Burns 24 (1998) 407-415 An investigation of the factors associated with an increase sychological morbidity in burn injured patients Josephine E. Tedstoneaak , Nicholas Tarrier’, Eric B. Faragher’ “Depariment of Clinical Psyckolo~; Central Nottingkamskire Hraithcare E-ust Headquarters, Soutkwell Road West. Mansfieki, Nottinglramskire, NGl8 4Hh! UK “Department of Clinical Psyckology,Sckool of Psychiatry and Bekavioural Sciences. Universiiy of MaruAcste~ Withingtou Hospitai. Wes/ Didstxuy, Manchester M20 8LR, UK ‘Department of Medical Statistics, Universit), Research Building, Witkington Hospital, West Didshury, Man&ester; -4420 8LR, UK Accepted 24March1998 -~ Abstract Previous research aimed at identifying factors that increase the risk of major burns patients experiencing psychological problems post-burn has generally ignored the potential role of psychological factors. In a prospective study, patientswith burn injuries ranging from < 1 per cent up to 40 per cent were interviewed within 2 weeksof sustaining the burn and followed up at ca 3 months post-burn in order to assess the effects of both non-psychological and psychological factors on their subsequent mental health. The factors investigated includedburn related information, demographic information. previous psychiatrichistory, levels of psychological morbidity at 2 weeks post-burn, responsibility for the injury, previouslife events, compensation claimsand factors from the coping literature including appraisal, coping strategies and coping efficacy. Forward stepwise multiple regression analyses were usedto investigate the relationships betweenthese factors and subsequent mental health. Post-burnpsychological morbidity was strongly associated with psychological factors including levels of psychological morbidity in the first 2 weeks of sustaining the injury and factors from the copingliterature. 0 1998 Elsevier Science Ltd for ISBI. All rights reserved. 1. Introduction It is widely accepted that people who have sustained burn injuries are likely to show a range of emotions and subsequent psychological problems. Depression, anxiety and post traumatic stress disorder (PTSD) are relatively common. Studies of the prevalence of depression have demon- strated that between 21 and 33 per cent of patients have clinically significant levels of depression during hospitalization [1,2]. Feelings of depression are likely to extend over 1 year [3], and some 11 per cent experi- ence suicidal ideation [2]. Anxiety is also common, with a prevalence of 31-50 per cent during hospitalization /4,5], and 27 per cent at 2 years post discharge [5]. Approximately 30-31 per cent meet the criteria for PTSD while inpatients [6,7], and 29 per cent of patients still have subclinical PTSD symptoms 12 months post-burn [7]. In addition, during the Iyear following discharge, 78 per cent meet DSM III-R “Corresponding author. Tel.: 01623 784910; Fax: 01623 634126. criteria for intrusive symptoms, 43 per cent avoidant symptoms and 65 per cent hyper arousal symptoms [8]. Clearly, not all patients experience significant psychological difficulties post-burn. It would be useful to be able to identify those patients most at risk of developing future psychological morbidity whilst they are still in contact with medical services, as, once out of the hospital system, patients experiencing such difficul- ties are less likely to be identified and directed to appropriate sources of help. In the search for factors associated with an increased risk of psychological morbidity post-burn, a number of factors have been investigated, resulting in conflicting results. Burn extent [9-121, burn location [3,4,9,13-161, demographic deta.ils [2,3,12,13,15] and previous psychiatric history [2,17-191 are commonly investigated. Factors from the psychological literature, especially the areas of PTSD and coping research could also be of use in identifying patients with a heightened risk of developing psychological morbidity post-burn, but seem to have been largely ignored. For example, factors associated with the development of PTSD including self blame [20,21], compensation 03054179/98/$19.00 -t 0.00 0 1998 Elsevier Science Ltd for ISBI. All rights reserved. PII: s0305-4179(98)00049-7