Perceived social support among patients with burn injuries: A perspective from the developing world

Prevalence of Post-traumatic Stress Disorder in Adult Burn Patients: A Study From Urban Tertiary Care Hospitals in Pakistan

Introduction Post-traumatic stress disorder (PTSD) is one of the main psychological conditions that develops after a traumatic event such as a burn injury. Patients often experience flashbacks, nightmares, anxiety attacks, and endless thoughts about the traumatic burn injury, which deteriorate their quality of life. These patients are usually socially isolated, have low self-esteem, and are more likely to commit suicide. Burn patients, who are particularly vulnerable, often do not receive adequate post-burn care, and psychological disorders like PTSD are often overlooked in developing nations such as Pakistan. Hence, this study investigated the prevalence of PTSD among adult burn patients in tertiary care hospitals and examined its distribution across different age groups, genders, and socioeconomic classes to highlight its overall burden as well as differences among these groups. Materials and methods This cross-sectional study was conducted from January 2024 to July 2024, recruiting 275 adult burn patients from tertiary care hospitals in Peshawar, Pakistan, using non-probability convenience sampling. Non-cooperative, unwilling, unconscious, and severe burn injury patients were excluded from the study. Additionally, individuals under the age of 18 years and those whose burn injuries occurred less than a month prior were omitted, as PTSD requires the traumatic event to have happened more than a month ago for diagnosis. All the burn patients were at different stages of recovery. A provisional diagnosis of PTSD was made by using the PTSD checklist for DSM-5, a 20-item checklist that assessed the symptoms of PTSD via a five-point Likert scale. The socioeconomic status was determined via a modified form of the Kuppuswamy Socioeconomic Status Scale. Results The diagnosis of PTSD was made in 52% (143 out of 275) of people who suffered burn injuries. The prevalence of PTSD in males and females was 40% (59 out of 148 males) and 66% (84 out of 127 females), respectively. Sixty-two percent of retirement-aged and 57% of middle-aged patients were mostly affected by PTSD. Similarly, PTSD was more prevalent in lower-class patients, i.e., 69% of patients with burn injuries from lower socioeconomic backgrounds were affected. Conclusion An alarmingly high prevalence of PTSD was found in burn patients. It was more prevalent in females than in males. A greater percentage of retirement-age and middle-aged adults were diagnosed with PTSD. When compared to patients from various socioeconomic backgrounds, burn patients from lower socioeconomic backgrounds were found to have a higher prevalence of PTSD.

Effect of a transitional tele-rehabilitation programme on quality of life of adult burn survivors: A randomised controlled trial

OBJECTIVE

To examine the effects of the transitional tele-rehabilitation programme on quality of life of adult burn survivors.

DESIGN

A prospective, single centre, randomised controlled trial and reported according to the Consolidated Standards of Reporting Trials (CONSORT) guidelines.

PARTICIPANTS

Adult burn survivors aged ≥18 years with burn size ≥10% total body surface area irrespective of the depth was considered eligible to participate.

INTERVENTION

The intervention was in two phases: pre-discharge and active follow-up phase (which occurred via WeChat). In both phases, comprehensive assessment and intervention guided by the Omaha System and evidenced-based protocols guided the care delivery over an 8-week period.

MAIN MEASURES

The outcome of interest was quality of life. Two outcome measures were used to assess the outcome of interest: Burn Specific Health Scale-Brief (BSHS-B) and the EQ-5D-5L tools. The outcome was assessed at three time points: T0 (baseline), T1 (immediate post-intervention) and T2 (4 weeks from T1).

RESULTS

In total, 60 adult burn survivors were randomly allocated to undergo the new programme. The transitional tele-rehabilitation programme elicited statistically significant improvement in simple abilities, affect, interpersonal relationship (T2) and overall quality life (T1 and T2) measured on the BSHS-B.

CONCLUSION

Ongoing rehabilitative care is essential to support the recovery process of burn survivors considering that some quality-of-life subscales may improve faster than others. The study findings highlight the potential of employing a social media platform to improve post-burn quality of life outcomes.

