title: Does attribution of blame influence psychological outcomes in facial trauma victims?
abstract: OBJECTIVE
  The relative importance of different variables and specific post-traumatic psychological reactions after facial injuries is poorly understood. The aim of the present study was to assess the association between the subjective attribution of blame and anxiety and depression in facial trauma victims.
  
  
  METHODS
  We undertook a comparative cross-sectional study of psychological outcomes in a cohort of adult patients who have sustained a facial injury. The primary predictor variable was the attribution of blame (self-blame vs blame-others). The main outcome variable was the Hospital Anxiety and Depression Scale (HADS) scores. We also considered several demographic and other clinical variables to assess their relationship with the nature of blame attribution. Cochran-Mantel-Haenszel statistics were used to assess the relationship between the primary predictor and outcome variables, adjusted for age, gender, and confounding factors.
  
  
  RESULTS
  The sample consisted of 102 facial trauma victims (77 men and 25 women). Of the 77 patients, 63 attributed blame for their injuries to someone else and 39 patients attributed blame to themselves. Psychometric scores suggestive of anxiety and the depressive state were significantly greater in the "blame-others" group than in the "self-blame" group (HADS-Anxiety 22% vs 13%, HADS-Depression 17% vs 8%). The prevalence of psychomorbidity in the blame-others group was approximately twice that found in the self-blame group (odds ratio 2.2). Facial trauma patients who blamed others for their injury were predominantly younger men (P = .01) and typically victims of intentional trauma (P < .001).
  
  
  CONCLUSIONS
  The results of the present study suggest that external attribution of blame for facial injury is associated with poor postinjury psychiatric outcomes.
authors.affiliation: Royal Wolverhampton Hospitals, Wolverhampton, UK. drshafiqislam@hotmail.co.uk
authors.forename: Shofiq
authors.initials: S
authors.lastname: Islam
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Cole
authors.forename: Gary M
authors.initials: GM
authors.lastname: Walton
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Dinan
authors.forename: Gary R
authors.initials: GR
authors.lastname: Hoffman
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001008:Anxiety Disorders / Q000209:etiology* / Q000523:psychology; D001828:Body Image; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000209:etiology* / Q000523:psychology; D005151:Facial Injuries / Q000150:complications / Q000523:psychology*; D005260:Female; D006801:Humans; D007389:Internal-External Control; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D055500:Resilience, Psychological; D012649:Self Concept; D012917:Social Adjustment; D013694:Temperament; D055815:Young Adult