||Thombs, B. D., Bresnick, M. G., & Magyar-Russell, G. (2006). Depression in survivors of burn injury: A systematic review. General Hospital Psychiatry, 28(6), 494-502.
||burn injury, risk factors, depression, survivors, prevalence, persistence, burns, major depression, risk factors, persistence, survivors
Background: Survivors of burn injury report high rates of post-traumatic stress disorder, experience anxiety related to body image, and often require rehabilitation and counseling for psychological adjustment to disability. Individuals who survive serious burn injuries are particularly susceptible to depression.
Objectives: To conduct a systematic review of research on the prevalence, persistence, risk factors, and treatment for depression following burn injury.
Search strategy: A search of the MEDLINE, CINAHL, and PsycINFO databases was conducted in June 2006 to identify studies that used a standardized interview or validated questionnaire to assess depression. The search was augmented by hand searching of selected journals and references of identified articles and reviews. No searching was conducted for unpublished research articles.
Selection criteria: Studies using a standardized instrument (i.e., interview protocol or questionnaire) to assess depression were included in the review. Only studies in English were included. Case series or case reports were excluded from the review. Studies that focused on self-inflicted burns were excluded.
Data collection and analysis: Two reviewers assessed the studies for inclusion. Evidence quality was classified using the AAN system.
Main results: A total of 18 articles were eligible for review. In general, studies using standardized interviews reported relatively low rates of major depression. Major depression was identified in 4-10% of adult patients during the year following hospital discharge. Commonly used instruments to measure depression were the Hospital Anxiety and Depression Scale and Beck Depression Inventory. Among studies using the HADS, the prevalence of significant depressive symptoms post discharge was 4-13%. Studies that used BDI reported rates between 13% and 26% for "moderate to severe" symptoms and between 22% and 54% for at least "mild" depression symptoms.
Conclusions: The quality of evidence is limited because the level of potential bias in the studies was high. Future studies should include larger sample sizes and report participant attrition rates. The search strategy used in the review identified no studies on the persistence of depression in burn survivors; there were no studies on treatment of burn injury; and there were no recent studies on youth with burn injury.