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Major depression and posttraumatic stress disorder symptoms following severe burn injury in relation to lifetime psychiatric morbidity
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
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2008 (English)In: Journal of Trauma - Injury, Infection and Critical Care, ISSN 0022-5282, Vol. 64, no 5, 1349-1356 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Psychiatric history has been suggested to have an impact on long-term adjustment in burn survivors. A rigorous, prospective, longitudinal approach was used to study psychiatric history in a population-based burn sample and its impact on symptomatology of depression and posttraumatic stress disorder (PTSD) at a 12-month follow-up. METHODS: Seventy-three consecutive patients admitted to the Uppsala Burn Unit were assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition for psychiatric disorders, of whom 64 were also assessed after 12 months. RESULTS: Forty-eight patients (66%) presented with at least one lifetime psychiatric diagnosis; major depression (41%), alcohol abuse or dependence (32%), simple phobia (16%), and panic disorder (16%) were most prevalent. At 12-months postburn, 10 patients (16%) met criteria for major depression, 6 (9%) for PTSD, and 11 (17%) for subsyndromal PTSD. Patients with lifetime anxiety disorder and with lifetime psychiatric comorbidity were more likely to be depressed at 12 months, whereas those with lifetime affective disorder, substance use disorder and psychiatric comorbidity were more likely to have symptoms of PTSD. CONCLUSIONS: Two-thirds of burn survivors exhibit a history of lifetime psychiatric disorders. Those with a psychiatric history have a higher risk of postburn psychiatric problems.

Place, publisher, year, edition, pages
2008. Vol. 64, no 5, 1349-1356 p.
Keyword [en]
Burns, Major depression, Posttraumatic stress disorder, Psychiatric morbidity
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-95104DOI: 10.1097/TA.0b013e318047e005ISI: 000255915400034PubMedID: 18469660OAI: oai:DiVA.org:uu-95104DiVA: diva2:169187
Available from: 2006-11-17 Created: 2006-11-17 Last updated: 2016-01-19Bibliographically approved
In thesis
1. Psychiatric History and Adaptation in Burn Injured Patients
Open this publication in new window or tab >>Psychiatric History and Adaptation in Burn Injured Patients
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The intertwined relationship between physical and psychological problems is a topic of much interest in the rehabilitation of severely injured patients, e.g. after a burn. The present study aims at gaining further knowledge concerning the impact of psychological factors and psychiatric morbidity on short and long-term adaptation after burn injury.

Outcome was assessed for three main areas: pruritus, return to work and psychiatric health. Three separate samples of previous or current adult patients treated at the Uppsala Burn Unit during different time periods: 1980-1995 (n=248), 1996-2000 (n=86), and 2000-2005 (n=73), were assessed.

Chronic burn-related pruritus is more common than previously reported and psychological factors such as anxiety-related personality traits and coping are significantly associated with its presence.

Only a small group of former patients with work-related accidents were not working an average of nine years after injury. The unemployed reported more pain and worse perceived health, particularly in psychosocial domains.

Returning to work was explained by both injury severity and personality characteristics. Those who were not working had lower health-related quality of life and poorer traumarelated physical and psychological health, and more pain.

Preburn psychiatric morbidity is high in a lifetime perspective. Two thirds of the sample had at least one disorder according to the Structured Clinical Interview for DSM-IV Axis I disorders. Affective disorders were especially highly represented. A logistic regression showed that having a history of preburn disorders was associated with a higher risk of both PTSD and depression one year after the injury. In this material it was actually uncommon for a patient without a preburn psychiatric history to develop postburn psychiatric symptomatology.

The results have strengthened the overall model for adaptation after burn injury by showing that psychological factors and psychiatric history are important moderators of the adaptation process after the injury.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2006. 60 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 199
Keyword
Psychiatry, Burns, Coping, Depression, Health Status, Outcome assessment, Personality, Post-Traumatic Stress Disorder, Psychiatric Disorders, Pruritus, Rehabilitation, Injuries, Psykiatri
Identifiers
urn:nbn:se:uu:diva-7252 (URN)91-554-6711-3 (ISBN)
Public defence
2006-12-08, Enghoffsalen, Entrance 50, Akademiska sjukhuset, Uppsala, 09:15 (English)
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Available from: 2006-11-17 Created: 2006-11-17 Last updated: 2009-05-07Bibliographically approved

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Willebrand, MimmieWikehult, BjörnGerdin, Bengt

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