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Psychological Distress After Major Burn Injury

Fauerbach, James A. PhD; McKibben, Jodi PhD; Bienvenu, O Joseph MD, PhD; Magyar-Russell, Gina PhD; Smith, Michael T. PhD; Holavanahalli, Radha PhD; Patterson, David R. PhD; Wiechman, Shelley A. PhD; Blakeney, Patricia PhD; Lezotte, Dennis PhD

doi: 10.1097/psy.0b013e31806bf393
Original Articles

Objective: To track the prevalence and stability of clinically significant psychological distress and to identify potentially modifiable inhospital symptoms predictive of long-term distress (physical, psychological, and social impairment).

Method: We obtained data from the Burn Model Systems project, a prospective, multisite, cohort study of major burn injury survivors. The Brief Symptom Inventory (BSI) was used to assess symptoms in-hospital (n = 1232) and at 6 (n = 790), 12 (n = 645), and 24 (n = 433) months post burn. Distress was examined dimensionally (BSI’s Global Severity Index (GSI)) and categorically (groups formed by dichotomizing GSI: T score ≥63). Attrition was unrelated to in-hospital GSI score.

Results: Significant in-hospital psychological distress occurred in 34% of the patients, and clinically significant and reliable change in symptom severity by follow-up visits occurred infrequently. Principal components analysis of in-hospital distress symptoms demonstrated “alienation” and “anxiety” factors that robustly predicted distress at 6, 12, and 24 months, controlling for correlates of baseline distress.

Conclusions: This is the largest prospective, multisite, cohort study of patients with major burn injury. We found that clinically significant in-hospital psychological distress was common and tends to persist. Two structural components of in-hospital distress seemed particularly predictive of long-term distress. Research is needed to determine if early recognition and treatment of patients with in-hospital psychological distress can improve long-term outcomes.

TBSA = total body surface area; BMS = burn model systems; PTSD = posttraumatic stress disorder; ASD = acute stress disorder; BSI = Brief Symptom Inventory; ROM = range of motion; GSI = Global Severity Index (of the BSI); OR = odds ratio; RCI = Reliable Change Index; SD = standard deviation; CI = confidence interval.

From the Johns Hopkins University School of Medicine (J.A.F., J.M., O.J.B., G.M.-R., M.T.S.), Baltimore, Maryland; University of Texas, Southwestern Medical Center (R.H.), Dallas, Texas; University of Washington School of Medicine (D.R.P., S.A.W.), Seattle, Washington; University of Texas Medical Branch (P.B.), Galveston, Texas; and University of Colorado Health Science Center (D.L.), Denver, Colorado.

Address correspondence and reprint requests to James A. Fauerbach, Johns Hopkins University School of Medicine, c/o Johns Hopkins Regional Burn Center, 4940 Eastern Avenue, Baltimore, MD 21224. E-mail:

Received for publication February 14, 2006; revision received February 27, 2007.

This study was supported by funds from the National Institute on Disability and Rehabilitation Research in the Office of Special Education and Rehabilitative Services in the US Department of Education (Burn Model System grants to J.A.F., D.R.P., P.B., and D.L.), Grant MH64543 from the National Institutes of Health (J.B.), and Grant MH14592 from the National Institute of Mental Health (J.M.).

Copyright © 2007 by American Psychosomatic Society
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