Long-term assessment of personality after burn trauma in adults

Stability in Personality After Physical Trauma

Personality trait stability may be influenced by several factors, there among different life events such as psychological trauma. However, little is known regarding trait stability after physical trauma. Therefore, our primary aim was to assess the extent of stability in personality in burn patients during the first year after injury. Eighty-four burn patients, admitted to a national burn center, were assessed with the Swedish universities Scales of Personality during acute care and 12 months postburn. Personality domain scores remained stable between acute care and 12 months postburn. On the trait level, the only change was seen in personality trait Stress Susceptibility, where burn patients' scores were lower compared with norm scores during acute care but then increased, and normalized, at 12 months postburn. To conclude, personality scores remained relatively stable during the first year after burn trauma.

Investigating the association between neuroticism and adverse obstetric and neonatal outcomes

Neuroticism is not only associated with affective disorders but also with certain somatic health problems. However, studies assessing whether neuroticism is associated with adverse obstetric or neonatal outcomes are scarce. This observational study comprises first-time mothers (n = 1969) with singleton pregnancies from several cohorts based in Uppsala, Sweden. To assess neuroticism-related personality, the Swedish universities Scales of Personality was used. Swedish national health registers were used to extract outcomes and confounders. In logistic regression models, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for the outcomes by an increase of 63 units of neuroticism (equalling the interquartile range). Analyses were adjusted for maternal age, educational level, height, body mass index, year of delivery, smoking during pregnancy, involuntary childlessness, and psychiatric morbidity. Main outcomes were mode of delivery, gestational diabetes mellitus, gestational hypertension, preeclampsia, induction of delivery, prolonged delivery, severe lacerations, placental retention, postpartum haemorrhage, premature birth, infant born small or large for gestational age, and Apgar score. Neuroticism was not independently associated with adverse obstetric or neonatal outcomes besides gestational diabetes. For future studies, models examining sub-components of neuroticism or pregnancy-specific anxiety are encouraged.

Neuroticism is associated with higher antenatal care utilization in obstetric low-risk women

INTRODUCTION

Elevated neuroticism is associated with higher health care utilization in the general population. This study aimed to investigate the association between neuroticism and the use of publicly financed antenatal care in obstetric low-risk women, taking predisposing and need factors for health care utilization into consideration.

MATERIAL AND METHODS

Participants comprised 1052 obstetric low-risk women (no chronic diseases or adverse pregnancy conditions) included in several obstetrics/gynecology studies in Uppsala, Sweden. Neuroticism was self-rated on the Swedish universities Scales of Personality. Medical records of their first subsequent pregnancy were scanned for antenatal care use. Associations between antenatal care use and neuroticism were analyzed with logistic regression (binary outcomes) or negative binomial regression (count outcomes) comparing the 75th and 25th neuroticism percentiles. Depending on the Akaike information criterion the exposure was modeled as either linear or with restricted cubic splines. Analyses were adjusted for predisposing (sociodemographic and parity) and need factors (body mass index and psychiatric morbidity).

RESULTS

After adjustment, women with higher neuroticism had more fetal ultrasounds (incidence rate ratio = 1.09, 95% confidence interval (CI) 1.02-1.16), more emergency visits to an obstetrician/gynecologist (incidence rate ratio = 1.22, 95% CI 1.03-1.45) and were more likely to visit a fear-of-childbirth clinic (odds ratio = 2.71, 95% CI 1.71-4.29). Moreover, they more often consulted midwives in specialized antenatal care facilities (significant J-shaped association).

CONCLUSIONS

Neuroticism was associated with higher utilization of publicly financed antenatal care in obstetric low-risk women, even after adjusting for predisposing and need factors. Future studies should address the benefits of interventions as a complement to routine antenatal care programs to reduce subclinical anxiety.

Personality traits in bipolar disorder and influence on outcome

BACKGROUND

The aim was to investigate the personality profile of bipolar disorder I and II, and healthy controls, and to study whether personality influences the course of bipolar disorder.

