DSM-5 acute stress disorder in hospitalized burn patients: The impact and interplay of pre- and peri-trauma psychological risk factors

Objective: Burn injuries can be traumatic and lead to psychological sequelae, particularly acute stress disorder (ASD). Information regarding the prevalence and risk factors of ASD following DSM-5 criteria is relatively limited among survivors of burn and other traumas. This study aimed to investigate the prevalence of probable ASD post-burn according to DSM-5 criteria and explore the impact and interplay of pre- and peri-trauma psychological risk factors on DSM-5 ASD symptomatology.

Methods: Between February 2017 and November 2020, 118 patients admitted to the largest burn center in Taiwan were enrolled, with 100 completing assessments within 30 days of injury during acute hospitalization. Most participants were men (73 %), with a mean age of 41.9±12.5 years. The average percentage of total body surface area (TBSA) burned was 15.1±11.5 %.

Results: Around 9 % of the hospitalized burn patients had probable DSM-5 ASD. The most common ASD symptoms were intrusive memories, distress triggered by trauma reminders, and distressing dreams. Pre- and peri-trauma psychological risk factors uniquely accounted for 42.4 % of the variance in DSM-5 ASD symptomatology post-burn after adjusting for covariates. Both peritraumatic emotions and peritraumatic dissociation emerged as strong predictors with medium-to-large effect sizes (semi-partial r² =.13 and .09). Notably, prior depression severity significantly moderated the associations between peri-trauma psychological risk factors and ASD symptoms post-burn (incremental R² = 5.6-8.8 %).

Conclusion: The findings underscore the interplay of pre- and peri-trauma psychological processes in susceptibility to ASD symptomatology post-burn.