Journal:J. Burn Care & Rehabilitation
Year, Volume, Issue, Page(s):04, 25, , 98-106
This study assessed long-term psychosocial sequelae of young adult pediatric burn survivors. Subjects were 101 young adults (43 females and 58 males) between the ages of 18 and 28 years who were at least 2 years (average, 14 years) postburn at least 30% TBSA (mean = 54 ± 20%). Educational status was 25% high school dropouts, 28% high school graduation only, 32% some college, and 5% completed college. Seventy-seven percent either worked or attended school; 28% had had a long-term partner. When assessed by Achenbach's Young Adult Self-Report (YASR) scale and compared with its published reference group, the males reported differences only in the somatic complaints, but the females endorsed significantly more externalizing and total problems, specifically withdrawn behaviors, somatic complaints, thought problems, aggressive behavior, and delinquent behavior. Despite these problems suffered by some female pediatric burn survivors, the overall outcome revealed that most pediatric burn survivors are making the transition into adulthood with minimal unexpected difficulty.
The past two decades have witnessed a marked increase in the number of individuals who survived severe burns as children and are now becoming adults. Twenty-five years ago only half of the children with greater than 50%Total Body Surface Area (TBSA) burns survived. Now, half of those who have 85% TBSA burns survive; and essentially all those with smaller burns routinely survive. 1 Many of those young survivors face futures as persons with obvious burn scars and significant disfigurement to the face and /or extremities (most burns over 30% cause such scarring). Yet, burn care experts know almost nothing about the impact of the injury and its accompanying disfigurement and/or disability upon the psychosocial functioning and/or quality of life of pediatric burn survivors when they become adults. Most assessments of the psychosocial problems and adjustment of pediatric burn survivors focus on the immediate burn period through the first years post-burn and indicate that the majority of young survivors during these early years have reasonably good psychosocial adjustment, with only about thirty percent having significant psychosocial problems. 2-6 These studies did not target long-term psychosocial adjustment during the survivors' transition from dependent adolescents to independent adults; they are not true longitudinal studies that involve more than one time point of evaluation.
Many people, lay and professional, have predicted that such survivors will lead lonely, isolated lives, rejected by peers and/or afraid to enter the mainstream of society. A few studies concerning how pediatric burn survivors function as adults have been published. 7-16 All of these reports have been optimistic and somewhat reassuring to the people who care for children who are burned. Blakeney et al 3,12,17 conducted three studies of older adolescents and young adults and found that, in each sample, 40 to 50% of the individuals presented as well adjusted while 50 to 60% presented with some degree of psychological distress; 25% presented with symptoms severe enough to warrant clinical attention. The most recent study by Sheridan et al 16 used a standardized instrument, the SF-36, to assess the quality of life of 80 adults (ages 24 ± 8 years) who received massive burn injuries of at least 70% TBSA as children (15.7 ± 5.5 years since injury). These individuals are reported to have, in comparison with the age-matched standardization group, similar responses in all domains except in physical disability. This would indicate that, even with physical complaints, the burn survivors are achieving satisfactory lives.
However, these studies leave many questions unanswered. The present authors, responsible in large degree for this optimistic view, know from our clinical work as well as research data that doing well and responding within the normal range are not phrases synonymous with entirely happy and adjusting with ease. What are the struggles of these children as they enter adulthood? Are they succeeding to their own satisfaction? Do they need special assistance? Are needed services provided? In publishing these general outcomes are we failing to adequately portray the difficulties and obstacles facing burn survivors as they fight to establish themselves as independent, self-supporting and valuable individuals?
The current study of 101 young adults burned as children was designed to address some of these unanswered questions and to identify more specifically the questions to be pursued. Because of our limited opportunity to interact with these young people who are now surpassing the upper age limit to receive care at our pediatric hospital, we attempted to gather as much information as was practical from each of the participants. Such an approach yields much data and will be reported in segments. The current paper, ie, the first segment, provides a comprehensive demographic and sociological picture and an overview of the psychological adjustment as reported by these individuals who suffered major burn injuries as children.