METHODS

One hundred ten patients with bipolar disorder I, 85 patients with bipolar disorder II, and 86 healthy individuals had their personality profile assessed using the Swedish universities Scales of Personality (SSP), an instrument developed to explore personality-related vulnerabilities and correlates of psychiatric disorders. Patients were followed prospectively for 2 years. To assess the impact of Neuroticism, Aggressiveness, and Disinhibition on illness course, we performed logistic regressions with the outcome variables mood episodes (depressive, hypo/manic, mixed), suicide attempts, violence, and the number of sick leave days.

RESULTS

Bipolar disorder I and II demonstrated higher global measures of Neuroticism, Aggressiveness, and Disinhibition as compared with healthy controls. A third of the patients scored ≥1 SD above the population-based normative mean on the global neuroticism measure. The two subtypes of bipolar disorder were, however, undistinguishable on all of the personality traits. In the unadjusted model, higher neuroticism at baseline predicted future depressive episodes and suicide attempts/violent behavior, but this association disappeared when adjusting for baseline depressive symptoms as assessed with MADRS.

CONCLUSIONS

A significant minority of the patients scored ≥1 SD above the population mean on the global measures of Neuroticism, Aggressiveness and Disinhibition; scores this high are usually evident clinically. Yet, the personality profile does not seem to have prognostic value over a 2-year period.

The main concern of burn survivors in Iran

Background:

The present work was conducted to study the burn patients’ experiences to get an insight into their main concerns when they suffer the tragic event, recover from it, and adjust back in the society, so that better rehabilitation programs can be planned corresponding to their needs as well as to the needs of the society and the existing situations.

Materials and Methods:

In this qualitative study, 17 burn survivors were enrolled. Unstructured interviews were used for data collection. All the interviews were recorded, transcribed, and analyzed using qualitative content analysis method.

Results:

Based on the existing elements of the explicit textual meanings, two categories of threat and disturbance were formed. The category of threat was extracted from the following five subcategories: (a) Threat to physical life; (b) threat to the process of living; (c) psychological threat; (d) spiritual threat; and (e) social threat. The category of disturbance was extracted from the following three subcategories: (a) Sensory disturbance: Suffering pain; (b) self-concept disturbance; and (c) behavioral disturbance.

Conclusions:

Burn survivors experience severe pain, enduring and suffering in their daily activities after burn. Passing through these difficult trajectories is perceived as a threat and disturbance in self-integrity.

Prevalence and prediction of prolonged pruritus after severe burns

Years after injury, pruritus is a common and severe problem for many burn patients. However, its characteristics and consequences are often only partially described. The authors therefore performed a prospective detailed examination of burn- and individual-related factors and considered those in relation to pruritus severity. Sixty-seven consecutive burn patients were assessed during acute care, and at 3 and 12 months postburn regarding preburn psychiatric disorders, health-related quality of life, post traumatic stress disorder, and personality traits. Postburn pruritus was subsequently assessed 2 to 7 years postburn using the Questionnaire for Pruritus Assessment. Fifty-one individuals, 76% of the participants, reported burn pruritus any time after the burn. Thirty-three individuals, 49% of the participants, reported ongoing pruritus the last 2 months. Information on the characteristics of pruritus was obtained from 32 of these individuals. Most perceived pruritus as bothersome or annoying and as present every day, 16 (50%) were considered to have severe pruritus, and 11 (34 %) scratched themselves to the point of bleeding. In logistic regressions, this was independently related to TBSA full-thickness burn and health-related quality of life at 3 months, and to TBSA full thickness burn and the personality trait impulsiveness, respectively. About half of the previous burn patients experienced ongoing pruritus on an average of 4.5 years after injury, and half of them had severe pruritus. Scratching oneself to the point of bleeding is linked both to a certain personality and to pruritus. It is suspected that many patients are left without access to the best available treatment.

The psychiatric sequelae of burn injury

OBJECTIVE

To examine factors predicting psychiatric morbidity, taking into account the full range of psychiatric disorders before and after burn injury.

