الفهرس 
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Abstract
Burn injuries are among the most devastating of all injuries and a major global public health crisis (Forjuoh, 2006; Peck et al., 2008). Burns are the fourth most common type of trauma worldwide. Approximately 90 percent of burns occur in low to middle income countries, regions that generally lack the necessary infrastructure to reduce the incidence and severity of burns (Peck and Pressman, 2013).
In Egypt, most burn injuries occur in a domestic setting, with cooking as the most common activity (Attia, 1997). Burns to adult females occur mostly at home, while burns to adult males occur mostly in outdoor or work locations (Hemeda et al., 2003). The elderly are most likely to sustain a burn in the bathroom, followed by the kitchen (Mabrouk et al., 2003).
The knowledge of pre-existing psychiatric problems is important for burn care mainly for two reasons: first, to better understand and identify psychiatric symptoms occurring during treatment and to recognize them as ongoing or reactivated problems instead of reactions to the injury and second, to increase awareness of potential difficulties during rehabilitation (McKibben et al., 2009; Tedstone and Tarrier, 1997).
Patients with pre-existing psychiatric morbidity have a higher risk of sustaining a preventable injury and in individuals with psychotic disorders self-inflicted burns are overrepresented. Personality disorders are also over-represented in burn patients compared to the general population and persons who score high on the personality traits neuroticism and extraversion appear to have a higher risk of injury (McKibben et al., 2009).
The primary aim of this cross-sectional study was to explore the prevalence of mental disorders among burn injury patients whether pre or post burn. The secondary aim was to determine the possible risk factors for the development of these psychiatric disorders.
We hypothesized that psychiatric morbidities are frequent among burn injury patients either before or after the occurrence of burn.
A total number of 109 hospitalized burn patients were recruited in this study from the inpatient burn unit, Ain Shams University. However, five children below 13 years were excluded from the study as their care givers refused to give consent. The remaining 104 subjects whom proved to be suitable were subjected to a thorough psychiatric assessment using SCID I, SCID II, BDI, SPS and socioeconomic family scales during their hospital stay receiving treatment for their burn.
In the current study, the age range of burn injury patients at the time of interview was found to be from 19 – 69 years. Our results showed that most of the patients 90.4% (94/104) were Muslims and only 9.6% (10/104) were christians. The majority of burn injuries were present among the primary school graduates 36.5% (38/104) and the least were present among the university graduates 4.8% (5/104). The highest percent of burn injury was present among skilled manual workers 42.3% (44/104) and the least was present among the not working group 17.3% (18/104). 41.3% (43/104) of the burn injury patients were married, 32.7% (34/104) of burn injury patients were single, 18.3% (19/104) were widowed and only 8% (19/104) were divorced. All patients were low to middle social class with 45.2% of them (47/104) below average social class and 14.4% (15/104) were very low social class.
In this study, 63.5% of burn injury patients (66/104) had flame type of burn 24% (25/104) had scald type of burn, while 12.5% (13/104) had electrical type of burn. Our study concluded that 54.8% of the burn injury patients (57/104) had acute burn (≤ 4 weeks duration since burn at the time of interview) and 45.2% (47/104) had chronic burn (> 4 weeks duration since burn at the time of interview). In the current study 40.4% of the patients (42/104) had multiple sites of burns, this was followed by lower limb injuries 29.8%, then upper limb burn injuries 18.3%. As for the severity of burn in relation to the body surface area 32.7% of the burn injury patients (34/104) had ≥20% burn surface area and 26% of them had (0 - <5%) burn surface area. Our results showed that 40.3% (42/104) of burn injury patients developed complications. The most common complication was infection 24%, followed by scar formation and then contractures. Moreover, the present study concluded that 60% of the burn injury patients (62/104) had been treated surgically, and 40% (42/104) had been treated conservatively.
By applying SCID I our study showed 55.8% psychiatric disorders among burn injury patients. The most common was substance abuse disorder 22/104 (21.2%), 19 patients out of 22 were before the onset of burn and 3 out of 22 were after the onset of burn. Major depressive disorder was the second common psychiatric morbidity among burn patients 14/104 (13.5%), 8 out of 14 was before the onset of burn and 6 out of 14 was after the onset of burn. BDI showed that 67.3 % of the patients had depressive symptoms, among those 42.3% had mild depressive symptoms and 25% had moderate depressive symptoms. Our study concluded that anxiety disorders were prevalent in burn injury patients, acute stress disorder was 9/104 (8.7%) and post-traumatic stress disorder was 7/104 (6.7%), all of these cases were after the onset of burn. In addition, the rate of paranoid schizophrenia was 6/104 (5.8%), all of them were before the onset of burn.
The current study revealed that 27.9% (29/104) of burn injury patients had personality disorders. The most common was borderline personality disorder 13.5% (14/104) followed by antisocial personality disorder 8.7% (9/104) followed by dependent personality disorder 5.8% (6/104).
The comparison between male group of patients versus the female group showed that education, religion and marital status had a statistically significant relation with illiteracy among females significantly more than males (p= 0.01). Also, Muslim males were significantly more than Muslim females (p= 0.002) and single males were significantly more than single females (p= 0.001).
Also, type, causes and site of burn showed a statistically significant relation with flame burn among males significantly more than females (p= 0.001). Accidental burn in males was significantly more than females (p= 0.005) and burns affecting multiple sites in males were significantly more than females (p= 0.009).
Substance abuse disorder was the most common disorder among males and paranoid schizophrenia was the most common among females. The second most common disorder was major depressive disorder among both males and females equally. (56.8%) of males and (80.4%) of females suffered from depression (BDI) with a significant difference between them as regards the severity of depression. The male group could not be distinguished from the female group in terms of suicidal risk.
In the current study, the type of burn injury, causes, site, severity and complications of burn injury were found to have significant difference in relation to the various types of psychiatric disorders before the onset of burn. All patients with major depression and all patients with paranoid schizophrenia were prone to flame burns, also, most of patients with psychiatric disorders were more liable to accidental burn. Severity and complications of burn were more among patients with psychiatric disorders before burn.
The sociodemographic data and their relation to psychiatric disorders before the onset of burn revealed that the age group, educational level, occupational level and social class showed significant difference as regards the psychiatric disorders before burn.
After the onset of burn, acute stress disorder was the most common psychiatric disorder, followed by post-traumatic stress disorder then major depressive disorder. The psychiatric disorders after burn in relation to the burn data showed that the chronicity of burn at the time of interview, causes of burn, severity, visibility and complications of burn had statistical significance.
The relationship between the psychiatric disorders after burn injury and the sociodemographic data was assessed, the educational level showed significant difference as all patients with psychiatric disorders after burn had primary level of education or illiterate.