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Reasons for Distress Among Burn Survivors at 6, 12, and 24 Months Postdischarge: A Burn Injury Model System Investigation

Published:December 16, 2017DOI:https://doi.org/10.1016/j.apmr.2017.11.007

      Abstract

      Objective

      To identify important sources of distress among burn survivors at discharge and 6, 12, and 24 months postinjury, and to examine if the distress related to these sources changed over time.

      Design

      Exploratory.

      Setting

      Outpatient burn clinics in 4 sites across the country.

      Participants

      Participants who met preestablished criteria for having a major burn injury (N=1009) were enrolled in this multisite study.

      Interventions

      Participants were given a previously developed list of 12 sources of distress among burn survivors and asked to rate on a 10-point Likert-type scale (0=no distress to 10=high distress) how much distress each of the 12 issues was causing them at the time of each follow-up.

      Main Outcomes Measures

      The Medical Outcomes Study 12-Item Short-Form Health Survey was administered at each time point as a measure of health-related quality of life. The Satisfaction With Appearance Scale was used to understand the relation between sources of distress and body image. Finally, whether a person returned to work was used to determine the effect of sources of distress on returning to employment.

      Results

      It was encouraging that no symptoms were worsening at 2 years. However, financial concerns and long recovery time are 2 of the highest means at all time points. Pain and sleep disturbance had the biggest effect on ability to return to work.

      Conclusions

      These findings can be used to inform burn-specific interventions and to give survivors an understanding of the temporal trajectory for various causes of distress. In particular, it appears that interventions targeted at sleep disturbance and high pain levels can potentially effect distress over financial concerns by allowing a person to return to work more quickly.

      Keyword

      List of abbreviations:

      MCS (Mental Component Summary), PCS (Physical Component Summary), SF-12 (Medical Outcomes Study 12-Item Short-Form Health Survey), SWAP (Satisfaction with Appearance Scale)
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      References