TRIAL REGISTRATION

ClinicalTrials.govNCT04517721. Registered on 20 August 2020.

Mindfulness, Social Support, and Psychological Distress Among Jordanian Burn Patients

Burn is associated with psychological distress, anxiety, and depression. Social support and mindfulness are considered a strength source for postburn survivors to resume their daily living activities. There is a lack of literature that supported the direct impact of mindfulness on social support and psychological distress among burn survivors. The aim of this study is to examine the impact of mindfulness and social support in enhancing the psychological well-being of burn survivors in Jordan. A cross-sectional descriptive design and convenience sampling technique were utilized to meet the study goal. A self-reported questionnaire was completed by a sample of 212 burn survivors. The questionnaire consists of 3 tools to measure psychological distress, social support, and mindfulness. A significant correlation was found between social support and psychological distress among the Jordanian burn survivors. Mindfulness revealed a distinctive variance in psychological distress among the study participants. In addition, some sociodemographic and clinical data have a relationship with psychological distress. Several factors among burn survivors have influenced their psychological and social support status. Also, mindfulness is important for enhancing psychological well-being and affecting the social support among burn patients.

The relationship between mindfulness and suboptimal health status: a chain/serial mediation model

Background

Suboptimal health status (SHS) represents a third state between health and disease and often progresses into chronic conditions, negatively impacting an individual's well-being. Studies have shown that mindfulness has a beneficial effect on various SHS symptoms. This study aims to explore the influence of mindfulness on SHS and its underlying mechanisms, with a particular focus on examining the mediating roles of stress and social support.

Methods

A total of 173 healthy Chinese college or graduate students, with an average age of 21.85 years, participated in this study. Measurements were taken using the Five Factor Mindfulness Questionnaire, the Sub-Health Measurement Scale, the Perceived Stress Scale, and a self-constructed scale that included demographic information. The PROCESS plugin for SPSS was used to assess mediating effects.

Results

Significant correlations were found among SHS, social support, mindfulness, and perceived stress (|r| = 0.38-0.85, p < 0.01). Specifically, mindfulness showed a significant positive correlation with SHS and social support (r = 0.38-0.77), while perceived stress was significantly negatively correlated with mindfulness, social support, and SHS (|r| = 0.45-0.85). Perceived social support was positively associated with SHS (r = 0.65). Furthermore, social support and perceived stress partially mediated the influence of mindfulness on SHS. Additionally, a sequential mediation effect of perceived social support and stress in the relationship between mindfulness and SHS was supported.

Conclusion

The cultivation of trait mindfulness may be advantageous for individuals' sub-health. Perceived social support and perceived stress are important underlying mechanisms contributing to this effect.

Evaluation of the Effect of Cichorium intybus L. on the Liver Enzymes in Burn Patients: A Randomized Double-Blind Clinical Trial

Burn injuries are considered an important public health problem in the world. Burns are considered the fourth most common kind of trauma in the world, after traffic accidents, falls, and interpersonal violence. Various biochemical agents are involved in the burn healing process such as cytokines (such as IL-6 and TNF-α), antioxidants, and liver and kidney damage biomarkers. Cichorium intybus L. and milk thistle extracts showed a wide range of pharmacological activities such as significant antimicrobial effect and antioxidant activity, as well as anti-inflammatory, antidiabetic, antiproliferative, antiprotozoal, and hepatoprotective effect. Also, these two herbs possess blood-cleansing, detoxifying, laxative, and invigorating activities. Some research confirmed that the preparations of the extract are very suitable for the treatment of nonalcoholic fatty liver disease. This is a double-blind randomized controlled clinical trial. Patients with 2nd and 3rd degree burns have been selected to participate in the study according to the inclusion criteria. A total of 60 patients were selected and divided into intervention and control groups (30 patients in each group). Patients in the intervention group received chicory seed syrup 10 cc three times a day and 1 placebo capsule, and those in the control group received placebo syrup (10 cc three times a day) and one Livergol (140 mg of silymarin in each capsule) capsule. Lab data such as liver function tests, albumin, creatinine, BUN, and hemoglobin were checked every 3 days and 1 week after discharge. The treatment lasted for 4 weeks. According to the results of the study, although the average of liver enzymes at the end of the study does not show a significant difference between the two groups, the level of liver enzymes in each group decreased on the 15th day of the study compared to the first day. This trial is registered with IRCT20180609040016N1.

