title: Psychiatric outcomes in operatively compared with non-operatively managed patients with facial trauma: Is there a difference?
abstract: Patients who sustain facial injury and who require an operation may be at greater risk for developing psychological distress and maladaptive coping. The purpose of this study was to examine psychological responses in adult victims of facial trauma after operation. A consecutive group of adult patients attending specialist outpatient clinics after facial trauma were evaluated for psychological distress. The subjects were divided into two groups based on whether their facial injuries were managed operatively or conservatively. The primary predictor variable in this study was surgical intervention. The main outcome variable was Hospital Anxiety and Depression Scale (HADS) scores. Chi-squared, Mann Whitney U-test, and multiple regression analysis were used to analyse data. The sample consisted of 102 subjects; 71 patients had been managed operatively and 31 patients treated non-operatively. Psychometric scores suggestive of anxiety were present in 21% (n = 15) of the operatively managed group compared with 13% (n = 4) of the non-operatively managed group of patients. The prevalence of depression was comparable between both groups (14% compared with 13%). The median anxiety subscale scores for the operatively managed group when compared with the conservatively managed group of patients were significantly higher (6.6 compared with 4.4, p = 0.02); however, differences in the depression subscale scores did not reach statistical significance (6.2 compared with 4.6, p = 0.06). This study shows an association between anxiety disorders and operative interventions in patients with facial trauma (HADS-A, β = 2.2, p = 0.04). Similar rates of depression were found in the surgically and conservatively managed patients.
authors.affiliation: Department of Plastic Surgery, Birmingham Children's Hospital, Birmingham, 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; D017677:Age Distribution; D001008:Anxiety Disorders / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D004954:Esthetics; D005151:Facial Injuries / Q000523:psychology / Q000601:surgery* / Q000628:therapy; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011182:Postoperative Care / Q000379:methods; D011594:Psychometrics; D019651:Plastic Surgery Procedures / Q000379:methods / Q000523:psychology*; D012044:Regression Analysis; D018570:Risk Assessment; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology