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Coping, Personality and Cognitive Processes in Burn Injured Patients

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Coping, Personality and Cognitive Processes in Burn Injured Patients ! ! " # $ ! "% ##& '#((&")*+ *,* +#-&)#,*,# !*(#&+# !!*(* .. Dissertation for the Degree of Doctor of Philosophy (Faculty of Medicine) in Psychiatry presented at Uppsala University in 2003. Abstract Willebrand, M. 2003. Coping, Personality and Cognitive Processes in Burn Injured Patients. Acta Universitatis Upsaliensis. Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine 1223. 55 pp. Uppsala. ISBN 91-554-5528-X. Being severely burned is a traumatic life event that affects the victim both physically and psychologically. Recovery can be a long process that is dependent in part upon psychological factors, but research in this area is still quite limited. The main aim of the thesis was to explore coping, personality and cognitive processes in long-term and short-term adaptation. The participants were recruited from three separate samples of former and consecutive adult burn patients. A questionnaire, the Coping with Burns Questionnaire (CBQ), was developed to retrospectively assess coping. It consisted of six coping factors related in different ways to self-reported health status. Regarding personality, the former patients displayed slightly more Neuroticism than people in general, suggesting an overrepresentation of premorbid neurotic personality traits. Avoidant coping was related to poorer perceived health status, more maladaptive personality traits, and was a strong predictor of psychological symptoms at three months post-burn. Regarding cognitive processes, a moderate attentional bias towards burn- related information was found in the former patients when using the emotional Stroop task. This indicates that the burn may still be an important issue years after the event. Finally, former patients’ reactions to participating in a trauma-related postal survey were investigated. A majority felt that participation was positive or even beneficial, while a small subgroup felt that participation was cumbersome or negative. To summarise, although many burn patients adapt well in the long run, the burn may still be a significant theme and the subgroup of Avoidant copers are especially vulnerable. The CBQ seems to be an adequate tool for discerning individuals at risk for poor adjustment. Trauma-related postal questionnaires are well accepted by a majority of former burn patients. Although long-term prospective follow-ups are needed to further validate the results, it is suggested that early screening of psychological factors could be of value in burn care. Key words: Accident, burn injury, coping, depression, ethics, health status, personality, posttraumatic stress, questionnaire, trauma Mimmie Willebrand, Department of Neuroscience, Psychiatry, University Hospital, SE-751 85, Uppsala, Sweden © Mimmie Willebrand, 2003 ISSN: 0282-7476 ISBN 91-554-5528-X Printed in Sweden by Uppsala University, Tryck & Medier, Uppsala, 2003 PAPERS INCLUDED IN THE THESIS This thesis is based on the following papers, which are referred to in the text by their Roman numerals: I Willebrand M, Kildal M, Ekselius L, Gerdin B, Andersson G. (2001). Development of the Coping with Burns Questionnaire. Pers Ind Dif 30: 1059-1072. II Willebrand M, Kildal M, Andersson G, Ekselius L. (2002). Long- term assessment of personality after burn trauma in adults. J Nerv Ment Dis 190: 53-6. III Willebrand M, Andersson G, Kildal M, Ekselius L. (2002). Exploration of coping patterns in burned adults: cluster analysis of the Coping with Burns Questionnaire (CBQ). Burns 28: 549-554. IV Willebrand M, Norlund F, Kildal M, Gerdin B, Ekselius L, Andersson G. (2002). Cognitive distortions in recovered burn patients: the emotional Stroop task and Autobiographical Memory Test. Burns 28: 465-471. V Willebrand M, Andersson G, Ekselius L. Prediction of psychological health following accidental burn. (Submitted) VI Willebrand M, Wikehult B, Ekselius L. Acceptance of a trauma- focused survey: do personality and health matter? (Submitted) Contents Introduction.....................................................................................................1 Epidemiology .............................................................................................1 Premorbid psychopathology..................................................................2 Aetiology and burn care.............................................................................2 The process of adaptation...........................................................................3 The burn.................................................................................................3 Perceived health and quality of life .......................................................3 Psychological reactions .........................................................................4 Depression ........................................................................................4 Anxiety..............................................................................................4 Coping........................................................................................................5 Coping and health..................................................................................6 Coping in burn injured patients .............................................................7 Personality..................................................................................................8 Personality traits in burn injured patients ..............................................8 Cognitive processes and post-trauma adjustment ......................................9 Negative appraisals................................................................................9 Autobiographical memory.....................................................................9 Attentional processes...........................................................................10 Participant reactions to postal questionnaires ..........................................11 Aims of the thesis .........................................................................................13 Specific aims ............................................................................................13 Methodology.................................................................................................14 Participants and procedure .......................................................................14 Assessments and measures.......................................................................17 Coping .................................................................................................17 Burn-specific health.............................................................................17 Personality traits ..................................................................................19 Cognitive tests .....................................................................................19 Cognitive status ...................................................................................20 Life events ...........................................................................................20 Psychological health............................................................................20 The burn accident ................................................................................21 Socio-demographic and injury-specific data .......................................21 Acceptance of the questionnaires ........................................................21 Statistical analyses ...................................................................................21 Ethics........................................................................................................22 Results...........................................................................................................23 Development of the Coping with Burns Questionnaire (paper I) ............23 Assessment of personality traits in former burn patients (paper II) .........25 Exploration of coping patterns in burn injured adults (paper III) ............26 Cognitive distortions in recovered burn patients (paper IV)....................27 The Autobiographical Memory Test ...................................................27 The Stroop task....................................................................................27 Prediction of psychological health following accidental burn (paper V).29 Acceptance of a trauma-focused postal survey (paper VI) ......................30 Discussion.....................................................................................................32 A burn-specific coping instrument...........................................................32 Maladaptive coping strategies .............................................................32 Adaptive coping strategies...................................................................33 Personality traits in burn injured adults....................................................34 Coping patterns, personality traits and health ..........................................35 Memory and attentional processes ...........................................................36 Prediction of psychological problems......................................................37 The coping instrument..............................................................................39 Personality traits, health and acceptance of a trauma-focused survey .....39 General methodological considerations ...................................................40 General
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