A systematic review of social support and related factors among burns patients

Burn injuries, as a major public health problem, can lead to high morbidity and mortality. Burns is considered as one of the most devastating injuries globally and the fourth most common injury after traffic accidents, falls and interpersonal violence. Burn injuries can affect human life, such as physical and mental health, functional skills, and performance. Changes in appearance, social isolation, stress, anxiety, depression, low self-esteem, unemployment, financial burden and family problems can occur in these patients. These burn complications can be exacerbated without adequate social support. This systematic review evaluated burn patients' social support and related factors. A systematic search was performed on the international electronic databases such as Scopus, PubMed, Web of Science and Persian electronic databases such as Iranmedex, and Scientific Information Database using keywords extracted from Medical Subject Headings such as 'Burns', 'Social support', 'Perceived social support' and 'Social care' from the earliest to 30 April 2022. The quality of the included studies in this review was assessed using the appraisal tool for cross-sectional studies (AXIS tool). A total of 1677 burn patients were included in this review from 12 studies. Mean score of social support in burn patients based on multidimensional scale of perceived social support, Phillips's social support questionnaire, social support questionnaire, social support scale and Norbeck social support questionnaire were 5.04 (SD = 1.59) of 7, 22.06 (SD = 3.05), 78.20 (SD = 15.00) of 95, 82.24 (SD = 13.70) and 4.14 (SD = 0.99), respectively. Factors such as income, educational attainment, burn surface area, reconstructive surgery, quality of life, self-esteem, socialisation, posttraumatic growth, spirituality, and ego resilience had a significant positive relationship with social support of burns patients. Social support in patients with burn had a significant negative relationship with factors such as psychological distress, having children, life satisfaction, neuroticism and post-traumatic stress disorder. Overall, patients with burns had moderate levels of social support. Therefore, it is recommended that health policymakers and managers make it easier for burn patients to adapt to burns by providing psychological intervention programs and the social support needed by burn patients.

The Importance of Psychometric and Physical Scales for the Evaluation of the Consequences of Scars-A Literature Review

BACKGROUND

Scars affect patients after trauma, burns, or surgical procedures and can generate both physical and psychosocial changes. The aesthetic damage represents the modification of a person's physical appearance, in its bodily integrity, causing numerous sufferings and determining social or economic consequences. The aim of this research is to evaluate the advantages and disadvantages offered by the available psychosocial and physical scar scales in assessing the physical, aesthetic, psychosocial, and juridical consequences of scars. This will aid to inform medical examiners about the most valued existing scales to allow them to select the most appropriate instrument to manage their patient.

METHODS

A broad search of relevant scientific studies on the psychosocial determinants of post-traumatic and surgical scars was conducted by using the following international database tools: PsycINFO, MedLine Social Science Index, Scopus, Web of Science, published from 1960 until 2022.

RESULTS

We analyzed 63 scientific studies to assess the advantages and limits of several psychometric and physical scar evaluation scales.

CONCLUSIONS

The researchers analyzed in this review highlight the advantages and limitation of existing instruments, evidencing the demand for future scar evaluation instruments and a scar-assessing algorithm that takes into account the physical, aesthetic, psychosocial, and legal consequences of scars.

Impact of Family Caregiver Training on Care of Burn Patients

The purpose of this study was to investigate the impact of a family caregiver training program on care provision to burn patients. A quasi-experimental study was conducted with 96 family caregivers of burn patients admitted to a burn hospital in Iran. The caregivers' knowledge and training needs were measured at baseline. Four training sessions were provided for the experimental group and caregivers' practices were measured 6 weeks after discharge. Comparing the scores of knowledge and total care with its subdomains (i.e., diet and medication, wound care, itch decrease, wound scar healing, pain management, use of mobility assistive devices, and follow-up considerations) revealed a significant difference between the two groups of caregivers after the intervention (p < 0.01). The caregivers' practices regarding provision of care to burn patients were improved after attending the training program. Receiving sufficient and continuous information from admission to discharge can empower family members.

