Depression and burn wounds

The Impact of Adverse Childhood Experiences on Burn Outcomes in Adult Burn Patients

Adverse childhood experiences (ACEs), including child maltreatment and household dysfunction, define adverse events that occur before 18 years of age. National and state data show that between 12.5 and 14.5% of the adult population report ≥4 ACEs (HIGH-ACE), respectively. HIGH-ACEs are associated with more chronic health problems. To date, the interaction between ACEs and burn injuries has not been studied. Herein, we sought to define the ACE exposure in our burn patients and its impact on early outcomes. Inpatient and outpatient adult burn survivors (≥18 years of age) were enrolled. Subjects completed surveys assessing adverse experiences (ACEs-18), needs, strengths, and resiliency at consent, and pain, depression, post-traumatic stress disorder (PTSD), and social participation surveys at 2 weeks to 3 months postinjury. Demographics, burn, and hospital course data were also collected. Chi-square and student's t-tests were used for descriptive analysis and to compare the groups (HIGH-ACE vs LOW-ACE). The HIGH-ACE group (n = 24; 45.3%) reported more depressive symptoms (P < .04) than the LOW-ACE group (n = 29, 54.7%). HIGH-ACE patients were less resilient when facing stressful events (P ≤ .02) and more likely to screen positive for probable PTSD (P = .01) and to score lower on the Life Impact Burn Recovery Evaluation Profile (LIBRE Profile), which assesses for social participation, in the domain of Family and Friends (P = .015). Our exploratory study suggests that ACE screening may help detect burn patients at risk for a more complicated recovery, thereby promoting personalized assistance in recovery.

Effects of depression on healing and inflammatory responses of acute wounds in rats

This study aimed to elucidate the effect of depression on the healing of acute wounds in rats. We hypothesized that depression would have negative effects on inflammation and wound healing and that antidepressant therapy would reverse these effects. This study included 100 rats randomly allocated into five groups: control group (CG), depression group (DG), pre-depression group (PDG), antidepressant group (AG), and pre-antidepressant group (PAG). Acute wounds were created on the rats' backs. The groups were subjected to no interventions (CG), aversive stimuli before (PDG) and after (DG) wound creation, and antidepressant treatment before (PAG) and after (AG) wound creation. On the day of wound creation and on days 3, 6, 9, and 12 after wound creation, observations of the wound area and degree of depression (evaluated using the sucrose preference test, open-field test, and weight change) were recorded. On days 6 and 12 after wound creation, venous serum and wound tissues were collected. Tumor necrosis factor alpha (TNF-α), interleukin (IL)-1β, IL-6, and IL-10 levels were measured using the enzyme-linked immunosorbent assay. Results showed an initial increase followed by a decrease in the degree of depression in all groups except DG (continuous decline). The wound-healing rate was significantly lower in PDG and DG than in CG; it was higher in AG and PAG than in CG. DG and PDG had higher concentrations of inflammatory cytokines than CG, and AG and PAG had lower concentrations than CG. This indicates that the onset of depression delays the healing of acute wounds and aggravates the inflammatory response in rats. Antidepressant treatment counteracts both of these negative effects.

Hypnosis for burn-related pain: Case studies and a review of the literature

Burn injuries create severe pain and psychological distress that are highly variable between patients. Distinct types of pain during various stages of injury and recovery make treatment complex. Standard pharmacological treatment of pain can have adverse effects and is not effective in treating anxiety and other psychological issues. Researchers have proposed that integrating clinical hypnosis as a complementary therapy can be highly beneficial to burn patients and their healthcare providers. The existing literature is reviewed and specific hypnosis techniques are discussed. Evidence exists indicating that adjunctive hypnosis is effective at reducing pain and procedural anxiety. Implementing a multidisciplinary burn care team that includes clinical hypnosis and focuses on the patients’ psychological health as well as pain reduction is likely to result in faster healing and reduced distress for patients and caregivers alike.

Aspects of sexual life in patients after burn: the most neglected part of postburn rehabilitation in the developing world

Burn patients are rendered with physical as well as mental scars; the latter usually are more protean in their manifestations. Rehabilitation after burn can be a grueling experience and the associated stress can blemish the patient's sexuality and intimacy. There is dearth of literature regarding the quality of sexual life after burn as well as sexual rehabilitation; it is fully known that a healthy sexual life is intricately related to a person's mental well being and a sexually compromised person can never be totally happy. The objective of this study was to ascertain the degree of satisfaction in postburn patients regarding their sexual lives, parameters associated with sexual dissatisfaction, if present, and ways to address the same. Quality of sexual life was investigated by making burn patients answer the Maudsley Marital Questionnaire (the sexual scale only) 6 months after burn. A control group of nonburn patients matched with the cases was made to answer the same and values were compared for significance. Results of the Maudsley Marital Questionnaire sexual scale were obtained for both groups and compared by means of a χ test (Pearson). The results were found to be highly significant, and there was a marked difference in the values of the two groups (χ = 117.8945, two-tailed P < .0001). A readily palpable deterioration in the sexual lives of burn patients is the most significant finding of this study. Also highlighted were the sociodemographic characteristics of this sexually suffering group and various other relevant parameters.

Psychopathology and psychological problems in patients with burn scars: epidemiology and management

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.