title: The reported pain coping strategies of pediatric burn survivors-does a correlation exist between coping style and development of anxiety disorder?
abstract: Unresolved pediatric pain, both acute and chronic, has been associated with negative short- and long-term physical and mental health outcomes. This study sought to determine whether an association existed between self-reported pain coping skills and anxiety levels in a cohort of pediatric burn patients, and whether gender would influence their responses. The sample comprised burn-injured children in attendance at one of three mature burn camp sites. The self-report measures utilized included the 41-item Screen for Child Anxiety Related Disorders Child Version and the 39-item Pain Coping Questionnaire. Parental consent was obtained. A psychologist administered the measures. Participants included 187 youth, mean age 12.4 ± 2.4 years, girls (n = 89) boys (n = 98) with 67% reporting visible burn scars. Among boys, the use of Internalizing Coping Strategies was moderately correlated with elevated scores on Panic Disorder symptoms (r = .42, P < .001). Among girls, the use of Internalizing Coping Strategies was associated with elevated Generalized Anxiety (r = .51, P < .001), Panic Disorder (r = .46, P < .001), and Total Anxiety Symptom Scores (r = .49, P < .001). Those children who reported using Behavioral Distraction Strategies did not have any elevated anxiety scores. These findings suggest that burn-injured children, who employ Internalization as their pain coping strategy, may be more vulnerable to the development of long-term anxiety disorder, which, if left untreated may result in a negative psycho/social outcome. Applicability to Practice: Assessment of in-patient pediatric patients with the Pain Coping Questionnaire may help to identify children who are more likely to experience long-term anxiety. Future studies should seek to confirm these findings and determine whether improved pain management and early treatment of anxiety can help to diminish the long-term implications of unhelpful pain strategies and increased anxiety in burn-injured children.
authors.affiliation: From the *Department of Surgery, Arizona Burn Center at Maricopa Medical Center, Phoenix; †AT Still University; and ‡Parkland Hospital, Dallas, Texas.
authors.forename: Ruth Brubaker
authors.initials: RB
authors.lastname: Rimmer
authors.forename: Now Bahar
authors.initials: NB
authors.lastname: Alam
authors.forename: R Curt
authors.initials: RC
authors.lastname: Bay
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Sadler
authors.forename: Kevin N
authors.initials: KN
authors.lastname: Foster
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Caruso
mesh_terms: D000222:Adaptation, Physiological; D000223:Adaptation, Psychological; D000293:Adolescent; D001008:Anxiety Disorders / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology*; D002056:Burns / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology*; D002648:Child; D002669:Child Welfare / Q000706:statistics & numerical data*; D015331:Cohort Studies; D016638:Critical Illness / Q000523:psychology; D005260:Female; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008297:Male; D012649:Self Concept; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data