649-52. [PMID: 17482369 DOI: 10.1016/j.burns.2006.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Accepted: 09/26/2006] [Indexed: 11/21/2022]
Abstract
This cross-sectional study was conducted to examine the prevalence and risk factors of post-traumatic stress disorder (PTSD) after severe burn, and the need for psychological intervention for burn patients in southern Taiwan. Participants (N=82) were assessed by means of the Mini-International Neuropsychiatry Interview (MINI) scale with a structured questionnaire. Results showed that the prevalence of post-traumatic stress disorder in burn patients who met the DSM-IV criteria for PTSD was 26.8%. The risk factors related to PTSD in burn patients were: female, unmarried, and a lack of leisure arrangements after adjusting for confounding factors. PTSD patients needed more psychological intervention than the non-PTSD patients. These results suggest that PTSD after severe burn was not uncommon in southern Taiwan. The identified risk factors could provide clues to help burn care professionals provide multidisciplinary intervention.
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Affiliation(s)
- Ming-Kun Lu
- Community Medicine Research Center & Institute of Public Health, National Yang-Ming University, Taiwan
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36
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Meyer WJ, Blakeney P, Thomas CR, Russell W, Robert RS, Holzer CE. Prevalence of major psychiatric illness in young adults who were burned as children. Psychosom Med 2007; 69:377-82. [PMID: 17510292 DOI: 10.1097/psy.0b013e3180600a2e] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the prevalence of major psychiatric illness in a group of young adults who suffered significant burn injury as children. METHOD A total of 101 persons (58 males, 43 females), aged 21 +/- 2.6 years, 14.0 +/- 5.4 years postburn of 54% +/- 20% total body surface area, were assessed for serious past and present mental illness by using a Structured Clinical Interview (SCID) for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) Axis I diagnoses. RESULTS The SCID findings demonstrated that the prevalence of any Axis I major mental illness was 45.5% for the past month (current) and 59.4% for lifetime. These rates of overall disorder and the rates for most specific disorders were significantly higher than those found in the US population of comparable age. Logistic regression was used to examine demographic and burn characteristics as predictors of current and lifetime psychiatric disorder within the burn survivor sample. The female gender was significantly associated with higher rates of any current disorder. Other demographic and burn characteristics were not significantly related to the overall prevalence of current or lifetime disorder. Only a small number of those with disorders reported any current mental health treatment. CONCLUSIONS Significant burn injury as a child leads to an increased risk of developing a major mental illness. Young adults who suffered major burn injury as children should be screened for these illnesses to initiate appropriate treatment.
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Affiliation(s)
- Walter J Meyer
- General Clinical Research Center, University of Texas Medical Branch at Galveston, TX 77555-0189, USA.
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Klein MB, Lezotte DL, Fauerbach JA, Herndon DN, Kowalske KJ, Carrougher GJ, deLateur BJ, Holavanahalli R, Esselman PC, San Agustin TB, Engrav LH. The National Institute on Disability and Rehabilitation Research Burn Model System Database: A Tool for the Multicenter Study of the Outcome of Burn Injury. J Burn Care Res 2007; 28:84-96. [PMID: 17211206 DOI: 10.1097/bcr.0b013e31802c888e] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Advances in critical care and surgical management have significantly improved survival after burn injury over the past several decades. However, today, survival alone is an insufficient outcome. In 1994, the National Institute on Disability and Rehabilitation Research (NIDRR) created a burn model system program to evaluate the long-term sequelae of burn injuries. As part of this multicenter program, a comprehensive demographic and outcome database was developed to facilitate the study of a number of functional and psychosocial outcomes after burns. The purpose of this study is to review the database design and structure as well as the data obtained during the last 10 years. This is a descriptive study of the NIDRR database structure as well as the patient data obtained from the four participating burn centers from 1994 to 2004. Data obtained during hospitalization and at 6, 12, and 24 months after discharge were reviewed and descriptive statistics were calculated for select database fields. The database is divided into several subsections, including demographics, injury complications, patient disposition, and functional and psychological surveys. A total of 4600 patients have been entered into the NIDRR database. To date, 3449 (75%) patients were alive at discharged and consented to follow-up data collection. The NIDRR database provides an expansive repository of patient, injury, and outcome data that can be used to analyze the impact of burn injury on physical and psychosocial function and for the design of interventions to enhance the quality of life of burn survivors.
