Mediational models of pain, mental health, and functioning in individuals with burn injury.

Abstract Introduction Temperature sensitivity is a common problem after burn injury. However, the impact of temperature sensitivity on health-related quality of life (QoL) is unknown. We aimed to describe characteristics associated with temperature sensitivity and determine its association with patient reported QoL. We hypothesized that temperature sensitivity negatively impacts both mental and physical health. Methods We reviewed a multicenter burn database for participants who had been asked about hot or cold temperature sensitivity 6, 12 and 24 months after injury. Outcomes of interest included the Satisfaction with Life Scale (SWLS) score and Veterans RAND 12 (VR-12) physical (PCS) & mental health summary (MCS) scores. Chi square and Kruskal-Wallis tests determined differences in patient and injury characteristics. Generalized linear regression models included burn size (%TBSA), graft size (%TBSA), location of burn, pruritis intensity, amputation status, study site, and review of systems questions at each follow-up visit as covariates to determine the impact of temperature sensitivity on QoL. Results The cohort was comprised of 637 participants. Prevalence of temperature sensitivity at each follow-up period ranged from 48%-54%. Those who experienced temperature sensitivity had larger burns, required more grafting, and had higher intensity of pruritus at discharge. Temperature sensitivity was associated with lower SWLS scores and lower VR-12 PCS and MCS at each follow-up period. After controlling for confounding variables, temperature sensitivity remained a significant independent predictor of lower SWLS scores (OR -3.2, 95% CI -5.4, -1.1) and VR-12 MCS (OR -4.4, 95% CI -7.4, -1.4) at 6 months follow-up. Conclusions Temperature sensitivity is a highly prevalent symptom after burn injury and an independent predictor of worse satisfaction with life and worse mental health recovery.

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Clinical profile of burn injured patients

Health & Research Journal ◽

10.12681/healthresj.19809 ◽

2016 ◽

Vol 2 (2) ◽

pp. 80

Author(s):

Flora Efstathiou ◽

Paraskevi Svardagalou

Keyword(s):

Mental Health ◽

Burn Injury ◽

Systemic Disease ◽

International Health ◽

Strong Relationship ◽

Risk Groups ◽

Reciprocal Relationship ◽

Clinical Profile ◽

World Health ◽

Health Organization

Introduction: Burn injury is a severe systemic disease with social implications.Aim: The recording of patient’s clinical profile with burn injury worldwide and in Greece, the outcome and impact of the injury on the patient’s mental health and social, professional and family life.Methods: There were collected surveys and reports concerned burn victims, men and women, teenagers and adults of all types and severities of burns in the world and in Greece. The information were been searched in database of Pubmed and websites of international health agencies (American Burn Association-ABA, World Health Organization-WHO , Centers for Diseases Control and Prevention-CDC) and statistical offices (Hellenic Statistical Authority), between the years 1985-2012.Results: In U.S.A. 183.036 burned victims were reported between the years 2002-11 and in Greece 1840 in 1993-2001. The most of studies were showed strong relationship between risk of burn and age, gender, standard of living and education, the place and conditions of the injury, the lack of information and habits of patients. The coexistence of chronic diseases burdened the risk of injury and the outcome. After burn injury, patients had difficulties on professional and social reintegration, because of physical complications and mental disorders. Their psychological condition upon leaving the hospital was important prognostic feature. Researchers suggested the detection of high-risk groups to train them and organized psychosocial reintegration of burned.Conclusion: There is a reciprocal relationship between clinical profile of burned patients before injury and outcome of the disease and their mental health, social, professional and family life. The need for continuous investigation into the profile of burned within multicenter study and organization of network for psychosocial reintegration became evident.