Coping strategies, social support, and mindfulness improve the psychological well-being of Jordanian burn survivors: A descriptive correlational study

BACKGROUND

Burn injury survivors usually experience multiple psychosocial problems, which occur commonly in low and middle-income countries. However, the previous literature provides limited information about the unique roles of coping strategies, social support, and mindfulness in improving the psychological well-being of burn survivors. Therefore, this study identified the role of coping strategies, social support, and mindfulness in improving the psychological well-being of burn survivors.

METHODS

A descriptive correlational study on 224 burn survivors at a large government hospital in Amman, Jordan, was conducted. Participants completed questionnaires about socio-demographic and clinical data, anxiety and depression, social support, mindfulness, and coping. Standard multiple regression was performed to identify the unique role of the main study variables in improving the psychological well-being of burn survivors.

RESULTS

Participants were found to have a severe level of psychological distress. Escape avoidance coping had the highest mean score among all other coping strategies, while acceptance of responsibility had the lowest mean score. Regression analysis showed that confrontive coping (β = -0.224, p=p<0.01), social support (β = -.212, p=p<0.01), and mindfulness (β = -.403, p=p<0.01) were significantly associated with less psychological distress.

CONCLUSIONS

Therefore, confrontive coping, social support, and mindfulness-based supportive interventions could be helpful in providing enhanced support to burn survivors.

"It was like nobody cared about what I said?" Iranian women committed self-immolation: a qualitative study

BACKGROUND

Suicide-attempts have increased across the world and have become higher among females. There has been a high prevalence of self-immolation in Iran, mostly young married women admitted to the burn centers. This study aimed to explore the factors and experiences of self-immolation in Iranian married women to develop prevention strategies to prevent the personal, social, and economic impacts of suicide and suicide attempts.

METHODS

A qualitative descriptive approach using open-ended, in-depth, face-to-face interviews was conducted in a purposive sample of 16 married Iranian women aged 16-40 years in the burn centers in Urmia city, a place in northwest Iran. Conventional content analysis was used to analyze the data.

RESULTS

Three themes emerged from the data, including (1) antecedents of self-immolation, (2) suicidal ideation method, and (3) pathway to recovery. Each of these themes is supported by sub-themes.

CONCLUSIONS

The study highlights the demand for health professionals to support self-immolation survivors to continue their normal lives. According to survivors' needs, a comprehensive supportive program is recommended to support their pathways to recovery in all its complexities. Health professionals should also not forget that the survivors' family also will need help to overcome this trauma. A family counseling program may also be provided.

Exploring Symptoms of Post-traumatic Stress Disorders and Perceived Social Support among Patients with Burn Injury

Introduction

Burns are a serious public health problem globally, causing an estimated 265,000 deaths per year. Although the association of burn injuries with mortality and morbidity rates has been well established, data on their psychological consequences are scarce. The present study explores the frequency of post-traumatic stress disorder (PTSD) and perceived social support among patients with burn injuries in Pakistan.

Methods

This cross-sectional study was conducted at two teaching hospitals in Lahore, Pakistan from May 2015 to July 2015. Eighty patients with burn injuries were included by convenience sampling and interviewed with a specifically designed questionnaire with items on demographics, and the Impact of Events Scale-Revised (IES-R) and Multidimensional Scale of Perceived Social Support (MSPSS) instruments.

Results

Data were analyzed for a total of 80 participants: 56 women (70.0%) and 24 men (30.0%). Mean age was 35.74 (11.15) years. A high proportion of participants perceived highest social support from friends, reported high ego resiliency levels, had more severe symptoms of avoidance and intrusion, and had high overall PTSD scores. There were no differences between groups in the proportions of respondents who reported high perceived social support from significant others or family, overall social support or symptoms of hyperarousal.

Conclusion

The findings reflect a high frequency of PTSD symptomatology and poor social support among Pakistani patients with burn injuries in our sample. These factors can exacerbate the patient’s physical injury, delaying both their physical and mental rehabilitation.