Bio-Psychological Predictors of Acute and Protracted Fatigue After Burns: A Longitudinal Study

Elise Boersma-van Dam; Iris M Engelhard; Rens van de Schoot; Nancy E E Van Loey

doi:10.3389/fpsyg.2021.794364

Bio-Psychological Predictors of Acute and Protracted Fatigue After Burns: A Longitudinal Study

Front Psychol. 2022 Jan 24:12:794364. doi: 10.3389/fpsyg.2021.794364. eCollection 2021.

Authors

Elise Boersma-van Dam^{1

2}, Iris M Engelhard², Rens van de Schoot^{3

4}, Nancy E E Van Loey^{2

5}

Affiliations

¹ Association of Dutch Burn Centres, Beverwijk, Netherlands.
² Department of Clinical Psychology, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, Netherlands.
³ Department of Methodology and Statistics, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, Netherlands.
⁴ Optentia Research Program, Faculty of Humanities, North-West University, Vanderbijlpark, South Africa.
⁵ Maasstad Hospital and Association of Dutch Burn Centres, Rotterdam, Netherlands.

Abstract

Objective: Fatigue after burns is often attributed to the hyperinflammatory and hypermetabolic response, while it may be best understood from a bio-psychological perspective, also involving the neuro-endocrine system. This longitudinal multi-center study examined the course of fatigue up to 18 months postburn. The contribution of bio-psychological factors, including burn severity, pain, and acute PTSD symptoms, to the course and persistence of fatigue was studied in a multifactorial model.

Methods: Participants were 247 adult burn survivors. Fatigue symptoms were assessed with the Multidimensional Fatigue Inventory during the acute phase and subsequently at 3, 6, 12, and 18 months postburn, and were compared to population norms. Age, gender, burn severity, acute PTSD symptoms and pain were assessed as potential predictors of fatigue over time in a latent growth model.

Results: At 18 months postburn, 46% of the burn survivors reported fatigue, including 18% with severe fatigue. In the acute phase, higher levels of fatigue were related to multiple surgeries, presence of pain, and higher levels of acute PTSD symptoms. Fatigue gradually decreased over time with minor individual differences in rate of decrease. At 18 months, pain and acute PTSD symptoms remained significant predictors of fatigue levels.

Conclusions: Protracted fatigue after burns was found in almost one out of five burn survivors and was associated with both pain and acute PTSD symptoms. Early detection of PTSD symptoms and early psychological interventions aimed at reducing PTSD symptoms and pain may be warranted to reduce later fatigue symptoms.

Keywords: PTSD symptoms; bio-psychological approach; burns; fatigue; pain.