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Affiliation(s)
- Matthew B Klein
- Division of Plastic Surgery and the Burn Center, Department of Surgery, Harborview Medical Center, University of Washington, Seattle, Washington 98104, USA
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Moi AL, Wentzel-Larsen T, Salemark L, Hanestad BR. Long-term risk factors for impaired burn-specific health and unemployment in patients with thermal injury. Burns 2006; 33:37-45. [PMID: 17079085 DOI: 10.1016/j.burns.2006.06.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Accepted: 06/01/2006] [Indexed: 11/29/2022]
Abstract
The success of acute burn therapy has led to an increased demand for high-quality rehabilitation. When optimizing burn care programs, knowledge of long-term risk factors associated with impaired health and unemployment of the patient may be significant. The health and work status of 95 patients (82.1% males; mean age 43.7 (S.D.: 14.5) years; mean total body surface burn 18.5 (S.D.: 14.2) % were assessed 47.0 (S.D.: 23.8) months after injury, using the Norwegian version of the abbreviated burn-specific health scale (BSHS-N) and a questionnaire asking for socio-demographic and medical characteristics. A regression model demonstrated that the BSHS-N total score was significantly reduced by chronic pain (P<0.001), psychological illness (P<0.001), and living alone (P=0.030), as well as full-thickness facial (P=0.011) and foot (P=0.013) burns. Unemployment was significantly associated with housing and economic problems (P=0.001), chronic pain (P=0.001), the extent of full-thickness injury (P=0.005), the presence of deformities (P=0.037), the number of operations (P=0.001) and the length of hospital stay (P=0.016). Thus, socio-demographic factors, non-burn-related morbidity and the injury itself significantly impaired long-term physical and psychosocial health and work status.
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Affiliation(s)
- Asgjerd Litleré Moi
- Section of Nursing Science, Department of Public Health and Primary Health Care, University of Bergen, Kalfarveien 31, N-5018 Bergen, Norway.
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MacKenzie EJ, Bosse MJ. Factors influencing outcome following limb-threatening lower limb trauma: lessons learned from the Lower Extremity Assessment Project (LEAP). J Am Acad Orthop Surg 2006; 14:S205-10. [PMID: 17003200 DOI: 10.5435/00124635-200600001-00044] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The Lower Extremity Assessment Project (LEAP) is a multicenter study of severe lower extremity trauma in the US civilian population. At 2- and 7-year follow-ups, the LEAP study found no difference in functional outcome between patients who underwent either limb salvage surgery or amputation. However, outcomes on average were poor for both groups. This study and others provide evidence of wide-ranging variations in outcome following major limb trauma, with a substantial proportion of patients experiencing long-term disability. In addition, outcomes often are more affected by the patient's economic, social, and personal resources than by the initial treatment of the injury--specifically, amputation or reconstruction and level of amputation. A conceptual framework for examining outcomes after injury may be used to identify opportunities for interventions that would improve outcomes. Because of essential differences between the civilian and military populations, the findings of the LEAP study may correlate only roughly with combat casualty outcomes.
