Anxiety and Depression Among Non-Facial Burn Patients at a Tertiary Care Center in Pakistan

Nomogram for predicting the risk of anxiety and depression in patients with non-mild burns

BACKGROUND

Post-burn anxiety and depression affect considerably the quality of life and recovery of patients; however, limited research has demonstrated risk factors associated with the development of these conditions.

AIM

To predict the risk of developing post-burn anxiety and depression in patients with non-mild burns using a nomogram model.

METHODS

We enrolled 675 patients with burns who were admitted to The Second Affiliated Hospital, Hengyang Medical School, University of South China between January 2019 and January 2023 and met the inclusion criteria. These patients were randomly divided into development (n = 450) and validation (n = 225) sets in a 2:1 ratio. Univariate and multivariate logistic regression analyses were conducted to identify the risk factors associated with post-burn anxiety and depression diagnoses, and a nomogram model was constructed.

RESULTS

Female sex, age < 33 years, unmarried status, burn area ≥ 30%, and burns on the head, face, and neck were independent risk factors for developing post-burn anxiety and depression in patients with non-mild burns. The nomogram model demonstrated predictive accuracies of 0.937 and 0.984 for anxiety and 0.884 and 0.923 for depression in the development and validation sets, respectively, and good predictive performance. Calibration and decision curve analyses confirmed the clinical utility of the nomogram.

CONCLUSION

The nomogram model predicted the risk of post-burn anxiety and depression in patients with non-mild burns, facilitating the early identification of high-risk patients for intervention and treatment.

Therapeutic approach to emotional reactions accompanied with thermal skin injury - from basic to epidemiological research

In this editorial, we discuss the status of a therapeutic approach to emotional reactions accompanying thermal skin injuries. Burns are considered a major health problem, as well as an economic and social problem, with potentially devastating and life-changing consequences. They affect a wide range of patients with different damage mechanisms, varied depths, and localizations of the burns. The most common are thermal burns, with more than 11 million occurrences annually according to the World Health Organization data. Thermal skin injuries are among the most tragic and catastrophic injuries, almost unsurpassed in terms of severity, morbidity, and mortality, as well as functional, aesthetic, social, economic, and psychological consequences. Burn survivors face stress, anxiety, depression, low self-esteem, body deformity, social isolation, unemployment, financial burden, and family problems. The advances in acute burn care have allowed researchers and physicians to pay more attention to other effects of burns, focusing on psychological consequences in particular. Apart from the significant improvements in routine protocols, it seems useful to take care of psychological disturbances that occur simultaneously but may emerge as the most lasting outcome of those injuries. In that sense, various standards and additional approaches may be involved to achieve overall recovery.

Effects of acupressure on sleep quality and anxiety of patients with second- or third-degree burns: a randomized sham-controlled trial

BACKGROUND

Although acupressure is proposed to boost sleep quality and alleviate anxiety in various disorders, no trials have yet documented these consequences in burn victims. Considering the high importance of managing sleep quality and anxiety among burn patients utilizing adjunctive non-pharmacological measures, this study sought to investigate the impacts of acupressure on sleep quality and anxiety among a population of Iranian patients with burn injuries.

METHODS

This trial was performed on 72 patients with second- or third-degree burns, who were divided into two equal arms to receive routine care plus 10-minute acupressure on either real acupoints (i.e., Yintang and Shen men) or sham points for three consecutive nights. Sleep quality and anxiety were investigated at baseline (T1) and on the fourth day (T2) by using St. Mary's Hospital Sleep Questionnaire (SMHSQ) and Spielberger's State-Trait Anxiety Inventory for State Anxiety (STAI-S), respectively.

RESULTS

The mean scores of SMHSQ and STAI-S were significantly lower in the real acupressure arm at T2 (P < 0.001 in two cases), implying better sleep quality improvement and higher anxiety alleviation. Also, the reduction in mean changes of SMHSQ and STAI-S scores from T1 to T2 was significantly more in the real acupressure arm (P < 0.001 in two cases).

CONCLUSION

Acupressure, as a low-cost complementary method, could be potentially helpful in enhancing sleep quality and decreasing the anxiety of burn patients. Additional long-term trials are required to identify the sustainability of the findings.

TRIAL REGISTRATION NO

IRCT20130424013110N13 (Registration date: 19/03/2021, https://www.irct.ir/trial/55076 ).

Wound Pain as a Determinant of Function in Patients Hospitalised for Burns

Burn wounds most often occur on visible parts of the body. They therefore cause fear of disfigurement and rejection by those around them. In addition, they cause pain. The main aim of this study was to analyse factors affecting the functioning of patients hospitalised for burns. The study included 57 patients hospitalised for burns. Each person was surveyed twice: on day seven after admission and on the day of discharge from the hospital. The following research tools were used: a personal questionnaire to collect clinical data and the scales of the Katz Activities of Daily Living (ADL), the short-form McGill Pain Questionnaire (SF-MPQ), the Beck Depression Inventory (BDI) and the Satisfaction with Appearance Scale (SWAP). On the discharge day, compared to day 7, there was an improvement in the patient's level of functioning in all areas analysed. Pain intensity (p < 0.0001), depression (p < 0.0001) and dissatisfaction with appearance (p = 0.0239) decreased significantly. Improvements in daily functioning were also obtained (p < 0.0001). Multiple regression was performed to estimate the effect of selected variables on patients' level of functioning. Burn area (p = 0.0126), pain level (questionnaire part B: p = 0.0004 and questionnaire part C: p = 0.0208) and gender (p = 0.0413) had a significant impact on the level of daily functioning. Pain complaints are the most crucial predictor affecting the functional status and depression levels in burn wound patients. Increased levels of depression promote dissatisfaction with one's appearance.

Frontal lobe hemodynamics detected by functional near-infrared spectroscopy during head-up tilt table tests in patients with electrical burns

Significance

Electrical burns can cause severe damage to the nervous system, resulting in autonomic dysfunction with reduced cerebral perfusion. However, few studies have investigated these consequences.

Aim

To elucidate changes in prefrontal cerebral hemodynamics using functional near-infrared spectroscopy (fNIRS) during the head-up tilt table test (HUT) for patients with electrical burns.

Approach

We recruited 17 patients with acute electrical burns within 1 week after their accidents and 10 healthy volunteers. The NIRS parameters acquired using an fNIRS device attached to the forehead were analyzed in five distinct HUT phases.

Results

Based on their HUT response patterns, patients with electrical burns were classified into the group with abnormal HUT results (APG, n = 4) or normal HUT results (NPG, n = 13) and compared with the healthy control (HC, n = 10) participants. We found trends in hemodynamic changes during the HUT that distinguished HC, NPG, and APG. Reduced cerebral perfusion and decreased blood oxygenation during the HUT were found in both the NPG and APG groups. Patients with electrical burns had autonomic dysfunction compared to the HC participants.

Conclusions

Using fNIRS, we observed that acute-stage electrical burn injuries could affect cerebral perfusion.