title: Body image and psychological outcome after severe skin and soft tissue infection requiring intensive care.
abstract: BACKGROUND
  Patients with severe skin and soft tissue infection (SSTI) requiring intensive care unit (ICU) stay are commonly treated with antibiotics, surgery and in some centers also with hyperbaric oxygen therapy. Long-term follow-up of body image and psychological outcome has not been described despite extensive surgery, potentially altered body image and subsequent psychological problems. The aim was to describe perceived body image and its relation to anxiety, depression and post-traumatic stress disorder (PTSD)-related symptoms in patients with severe SSTI 1 year after ICU stay. Specifically, we aimed to assess potential differences related to gender and anatomic site of infection.
  
  
  METHODS
  Fifty patients treated for severe SSTI in the General ICU, Karolinska University Hospital 2008-2010 received the body image scale (BIS), impact of event scale (IES), and hospital anxiety and depression scale (HADS) 1 year after ICU discharge.
  
  
  RESULTS
  Abdominoperineal SSTI was associated with more body image problems than other anatomic sites of infection in both men and women. Generally, women reported higher BIS scores than men (median 9.5 vs. 3.0 of total 30, P < 0.03) indicating more negative body image. A substantial number of patients reported scar dissatisfaction (63.9%), body dissatisfaction (51.1%) and body feeling less whole (51.0%). BIS scores correlated with HADS anxiety (r = 0.59, P < 0.01), depression (r = 0.60, P < 0.01) and IES (r = 0.61, P < 0.01) scores.
  
  
  CONCLUSIONS
  One year after severe SSTI requiring intensive care, women and patients with abdominoperineal SSTI reported significantly more body image problems. Negative body image was associated with anxiety, depression and PTSD-related symptoms. Specific follow-up for SSTI patients is warranted.
authors.affiliation: Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital Solna, Stockholm, Sweden. elisabeth.hellgren@karolinska.se
authors.forename: E M
authors.initials: EM
authors.lastname: Hellgren
authors.forename: P
authors.initials: P
authors.lastname: Lagergren
authors.forename: A C
authors.initials: AC
authors.lastname: Larsson
authors.forename: A R
authors.initials: AR
authors.lastname: Schandl
authors.forename: P V
authors.initials: PV
authors.lastname: Sackey
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology; D001828:Body Image; D003422:Critical Care; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012727:Sex Characteristics; D012874:Skin Diseases, Infectious / Q000382:microbiology / Q000523:psychology* / Q000628:therapy; D018461:Soft Tissue Infections / Q000382:microbiology / Q000523:psychology* / Q000628:therapy; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome