Epidemiology of burn injuries II: Psychiatric and behavioural perspectives

Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814-4799, USA.
International Review of Psychiatry (Impact Factor: 1.8). 01/2009; 21(6):512-21. DOI: 10.3109/09540260903343794
Source: PubMed


Modern technological advances have decreased the incidence and severity of burn injuries, and medical care improvements of burn injuries have significantly increased survival rates, particularly in developed countries. Still, fire-related burn injuries are responsible for 300,000 deaths and 10 million disability-adjusted life years lost annually worldwide. The extent to which psychiatric and behavioural factors contribute to the incidence and outcomes of these tragedies has not been systematically documented, and the available data is often insufficient to reach definitive conclusions. Accordingly, this article reviews the evidence of psychiatric and behavioural risk factors and prevention opportunities for burn injuries worldwide. Psychiatric prevalence rates and risk factors for burn injuries, prevalence and risks associated with 'intentional' burn injuries (self-immolation, assault, and child maltreatment), and prevention activities targeting the general population and those with known psychiatric and behavioural risk factors are discussed. These issues are substantially interwoven with many co-occurring risk factors. While success in teasing apart the roles and contributions of these factors rests upon improving the methodology employed in future research, the nature of this entanglement increases the likelihood that successful interventions in one problem area will reap benefits in others.

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    • "Burn survivors are at risk to suffer from severe long-term psychological problems (Fauerbach et al., 2007; McKibben et al., 2009). Symptoms of acute stress disorder (ASD), posttraumatic stress disorder (PTSD), anxiety, depression, as well as delirium and problems with sleeping and frequent nightmares are commonly experienced in the aftermath of severe burn injuries (Davydow et al., 2009; Thombs et al., 2006). "
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    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.
    Journal of Behavioral Medicine 04/2015; 38(4). DOI:10.1007/s10865-015-9638-1 · 3.10 Impact Factor
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    • "The findings of this study also show an association between PTSD and male gender. This may be explained by the higher prevalence of some types of burns in men, according to the literature.28–32 With regard to specific types of burns, eg, electrical and occupational burns, the male predominance is even higher, reaching up to 98% in some studies.29,33 "
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    ABSTRACT: A burn injury can be a traumatic experience with tremendous social, physical, and psychological consequences. The aim of this study was to investigate the existence of post-traumatic stress disorder (PTSD) and predictors of PTSD Checklist score initially and 3 months after injury in burns victims admitted to the Sina Burn Center in north-west Iran. This prospective study examined adult patients aged 16-65 years with unintentional burns. The PTSD Checklist was used to screen for PTSD. Flame burns constituted 49.4% of all burns. Mean PTSD score was 23.8 ± 14.7 early in the hospitalization period and increased to 24.2 ± 14.3, 3 months after the burn injury. Twenty percent of victims 2 weeks into treatment had a positive PTSD screening test, and this figure increased to 31.5% after 3 months. The likelihood of developing a positive PTSD screening test increased significantly after 3 months (P < 0.01). Using multivariate regression analysis, factors independently predicting PTSD score were found to be age, gender, and percentage of total body surface area burned. PTSD was a problem in the population studied and should be managed appropriately after hospital admission due to burn injury. Male gender, younger age, and higher total body surface area burned may predict a higher PTSD score after burn injury.
    Neuropsychiatric Disease and Treatment 07/2011; 7(1):425-9. DOI:10.2147/NDT.S23041 · 1.74 Impact Factor
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    • "The recognition that the majority of pediatric burns occur at home provides opportunities to significantly impact on the burden of these devastating injuries through prevention, which remains the single best management strategy.2Much of the progress towards reductions in burn-related deaths in recent decades can be attributed to improvements in medical and surgical care, however a more important component are interventions that alter the physical or social environment affecting incidence and severity of injuries encountered.34Adequate supervision of children remains a major prevention tool for avoiding accidents of all types. "
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    ABSTRACT: Burns are an important cause of injury to young children, being the third most frequent cause of injury resulting in death behind motor vehicle accidents and drowning. Burn injuries account for the greatest length of stay of all hospital admissions for injuries and costs associated with care are substantial. The majority of burn injuries in children are scald injuries resulting from hot liquids, occurring most commonly in children aged 0-4 years. Other types of burns include electrical, chemical and intentional injury. Mechanisms of injury are often unique to children and involve exploratory behavior without the requisite comprehension of the dangers in their environment. Assessment of the burnt child includes airway, breathing and circulation stabilization, followed by assessment of the extent of the burn and head to toe examination. The standard rule of 9s for estimating total body surface area (TBSA) of the burn is inaccurate for the pediatric population and modifications include utilizing the Lund and Browder chart, or the child's palm to represent 1% TBSA. Further monitoring may include cardiac assessment, indwelling catheter insertion and evaluation of inhalation injury with or without intubation depending on the context of the injury. Risk factors and features of intentional injury should be known and sought and vital clues can be found in the history, physical examination and common patterns of presentation. Contemporary burn management is underscored by several decades of advancing medical and surgical care however, common to all injuries, it is in the area of prevention that the greatest potential to reduce the burden of these devastating occurrences exists.
    Journal of injury & violence research 07/2011; 3(2):98-110. DOI:10.5249/jivr.v3i2.91
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