Psychiatry - Theses
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ItemGathering longitudinal outcomes in wellbeing after burns (GLOW) study( 2017)Objective: Burn injuries are common and debilitating traumatic injuries that are associated with a range of post-injury maladjustments. Burn patients experience high rates of psychiatric morbidity, have low rates of return to work and experience reductions in quality of life in the months and years after discharge. Despite this, very limited longitudinal research has evaluated these outcomes in less severe burns, and has examined what early psychosocial risk factors may contribute to these outcomes. Further, common limitations across burns psychological research include variation in sample characteristics, limited reporting of findings, simplistic methodologies and small sample sizes. Aims: In light of the limitations in the burns literature, this research study aimed to investigate what pre-burn, acute and 3-month early psychosocial risk factors contribute to psychopathology, quality of life and return to work outcomes 6-months after burn injury. Method: Consecutive admissions to the burns unit in Melbourne, Victoria with a Total Burned Surface Area of 20% or less were recruited for the study. 109 burn patients provided consent to participate, and 74 completed the 3 and 6-month follow-up assessments. Participants completed structured clinical interviews to measure psychiatric history and post-trauma symptomatology, and a battery of self-report questionnaires assessing factors such as pain, sleep quality, appearance dissatisfaction, anger and social support. Bayesian Structural Equation Modeling was conducted for each outcome (psychopathology, quality of life, return to work) to identify early psychosocial contributors to these outcomes. Results: At 6-months, 28.4% of participants met criteria for an Axis I psychiatric disorder, and while only 3.0% met criteria for PTSD, 7.5% met criteria for subsyndromal PTSD. Quality of life was most affected in relation to taking care of the burn and skin sensitivity. 14% reported not having returned to work at 6-months as a result of the burn, and many participants reported at least moderate difficulty with performing work tasks. Symptoms of PTSD at 6-months were predicted by 3-month mental health symptoms, higher 3-month pain and social support. Symptoms of depression were predicted by higher age and more mental health symptoms at 3-months. Symptoms of anxiety were predicted by 3-month mental health symptoms only. Quality of life, as indicated by the domains of Affect and Relations, Skin Involvement and Functioning, were significantly predicted by various earlier risk factors, but they differed by domain outcome. Specifically, Affect and Relations, meaning problems related to affect, interpersonal relationships and sexuality, was predicted by 3-month mental health symptoms and higher pain. Skin involvement, meaning problems related to skin sensitivity and taking care of the burn, was predicted by burn severity (TBSA) and 3-month mental health symptoms. Functioning at 6-months was only significantly predicted by higher age. Problems returning to work at 6-months was significantly predicted by 3-month greater pain and more mental health symptoms. Conclusions: The findings from this study suggest that even in minor burn injuries, maladjustment is common in the months following the burn. Specifically, these burns experience elevated rates of psychiatric disorders, reduced quality of life and problems returning to work. While these outcomes are related, the findings further demonstrate that different risk factors are important to predicting each of these outcomes. Overall this study highlights the need for early, although not acute, psychosocial screening of even minor burns in order to improve psychosocial services available to minor burns.
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ItemPersonality and the trajectory of posttraumatic psychopathology( 2015-02-06)Objective: Comorbidity between psychiatric disorders is the rule rather than the exception, with some patterns of comorbidity more common than others. The tendency for disorders to cluster together in predictable patterns can be accounted for by the existence of higher order internalising and externalising dimensions. These dimensions, in turn, are underpinned by personality traits. The relationship between personality and psychopathology has been a particular focus of researchers interested in explaining the diverse range of psychopathology experienced by survivors of traumatic events. However, extant research in this field has been limited to cross-sectional investigations of PTSD comorbidity, despite the fact that PTSD patients represent only a small minority of trauma survivors. In addition, the relationship between personality and posttraumatic functioning outside of the mental health domain has received minimal attention. Perhaps most importantly, the influence of personality on the longitudinal trajectory of posttraumatic disorders has not been examined. Therefore it is not known whether personality profiles varying on the internalising and externalising dimensions respond differently to trauma exposure over time. Aims: In light of the limitations of the extant literature, this study aimed to 1) investigate whether and how pre-trauma personality influences the trajectory of a range of common posttraumatic disorders, and 2) establish the relationship between personality and non-psychiatric maladaptive responses to trauma. Method: During hospitalisation for serious physical injury, 323 Australian adults completed a retrospective assessment of pre-injury personality and psychiatric history. Post-injury psychiatric diagnoses were assessed 3 and 12 months later using a structured clinical interview. A range of non-psychiatric outcomes were also assessed at 12 months post-injury (e.g., disability, quality of life, anger, risk of re-injury, exposure to trauma and life stress). Latent profile analysis conducted on initial personality scores identified subgroups of participants, while latent change modelling examined differences in disorder trajectories controlling for psychiatric history. Regression analyses were used to investigate the influence of personality on non-psychiatric outcomes. Results: Three personality-based classes of trauma survivors were identified, corresponding to internalising, externalising, and normal personality profiles. After controlling for psychiatric history, the internalising class showed a high risk of developing all disorders. Unexpectedly, however, the normal personality class was not always at lowest risk of disorder. Rather, the externalising class, while more likely than the normal personality class to develop substance use disorders, were less likely to develop PTSD and depression. In terms of non-psychiatric outcomes, internalisers reported poorer health and higher levels of life stress and trauma exposure in the year after injury, while externalisers were more likely to engage in activities that put them at risk of re-injury. These relationships, however, were largely accounted for by gender and the experience of pain at 12 months post-injury. Conclusions: Results suggest that personality is an important mechanism in influencing the development and form of psychopathology and related outcomes after trauma. These findings suggest that screening and early intervention using a personality-based approach may be an effective method of predicting and subsequently preventing much of the burden of posttraumatic problems across both mental health and related domains.