METHODS

A cohort of 107 patients consecutively admitted to a Swedish national burn center was examined for lifetime psychiatric morbidity, as well as 94 patients at 1 year postinjury. Sixty-seven individuals, some from that same cohort, were interviewed at 2 to 7years postinjury. The predictive effects of psychiatric history, personality and other risk factors for psychiatric morbidity following burn were evaluated with multiple regression analyses.

RESULTS

The prevalence of having a psychiatric disorder preburn was 57%. One year postinjury 19% had minor or major depression and 23% had subsyndromal or full posttraumatic stress disorder. At 2 to 7years, 31% fulfilled the criteria for a psychiatric disorder. The strongest contributing factors were a history of psychiatric morbidity and neuroticism.

CONCLUSIONS

Two-thirds of the patients had a lifetime psychiatric disorder, and one-third had a psychiatric diagnosis 2 to 7years postburn. Mental health problems can have a major impact on daily life and functional abilities. Thus, identification and treatment of a range of psychiatric disorders, taking into account preburn psychiatric disorders and personality, is important for optimal adjustment after burn.

Impact of personality disorders on health-related quality of life one year after burn injury

PURPOSE

Personality disorders (PDs) are associated with significant distress, disability, and cause great difficulties in life. PDs have been suggested to influence adaptation after major burns, but the potential relationship has not been fully elucidated. This study aimed to describe the prevalence of PDs in 107 patients with major burn injury, and to identify the impact of PDs on perceived patient outcome assessed as health-related quality of life (HRQoL) one year after burn.

METHODS

One burn-specific instrument (Burn Specific Health Scale-Brief (BSHS-B)) and two generic instruments (EuroQol Five Dimensions and Short Form 36 Health Survey) were used, and Psychiatric Axis I and II disorders were assessed one year post burn.

RESULTS

This study identified an above normal prevalence of PDs among individuals afflicted by burn, and participants with PD had a significantly larger lifetime burden of Axis I disorders compared to participants without PD. Participants with PDs scored significantly lower than those without PD in the BSHS-B domain Skin involvement, and the effect of having a PD was related to the subscale Treatment regimens. There was no relationship between the presence of PD and generic HRQoL.

CONCLUSIONS

An implication of these observations is that special rehabilitation efforts including more tailored interventions must be offered to these patients to ensure that the obstacles they perceive to caring for themselves in this respect are eliminated.

IMPLICATIONS FOR REHABILITATION

This study identified an above normal prevalence of PDs among individuals afflicted by burn and these individuals reported poor burn-specific health-related quality of life. The identification of difficulties with compliance and endurance regarding daily skin care may cause negative consequences for optimal rehabilitation and underscore the importance of offering more tailored interventions in rehabilitation. Inflexible behavioral patterns related to the PD diagnosis imply the need for communication strategies by the rehabilitation team, which include flexibility, creativity, and diplomacy. There is a need for further research focusing on identifying the factors that facilitate the individual's own ability to take action and have control.

Extending Findings of a Relation between Posttraumatic Stress Disorder and Emotion Dysregulation among African American Individuals: A Preliminary Examination of the Moderating Role of Gender

Although previous literature highlights the robust relationship between posttraumatic stress disorder (PTSD) and emotion dysregulation across diverse racial/ethnic populations, few studies have examined factors that may influence levels of emotion dysregulation among African American individuals with PTSD. The goal of the current study was to extend previous findings by examining the moderating role of gender in the relationship between PTSD and emotion dysregulation in an African American sample. Participants were 107 African American undergraduates enrolled in a historically black college in the southern United States who reported exposure to a Criterion A traumatic event. Participants with probable PTSD (vs. no PTSD) reported significantly greater emotion dysregulation, both overall and across many of the specific dimensions. Although the main effect of gender on emotion dysregulation was not statistically significant, results revealed a significant interaction between gender and probable PTSD status for overall emotion dysregulation and the specific dimensions of difficulties controlling impulsive behaviors when distressed, limited access to emotion regulation strategies perceived as effective, and lack of emotional clarity. Specifically, post-hoc analyses revealed a significant association between probable PTSD and heightened emotion dysregulation among African American women but not African American men, with African American women with probable PTSD reporting significantly higher levels of these dimensions of emotion dysregulation than all other groups. Findings highlight the relevance of emotion dysregulation to PTSD among African American women in particular, suggesting the importance of assessing and treating emotion dysregulation within this population.

