Burn care

Burns – Psychological Aspects

By: Mölnlycke Health Care, August 23 2013Posted in: Burn care

Introduction
Over the past 50 years, mortality rates following major burns have dramatically reduced due to the expanding knowledge of the pathophysiology of thermal injury and its systemic consequences, the advances in medical technology and improved surgical techniques. The focus on psychiatric morbidity and welbeing of burn survivors has increased in importance as mortality has decreased.

The first year following a burn injury is the most vulnerable period during which time many patients suffer from anxiety, depression, delirium and psychosis. Most studies highlight that patients suffer long-term psychological complications, with a prevalence rate spanning 10–65% (Klinge et al, 2009). Anxiety and depression are the most frequent long-term symptoms reported by burn patients. Identifying risk factors is essential to identify those at risk of psychological problems following injury to implement preventive and rehabilitative strategies.
(Insert table 1 from Klinge et al (2009), p. 2277)

Six variables that influence how well burn patients adjust to post burn injury have been identified:

(1) Psychological status prior to burn injury
Burn patients have a higher incidence of pre-existing psychopathology than the general
population. Pre-existing psychiatric disorders, alcohol, substance abuse and depression play a statistically significant causal role in these injuries (Dyster-Aas et al, 2008). Reduced cognitive processes related to disregard for self-protection lead to risk-taking behaviours (Noronha and Faust, 2006).  The importance of early psychological intervention to recognize and treat pre-existing impairments is therefore essential to reduce the complications of long-term adjustment.

(2) Vocational status prior to burn injury
Being unemployed at the time of injury, coupled with pre-existing factors such as alcohol
dependence and illegal substance use has been associated with poorer psychological outcomes following burn injury (Fauerbach et al, 2001). Early identification of problems and vocational rehabilitation can address the barriers to employment experienced by many burn patients.

(3) Personality and coping style
Individuals with specific personality traits experience greater adjustment difficulties. Neuroticism, the main trait identified, is characterized by pessimism, negative affect, introversion and the use of avoidance coping strategies. A correlation has been demonstrated between neuroticism-related personality traits and psychosocial and physical adjustment after injury (Klinge et al, 2009).

(4) Efficacy of support networks
Studies support linking a stable, supportive social network (and being employed at the time of
burn injury) with better outcome (Klinge et al, 209).

(5) Burn characteristics
Pre-existing psychological problems may have a greater impact on the person’s psychological
adjustment than the extent or location of the injury (Klinge et al, 2009).

(6) Gender
Society values beauty and those bearing visible scars are frequently socially stigmatized and
marginalized or under-valued. However, it has been shown that pre-injury factors have a greater influence on post burn psychological adjustment than does the extent or location of the injury (Fauerbach et al. 2002). Depending upon the location and visibility of the scarring, females generally suffered greater and more prolonged psychological maladjustment related to altered body image and sexual dysfunction than their male counterparts (Klinge et al, 2009).

Conclusion
Study results have demonstrated that heterogeneity and co-morbidity are key characteristics of this patient group (Klinge et al, 2009). The diverse reactions to injury and compounding psychological problems that affect adjustment make it difficult to predict how an individual will react. Treatment programmes need to be proactive and preventive, and this can be achieved by targeting specific risk factors to activate and strengthen resources relevant to the desired outcome (Wallis et al. 2006).

References
Dyster-Aas J., Willebrand M., Wikehult B., Gerdin B. & Ekselius L. (2008) Major depression and posttraumatic stress disorder symptoms following severe burn injury in relation to lifetime psychiatric
morbidity. Journal of Trauma Injury Infection and Critical Care 64(5), 1349–1356.
 
Fauerbach J.A., Heinberg L.J., Lawrence J.W. & Bryant A.G. (2002) Coping with body image changes following a disfiguring burn injury. Health Psychology 21(2), 115–121.

Fauerbach J.A., Engrav L., Kowalske K., Brych S., Bryant A., Lawrence J., Guohua L., Munster A. & deLateur B. (2001) Barriers to employment among working-aged patients with major burn
injury. Journal of Burn Care & Rehabilitation 22(1), 26–34.

Klinge K et al. Psychological adjustments made by postburn injury patients: an integrative literature review. Journal of Advanced Nursing. 2009; 65(11): 2274-2292.

Noronha D.O. & Faust J. (2006) Identifying the variables impacting post-burn psychological adjustment: a meta-analysis. Journal of Pediatric Psychology 32(3), 380–391.33(2), 167–172.
Wallis H., Renneberg B., Ripper S., Germann G., Wind G. & Jester

Wallis H., Renneberg B., Ripper S., Germann G., Wind G. & Jester A. (2006) Emotional distress and psychosocial resources in patients recovering from severe burn injury. Journal of Burn Care & Re-
search 27(5), 734–741.

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