The Psychological Impact of Paediatric Burn Injuries: a Systematic Review

Abstract

Title: The psychological impact of paediatric burn injuries: a systematic reviewObjective To review and synthesise qualitative literature regarding the psychological outcomes following paediatric burn injuries, and to determine if children and adolescents who experience a burn injury have elevated risk of psychopathology following the injury.Design: Systematic review of quantitative and qualitative studies.Data sources: Informit health, Medline, Embase, and PsycINFO were searched from January 2010 to December 2020.Data extraction and synthesis: Two reviewers screened articles, and one reviewer extracted data (with cross-checking from another reviewer) from the included studies and assessed quality using an established tool. Narrative synthesis was used to synthesise the findings from the quantitative studies, and thematic synthesis was used to synthesise the findings of included qualitative studies.Results: Searches yielded 1240 unique titles, with 130 retained for full-text screening. Forty-five studies from 17 countries were included. The psychological outcomes included in the studies were mental health diagnoses, medication for mental illness, depression, anxiety, stress, fear, post-traumatic stress, post-traumatic growth, emotional issues, self-harm, self-esteem, self-concept, stigmatisation, quality of life, level of disability, resilience, coping, and suicidality.Conclusions: Our findings highlight paediatric burn patients as a particularly vulnerable population following the burn injury. Studies suggest elevated anxiety and traumatic stress symptoms, and higher rates of psychopathology in the long-term. Further research is recommended to determine the psychological outcomes in the other mental health domains highlighted in this review, as findings were mixed.Clinical care teams responsible for the aftercare of burn patients should involve psychological support for the children and families to improve outcomes.

“I just get scared it’s going to happen again”: A qualitative study of the psychosocial impact of pediatric burns from the child’s perspective

“…In line with previous research, the participants in our study reported heightened anxiety, fear, and posttraumatic stress following their burn injury (5). The majority (71%) of our participants reported that their mental health was signi cantly worse after their injury, and of those who reported worse mental health, all stated that they experienced anxiety.…”

“…In addition, better scar treatments have improved the physical health outcomes of those who have experienced a burn injury (4). However, psychosocial outcomes have not seen the same improvement, and burn injuries can be distressing for both the child or young person, negatively affecting their wellbeing (5).…”

“…Children and young people who have experienced a burn injury (hereafter 'pediatric burn patient') are at a higher risk of developing psychopathology compared to the general population (5,6). Studies show pediatric burn patients are at risk of developing posttraumatic stress symptoms or Posttraumatic Stress Disorder (PTSD) within the rst month after the burn injury (7)(8)(9).…”

The impact of childhood burns on academic performance: A matched population-based cohort study

“…Paediatric burn survivors who are female have also shown higher levels of helpseeking and anxiety, and externalising negative behaviours (e.g., irritability, temper tantrums) compared with males (39). These outcomes are likely to stem from longitudinally poorer mental health states among female burn survivors when compared with male burn survivors (13,40). Additionally, poorer body image perceptions (41,42) and worsened scarring outcomes (e.g., increased physical pain) (43) among young female burn survivors may also hamper their motivation and/or ability to attend school, interact with peers, or participate in school-based activities (e.g., limited participation in sports or crafts due to loss of motor skills).…”

“…Worse academic performance among young people hospitalised after sustaining a burn compared with young people hospitalised for other health conditions, has been demonstrated in a previous Australian study in Grades 3, 5, and 7, although the authors did not disaggregate by gender (16). There are several possible reasons for worsened scholastic performance among young people with burn injuries and these could include reduced learning opportunities, school absenteeism caused by time spent undergoing rehabilitative programmes (29), or psychosocial anxieties with peer interaction and social participation due to lower self-esteem and stigmatisation (13). Additionally, poor sleep quality (30) and chronic pain, which can be sustained well beyond the acute recovery phase following a burn (31), may disrupt young people's ability to learn and engage with learning curricula over several years.…”