Josefin Sveen

Validation of a Swedish version of the Impact of Event Scale-Revised (IES-R) in patients with burns

The Impact of Event Scale (IES) and the Impact of Event Scale-Revised (IES-R) are often used as self-report instruments for symptoms of post-traumatic stress disorder (PTSD). However, there are few validations of the IES and the IES-R against structured clinical interviews. In this study the two scales, together with the three subscales of the IES-R, were assessed for their agreement with a diagnosis of PTSD in patients with burns 1 year after injury. Sixty patients with burns were evaluated 1 year after injury using the Structured Clinical Interview for the DSM-IV Axis I (SCID-I) psychiatric disorders and a Swedish version of the IES-R. The total score of the IES-R had the best discriminant ability (0.89) with a sensitivity of 1.0 and a specificity of 0.78. In conclusion, the total IES-R had good properties as a screening tool for PTSD and subsyndromal PTSD 1 year after burn injury.

Psychometric properties of the impact of event scale-revised in patients one year after burn injury

Burn injury can be a life-threatening and traumatic event. Despite considerable risk for psychological morbidity, few outcome measures have been evaluated. The aim of this study was to examine the psychometric properties of a Swedish version of the Impact of Event Scale-Revised (IES-R) in patients 1 year after burn injury (N = 147). A principal component analysis was performed, and the results supported the three-factor structure of the IES-R. High internal consistency and intelligible associations with concurrent psychological symptoms and known risk factors for distress after trauma indicate satisfactory psychometric properties. Thus, the study supports the use of the IES-R as a screening tool for measuring traumatic distress after burn.

A prospective longitudinal study of posttraumatic stress disorder symptom trajectories after burn injury.

BACKGROUND Psychologic problems are common after burns, and symptoms of posttraumatic stress disorder (PTSD) are some of the most prevalent. Risk factors for PTSD have been identified, but little is known about the onset and course of these symptoms. The objective was to investigate whether there are different PTSD symptom trajectories after burns. METHODS Ninety-five adults with burns were enrolled in a prospective study from in-hospital treatment until 12 months after burn. Symptoms of PTSD were assessed with the Impact of Event Scale-Revised and scores at 3, 6, and 12 months after the burn were used in a cluster analysis to detect trajectories. The trajectories were compared regarding known risk factors for PTSD using non-parametric analysis of variance. RESULTS Four clusters were identified: (1) resilient, with low levels of PTSD symptoms that decreased over time; (2) recovery, with high levels of symptoms that gradually decreased; (3) delayed, with moderate symptoms that increased over time; and (4) chronic, with high levels of symptoms over time. The trajectories differed regarding several risk factors for PTSD including life events, premorbid psychiatric morbidity, personality traits, avoidant coping, in-hospital psychologic symptoms, and social support. The resilient trajectory consistently had fewer of the risk factors and differed the most from the chronic trajectory. CONCLUSIONS There are subgroups among patients with burns that have different patterns of PTSD symptom development. These findings may have implications for clinical practice, such as the timing of assessment and the management of patients who present with these symptoms.

The psychiatric sequelae of burn injury

OBJECTIVE To examine factors predicting psychiatric morbidity, taking into account the full range of psychiatric disorders before and after burn injury. METHODS A cohort of 107 patients consecutively admitted to a Swedish national burn center was examined for lifetime psychiatric morbidity, as well as 94 patients at 1 year postinjury. Sixty-seven individuals, some from that same cohort, were interviewed at 2 to 7years postinjury. The predictive effects of psychiatric history, personality and other risk factors for psychiatric morbidity following burn were evaluated with multiple regression analyses. RESULTS The prevalence of having a psychiatric disorder preburn was 57%. One year postinjury 19% had minor or major depression and 23% had subsyndromal or full posttraumatic stress disorder. At 2 to 7years, 31% fulfilled the criteria for a psychiatric disorder. The strongest contributing factors were a history of psychiatric morbidity and neuroticism. CONCLUSIONS Two-thirds of the patients had a lifetime psychiatric disorder, and one-third had a psychiatric diagnosis 2 to 7years postburn. Mental health problems can have a major impact on daily life and functional abilities. Thus, identification and treatment of a range of psychiatric disorders, taking into account preburn psychiatric disorders and personality, is important for optimal adjustment after burn.

Psychometric properties of the PTSD Checklist for DSM-5: a pilot study

Background To date there is a lack of studies assessing the psychometric properties of the recently revised PTSD Checklist (PCL), the PTSD Checklist for DSM-5 (PCL-5). The aim of this pilot study was to examine the psychometric properties of the PCL-5 in parents of children with burns. Methods The participating parents (N=62, mean age=38) completed self-report questionnaires, 0.8–5.6 years after their childs burn. Measures were the PCL-5, the Impact of Event Scale-Revised (IES-R), the Montgomery–Åsberg Depression Rating Scale (MADRS), and the Perceived Stress Scale (PSS). Burn severity of the child and sociodemographic variables was obtained. Results The parents’ average PCL-5 scores were low to moderate. The internal consistency of the PCL-5 was satisfactory, with Cronbachs alpha ranging from 0.56 to 0.77 and mean inter-item correlations ranging from 0.22 to 0.73 for the four PCL-5 subscales and the PCL-5 total. The PCL-5 subscales were moderately to highly correlated with the corresponding IES-R subscales as well as MADRS and PSS (p<0.05), whereas associations with sociodemographics and burn severity were low to moderate. Conclusions This study provides preliminary support for the use of PCL-5. The results indicate satisfactory psychometric properties of the PCL-5 as measured with internal consistency, test–retest reliability, and aspects of convergent validity.