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Affiliation(s)
- Ellen J MacKenzie
- Health Policy and Management, The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
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Affiliation(s)
- Peter C Esselman
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
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Tcheung WJ, Robert R, Rosenberg L, Rosenberg M, Villarreal C, Thomas C, Holzer CE, Meyer WJ. Early treatment of acute stress disorder in children with major burn injury. Pediatr Crit Care Med 2005; 6:676-81. [PMID: 16276335 DOI: 10.1097/01.pcc.0000165562.04157.da] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study examines retrospectively the response rate of pediatric burn survivors with acute stress disorder to either imipramine or fluoxetine. METHODS On retrospective chart review, 128 intensive care unit patients (85 boys, 43 girls) with 52%+/- 20% total body surface area burn, length of stay of 32.8+/- 25.2 days, mean age of 9.1+/- 4.7 yrs, and age range of 13 months to 19 yrs met criteria for acute stress disorder after >or=2 days of symptoms and were treated with either imipramine or fluoxetine. If significant improvement did not occur within 7 days, the medication was either increased or switched to the other class. RESULTS Initially, 104 patients were treated with imipramine and 24 with fluoxetine. A total of 84 patients responded to imipramine: seven of these patients required a higher dose. A total of 18 patients responded to initial fluoxetine treatment. Of 26 nonresponders to the initial medication, 13 imipramine failures and one fluoxetine failure refused further treatment. The other 12 responded to the second medication. Therefore, 114 of 128 treated patients (89%) responded to either fluoxetine (mean dose, 0.30+/- 0.14 mg/kg) or imipramine (mean dose, 1.30+/- 0.55 mg/kg). Response was independent of sex and age but was less for those with burns of >60% total body surface area. The side effects of each medication were not significant. Most patients continued treatment for >or=3 months; some required 6 months of treatment before successful discontinuation. CONCLUSIONS Early treatment of acute stress disorder with either imipramine or fluoxetine is often able to reduce its symptoms. This is a review of a single hospital's experience in managing psychiatric distress in this very high-risk group of burned children. Additional clinical studies are needed before generalizing these findings.
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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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Lambert JF, Difede J, Contrada RJ. The relationship of attribution of responsibility to acute stress disorder among hospitalized burn patients. J Nerv Ment Dis 2004; 192:304-12. [PMID: 15060405 DOI: 10.1097/01.nmd.0000120890.16617.af] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Attribution of responsibility for a traumatic event has been related to subsequent adjustment. Self-blame has been associated with better adjustment in some cases and worse in others, whereas other-blame has consistently been associated with poorer outcomes. This study assessed the relationship between attribution of responsibility and acute stress disorder (ASD) in burn victims. Hospitalized burn patients (N = 124) underwent psychological assessment within 2 weeks of their burn injury. Participants were categorized as reporting self-blame (N = 49), other-blame (N = 36), both (N = 10), or neither (N = 29). Twenty-three percent of those with other-blame were diagnosed with ASD, compared with 0% of those with self-blame. Self-blame and other-blame also were related to ASD in logistic regression analyses controlling for demographic and medical variables. With both types of blame in the same model, self-blame was significantly associated with lower rates of ASD, whereas other-blame was related to higher rates, but this did not reach significance. When analyzed in separate models, both of these relationships attained statistical significance. These findings have implications for identifying and treating people at risk for posttraumatic stress disorder after exposure to trauma.
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Affiliation(s)
- Jennifer F Lambert
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
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Cuthbertson BH, Hull A, Strachan M, Scott J. Post-traumatic stress disorder after critical illness requiring general intensive care. Intensive Care Med 2004; 30:450-5. [PMID: 12961065 DOI: 10.1007/s00134-003-2004-8] [Citation(s) in RCA: 185] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2003] [Accepted: 08/05/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine the incidence and severity of symptoms related to the diagnosis of post-traumatic stress disorder (PTSD) in a cohort of general ICU patients. DESIGN A prospective cohort study 3 months after general ICU discharge. SETTING A general ICU in a teaching hospital in northern Scotland. PATIENTS AND PARTICIPANTS Seventy-eight ICU survivors of general ICU. INTERVENTIONS Patients were contacted 3 months after ICU discharge and asked to complete a telephone assessment of the Davidson Trauma Scale. MEASUREMENTS AND RESULTS The median score was 8, with 22% recording a score of at least 27 and 14% meeting the full diagnostic criteria for PTSD. The overall score was not correlated with sex, ICU length of stay, or APACHE II score but was inversely correlated with age and directly correlated with length of mechanical ventilation. The overall score was also related to the patient reporting having visited a GP or a mental health professional for psychological distress previous to ICU. CONCLUSIONS We found a high incidence of symptoms consistent with PTSD 3 months after ICU discharge in this general ICU cohort. This was associated with younger patients and those who visited their GP or a mental health professional complaining of psychological symptoms. Further research and a greater liaison between ICU staff and family practitioners and mental health practitioners is required to better identify individuals at risk and reduce psychological morbidity in this group.
