Burn severity and long-term psychosocial adjustment after burn injury: The mediating role of body image dissatisfaction

Abstract

Background: Persons with severe burns often develop long-term psychosocial difficulties such as posttraumatic stress disorder (PTSD) and depression. Significant appearance changes following burn injury (e.g., scarring and disfigurement) can lead to body image dissatisfaction (BID) that causes psychological problems. Using a two-wave longitudinal design, this study examined the association between burn severity and psychosocial adjustment after burns (symptoms of PTSD and depression), particularly through the mediating role of BID.

Method: Participants were 111 burn survivors of the 2015 Formosa Fun Coast Water Park explosion. The mean age was 24.23 years, and 62.2% were female. The average TBSA burned was 50.3%, and the mean length of stay (LOS) in hospital was 85.44 days. Data were collected two (Time 1, T1) and three years (Time 2, T2) after the 2015 explosion. A composite burn severity score (CBSS) was additionally created based on TBSA and LOS.

Results: Three main findings emerged: (1) burn severity (TBSA, LOS, and CBSS) were significantly associated with T1 BID and T2 depressive symptoms, but not with T2 PTSD symptoms; (2) T1 BID significantly mediated the relationship between burn severity (TBSA and CBSS) and T2 PTSD symptoms, after controlling for T1 PTSD symptoms; and (3) T1 BID significantly mediated the relationship between burn severity (TBSA, LOS, and CBSS) and T2 depressive symptoms, after controlling for T1 depressive symptoms.

Conclusions: The current findings highlight the importance of BID in the development and maintenance of psychosocial maladjustment long after burn injury.

Keywords: Body image dissatisfaction; Burn severity; Depression; Disaster; Mediation; PTSD.