Attentional Bias and Symptoms of Posttraumatic Stress Disorder One Year After Burn Injury

Trauma-related attentional bias is suggested to play a role in maintaining posttraumatic stress disorder (PTSD). Although being burn injured is a traumatic event for many patients, there are no prospective studies investigating attentional bias. The aims were to assess burn-specific attentional bias 1 year after burn, and its associations with risk factors for PTSD and symptoms of PTSD. A total of 38 adult patients with burns were assessed with a structured clinical interview and a Swedish version of the Impact of Event Scale-Revised up to 1-year after burn. The Emotional Stroop Task was used to assess attentional bias 1 year after burn. In total 29 participants displayed burn-specific attentional bias. This group had more previous life events, perceived life threat, larger burns, and higher PTSD symptom severity. In conclusion, the majority of the patients had burn-specific attentional bias 1 year after burn and this was related to symptoms of PTSD.

Health-related quality of life in Swedish pediatric burn patients and associations with burn and family characteristics

Although many children with burns recover well and have a satisfying quality of life after the burn, some children do not adjust as well. Health-related quality of life (HRQoL) focuses on the impact health status has on quality of life. The aim of this study was to assess HRQoL with the American Burn Association/Shriners Hospitals for Children Burn Outcomes Questionnaire (BOQ) in a nationwide Swedish sample of children with burns 0.3-9.0 years after injury. Participants were parents (n=109) of children aged up to 18 years at the time of investigation who were treated at the Linköping or Uppsala Burn Center between 2000 and 2008. The majority of children did not have limitations in physical function and they did not seem to experience much pain. However, there were indications of psychosocial problems. Parents of preschool children reported most problems with the childrens behavior and family disruption, whereas parents of children aged 5-18 years reported most problems with appearance and emotional health. There were mainly burn-related variables associated with suboptimal HRQoL in children aged 5-18 years, while family-related variables did not contribute as much.

Psychometric Properties of the Swedish Version of the Burn Outcomes Questionnaire for Children Aged 5 to 18 Years

Although pediatric burn injuries are common, there is a lack of burn-specific health outcome measurements for children. The American Burn Association and the Shriners Hospitals for Children have developed the Burn Outcomes Questionnaire (BOQ), which is a parent-report questionnaire measuring the functional outcome after burn in children aged 5 to 18 years. The aim of this study was to examine the psychometric properties of the Swedish version of the BOQ, assessing feasibility, reliability, and validity aspects. Participants were parents (n = 70) of children aged 5 to 18 years who were treated at the Uppsala or Linköping burn center between January 2000 and December 2008. For most subscales, feasibility was adequate and the internal consistency was good: Cronbach’s &agr; values were above 0.76 in all but 1 subscale, and mean interitem correlations ranged from 0.34 to 0.90. The test–retest reliability was significant in the majority of subscales. Evidence of validity was shown by associations among the BOQ subscales and between BOQ subscales and measures of burn severity, heat sensitivity, fear-avoidance beliefs, and parent reports of the child’s psychological problems. In conclusion, with the exception of a few subscales, this study supports the continued evaluation of the Swedish version of BOQ as a tool to measure outcome after burn in children aged 5 to 18 years.

Psychometric properties of the Prolonged Grief Disorder-13 (PG-13) in bereaved Swedish parents

This study aimed to validate the Swedish version of the Prolonged Grief Disorder-13 tool (PG-13) by examining its psychometric properties, including factor structure, discriminant and concurrent validity. The PG-13 was assessed in a sample of Swedish parents who had lost a child to cancer 1-5 years previously. The sample included 225 parents (133 mothers and 92 fathers) with a mean age of 46.02 years (SD = 8.15) and 16.0% met the criteria for Prolonged Grief Disorder (PGD). A principal component analysis was performed, and the results supported a one-factor structure of the PG-13. The PG-13 was shown to have high internal consistency and intelligible associations with concurrent psychological symptoms and grief rumination as well as with known risk factors for PGD. These results indicate satisfactory psychometric properties of the instrument, thus supporting the use of the PG-13 as a valid measure of PGD.

Family Bereavement Care in Pediatric Oncology

Studies have shown that grief after losing a child is more intense and prolonged than after the loss of a spouse or a parent. Children are expected to outlive their parents, and losing one’s child has been described as one of the most traumatic experiences possible. While a majority of bereaved parents adjust to the loss of a child without professional help, a significant minority will experience persistent and intensive grief reactions and may need treatment. Siblings are often called “the forgotten grievers” based on the idea that they are not the focus of family, friends, and health-care professionals, who often primarily focus on the ill child and the parents. Unfortunately, research has shown that a majority of siblings still grieve many years after the loss. As research shows that long-term psychological morbidity, including grief, among parents and siblings is affected by modifiable and/or avoidable factors during illness, end of life, and after the loss, family bereavement care should start early and beyond the child’s death. This chapter describes factors that can contribute to the psychological outcomes for parents and siblings after bereavement. Symptom management in the end of life has shown important as well as a good relationship between the health-care professionals and the parents/siblings during the illness trajectory. Parents and siblings need open and honest communication relating to diagnosis, prognosis, and impending death as it allows them to better prepare for the loss—something that are important for their psychological well-being years after bereavement. Bereavement support for the family after the loss is also described in this chapter. For example, it is important for families to have access to the care team after the loss of the child as they have expressed a need for, e.g., remembrance ceremonies and for obtaining more knowledge about the end-of-life care. Parent support groups are much appreciated by the parents but lack evaluation of their effect. This is also the case for sibling camps. As much of bereavement care is not evidence based, or not even theoretically based, more research is needed in order to better facilitate the grieving process and long-term psychological well-being for parents and siblings.