Personality disorders in young adult survivors of pediatric burn injury

OBJECTIVE

Life experience shapes personality and chronic trauma in childhood has been associated with risk for development of subsequent personality disorder. The purpose of this study is to determine the prevalence and character of personality disorders and traits in young adult survivors of severe pediatric burn injury. METHOD.: SCID-II and 16PF were completed by 98 young adult survivors of pediatric burn trauma.

RESULTS

48 (49%) met criteria for one or more personality disorders. The most frequent personality disorders were Paranoid (19.4%), Passive Aggressive (18.4%), Antisocial (17.3%), Depressive (11.2%), and Borderline (9.2%). Diagnosis with a personality disorder was associated with comorbid Axis I diagnoses and strongly correlated with personality traits as measured by the 16PF.

CONCLUSIONS

Pediatric burn trauma is similar to other chronic traumas of childhood in significant correlation with subsequent personality disorder.

Psychiatric morbidity predicts perceived burn-specific health 1 year after a burn

OBJECTIVE

Individual factors such as gender, age, coping and personality traits and injury-related factors such as injury severity have been implicated as risk factors for poor perceived health after burns. As psychiatric morbidity is common in individuals who sustain burns, the aim of this study was to examine the effect of preinjury psychiatric problems on perceived health after injury.

METHOD

A total of 85 consecutive patients treated at a national burn center were prospectively assessed: the patients were interviewed during acute care with the Structured Clinical Interview for DSM-IV Axis I Disorders. One year after injury, perceived health was assessed with the Burn-Specific Health Scale-Brief (BSHS-B). Multiple regression analyses were used to evaluate the predictive effect of preinjury psychiatric history on perceived postinjury health.

RESULTS

Psychiatric morbidity, especially mood disorders, affected outcome for six of the nine BSHS-B subscales, with the covariates mainly being the length of hospital stay and total burn size.

CONCLUSION

The results show that a history of preinjury psychiatric disorders, especially during the year before the burn, affects perceived outcome regarding both physical and psychological aspects of health 1 year after injury and that it is a risk factor for worse perceived outcome.

A prospective longitudinal study of posttraumatic stress disorder symptom trajectories after burn injury

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.

The overlooked relationship between motivational abilities and posttraumatic stress: a review

How does traumatic stress change the ability to motivate oneself to achieve certain goals? How do motivational abilities influence the development and course of trauma sequelae? Few studies have focused on motivational constructs within posttraumatic stress research. From a trauma research perspective, it can be hypothesized that traumatic stress may contribute to motivational dysfunction. The main goal of the present article is to fill this gap in research by reviewing and discussing the existing trauma literature in terms of motivation-related concepts, such as self-efficacy, locus of control, self-esteem, and self-control/impulsivity. Fifty-four studies were reviewed, 10 of which were longitudinal studies. Approximately 20% of the reviews assessed whether motivational concepts predict posttraumatic stress, whereas only 8% examined the reverse relationship. With the exception of a few studies, motivational constructs seem to predict posttraumatic stress over the life span. The strongest relationships were reported for self-efficacy, followed by locus of control and self-esteem and, lastly, impulsivity/self-control. Overall, the findings of this review indicate that there is a lack of research investigating motivational factors as outcome variables following traumatic experiences. Furthermore, the need for longitudinal studies and studies with older adults is noted.

