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Pruritus, personality traits and coping in long-term follow-up of burn-injured patients
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience. (Psykiatri UAS)
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 Neuroscience. (Psykiatri UAS)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
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2004 (English)In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 84, no 5, 375-80 p.Article in journal (Other academic) Published
Abstract [en]

Pruritus is a major problem after burn injury; however, prevalence and predictors of prolonged pruritus are not known. The aims were to assess frequency of pruritus and the role of personality traits and coping in prolonged pruritus. The participants were burn patients injured 1-18 years earlier (n=248). Pruritus was assessed with an item from the Abbreviated Burn Specific Health Scale, personality was assessed with the Swedish universities Scales of Personality, and coping with the Coping with Burns Questionnaire. In all, 60% of the participants had pruritus at follow-up, however as the time after injury increased, the number of patients with persistent itch decreased. In logistic regression, 39% of the likelihood of having persistent pruritus was explained by greater extent of burn, less time after injury, and psychological features (being less assertive, and using more instrumental but less emotional support). In summary, chronic burn-related pruritus is rather common and psychological factors such as anxiety-related traits and coping are significantly associated with its presence.

Place, publisher, year, edition, pages
2004. Vol. 84, no 5, 375-80 p.
Keyword [en]
Adaptation; Psychological, Anxiety/*psychology, Burns/*complications/psychology, Chronic Disease, Follow-Up Studies, Humans, Personality, Pruritus/etiology/*psychology
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-14542DOI: 10.1080/00015550410032941PubMedID: 15370704OAI: oai:DiVA.org:uu-14542DiVA: diva2:42313
Available from: 2008-01-30 Created: 2008-01-30 Last updated: 2017-12-11Bibliographically 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)
Opponent
Supervisors
Available from: 2006-11-17 Created: 2006-11-17 Last updated: 2009-05-07Bibliographically approved
2. It’s Not Just a Burn: Physical and Psychological Problems after Burns
Open this publication in new window or tab >>It’s Not Just a Burn: Physical and Psychological Problems after Burns
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Survival after severe burns has improved in recent decades, but there is limited information on the course of recovery after surviving a burn and on factors that can affect recovery.

The aims of this thesis were to investigate the occurrence of physical and psychological problems after burns, and to examine the consequences of psychological problems for the clinical management of burn patients.

Three groups of consecutive patients who were treated at the Burn Unit at Uppsala University Hospital between 1980 and 2005 were included in the studies. The Burn Specific Health Scale (BSHS) was used for self-report of burn-specific aspects of health. Personality traits and coping strategies as psychological factors during recovery were examined with the Swedish universities Scales of Personality (SSP) and the Coping with Burns Questionnaire (CBQ). Presence of symptoms of posttraumatic stress were assessed with the Impact of Event Scale-Revised (IES-R), and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) was used to determine the concurrent validity of the IES-R as a measure of Posttraumatic Stress Disorder (PTSD). Furthermore, the effect of pre-injury psychiatric morbidity on perceived health one year after injury was assessed.

Both pruritus and nightmares were common problems after burns; 59% of the individuals in the study reported pruritus and 43% reported nightmares. Neuroticism-related personality traits and avoidant coping strategies were associated with an increased risk of having pruritus or nightmares. The presence of nightmares could be used as a screening tool for high scores in the IES-R. The IES-R was in turn shown to be a good, although overly inclusive, test for the diagnosis of PTSD. Pre-injury psychiatric morbidity predicted perceived outcome in six out of nine burn-specific health domains.

These studies show that psychological factors and psychiatric morbidity affect outcome after burns.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2007. 69 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 242
Keyword
Surgery, Burns, Injury, Trauma, Health Status, Rehabilitation, Outcome Assessment, Personality, Coping, Depression, Posttraumatic Stress Disorder, Impact of Event Scale, Nightmares, Pruritus, Itch, Skin, Psychiatric Disorders, Kirurgi
Identifiers
urn:nbn:se:uu:diva-7758 (URN)978-91-554-6832-3 (ISBN)
Public defence
2007-04-14, Enghoffsalen, Ing. 50, Akademiska sjukhuset Uppsala, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2007-03-23 Created: 2007-03-23 Last updated: 2009-05-07Bibliographically approved

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Willebrand, MimmieLow, AiliKildal, MortenEkselius, LisaGerdin, Bengt

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