Psychiatry - Theses
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ItemGathering longitudinal outcomes in wellbeing after burns (GLOW) studyTerhaag, Sonia ( 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.