        • Ehde D.M.
        • Patterson D.R.
        • Wiechman S.A.
        • Wilson L.G.
        Post-traumatic stress symptoms and distress following acute burn injury.
        Burns. 1999; 25: 587-592
        • Tedstone J.E.
        • Tarrier N.
        An investigation of the prevalence of psychological morbidity in burn-injured patients.
        Burns. 1997; 23: 550-554
        • Fauerbach J.A.
        • Lawrence J.
        • Haythornthwaite J.
        • et al.
        Preburn psychiatric history affects posttrauma morbidity.
        Psychosomatics. 1997; 38: 374-385
        • Patterson D.R.
        • Everett J.J.
        • Bombardier C.H.
        • Questad K.A.
        • Lee V.K.
        • Marvin J.A.
        Psychological effects of severe burn injuries.
        Psychol Bull. 1993; 113: 362-378
        • McKibben J.B.
        • Bresnick M.G.
        • Wiechman Askay S.A.
        • Fauerbach J.A.
        Acute stress disorder and posttraumatic stress disorder: a prospective study of prevalence, course, and predictors in a sample with major burn injuries.
        J Burn Care Res. 2008; 29: 22-35
        • Mason S.T.
        • Corry N.
        • Gould N.F.
        • et al.
        Growth curve trajectories of distress in burn patients.
        J Burn Care Res. 2010; 31: 64-72
        • Wiechman S.A.
        • Ptacek J.T.
        • Patterson D.R.
        • Gibran N.S.
        • Engrav L.E.
        • Heimbach D.M.
        Rates, trends, and severity of depression after burn injuries.
        J Burn Care Rehabil. 2001; 22: 417-424
        • Fauerbach J.A.
        • McKibben J.
        • Bienvenu O.J.
        • et al.
        Psychological distress after major burn injury.
        Psychosom Med. 2007; 69: 473-482
        • Edwards R.R.
        • Smith M.T.
        • Klick B.
        • et al.
        Symptoms of depression and anxiety as unique predictors of pain-related outcomes following burn injury.
        Ann Behav Med. 2007; 34: 313-322
        • Smith M.T.
        • Klick B.
        • Kozachik S.
        • et al.
        Sleep onset insomnia symptoms during hospitalization for major burn injury predict chronic pain.
        Pain. 2008; 138: 497-506
        • Van Loey N.E.
        • Van Son M.J.
        Psychopathology and psychological problems in patients with burn scars: epidemiology and management.
        Am J Clin Dermatol. 2003; 4: 245-272
        • Askay S.W.
        • Stricklin M.
        • Carrougher G.J.
        • et al.
        Using QMethodology to identify reasons for distress in burn survivors postdischarge.
        J Burn Care Res. 2009; 30: 83-91
        • Stephenson W.
        The study of behavior.
        University of Chicago Press, Chicago1935
        • McKeown B.
        • Thomas D.
        Q methodology.
        Sage Publications, Thousand Oaks1988
        • Goverman J.
        • Mathews K.
        • Holavanahalli R.
        • et al.
        The National Institute on Disability, Independent Living and Rehabilitation Research Burn Model System: twenty years of contributions to clinical service and research.
        J Burn Care Res. 2017; 38: e240-e253
        • Klein M.B.
        • Lezotte D.L.
        • Fauerbach J.A.
        • et al.
        The National Institute on Disability and Rehabilitation Research burn model system database: a tool for the multicenter study of the outcome of burn injury.
        J Burn Care Res. 2007; 28: 84-96
        • Ware J.E.
        • Kosinski S.K.
        • Gandek M.B.
        SF-36 health survey: manual and interpretation guide.
        The Health Institute, New England Medical Centre, Boston1993
        • Lawrence J.W.
        • Heinberg L.J.
        • Roca R.
        • et al.
        Development and validation of the Satisfaction with Appearance Scale: assessing body image among burn-injured patients.
        Psychol Assess. 1998; 10: 64-70
        • Schneider J.
        • Bassi S.
        • Ryan C.M.
        Employment outcomes after burn injury: a comparison of those burned at work and those burned outside of work.
        J Burn Care Res. 2011; 32: 294-301
        • Schneider J.
        • Bassi S.
        • Ryan C.M.
        Barriers impacting employment after burn injury.
        J Burn Care Res. 2009; 30: 284-300
        • Lee A.F.
        • Ryan C.M.
        • Schneider J.C.
        • et al.
        Quantifying risk factors for long-term sleep problems after burn injury in young adults.
        J Burn Care Res. 2017; 38: e510-e520
        • Patterson D.R.
        • Jensen M.P.
        • Wiechman S.A.
        • Sharar S.R.
        Virtual reality hypnosis for pain associated with recovery from physical trauma.
        Int J Clin Exp Hypn. 2010; 58: 288-300
        • Wiechman Askay S.
        • Patterson D.R.
        • Sharar S.R.
        • Mason S.
        • Faber B.
        Pain management in patients with burn injuries.
        Int Rev Psychiatry. 2009; 21: 522-530
        • Morin C.M.
        • Bootzin R.R.
        • Buysse D.J.
        • Edinger J.D.
        • Espie C.A.
        • Lichstein K.L.
        Psychological and behavioral treatment of insomnia: update of the recent evidence (1998-2004).
        Sleep. 2006; 29: 1398-1414
        • Schneider J.C.
        • Nadler D.L.
        • Herndon D.N.
        • et al.
        Pruritus in pediatric burn survivors: defining the clinical course.
        J Burn Care Res. 2015; 36: 151-158
        • Thombs B.D.
        • Notes L.D.
        • Lawrence J.W.
        • Magyar-Russell G.
        • Bresnick M.G.
        • Fauerbach J.A.
        From survival to socialization: a longitudinal study of body image in survivors of severe burn injury.
        J Psychosom Res. 2008; 64: 205-212
        • Ryan C.M.
        • Lee A.
        • Kazis L.E.
        • et al.
        Recovery trajectories following burn injury in young adults: does burn size matter?.
        J Burn Care Res. 2015; 36: 118-129
      1. Holavanahalli RK, Sanchez A, Kowalske KJ. Disparities in self-reported outcomes among racial and ethnic minority groups following a major burn injury. Paper presented at: American Burn Association Annual Meeting. May 3-6, 2016; Las Vegas, NV.

        • Ryan C.M.
        • Schneider J.C.
        • Kazis L.E.
        • et al.
        Benchmarks for multidimensional recovery following burn injury in young adults: the development, validation, and testing of the American Burn Association/Shriners Hospitals for Children Young Adult Outcome Questionnaire.
        J Burn Care Res. 2013; 34: e121-e142
        • Griggs C.
        • Schneider J.C.
        • Kazis L.E.
        • Ryan C.M.
        Patient reported outcome measures: a stethoscope for the patient history.
        Ann Surg. 2017; 265: 1066-1067
        • Ryan C.M.
        • Lee A.F.
        • Kazis L.E.
        • et al.
        Is real-time feedback of burn-specific patient-reported outcome measures (PROMs) in clinical settings practical and useful? A pilot study implementing the Young Adult Burn Outcome Questionnaire (YABOQ).
        J Burn Care Res. 2016; 37: 64-74
        • Edwards R.R.
        • Magyar-Russell G.
        • Thombs B.
        • et al.
        Acute pain at discharge from hospitalization is a prospective predictor of long-term suicidal ideation after burn injury.
        Arch Phys Med Rehabil. 2007; 88: S36-42