Pre-existing psychiatric disorders, psychological reactions to stress and the recovery of burn survivors

Abstract 

This study aimed to investigate whether previous findings from a small retrospective study could be replicated prospectively. The previous study showed that patients with an existing diagnosis of psychosis or depression, admitted to a burns service, had longer hospital stays and longer wound healing times when compared with controls matched for burn injury but without a pre-existing psychiatric condition [1]. In this study it was hypothesised that those patients without pre-existing psychiatric diagnosis, but with high levels of psychological distress after burn would also show a similar pattern of delayed recovery to those with a pre-existing psychiatric illness. In addition, we examined potential mechanisms for slowed recovery, including; adherence with treatment; delayed discharge on social grounds and psychological distress. It was hypothesised that patients with pre-existing psychiatric diagnosis would exhibit poorer adherence and delayed placement due to social reasons, compared to patients without pre-existing psychiatric diagnoses.

107 consecutive admissions to a burns service over a seven-month period were included in the study. Psychiatric history and level of psychological distress post-burn were collected for all patients as part of routine psychological screening. Patients were compared on the following outcome variables: number of days spent in hospital and number of procedures required.

24% (n=27) were found to have a pre-existing psychiatric diagnosis. This group were also found to have significantly longer hospital stays (Mann–Whitney U=585.50, p<0.01) and required more surgical procedures than the group without a psychiatric history (Mann–Whitney U=569.00, p=<0.001). The pattern of results for the group with high psychological distress but without pre-existing psychiatric diagnoses mirrored that of the group with pre-existing psychiatric diagnoses, suggesting that heightened psychological distress alone, has a significant delaying effect upon the rate of recovery (Kruskal–Wallis X=24.75, p<0.01). An exploratory model entering all the variables stepwise at the same stage identified poor adherence and delayed discharge issues as making significant contributions to the final model (r=0.81 adjusted r²=62.9, F (4, 42)=20.48, p<0.001). In conclusion, this study supports the role of psychosocial factors, such as pre-existing psychiatric diagnosis and in hospital psychological distress, in contributing the recovery of survivors of burns. This suggests that identifying and working with these difficulties may impact not only on psychosocial, but also physical aspects of recovery.

Keywords: Pre-existing psychiatric diagnoses, Psychological influences on physical recovery