Mental health refers to the condition of an individual in regards to their psychological, social and emotional well-being.  Burns can be physically and psychologically devastating. Recovery of optimal function to associate with the society both physically and psychologically is an important factor in the treatment of Burn victims.-

Burns may result in traumatic stress, shock, sepsis, pain and altered functioning of the hypothalamic-pituitary adrenocortical system or the immune system. These changes occur as a result of the initial burn event and the injury along with the treatment components. The treatment components include medication regimens, loss of occupation, days of work lost, pain due to the wound, daily aversive dressing changes, pain during physiotherapy, surgical debridement and the wound healing process.

Nowadays, survival and mortality rates of burn victims have improved substantially as a direct result of medical advancements. These advancements include painful and sometimes lifelong medical procedures. The psychological wellbeing of the burn patients becomes an important consideration not only because of recent disfigurement, functional loss, and trauma but also for the maintenance of the compliance with the long treatment and recovery process. Physiological recovery is seen as a continual process which is divided into three stages that is resuscitative or critical, acute, and long-term rehabilitation.

Why people burn themselves?

Some people hurt themselves to help them deal with negative thoughts and feelings. The reasons are listed below.

• To deal with annoying or undesirable feelings like anxiety or depression
• To suffer from grief, loss, violence or chronic illness
• To punish themselves or to express self-hatred or self-anger, or feelings of failure
• To control their emotional pain
• To feel real, feel anything or to cope with feelings of emptiness or numbness

Physical implications:

Depression:

One of the major problems faced by the burn victims is depression. Depression is a common and serious medical illness which can lead to losses in three ways such as physical, psychological and social. This may develop into a more serious psychological complication in a period of time.  It is normal for an individual to have grief reactions like sadness, fear, and anger but if it becomes deep and gets involved with functioning, then it can pave the way for depression.

Signs and Symptoms of Depression:

• Inappropriate feeling of guilt
• Persistent feeling of helplessness or hopelessness
• Sleep and/or appetite disturbance that affects overall health
• Feelings of worthlessness
• Social withdrawal
• Suicidal thoughts

If left untreated depression can give rise to the thoughts of suicide or death. Therefore, it is very much essential for an individual to ask for help instantly. The clinical depression can make the burn survivors weaken but they are treatable.

Anxiety:

Along with depression, Anxiety is also another factor that is witnessed in burn survivors. State anxiety and Trait anxiety can be measured by STAI. State anxiety when confronted with specific situations demands for a particular object or event especially when they experience unpleasant feelings. It rises furthermore when the person makes a mental assessment or any kind of threat. On the other hand trait anxiety rises in response to a perceived threat, but is differs in the form of intensity, duration and the range of the situations that it falls in. State anxiety is a continuously changing condition which is usually experienced with slow recovery and wound healing whereas trait anxiety remains more stable.

A study was conducted to examine the psychological impact of patient factors on self-consciousness and anxiety. It was carried out with a total of 63 participants (majority male) aged between 18 and 55 years from Accident and Emergency (A&E) unit. Scar size, living arrangement and cause of injury had a significant impact on self-consciousness. The study concluded that anxiety and social self – consciousness did not decrease at 6 months post injury. The support related to the living arrangement should be made available based on an individual’s needs due to the mixed results of the study. It was also found that scar size did not impact anxiety until 6 months.

STAI (State-Trait Anxiety Inventory):

The State-Trait Anxiety Inventory (STAI), constructed by Spielberger in 1970 was included as a definitive measure of anxiety. It is an instrument specifically used to simplify the separation between state anxiety and trait anxiety, feelings of anxiety and depression. It is used in clinical settings, as well as in research. It includes a 40 question response taking approximately 10-20 minutes for completion. There are two scales in the test such as the S – Anxiety scale and the T- Anxiety scale, having 20 questions each. These tests are answered on the basis of a 1-4 scale, with the focused areas including worry, tension, apprehension, and nervousness. The STAI has been translated and adapted in 48 languages.

Post-Traumatic Stress Disorder:

Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder that some people develop after experiencing or witnessing a life threatening event. It is characterized by three symptom clusters-

• Re-experiencing intrusive, distressing thoughts, dreams, or images of the traumatic events
• Avoidance of trauma related thoughts, feelings, and situations
• Hyperarousal i.e. persistent sleep disturbance, easy startle, increased tension and irritability

If an individual is consistently undergoing such symptoms for at least one month or longer, then the person may be suffering from Post-Traumatic Stress Disorder.

In the first post- burn year, about between 20-46% of burn survivors meet the criteria for PSTD and almost 50-63 % of survivors meet the criteria for at least one of the symptom clusters. These symptoms tend to dissipate by the time of hospital discharge for the larger number of burn patients. PSTD among burn survivors has not been found related to the severity of injuries rather it is related to more intense pain among the hospitalized burn patients. One of the robust findings across studies was that the post traumatic distress influences psychosocial but not physical adjustment in burn survivors. PTSD is treatable with a combination of therapies by the burn teams in hospitals, and rehabilitation centers.

A publication of Dr. Shobha Chamania, A social Initiative: Choithram Hospital, Indore

Burn Rehabilitation: The successful rehabilitation of the burn survivor requires the involvement of a multi-disciplinary team from the 1st day in order to meet the patient’s complex needs. Following this, the burns team in Choithram hospital, ensures the continuation of rehabilitation before and after discharge of the patient from the hospital. Finally, the patient is encouraged to join social networking activities to help regain confidence in order to come out of stress and depression. To ensure that the burn victim can return to their families, work and society to lead a long and fulfilled life, a multidisciplinary burn team which is dedicated towards securing a patient’s physical, psychological, social and spiritual well-being is required.

Social Implications:

Everyday dehumanizing behavior is experienced by those with physical distinction, including burn scars. These behaviors include blatant staring, whispering, double takes, bullying and can be more subtle like avoidance, ignoring, lack of eye contact, walking faster when approaching. These behaviors have three effects on people such as

• Low Body Esteem
• Sense of social isolation
• Violation of privacy(This is the right to remain anonymous among crowds)

One of the most common impairments of post-burn is scar contractures. It limits the movements and deforms normal anatomical structures. Most of the burn survivors feel socially limited because of scars and keloids, some to the extent withdrawing from school and this may also have an impact on their professional lives. However, a victim/ survivor’s adjustment is heavily dependent upon the love and support that is offered by the family members and friends of the burn victim/survivor

Conclusion:

As a conclusion, several studies on the mental health of burn victims report not only the status of the patient’s post – treatment but also provide the factors that are essential for a good recovery. The two main factors that have been found related to psychological and social adjustment are

• Enduring love and quality of family
• Social support received by the patient and willingness on the part of the patient to take social risks.

Consequently, these findings and clinical experience can improve the mental health of the burn victims/survivors.

Mental health awareness matters:

If we look at suicides most of them are connected to depression and the mental health system just causes them. It’s so woeful that-

                                          “We know what to do, but we just don’t do it”