Epidemiology of burn injuries II: psychiatric and behavioural perspectives

Modern technological advances have decreased the incidence and severity of burn injuries, and medical care improvements of burn injuries have significantly increased survival rates, particularly in developed countries. Still, fire-related burn injuries are responsible for 300,000 deaths and 10 million disability-adjusted life years lost annually worldwide. The extent to which psychiatric and behavioural factors contribute to the incidence and outcomes of these tragedies has not been systematically documented, and the available data is often insufficient to reach definitive conclusions. Accordingly, this article reviews the evidence of psychiatric and behavioural risk factors and prevention opportunities for burn injuries worldwide. Psychiatric prevalence rates and risk factors for burn injuries, prevalence and risks associated with 'intentional' burn injuries (self-immolation, assault, and child maltreatment), and prevention activities targeting the general population and those with known psychiatric and behavioural risk factors are discussed. These issues are substantially interwoven with many co-occurring risk factors. While success in teasing apart the roles and contributions of these factors rests upon improving the methodology employed in future research, the nature of this entanglement increases the likelihood that successful interventions in one problem area will reap benefits in others.

Use of healthcare a long time after severe burn injury; relation to perceived health and personality characteristics

PURPOSE

The aim of the study was to evaluate which factors are associated with the use of healthcare a long time after severe burn injury.

METHOD

After a review process based on clinical reasoning, 69 former burn patients out of a consecutive group treated at the Uppsala Burn Unit from 1980--1995 were visited in their homes and their use of care and support was assessed in a semi-structured interview. Post-burn health was assessed with the Burn-Specific Health Scale-Brief (BSHS-B) and personality was assessed with the Swedish universities Scales of Personality (SSP).

RESULTS

The participants were injured on average eight years previously. Thirty-four had current contact with healthcare due to their burn injury and had significantly lower scores on three BSHS-B-domains: Simple Abilities, Work and Hand function, and significantly higher scores for the SSP-domain Neuroticism and the SSP-scales Stress Susceptibility, Lack of Assertiveness, and lower scores for Social Desirability. There was no relation to age, gender, time since injury, length of stay, or to the surface area burned.

CONCLUSIONS

A routine screening of personality traits as a supplement to long-term follow-ups may help in identifying the patient's need for care.

Prediction of patient satisfaction with care one year after burn

The aim of this prospective study was to find predictors of patient satisfaction with burn care. Sixty-nine consecutive adult patients undergoing acute treatment in a Burn Unit completed the following questionnaires: the Swedish universities Scales of Personality, the Impact of Event Scale-Revised, and the Hospital Anxiety and Depression Scale. Socio-demographic data and burn severity were registered. One year later they completed the Patient Satisfaction-Results and Quality (PS-RESKVA) questionnaire containing four subscales: quality of contact with nursing staff (QCN), quality of contact with medical staff (QCM), adequate treatment information (INF), and global satisfaction with treatment (GS). Each subscale was treated as a dependent variable in separate multiple regression models. Overall, the explained variance was low to moderate (range adjusted R(2)=0.06-0.19). Variables remaining in the models were: intrusive symptoms, and the personality trait stress susceptibility for QCN; age, education, and symptoms of hyperarousal for QCM; trait irritability for INF; and age and the personality traits detachment and social desirability for GS. In conclusion, psychological and socio-demographic variables predicted satisfaction to some degree, whereas injury severity did not. The low amount of explained variance suggests that other factors, hypothetically related to care itself, determine patient satisfaction as assessed by the PS-RESKVA.

Patient satisfaction with burn care 1-6 years after injury

Patient satisfaction is an important outcome in health care but has not been studied in relation to burn care. The aim was to explore factors related to satisfaction with care 1-6 years after a burn. Participants were 86 adult burn patients, injured on average 3.6 years previously. The Patient Satisfaction-Results and Quality (PS-RESKVA) was used to assess satisfaction. It has four subscales: Quality of contact with the nursing staff (QCN), Quality of contact with the medical staff (QCM), Adequate treatment information (INF) and Global satisfaction with treatment (GS). Further, data were gathered regarding personality traits and health. Average scores for QCN were significantly higher than scores for the other subscales, and INF received the lowest mean score. In multiple regressions, the PS-RESKVA subscales were associated with better interpersonal relationships (all PS-RESKVA subscales), more sensation seeking (QCM, INF, and GS) and less aggressiveness (QCM and GS). Other variables contributed to a lesser degree. Total amount of explained variance ranged between 18% and 25% for the PS-RESKVA subscales. In summary, satisfaction with burn care was only moderately explained by health and personality characteristics. Further, former patients rated satisfaction with nursing staff higher than other aspects of care, especially information routines.

Injury-related fear-avoidance, neuroticism and burn-specific health

Dysfunctional beliefs such as fear-avoidance (i.e. fear of re-injury) and personality traits such as neuroticism are risk factors for poor health. However, there is little information regarding associations with poor perceived health after severe burn and what level of fear-avoidance is associated with poor health. In this study, we investigated fear-avoidance and neuroticism regarding their associations with post-burn health. Participants were 86 recovered burn patients and data were collected by a postal survey. Post-burn health was assessed with the nine subscales of the Burn Specific Health Scale-Brief (BSHS-B). In logistic regressions, fear-avoidance was related to poorer health in six subscales assessing both physical and psychosocial problems. Neuroticism was associated with poorer health in three subscales assessing mainly psychosocial problems. Chi-square analyses showed that participants with a moderate or high level of fear-avoidance >or=1.0 (out of 4) were more likely to describe their health as poor and had a longer sick leave than those with a fear-avoidance level of <1.0. In summary, fear-avoidance was associated with poorer health even at moderate levels and was associated with several aspects of post-burn health.

Social desirability, psychological symptoms, and perceived health in burn injured patients

Social desirability was previously seen as a nuisance in assessment, but today it is regarded as a personality trait with an influence on health. The aim was to explore relations between social desirability and health in former burn patients. Eighty-four burn patients injured on average 3.8 years ago responded to a questionnaire booklet. Social desirability was assessed with the social desirability subscale of the Swedish universities Scales of Personality, which is standardized in a normative sample. The results showed that a subgroup with high degree of social desirability displayed significantly poorer perceived health on the burn-specific health subscales heat sensitivity, work, and body image than normal responders did. There were no differences regarding age, education, injury-related variables, sick leave, or symptoms of anxiety and depression. In conclusion, participants with high social desirability were characterized by postburn problems in outdoor and work-related situations, and more self-consciousness about appearance.

Personality Characteristics and Perceived Health Problems After Burn Injury

The relationship between personality traits and the perceived outcome of burn injury 1 to 18 years (mean, 9.2 years) after severe burn injury was evaluated in 166 individuals treated at the Uppsala Burn Unit. The perceived outcome was measured with the Burn Specific Health Scale-Brief (BSHS-B) and was related to personality traits evaluated by means of the Swedish universities Scales of Personality. After controlling for age at inquiry, time since injury, burn area, and sex, a stepwise logistic regression analysis revealed an association between the Swedish universities Scales of Personality domain Neuroticism and Bad outcome in all BSHS-B domains, both psychosocial and physical, and Insufficient outcome in the domains Work, Body image, Affect, and BSHS-B total score. The neurotic traits Somatic trait anxiety, Psychic trait anxiety, Stress susceptibility, Embitterment, and Mistrust each or in different combinations explained the observed relationships. The data suggest that personality is related to health status because it is perceived a long time after severe burn injury and that its effect is not confined only to psychological but also to physical aspects of life.

Acceptance of a trauma-focused survey: do personality and health matter?