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Affiliation(s)
- Brian H Cuthbertson
- Anaesthesia and Intensive Care, Medicine and Therapeutics, Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, Scotland, UK.
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Sin MK, Sanderson B, Weaver M, Giger J, Pemberton J, Klapow J. Personal characteristics, health status, physical activity, and quality of life in cardiac rehabilitation participants. Int J Nurs Stud 2004; 41:173-81. [PMID: 14725781 DOI: 10.1016/s0020-7489(03)00127-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The purpose of this study was to examine the relationships between personal factors, health status, and adherence to physical activity behavior, and quality of life in cardiac rehabilitation participants. The record of 146 subjects, who met inclusion criteria were obtained from the University Cardiac Rehabilitation Database. Change scores in physical activity were used as a proxy for adherence. Participants who were categorized as not working, female gender, and at high-risk health status had lower means and lower improvement scores from repeated measures analysis of variance. This study found that some personal factors and health status are significant factors influencing the participant's adherence to physical activity recommendations and quality of life in this cardiac rehabilitation program.
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Affiliation(s)
- Mo-Kyung Sin
- School of Nursing, University of Washington, Box 357266, Seattle, WA 98195-7266, USA.
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Van Loey NEE, Van Son MJM. Psychopathology and psychological problems in patients with burn scars: epidemiology and management. Am J Clin Dermatol 2003; 4:245-72. [PMID: 12680803 DOI: 10.2165/00128071-200304040-00004] [Citation(s) in RCA: 337] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Burn injury is often a devastating event with long-term physical and psychosocial effects. Burn scars after deep dermal injury are cosmetically disfiguring and force the scarred person to deal with an alteration in body appearance. In addition, the traumatic nature of the burn accident and the painful treatment may induce psychopathological responses. Depression and post-traumatic stress disorder (PTSD), which are prevalent in 13-23% and 13-45% of cases, respectively, have been the most common areas of research in burn patients. Risk factors related to depression are pre-burn depression and female gender in combination with facial disfigurement. Risk factors related to PTSD are pre-burn depression, type and severity of baseline symptoms, anxiety related to pain, and visibility of burn injury. Neuropsychological problems are also described, mostly associated with electrical injuries. Social problems include difficulties in sexual life and social interactions. Quality of life initially seems to be lower in burn patients compared with the general population. Problems in the mental area are more troublesome than physical problems. Over a period of many years, quality of life was reported to be rather good. Mediating variables such as low social support, emotion and avoidant coping styles, and personality traits such as neuroticism and low extraversion, negatively affect adjustment after burn injury. Few studies of psychological treatments in burn patients are available. From general trauma literature, it is concluded that cognitive (behavioral) and pharmacological (selective serotonin reuptake inhibitors) interventions have a positive effect on depression. With respect to PTSD, exposure therapy and eye movement reprocessing and desensitization are successful. Psychological debriefing aiming to prevent chronic post-trauma reactions has not, thus far, shown a positive effect in burn patients. Treatment of problems in the social area includes cognitive-behavioral therapy, social skills training, and community interventions. Sexual health promotion and counseling may decrease problems in sexual life.In conclusion, psychopathology and psychological problems are identified in a significant minority of burn patients. Symptoms of mood and anxiety disorders (of which PTSD is one) should be the subject of screening in the post-burn phase and treated if indicated. A profile of the patient at risk, based on pre-injury factors such as pre-morbid psychiatric disorder and personality characteristics, peri-traumatic factors and post-burn factors, is presented. Finally, objective characteristics of disfigurement appear to play a minor role, although other factors, such as proneness to shame, body image problems, and lack of self-esteem, may be of significance.
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Affiliation(s)
- Nancy E E Van Loey
- Department of Research, Dutch Burns Foundation, Beverwijk, The Netherlands.
