title: Impact of facial burns: relationship between depressive symptoms, self-esteem and scar severity.
abstract: OBJECTIVE
  This study assessed the role of self-reported facial scar severity as a possible influencing factor on self-esteem and depressive symptoms in patients with facial burns.
  
  
  METHODS
  A prospective multicentre cohort study with a 6 months follow-up was conducted including 132 patients with facial burns. Patients completed the Patient and Observer Scar Assessment Scale, the Rosenberg Self-esteem Scale and the Hospital Anxiety and Depression Scale. Structural Equation Modeling was used to assess the relations between depressive symptoms, self-esteem and scar severity.
  
  
  RESULTS
  The model showed that patient-rated facial scar severity was not predictive for self-esteem and depressive symptoms six months post-burn. There was, however, a significant relationship between early depressive symptoms and both patient-rated facial scar severity and subsequent self-esteem. The variables in the model accounted for 37% of the variance in depressive symptoms six months post-burn and the model provided a moderately well-fitting representation of the data.
  
  
  CONCLUSIONS
  The study suggests that self-esteem and depressive symptoms were not affected by self-reported facial scar severity but that earlier depressive symptoms were indicative for a more severe self-reported facial scar rating. Therefore, routine psychological screening during hospitalisation is recommended in order to identify patients at risk and to optimise their treatment.
authors.affiliation: Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Centre, Amsterdam, the Netherlands. Electronic address: hoogewerfc@maasstadziekenhuis.nl.
authors.forename: Cornelis Johannes
authors.initials: CJ
authors.lastname: Hoogewerf
authors.affiliation: Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands; Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Margriet Elisabeth
authors.initials: ME
authors.lastname: van Baar
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Centre, Amsterdam, the Netherlands; Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, the Netherlands.
authors.forename: Esther
authors.initials: E
authors.lastname: Middelkoop
authors.affiliation: Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, the Netherlands; Department of Clinical and Health Psychology, Utrecht University, Utrecht, the Netherlands.
authors.forename: Nancy Elisa
authors.initials: NE
authors.lastname: van Loey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002056:Burns / Q000150:complications / Q000523:psychology*; D002921:Cicatrix / Q000523:psychology*; D003863:Depression / Q000209:etiology / Q000523:psychology*; D005151:Facial Injuries / Q000209:etiology / Q000523:psychology*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012649:Self Concept; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Depressive symptoms; Facial burn injury; POSAS; Scar severity; Self-esteem