Health evaluations after trauma are often performed by postal surveys, although previous studies show that some participants experience distress reactions afterwards. The aim was to explore how former burn patients react to filling in a trauma-related survey and whether the reactions are related to individual factors. The survey contained 307 questions, of which one was an open question to elicit reactions to participation. Personality was measured with the Swedish universities Scales of Personality, health with the Burn Specific Health Scale-Brief, and psychological health with the Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised. Participants were 78 (67%) adult burn patients, injured on average 3.9 years previously. Three groups of reactions were identified: positive/beneficial (55%), effort/time-consuming (32%), and negative/intrusive (13%). Only four participants expressed that the survey had been intrusive. Negative reactions were associated with maladaptive personality traits, poorer relationships, and more stress symptomatology, but not with burn severity or sociodemographic variables. Patients with self-inflicted injuries were evenly spread across the groups, but those with negative reactions were responsible for most of the group differences in individual factors. While a small subgroup reacted negatively, the majority accepted the trauma-focused survey and even found it beneficial.

The management of subjective quality of life by short-stay hospital patients: an exploratory study

BACKGROUND

This study tested the homeostatic model of subjective quality of life in a group of 47 short stay patients as they progressed through the stages of hospitalization for surgery.

METHOD

Participants completed a questionnaire measuring subjective quality of life, positive and negative affect, self-esteem, optimism and cognitive flexibility, the day prior to admission (T1), two days post-operation (T2) and one week after discharge (T3). Neuroticism and Extroversion were measured at Time 1.

RESULTS

All variables remained stable across the three times, apart from positive affect, which dropped significantly post-operation but returned to its previous level post discharge.

CONCLUSION

Although the homeostatic model of subjective quality of life was supported at Time 1, the analyses raise doubts about the stability of personality. This finding is consistent with recent discussions of personality.

Chronic Nightmares After Severe Burns: Risk Factors and Implications for Treatment

Although patients frequently experience sleep disturbances and nightmares in the first weeks after a severe burn, information is scarce on the course and prevention of this problem. Prolonged experience of nightmares in adults is one of the symptoms of posttraumatic stress disorder. The aim of this work was to determine risk factors for developing chronic nightmares after severe burns. Personality traits and coping strategies were assessed. As part of a follow-up study of patients treated at the Burn Center at Uppsala University Hospital, Uppsala, Sweden, between 1980 and 1995, the questionnaires of 166 patients (34 females, 132 males, average age 50 years, average burn size 25% TBSA, full-thickness burn size 10% TBSA, average time since burn 11.4 years) were analyzed. The effects of individual personality traits and coping strategies on the frequency of nightmares were evaluated by regression analysis. Nightmares were reported by 43% of the patients, by females more frequently than males. The frequency of nightmares was shown to be associated with the size of the full-thickness burn. The use of Avoidance or Revaluation/Adjustment scales as coping strategies and the presence of Somatic Trait Anxiety as a personality trait were associated with a higher frequency of nightmares after correction for gender. In contrast, persons seeking Emotional Support as a coping strategy reported significantly fewer nightmares. Certain personality traits and coping strategies apparently increase the risk of having nightmares after a severe burn. Helping persons at risk develop different coping strategies may be a possible means of prevention or treatment.

Exploration of coping patterns in burned adults: cluster analysis of the coping with burns questionnaire (CBQ)

The aim of this study was to investigate coping patterns, health status and personality traits in burned adults. Subjects were 161 burn patients treated at the Uppsala University Hospital between 1980 and 1995. Measures were the coping with burns questionnaire (CBQ), the burn specific health scale-brief (BSHS-B) and the Swedish universities scales of personality (SSP). The CBQ was subjected to a K-means cluster analysis and three clusters were derived: extensive, adaptive, and avoidant copers. Extensive copers used the most coping and took an intermediate role regarding health status and the personality trait of neuroticism. Adaptive copers preferred the strategies emotional support and optimism/problem solving, and had the highest health status ratings. Avoidant copers preferred the strategy avoidance and reported the lowest use of emotional support and optimism/problem solving. They had the lowest health status ratings and the highest ratings on neuroticism and aggressiveness. The clusters did not differ in severity of injury or time since injury. In conclusion, coping patterns can be discerned among burn patients, and those individuals preferring avoidance and lacking other coping options displayed more maladaptive traits and poorer health status years after the burn.