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771 Psychiatric Illness Among Burn Patients: Experience at a Single ABA Verified Burn Center

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.349 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S219-S220

Author(s):

Spogmai Komak ◽

James Cross

Keyword(s):

Mental Health ◽

Bipolar Disorder ◽

Psychiatric Diagnosis ◽

Psychiatric Illness ◽

Burn Injury ◽

Operative Intervention ◽

Burn Patients ◽

Psychiatric Consultation ◽

Burn Center ◽

Burn Unit

Abstract Introduction Burn injury is uniquely characterized by the initial traumatic event in addition to the psychiatric component associated with physical change and recovery. Recent work has highlighted the importance of pre-existing psychiatric illness on both recovery and final outcomes in burn patients (Tarrier et al 2005, Hudson et al 2017, Wisely et al 2009). We examined the prevalence and association of psychiatric illness in our ABA verified burn unit. Knowledge of this information is critical in allocation of limited resources aimed toward addressing both the physical and mental aspect of burn injury. Methods The burn registry at a single verified burn center was examined from July 2017-July 2018. All consecutive burn patients with psychiatric illness who were admitted were included. Psychiatric illness was broken down into: depression, anxiety, bipolar disorder, schizophrenia and delirium. Need for psychiatric consultation, %TBSA, length of hospital stay, and operative intervention was also examined. Results 416 patients were admitted during the study period—44 pts (10.5%) had a psychiatric diagnosis on admission. Seventy-five percent of pts were male. The average TBSA burned was 15.3%. Seventy-five percent of patients required psychiatric consultation, and 57% required operative intervention (Table 1). The most common psychiatric condition was anxiety (50%), followed by depression (36%), bipolar disorder (27%), schizophrenia (23%), and delirium (18%). Forty-eight percent of patients had multiple (>1) psychiatric conditions. Female patients had a significant less TBSA burn (5.8%) vs. male (18.2%), P=.001, as well as a shorter LOS (12.1 dys vs. 31.5 dys) p=.004. Conclusions The association between burn injury and pre-existing psychiatric illness is well known (Hudson et al 2017, Wisely et al 2009). We found that over 10% of pts admitted to our burn unit had a psychiatric diagnosis, and a large number of these required further inpatient psychiatry consultation. More than half of patients required operative intervention indicating that severity of burn injury was high, with optimization of pre-existing conditions especially important. Additionally, psychiatric illness did not occur in isolation--48% of pts had >1 psychiatric diagnosis —a finding which has implications for resource allocation for mental health/ dedicated psychiatrist for burn patients. Applicability of Research to Practice Implications for resource allocations for dedicated burn psychiatrist/ resources for mental health.

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Qualitative research investigating the mental health care service gap in Chinese burn injury patients

BMC Health Services Research ◽

10.1186/s12913-018-3724-3 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 4

Author(s):

Zhengjia Ren ◽

PeiChao Zhang ◽

HongTao Wang ◽

Hongyan Wang

Keyword(s):

Mental Health ◽

Health Care ◽

Qualitative Research ◽

Mental Health Care ◽

Burn Injury ◽

Care Service ◽

Health Care Service ◽

Mental Health Care Service ◽

Service Gap

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31 Patients in Need: Are We Identifying and Helping Them?

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.035 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S22-S23

Author(s):

Mikenzy Fassel ◽

Colette Galet ◽

Lucy Wibbenmeyer

Keyword(s):

Mental Health ◽

Food Insecurity ◽

Burn Injury ◽

Basic Needs ◽

Psychosocial Assessment ◽

Burn Patients ◽

Psychosocial Needs ◽

Burn Wound ◽

Symptoms Of Depression ◽

Number Of Patients

Abstract Introduction Healing from a burn injury is a complex process that takes months to years. Survivors and families with basic needs or mental health issues may experience additional challenges during recovery. We previously showed a significant and positive correlation between adverse childhood events (ACEs) and number of needs (r = 0.5), housing insecurity (r = 0.23), food insecurity (r = 0.34), stress (r = 0.39), and symptoms of depression (r = 0.44). Herein, we assessed whether these needs were identified and addressed prior to discharge. Methods Medical charts of the 175 burn patients enrolled in our ACEs study were reviewed to assess if a social worker assessment (SWA) was done. SWA is primarily performed for discharge planning. We collected patient/family identified needs, resources provided, mental health consultation (adults only), and whether patients received additional information (burn bag) on support programs, burn/wound care guide, alternative dressings, post-traumatic stress disorder, and intimacy; the latter being only distributed to adult patients. Collected data were compared to the Family Strengths and Needs Assessment Survey (Strengths and Needs Survey) completed at the time of consent and analyzed using SPSS. Results SWA was completed on 50 inpatients (63.3%) and one outpatient. Based on the Strengths and Needs Survey, patients receiving SWA were more likely to rent (45.2% vs. 30%) or live in shared/temporary housing or be homeless (9.4% vs. 5.7%; p = 0.035) and report police interaction (15.1% vs. 4.1%; p = 0.023). Housing was addressed in only three SWA (5.7%). A higher number of patients with SWA reported food insecurity (22.6% vs. 12.3%; p = 0.082). Five SWA included food stamp status, with only one patient being provided information on food stamps. No difference was observed regarding stress and symptoms of depression between those who received a SWA and those who did not (45.3% vs. 39.3%; p = 0.36 and 39.6% vs 29.5%; p = 0.5, respectively). Psychosocial assessment need was noted in 46 SWA (90.6%). Only 12 adult inpatients (15%) were seen by mental health providers; 10 had a SWA. Burn bags were provided to 30 patients (58.8%), more often to adult than to pediatric patients (73.3% vs. 40%; p = 0.04). Conclusions Our study shows that many of our patients’ needs are not adequately assessed with the current social work and mental health capabilities. While SWA is performed on many of our patients with basic needs, many are not addressed, and individualized resources are often not provided. Moreover, only a third of our patients with identified psychosocial needs received consultation. Further study is warranted to develop a targeted approach to better meet the needs of our burn patients and their families. Applicability of Research to Practice By further assessing our patients’ needs, we will be able to better connect them with relevant resources to lighten the burden they face during their recovery.

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The psychological impact of paediatric burn injuries: a systematic review

BMC Public Health ◽

10.1186/s12889-021-12296-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Alix Woolard ◽

Nicole T. M. Hill ◽

Matthew McQueen ◽

Lisa Martin ◽

Helen Milroy ◽

...

Keyword(s):

Mental Health ◽

Systematic Review ◽

Traumatic Stress ◽

Burn Injury ◽

Clinical Care ◽

Psychological Outcomes ◽

Qualitative Studies ◽

Burn Injuries ◽

Burn Patients ◽

Post Traumatic

Abstract Objective To review and synthesise qualitative literature regarding the psychological outcomes following paediatric burn injuries, and to determine if children and adolescents who experience a burn injury have elevated risk of psychopathology following the injury. Design Systematic review of quantitative and qualitative studies. Data sources Informit health, Medline, Embase, and PsycINFO were searched from January 2010 to December 2020. Data extraction and synthesis Two reviewers screened articles, and one reviewer extracted data (with cross-checking from another reviewer) from the included studies and assessed quality using an established tool. Narrative synthesis was used to synthesise the findings from the quantitative studies, and thematic synthesis was used to synthesise the findings of included qualitative studies. Results Searches yielded 1240 unique titles, with 130 retained for full-text screening. Forty-five studies from 17 countries were included. The psychological outcomes included in the studies were mental health diagnoses, medication for mental illness, depression, anxiety, stress, fear, post-traumatic stress, post-traumatic growth, emotional issues, self-harm, self-esteem, self-concept, stigmatisation, quality of life, level of disability, resilience, coping, and suicidality. Conclusions Our findings highlight paediatric burn patients as a particularly vulnerable population following a burn injury. Studies suggest elevated anxiety and traumatic stress symptoms, and higher rates of psychopathology in the long-term. Further research is recommended to determine the psychological outcomes in the other mental health domains highlighted in this review, as findings were mixed. Clinical care teams responsible for the aftercare of burn patients should involve psychological support for the children and families to improve outcomes.

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810 Routine Psychosocial Screening and Follow-up of Adult Burn Patients in an Outpatient Clinic

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.387 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S243-S244

Author(s):

Alaina Tiani ◽

Desiree N Williford ◽

Carrie B Jackson ◽

Kristine Durkin ◽

Ariana Langholz ◽

...