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Moi AL, Wentzel-Larsen T, Salemark L, Hanestad B. Validation of a Norwegian version of the Burn Specific Health Scale. Burns 2003; 29:563-70. [PMID: 12927981 DOI: 10.1016/s0305-4179(03)00146-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The abbreviated Burn Specific Health Scale (BSHS-A) is an 80-item questionnaire that has proven useful in measuring physical, mental, social and general health in burn survivors. The aim of this study was to adapt the BSHS-A into Norwegian, including assessing reliability and validity. METHODS Standard procedures for forward and backward translation including discussions with professionals and patients to ensure conceptual equivalence were used. A pilot study (11 burn patients) confirmed that the Norwegian version (BSHS-N) was clear, understandable and easy to self-administer. Subsequently, 95 adults admitted to the Burn Center, Haukeland University Hospital, between 1995 and 2000 entered a validation study by completing the BSHS-N and the general health measure SF-36. Sixty-nine of the 95 (72%) responders completed a retest. RESULTS The overall internal consistency reliability (Cronbach's alpha=0.97) and the test-retest reliability (ICC=0.95) for the BSHS-N were satisfactory. Tests for criterion validity showed expected patterns for association between comparable domains in the BSHS-N and the SF-36, with correlations ranging from r=0.61 to 0.81. Tests for construct validity showed that patients with full thickness injury (P=0.003), patients hospitalised more than 10 days (P=0.003), patients undergoing more than two operations (P=0.001) and patients unemployed at the time of study (P<0.001), had significantly lower total scores than the rest of the patients. CONCLUSION BSHS-N seems to be a reliable and valid instrument for use in the Norwegian population. The translation and cross-cultural adaptation of this instrument allows for comparative international studies.
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Affiliation(s)
- A Litleré Moi
- Department of Plastic Surgery and Burn Center, Haukeland University Hospital, N-5021, Bergen, Norway.
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Williams R, Doctor J, Patterson D, Gibran N. Health outcomes for burn survivors: A 2-year follow-up. Rehabil Psychol 2003. [DOI: 10.1037/0090-5550.48.3.189] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
The present study investigates factors influencing the quality of life and social reintegration of burn victims. A study concept was developed to assess the functional and aesthetic long-term outcomes of burn victims. Objective data from a clinical examination was correlated with subjective data from completed questionnaires. The success of social rehabilitation was documented and an indicative profile of life quality evaluated. This profile could prompt early intervention if found necessary. Ninety-two patients were examined 5.4+/-1.1 years after trauma in relation to three factors: physical functions, localization of the burn injuries and extent of the body surface area burned. Physical functioning allows the best predictions for successful rehabilitation, because all areas of life quality are affected by it. Localization of burns in the face and hands creates disadvantages in social reintegration. Of less value in prediction is the extent of the body surface area burned, which is only closely linked to occupational rehabilitation and directly correlates to physical functional limitations. Our correlation showed, that even slight functional limitations were linked to severe depressions, similar to the values found with patients with serious functional impairment. Interdisciplinary cooperation between plastic surgeons and psychosomatic specialists will optimize early intervention with patients exposed to social maladaptation.
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Affiliation(s)
- N Pallua
- Department of Plastic, Hand and Reconstructive Surgery, Burn Center, Klinikum der RWTH Aachen, Pauwelstrasse 30, D-52074 Aachen, Germany.
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Lawrence JW, Fauerbach JA. Personality, coping, chronic stress, social support and PTSD symptoms among adult burn survivors: a path analysis. THE JOURNAL OF BURN CARE & REHABILITATION 2003; 24:63-72; discussion 62. [PMID: 12543997 DOI: 10.1097/00004630-200301000-00016] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This paper presents a longitudinal study of the relationship between personality, coping, chronic stress, social support and posttraumatic stress disorder (PTSD). A hypothesized model of the relationship between the predictor variables and PTSD symptoms was proposed. Path analyses was completed to test the model. One hundred fifty-eight adult burn survivors completed questionnaires measuring each of the variables in the hospital. Of those 124 and 94 completed the PTSD measure at 1 month and 6 months postdischarge, respectively. The hypothesized model fit the data at each time point with slight variations. The model accounted for 46 and 29% of the variance of PTSD symptoms at hospitalization and 1 month. Neuroticism was the most important personality dimension in predicting PTSD. Avoidant Coping and Social Support mediated a high percentage of the relationship between Neuroticism and PTSD. The best predictor of PTSD symptoms at 1 and 6 months was PTSD symptoms at hospitalization.
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Affiliation(s)
- John W Lawrence
- Baltimore Regional Burn Center, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
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