Psychosocial aspects of burn injuries

The recent article by Wiechman and Patterson (1) provided an
invaluable overview of the Psychological rehabilitation of patients with
Burns. But the authors did not address the issue of pre-existing
Psychological and Psychiatric problems in patients presenting with burns.

Data collected for inpatients with burns at the Welsh Centre for
Burns and Plastic Surgery over the past 3 years show that approximately
5% of all admissions (and 24% of mental health referrals) resulted from
burns occurring as deliberate self-harm. Also, among 174 consecutive
mental health referrals, 11% had a diagnosis of a Psychotic disorder, and
36% had substance misuse problems, which preceded, and may have been
aetiologically significant in, the burn injury. Finally, the largest
diagnostic group seen was mood disorders (46%) and here these symptoms
preceded the burns in most cases.

Therefore managing pre-existing Psychiatric and Psychological
problems forms a major part of the Psycho-social workload on our unit.
Patients with such problems may require a different approach to Psycho-
social re-rehabilitation. We would certainly endorse the article's
recommendation that Burns Centres employ Social Workers, Counsellors and
Psychologists as part of the Multidisciplinary team, but would recommend
that Psychiatrists and / or Psychiatric Nurses be added to this list.

Reference:
Shelley A Wiechman and David R Patterson
Psychosocial aspects of burn injuries
BMJ 2004; 329: 391-393

Competing interests:
None declared