Patricia Blakeney

PTSD symptoms among men and women survivors of intimate partner violence: the role of risk and protective factors.

The purpose of this cross-sectional analysis of the National Violence Against Women Survey was to characterize current symptoms of posttraumatic stress disorder (PTSD) among 185 men and 369 women survivors of intimate partner violence (IPV). In this subsample, 24% of women and 20% of men had current moderate-to-severe PTSD symptoms. PTSD scores were higher for women than men. Protective factors that appear to increase resiliency of survivors were higher education and income, being currently married, and reporting that IPV had stopped. Higher physical or psychological IPV scores, current depressive symptoms, and the survivor having left the relationship at least once were associated with risk of moderate-to-severe symptoms of PTSD. Protective factors may be used to boost resiliency of IPV survivors and reduce PTSD symptoms.

Imipramine treatment in Pediatric burn patients with symptoms of acute stress disorder : A pilot study

OBJECTIVE Pediatric burn patients often exhibit acute stress disorder (ASD) symptoms. Information on psychopharmacological treatment of ASD symptoms in children is scarce. This pilot study used a prospective, randomized, double-blind design to test whether thermally injured children suffering ASD symptoms benefit from imipramine. METHOD Twenty-five children, aged 2 to 19 years, received either imipramine or chloral hydrate for 7 days. A structured interview (clinically useful, but validity and reliability not yet established) was used to assess the presence and frequency of ASD symptoms both before treatment and 3 times during the treatment period. RESULTS Eleven females and 14 males participated, with a mean total burn surface area of 45% (SD = 23%) and mean age of 8 years (SD = 6). Imipramine was more effective than chloral hydrate in treating ASD symptoms (chi 2 [1, N = 25] = 5.24, p < .02). Five of 13 were positive responders to chloral hydrate (38%). Ten of 12 were positive responders to low-dose imipramine (83%). CONCLUSIONS This pilot study suggests a place for cautious initial use of imipramine to reduce ASD symptoms in burned children. Care must be taken to minimize cardiovascular risks in an off-label application of imipramine in children, especially those receiving additional medications.

Burden of burn: A norm-based inquiry into the influence of burn size and distress on recovery of physical and psychosocial function

This prospective, longitudinal study examined the influence of baseline physical and psychological burden on serial assessments of health-related quality of life among adults with major burns from three regional burn centers (n = 162). Physical burden groups were defined by % TBSA burned: <10%, 10% to 30%, or >30%. Psychological burden groups were defined by in-hospital distress using the Brief Symptom Inventory Global Severity Index T-score with scores of < 63 or > or = 63. Analyses compared groups across level of burden and with published normative data. Assessments reflected health and function (Short Form 36) during the month before burn, at discharge, and at 6 and 12 months after burn. Physical functioning was significantly more impaired and the rate of physical recovery slower among those with either large physical burden or large psychological burden. Notably, psychosocial functioning also was more impaired and the rate of psychosocial recovery slower among those with greater psychological burden. These results suggest that, in addition to aggressive wound closure, interventions that reduce in-hospital distress may accelerate both physical and psychosocial recovery.

Long-term psychosocial adaptation of children who survive burns involving 80% or greater total body surface area

OBJECTIVE To examine the psychosocial adjustment of survivors of massive pediatric burn injuries, the change in adjustment across time, and the impact on parents. BACKGROUND Patients/parents were assessed at regular intervals postburn using standardized tests of adjustment. Patients who could not be included in standardized longitudinal assessments were administered questionnaires by mail/telephone. METHODS The Child Behavior Checklist, the Teacher Report Form, the Youth Self Report Form, and the Parenting Stress Index were utilized to assess adjustment. RESULTS On all objective measures, the group of survivors and their parents were within normal limits. Adjustment neither improved nor deteriorated over time. CONCLUSION Children who survive massive burn injuries can achieve positive psychosocial adaptation.

Long-term psychosocial adjustment following burn injury

Young adult survivors of severe childhood burn injuries were assessed for indicators of psychopathology and for factors that might enhance psychosocial adjustment. The results describe this group of burn victims as young people of average intelligence, still in school or otherwise employed and within normal limits on the measures of psychological adjustment. Some individuals, however, did evidence significant indicators of psychological disturbance. The only factors identified as significantly differentiating the most obviously disturbed subjects from the better-adjusted or well-adjusted victims were the perceptions held by those subjects that their families are less cohesive and less independent. These results emphasize the need to promote the familial support system and to encourage the values of autonomy and self-sufficiency. The results also affirm that severely injured burn victims can be expected to develop acceptably happy lives.

Psychological distress after major burn injury

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.

