Depresión y estrés post-traumático en quemados

The Journal of TRAUMA Injury, Infection, and Critical Care

Major Depression and Posttraumatic Stress Disorder Symptoms Following Severe Burn Injury in Relation to Lifetime Psychiatric Morbidity
Johan Dyster-Aas, MD, Mimmie Willebrand, PhD, Bjorn Wikehult, RN, CCN, Bengt Gerdin, MD, PhD, ¨ and Lisa Ekselius, MD, PhD
Background: Psychiatric history has been suggested to have an impact onlongterm adjustment in burn survivors. A rigorous, prospective, longitudinal approach was used to study psychiatric history in a population-based burn sample and its impact on symptomatology of depression and posttraumatic stress disorder (PTSD) at a 12-month follow-up. Methods: Seventy-three consecutive patients admitted to the Uppsala Burn Unit were assessed with the Structured Clinical Interview forDiagnostic and Statistical Manual of Mental Disorders,
Fourth Edition for psychiatric disorders, of whom 64 were also assessed after 12 months. Results: Forty-eight patients (66%) presented with at least one lifetime psychiatric diagnosis; major depression (41%), alcohol abuse or dependence (32%), simple phobia (16%), and panic disorder (16%) were most prevalent. At 12-months postburn, 10patients (16%) met criteria for major depression, 6 (9%) for PTSD, and 11 (17%) for subsyndromal PTSD. Patients with lifetime anxiety disorder and with lifetime psychiatric comorbidity were more likely to be depressed at 12 months, whereas those with lifetime affective disorder, substance use disorder and psychiatric comorbidity were more likely to have symptoms of PTSD. Conclusions: Two-thirds of burnsurvivors exhibit a history of lifetime psychiatric disorders. Those with a psychiatric history have a higher risk of postburn psychiatric problems. Key Words: Burns, Psychiatric morbidity, Posttraumatic stress disorder, Major depression.
J Trauma. 2008;64:1349 –1356.

number of studies suggest that patients previously afflicted by burn have a considerable burden of psychopathology,1 and alsothat such psychopathology is related to the success of the adaptation process.2–5 However, previous investigations report a large discrepancy with respect to prevalence rates of psychiatric morbidity. The prevalence of premorbid psychiatric morbidity, for example, has been reported to vary between 28%6 and 75%.7 The prevalence rates of depression within the first month after the burn show evengreater variation, with studies reporting figures between 2.2%8 and 53%.9 At 12 months postburn, prevalence rates vary between 13%10 and 34%.9 Rates of posttraumatic stress disorder (PTSD) in the early period after a burn trauma have been reported to be between 2.2%8 and 26%,11 whereas 12-month prevalences vary between 13%12 and 45%.13 Consid-

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Submitted for publication August 31, 2006.Accepted for publication February 8, 2007. Copyright © 2008 by Lippincott Williams & Wilkins From the Departments of Neurosciences Psychiatry (J.D.-A., L.E.), Neurosciences Psychiatry and Burn Unit (M.W.), and Surgical Sciences, Plastic Surgery and Burn Unit (B.W., B.G.), University Hospital, Uppsala, Sweden. Supported by the Swedish Research Council, the Swedish Council for Working Life and SocialResearch, the Soderstrom-Konigska Foundation, ¨ ¨ ¨ and the Vårdal Foundation. Address for reprints: Lisa Ekselius, MD, PhD, Department of Neurosciences, Psychiatry, University Hospital, SE-751 85 Uppsala, Sweden. email: lisa.ekselius@uaspsyk.uu.se. DOI: 10.1097/TA.0b013e318047e005

erably higher prevalences have been reported for subsyndromal PTSD.14,15 There are a number of potential explanationsfor these reported discrepancies. First, the patients’ level of mental health functioning before their burn injury is often ignored, although premorbid psychiatric disorders have been reported to be common in burn patients.1 Studies that overlook this fact may erroneously blame postburn psychiatric problems on the burn itself or on the subsequent burn care, when in reality they were already...