Burn injury is often a devastating event with long-term physical and psychosocial effects. Burn scars after
deep dermal injury are cosmetically disfiguring and force the scarred person to deal with an alteration in body
appearance. In addition, the traumatic nature of the burn accident and the painful treatment may induce
psychopathological responses.
Depression and post-traumatic stress disorder (PTSD), which are prevalent in 13–23% and 13–45% of cases,
respectively, have been the most common areas of research in burn patients. Risk factors related to depression
are pre-burn depression and female gender in combination with facial disfigurement. Risk factors related to
PTSD are pre-burn depression, type and severity of baseline symptoms, anxiety related to pain, and visibility of
burn injury. Neuropsychological problems are also described, mostly associated with electrical injuries. Social
problems include difficulties in sexual life and social interactions. Quality of life initially seems to be lower in
burn patients compared with the general population. Problems in the mental area are more troublesome than
physical problems. Over a period of many years, quality of life was reported to be rather good. Mediating
variables such as low social support, emotion and avoidant coping styles, and personality traits such as
neuroticism and low extraversion, negatively affect adjustment after burn injury.
Few studies of psychological treatments in burn patients are available. From general trauma literature, it is
concluded that cognitive (behavioral) and pharmacological (selective serotonin reuptake inhibitors) interventions
have a positive effect on depression. With respect to PTSD, exposure therapy and eye movement
reprocessing and desensitization are successful. Psychological debriefing aiming to prevent chronic post-trauma
reactions has not, thus far, shown a positive effect in burn patients. Treatment of problems in the social area
includes cognitive-behavioral therapy, social skills training, and community interventions. Sexual health
promotion and counseling may decrease problems in sexual life.
In conclusion, psychopathology and psychological problems are identified in a significant minority of burn
patients. Symptoms of mood and anxiety disorders (of which PTSD is one) should be the subject of screening in
the post-burn phase and treated if indicated. A profile of the patient at risk, based on pre-injury factors such as
pre-morbid psychiatric disorder and personality characteristics, peri-traumatic factors and post-burn factors, is
presented. Finally, objective characteristics of disfigurement appear to play a minor role, although other factors,
such as proneness to shame, body image problems, and lack of self-esteem, may be of significance.