Bio-Psychological Predictors of Acute and Protracted Fatigue After Burns: A Longitudinal Study

Abstract

ObjectiveFatigue after burns is often attributed to the hyperinflammatory and hypermetabolic response, while it may be best understood from a bio-psychological perspective, also involving the neuro-endocrine system. This longitudinal multi-center study examined the course of fatigue up to 18 months postburn. The contribution of bio-psychological factors, including burn severity, pain, and acute PTSD symptoms, to the course and persistence of fatigue was studied in a multifactorial model.MethodsParticipants were 247 adult burn survivors. Fatigue symptoms were assessed with the Multidimensional Fatigue Inventory during the acute phase and subsequently at 3, 6, 12, and 18 months postburn, and were compared to population norms. Age, gender, burn severity, acute PTSD symptoms and pain were assessed as potential predictors of fatigue over time in a latent growth model.ResultsAt 18 months postburn, 46% of the burn survivors reported fatigue, including 18% with severe fatigue. In the acute phase, higher levels of fatigue were related to multiple surgeries, presence of pain, and higher levels of acute PTSD symptoms. Fatigue gradually decreased over time with minor individual differences in rate of decrease. At 18 months, pain and acute PTSD symptoms remained significant predictors of fatigue levels.ConclusionsProtracted fatigue after burns was found in almost one out of five burn survivors and was associated with both pain and acute PTSD symptoms. Early detection of PTSD symptoms and early psychological interventions aimed at reducing PTSD symptoms and pain may be warranted to reduce later fatigue symptoms.

The impact of necrotizing soft tissue infections on the lives of survivors: a qualitative study

“…These local and systemic effects corroborate a previous study among NSTI survivors [ 19 ]. Additionally, our study revealed that ‘fatigue and sleeping problems’ and ‘cognitive changes’, were long-term problems affecting HRQoL, problems also present after burns, which adds to the understanding of the impact of NSTI on patients’ lives [ 36 , 37 ].…”

Development and Testing of the Aftercare Problem List, a Burn Aftercare Screening Instrument

“…Well-established psychological problems comprise posttraumatic stress and depressive symptoms, anxiety, and body image concerns [6][7][8][9], often complicated by social problems [10], stigmatization, or vocational problems [11][12][13]. Furthermore, fatigue and sleep problems were identified as enduring problems in burn survivors [14][15][16], as well as sexual problems which are largely unaddressed [17]. Among this summary of problems, the psychosocial impact of burn injuries can be considerable [18], severe enough to require mental health visits and targeted interventions [19].…”

Researches on cognitive sequelae of burn injury: Current status and advances

“…The main neurological sequelae following burn injury are cognitive dysfunctions, including memory defects, amnesia, dementia, depression, anxiety, post-traumatic stress disorder (PTSD), hallucinations, and delirium (Wollgarten-Hadamek et al, 2009). Although other neurological sequelae including peripheral neuropathies, chronic neuropathic pain, post-burn pruritus, and acute/chronic fatigue are also noted (Chung et al, 2020;Boersma-van Dam et al, 2021a;Shu et al, 2022), memory defects and psychological impairments as the most common clinical manifestations of cognitive dysfunctions following burn injury are the main points to be covered in this article (Purohit et al, 2014). This review elaborates the mechanisms of memory defects following burn injury, such as neuroinflammation, destruction of blood-brain barrier (BBB), and hormone imbalance.…”