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Posttraumatic Stress and Cognitive Processes in Patients with Burns
Uppsala universitet.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

A severe burn is one of the most traumatic injuries a person can experience. Posttraumatic stress disorder (PTSD) is relatively common after burns, and can be devastating for the individual’s possibilities for recovery. The principal aims were to gain knowledge regarding posttraumatic stress symptoms and cognitive processes after burn and to evaluate methods for assessing symptoms of PTSD up to one year after burn.

The psychometric properties of a Swedish version of the Impact of Event Scale-Revised (IES-R) were examined. The results indicate that the IES-R is a valid screening instrument for measuring PTSD symptoms in patients with burns and it can be used during hospitalisation to identify resilient individuals.

The pattern of PTSD symptoms over time was also investigated. Four distinct trajectories of PTSD symptoms were identified, i.e. four groups of patients with significantly different onsets and courses. The trajectories differed in the expected direction regarding several risk factors associated with PTSD symptoms.

Several previously known risk factors for PTSD symptoms were also identified including burn severity, psychiatric history, previous life events, early psychological symptoms, neuroticism-related personality traits, avoidant coping and low social support. The risk factors correspond well with those reported in the international trauma literature, which strengthens the findings in this thesis.

Finally, using the emotional Stroop task at one year post burn it was found that burn-specific attentional bias was common and associated with more previous life events, more perceived life threat, larger burns and higher levels of PTSD symptoms.

In summary, there are individual differences in the development and course of PTSD symptoms after burn and attentional bias is a common cognitive phenomenon related to these symptoms. The findings also support the use of the IES-R as a screening instrument for PTSD symptoms in patients with burns.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2011. , 58 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 639
Keyword [en]
Burn, Posttraumatic stress disorder, Outcome Assessment, Injuries, Trauma, Psychological distress, Psychiatric Disorders
National Category
Psychiatry Psychology
Research subject
Psychiatry
Identifiers
URN: urn:nbn:se:esh:diva-6268ISBN: 978-91-554-7993-0 (print)OAI: oai:DiVA.org:esh-6268DiVA: diva2:1136836
Public defence
2011-03-11, Enghoffsalen, Entrance 50, Uppsala University Hospital, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2017-08-29 Created: 2017-08-29 Last updated: 2017-08-29Bibliographically approved
List of papers
1. Psychometric properties of the impact of event scale-revised in patients one year after burn injury
Open this publication in new window or tab >>Psychometric properties of the impact of event scale-revised in patients one year after burn injury
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2010 (English)In: Journal of Burn Care & Research, ISSN 1559-047X, E-ISSN 1559-0488, Vol. 31, no 2, 310-318 p.Article in journal (Refereed) Published
Abstract [en]

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.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:esh:diva-6269 (URN)10.1097/BCR.0b013e3181d0f523 (DOI)000275193400013 ()20182373 (PubMedID)
Available from: 2010-04-20 Created: 2017-08-29 Last updated: 2017-08-30
2. Validation of a swedish version of the impact of event scale-revised (IES-R) in patients with burns
Open this publication in new window or tab >>Validation of a swedish version of the impact of event scale-revised (IES-R) in patients with burns
Show others...
2010 (English)In: Journal of Anxiety Disorders, ISSN 0887-6185, E-ISSN 1873-7897, Vol. 24, no 6, 618-622 p.Article in journal (Refereed) Published
Abstract [en]

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

Keyword
Burns, IES-R, Physical trauma, Post-traumatic stress disorder, SCID, Validation
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:esh:diva-6270 (URN)10.1016/j.janxdis.2010.03.021 (DOI)000278476900011 ()20434306 (PubMedID)
Available from: 2010-06-08 Created: 2017-08-29 Last updated: 2017-08-30
3. A prospective longitudinal study of posttraumatic stress disorder symptom trajectories after burn injury
Open this publication in new window or tab >>A prospective longitudinal study of posttraumatic stress disorder symptom trajectories after burn injury
2011 (English)In: Journal of Trauma, ISSN 0022-5282, E-ISSN 1529-8809, Vol. 71, no 6, 1808-1815 p.Article in journal (Refereed) Published
Abstract [en]

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.

Keyword
Burns, Cluster analysis, Post-traumatic stress disorder, Trauma, IES-R
National Category
Surgery Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:esh:diva-6267 (URN)10.1097/TA.0b013e31822a30b8 (DOI)000298616400067 ()
Available from: 2011-01-17 Created: 2017-08-29 Last updated: 2017-08-30
4. Attentional bias and symptoms of posttraumatic stress disorder one year after burn injury
Open this publication in new window or tab >>Attentional bias and symptoms of posttraumatic stress disorder one year after burn injury
2009 (English)In: Journal of Nervous and Mental Disease, ISSN 0022-3018, E-ISSN 1539-736X, Vol. 197, no 11, 850-855 p.Article in journal (Refereed) Published
Abstract [en]

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.

Keyword
Impact of event scale-revised, Physical trauma, Posttraumatic stress disorder, Selective attention, Stroop Task
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:esh:diva-6271 (URN)10.1097/NMD.0b013e3181bea555 (DOI)000272020900009 ()19996724 (PubMedID)
Available from: 2010-04-20 Created: 2017-08-29 Last updated: 2017-08-30

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