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A prospective longitudinal study of posttraumatic stress disorder symptom trajectories after burn injury
Uppsala universitet.ORCID iD: 0000-0002-5523-8126
Uppsala universitet.
Uppsala universitet.
Uppsala universitet.
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.

Place, publisher, year, edition, pages
2011. Vol. 71, no 6, 1808-1815 p.
Keyword [en]
Burns, Cluster analysis, Post-traumatic stress disorder, Trauma, IES-R
National Category
Surgery Psychiatry
Research subject
Psychiatry
Identifiers
URN: urn:nbn:se:esh:diva-6267DOI: 10.1097/TA.0b013e31822a30b8ISI: 000298616400067OAI: oai:DiVA.org:esh-6267DiVA: diva2:1136837
Available from: 2011-01-17 Created: 2017-08-29 Last updated: 2017-08-30
In thesis
1. Posttraumatic Stress and Cognitive Processes in Patients with Burns
Open this publication in new window or tab >>Posttraumatic Stress and Cognitive Processes in Patients with Burns
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
Burn, Posttraumatic stress disorder, Outcome Assessment, Injuries, Trauma, Psychological distress, Psychiatric Disorders
National Category
Psychiatry Psychology
Research subject
Psychiatry
Identifiers
urn:nbn:se:esh:diva-6268 (URN)978-91-554-7993-0 (ISBN)
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

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