title: Psychological distress after major burn injury.
abstract: OBJECTIVE
  To track the prevalence and stability of clinically significant psychological distress and to identify potentially modifiable in-hospital symptoms predictive of long-term distress (physical, psychological, and social impairment).
  
  
  METHODS
  We obtained data from the Burn Model Systems project, a prospective, multisite, cohort study of major burn injury survivors. The Brief Symptom Inventory (BSI) was used to assess symptoms in-hospital (n = 1232) and at 6 (n = 790), 12 (n = 645), and 24 (n = 433) months post burn. Distress was examined dimensionally (BSI's Global Severity Index (GSI)) and categorically (groups formed by dichotomizing GSI: T score > or =63). Attrition was unrelated to in-hospital GSI score.
  
  
  RESULTS
  Significant in-hospital psychological distress occurred in 34% of the patients, and clinically significant and reliable change in symptom severity by follow-up visits occurred infrequently. Principal components analysis of in-hospital distress symptoms demonstrated "alienation" and "anxiety" factors that robustly predicted distress at 6, 12, and 24 months, controlling for correlates of baseline distress.
  
  
  CONCLUSIONS
  This is the largest prospective, multisite, cohort study of patients with major burn injury. We found that clinically significant in-hospital psychological distress was common and tends to persist. Two structural components of in-hospital distress seemed particularly predictive of long-term distress. Research is needed to determine if early recognition and treatment of patients with in-hospital psychological distress can improve long-term outcomes.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA. jfauerba@jhmi.edu
authors.forename: James A
authors.initials: JA
authors.lastname: Fauerbach
authors.forename: Jodi
authors.initials: J
authors.lastname: McKibben
authors.forename: O Joseph
authors.initials: OJ
authors.lastname: Bienvenu
authors.forename: Gina
authors.initials: G
authors.lastname: Magyar-Russell
authors.forename: Michael T
authors.initials: MT
authors.lastname: Smith
authors.forename: Radha
authors.initials: R
authors.lastname: Holavanahalli
authors.forename: David R
authors.initials: DR
authors.lastname: Patterson
authors.forename: Shelley A
authors.initials: SA
authors.lastname: Wiechman
authors.forename: Patricia
authors.initials: P
authors.lastname: Blakeney
authors.forename: Dennis
authors.initials: D
authors.lastname: Lezotte
mesh_terms: D000328:Adult; D002056:Burns / Q000523:psychology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology; D017741:Survivors / Q000523:psychology