Keyword(s):

Mental Health ◽

Substance Use ◽

Burn Injury ◽

Psychological Services ◽

Post Traumatic Stress ◽

Increased Risk ◽

Burn Survivors ◽

Clinically Significant ◽

At Home

Abstract Introduction Sustaining a burn injury is associated with increased risk of mental health issues, and common among these are depression, anxiety, post-traumatic stress disorder (PTSD), and substance use. Unfortunately, less than half of these adult burn survivors receive services related to their mental health concerns. Moreover, few studies have examined the routine implementation of a psychosocial screener in an outpatient burn clinic setting, and there is a paucity of research which examines how to proceed when patients endorse symptomology. The aim of the current study is to report on outcomes of a routine psychosocial screener in a sample of adult burn survivors and patient response to brief psychological consultation at initial screen and 1-month follow-up. Methods A psychosocial screener was developed and implemented (October 2016-August 2019) in an outpatient burn clinic to identify patients who endorse clinically significant psychosocial distress. Comprised of very brief, validated scales (and their clinical cut-off scores), the screener assessed for safety at home, suicidal risk, depression, anxiety, and substance use. Adult burn survivors completed the questionnaire at their first outpatient appointment. Patients who endorsed safety concerns at home and/or suicidal ideation/risk were immediately evaluated by a physician or psychology staff. Those who endorsed significant distress, but no suicidal or safety risk, were contacted by psychology staff within one week of the screener date. Those who did not indicate significant clinically significant distress did not require further action. Results Of the 393 patients who completed the screener, 102 individuals (26%) indicated clinically significant mental/behavioral distress. Psychology staff were able to reach 80 patients (78%) for initial brief consultation (i.e., within one week). Of those contacted, 14 (18%) indicated that they were already receiving psychological services, 25 (31%) reported they were not interested in a psychological referral, 20 (25%) accepted a new referral for psychological services, and 19 (24%) endorsed minimal or decreased symptoms. In February 2019, we began to conduct 1-month follow-up. A total of 19 individuals were eligible (had positive screens) and 8 (42%) were reached. Of those reached, 2 (25%) accepted a new psychological referral, 2 (25%) indicated no interest in a referral, and 3 (37%) reported minimal/no psychological symptoms. Conclusions Implementing a psychosocial screener is a feasible way to screen for distress in outpatients. Applicability of Research to Practice A 1-month follow-up contact helps staff to understand whether referrals are utilized or how symptoms may change over time and yields another opportunity to provide referrals to those previously uninterested.

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The Psychological Impact of Paediatric Burn Injuries: a Systematic Review

10.21203/rs.3.rs-839346/v1 ◽

2021 ◽

Author(s):

Alix Woolard ◽

Nicole T M Hill ◽

Matthew McQueen ◽

Lisa Martin ◽

Helen Milroy ◽

...

Keyword(s):

Mental Health ◽

Systematic Review ◽

Traumatic Stress ◽

Burn Injury ◽

Psychological Impact ◽

Psychological Outcomes ◽

Qualitative Studies ◽

Burn Injuries ◽

Burn Patients ◽

Post Traumatic

Abstract Title: The psychological impact of paediatric burn injuries: a systematic reviewObjective To review and synthesise qualitative literature regarding the psychological outcomes following paediatric burn injuries, and to determine if children and adolescents who experience a burn injury have elevated risk of psychopathology following the injury.Design: Systematic review of quantitative and qualitative studies.Data sources: Informit health, Medline, Embase, and PsycINFO were searched from January 2010 to December 2020.Data extraction and synthesis: Two reviewers screened articles, and one reviewer extracted data (with cross-checking from another reviewer) from the included studies and assessed quality using an established tool. Narrative synthesis was used to synthesise the findings from the quantitative studies, and thematic synthesis was used to synthesise the findings of included qualitative studies.Results: Searches yielded 1240 unique titles, with 130 retained for full-text screening. Forty-five studies from 17 countries were included. The psychological outcomes included in the studies were mental health diagnoses, medication for mental illness, depression, anxiety, stress, fear, post-traumatic stress, post-traumatic growth, emotional issues, self-harm, self-esteem, self-concept, stigmatisation, quality of life, level of disability, resilience, coping, and suicidality.Conclusions: Our findings highlight paediatric burn patients as a particularly vulnerable population following the burn injury. Studies suggest elevated anxiety and traumatic stress symptoms, and higher rates of psychopathology in the long-term. Further research is recommended to determine the psychological outcomes in the other mental health domains highlighted in this review, as findings were mixed.Clinical care teams responsible for the aftercare of burn patients should involve psychological support for the children and families to improve outcomes.

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