About Rachel Kornhaber, Denis Visentin, Loyola McLean, Michelle Cleary

Rachel KORNHABER, RN, PhD, Senior Lecturer, University of Tasmania, School of Nursing, College of Health and Medicine, Sydney, NSW Australia. Denis VISENTIN, PhD, Senior Lecturer, University of Tasmania, School of Nursing, College of Health and Medicine, Sydney, NSW Australia. Loyola McLEAN, BA MBBS (Hons) FRANZCP PhD Dip Psych Psychotherapy Cert ATP, Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; c Westmead Psychotherapy Program, Western Sydney Local Health District and The University of Sydney, Discipline of Psychiatry, The University of Sydney, Cumberland Hospital, Parramatta, NSW, Australia; d Consultation-Liaison Psychiatry, Royal North Shore Hospital, Sydney, NSW, Australia. Michelle CLEARY, RN, PhD, University of Tasmania, School of Nursing, College of Health and Medicine, Sydney, NSW Australia.

Recovering from a burn is not just a physical challenge, but also a mental one, as those who suffer the injury often develop PTSD because of it.

 

 

 

The challenges of recovering from burn injury (including mental health challenges) are largely unknown in our community. To help decrease the long-term mental health problems arising from burns injury, a greater understanding of the traumatic nature of the injury and the recovery to better inform care for burns survivors and their families is needed.

Around 11 million burn injuries occur each year globally. In Australia, approximately 200,000 people sustain a burn injury each year. The WHO have identified burns as a leading cause of injury that often causes stigma affecting daily life.

A severe burn is an injury for life, and a common one, often accompanied by physical and emotional trauma. Despite this, we do not automatically link the burn injury with the risk of mental ill-health in the same way that we link smoking with cancer or violence with trauma.

We outline four key ways to improve care, to create a positive environment for both physical recovery and mental health wellbeing.

 

What are the risks?

The relationship between mental ill-health and burn injury is two-fold. Those who experience a burn injury are more likely to develop a mental illness as a consequence as well as those with a pre-existing mental health issue being at greater risk of a burn injury than the general population. A pre-existing psychiatric disorder such as depression, substance use disorder, schizophrenia and generalized anxiety disorder, is associated with worse outcomes and a significant predictor of death for burns survivors.

Post-traumatic stress disorder (PTSD) is a significant mental health issue among patients with burn injuries. PTSD remains among the most prevalent mental health issues for those with burns and has been seen in between 30% to 70% of burn survivors. Burn survivors with PTSD had a lower quality of life compared to those without PTSD.

Yet the question remains as to what can be done to assist burn survivors who are at such risk of mental health consequences and co-morbidities as a partner to their injury.

 

 

Who is at risk?

Those who reside in developing countries are at higher risk of a burn than those living in developed countries. Alcohol consumption and substance use contribute to the risk of sustaining a burn injury.  Alcohol-related burns are increasing and, accounted for nearly 20% of all admissions in a UK study. More than half of burn patients were under the influence of alcohol and one-fifth had also been smoking when burnt at a burn centre in Helsinki. Age is another factor, with burns the 5th main cause of non-fatal childhood injuries. Health issues such as mental illness, dementia, epilepsy, and diabetes also place people at a higher risk of a burn as does substance misuse.

At the extreme end, a burns injury may result from self-harm, a suicide attempt or from an attack.

Burns are costly to families and society limiting the person and their carers ability to work. In addition to the cost of medical care and rehabilitation, a prolonged recovery period and common complications such as wound infection have a longer-term impact on the quality of life.

Burn injury is associated with pain and distress experienced through daily dressings, wound cleansing and physiotherapy, with the road to recovery more often than not protracted over several years. Survivors of severe burn injury are often left with significantly altered body image and a loss or change of identity requiring considerable adjustment. It is not surprising therefore that survivors often experience mental health issues.

Despite significant advancements in skin replacement technology that improves the physical appearance of burns and therefore the appearance of the survivor, and life-saving early critical care, awareness of the psychological and social impacts may be just as significant.

Shedding light on the lesser-known factors of mental health of burn survivors can help to understand where essential mental health services are required and where research needs to be directed.

 

What can we do?

The adage “prevention is better than the cure” is highly relevant to burn injuries since these injuries are almost always preventable. Although much progress has been made in reducing the incidence of burns through education and prevention strategies, little targeted response is aimed at those with pre-existing mental illness, and thus misses a target population at significant risk. Greater community awareness would certainly be a step in the right direction to reduce the incidence of burns.

This requires more resources than are currently being invested to bring this issue into plain sight.

  1. With only a small percentage of burn survivors receiving appropriate psychiatric care, early screening of survivors of burn injury is necessary to enable the early identification of psychological symptoms. This would allow for an earlier assessment of possible mental health impacts and hasten the necessary fitted response to this.
  2. Assessing burn survivors for pre-existing trauma can also lead to early intervention and better rehabilitation outcomes. To achieve this, an understanding by health care staff of the strong link between burn injuries and mental health, and an understanding of the trauma encountered during the injury and the treatment process, are fundamental to appropriate patient care.
  3. The type of injury is also important. Injuries to the face and hands are more prominent and affect self-image and identity.  Other injuries may affect mobility. These may have greater impact on daily living which may cause mental ill-health.
  4. One thing that may assist is a true team approach where an understanding of the trauma that the patient has suffered is central to the care they receive. Acknowledgement of the trauma can show health care professionals how to proceed and make them more aware of the sensitivities and needs for that person’s treatment and recovery. It is bound to be more fraught than for many other patient groups and thus needs to be approached accordingly.

Mental recovery is just as important as physical, and there needs to be a greater understanding and awareness across society of mental ill-health and burn injuries to provide complete care.

 

This piece has multiple authors and researchers – they are listed below:

Rachel KORNHABER, RN, PhD, Senior Lecturer, University of Tasmania, School of Nursing, College of Health and Medicine, Sydney, NSW Australia. [email protected]

Denis VISENTIN, PhD, Senior Lecturer, University of Tasmania, School of Nursing, College of Health and Medicine, Sydney, NSW Australia. [email protected]

Loyola McLEAN, BA MBBS (Hons) FRANZCP PhD Dip Psych Psychotherapy Cert ATP, Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; c Westmead Psychotherapy Program, Western Sydney Local Health District and The University of Sydney, Discipline of Psychiatry, The University of Sydney, Cumberland Hospital, Parramatta, NSW, Australia; d Consultation-Liaison Psychiatry, Royal North Shore Hospital, Sydney, NSW, Australia. [email protected]

Michelle CLEARY, RN, PhD, University of Tasmania, School of Nursing, College of Health and Medicine, Sydney, NSW Australia. Email: [email protected]