Symptoms of depression and anxiety as unique predictors of pain-related outcomes following burn injury

Background: The adverse consequences of burn injuries include pain and psychological distress, which show bidirectional associations. However, much of the existing research has relied on global measures of distress that do not separate distinct symptoms of anxiety and depression.Purpose: The purpose is to assess the prospective effects of anxiety and depression on pain and functional outcomes following burn injury.Methods: This article describes a 2-year cohort study in patients hospitalized for serious burn injuries (assessments at discharge and 6-month, 1-year, and 2-year follow-up). Linear mixed effects analyses were conducted to model anxiety and depression’s unique longitudinal effects; at each time point, depressive and anxiety symptoms were studied as predictors of subsequent changes in pain, fatigue, and physical function.Results: When studied in separate prediction models, both depression and anxiety were strong prospective predictors of greater pain, more fatigue, and physical dysfunction at the subsequent time point (ps<.01). However, when both were included in a single model to study their unique effects, depressive symptoms (but not anxiety) emerged as a signfiicant predictor of subsequent increases in pain and reductions in physical functioning, whereas anxiety (but not depression) predicted subsequent elevations in fatigue.Conclusions: These findings suggest potentially distinct effects of depression and anxiety and imply that assessment and early treatment of both depressive and anxiety symptoms may help improve a broad range of long-term pain-related outcomes following burn inury.

Sleep onset insomnia symptoms during hospitalization for major burn injury predict chronic pain.

&NA; Both cross‐sectional studies of chronic pain and sleep deprivation experiments suggest a bi‐directional relationship between sleep and pain. Few longitudinal studies, however, have assessed whether acute insomnia following traumatic injury predicts the development of persistent pain. We sought to evaluate (1) whether in‐hospital insomnia independently predicts long‐term pain after burn injury and (2) whether in‐hospital pain predicts future insomnia symptoms. We analyzed data on 333 subjects hospitalized for major burn injury (72.7% male; mean age = 41.1 ± 14.5 years) who were participating in the multi‐site, Burn Model System project. Subjects completed measures of health, function (SF‐36), and psychological distress (Brief Symptom Inventory) while in hospital, at 6, 12, and 24 months after discharge. Participants were categorized as either having or not having sleep onset insomnia at discharge. Linear mixed effects analyses revealed that persons reporting insomnia at discharge (40.5%) had significantly decreased improvement in pain and increased pain severity during long‐term follow‐up (p < 0.001). More severe pain during the week preceding hospital discharge, time from injury, lack of college education and older age also contributed independent effects on chronic pain (p < 0.05). In a reciprocal model (N = 299), more severe pain during the week preceding discharge predicted increased rates of long‐term sleep onset insomnia. In‐hospital insomnia and pre‐burn mental health symptoms were also highly significant predictors of insomnia. This study provides support for a long‐term, prospective and reciprocal interaction between insomnia and pain. Future work should ascertain whether treatment of insomnia and pain during acute injury can prevent or minimize chronic pain.

PSYCHOLOGICAL PROBLEMS REPORTED BY YOUNG ADULTS WHO WERE BURNED AS CHILDREN

This study assessed long-term psychosocial sequelae of young adult pediatric burn survivors. Subjects were 101 young adults (43 females and 58 males) between the ages of 18 and 28 years who were at least 2 years (average, 14 years) postburn at least 30% TBSA (mean = 54 +/- 20%). Educational status was 25% high school dropouts, 28% high school graduation only, 32% some college, and 5% completed college. Seventy-seven percent either worked or attended school; 28% had had a long-term partner. When assessed by Achenbachs Young Adult Self-Report (YASR) scale and compared with its published reference group, the males reported differences only in the somatic complaints, but the females endorsed significantly more externalizing and total problems, specifically withdrawn behaviors, somatic complaints, thought problems, aggressive behavior, and delinquent behavior. Despite these problems suffered by some female pediatric burn survivors, the overall outcome revealed that most pediatric burn survivors are making the transition into adulthood with minimal unexpected difficulty.

Psychosocial sequelae of pediatric burns involving 80% or greater total body surface area

Important questions for pediatric burn care specialists relate to the quality of life for those children who survive the most severe burn injuries. This study examines the psychological adjustment of 25 children who survived injuries > or = 80% total body surface area and the impact of such injury on the families. Data were analyzed from the most recent assessment, with the Child Behavior Checklist, Teacher Report Form, Piers-Harris Childrens Self-Concept Scale, Parenting Stress Index, and a parental questionnaire designed by the authors. As a group, the childrens behavioral problems as reported by both parents and teachers were within normal limits. Measures of parental stress, however, clearly differentiated the burn population. These parents attributed more stress to characteristics of their children. Children with > or = 80% TBSA burns develop positive feelings about themselves and appear no more troubled than a comparable group of nonburned children. The impact on the families is significant, however, and must be considered of consequence in the rehabilitation of the burned child.