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.