Predictors of Posttraumatic Stress Disorder, Trajectories of Posttraumatic Adjustment, and Posttraumatic Growth among Burn Survivors: a Multiple-Wave Prospective Study

This three-year prospective study aims to investigate the changing process of posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) and their potential predictors as well as different trajectories of posttraumatic adjustment and their differentiating factors after burn trauma. Burn injury often leads to scarring, contractures, disfigurement, and pain, which require long-term physical rehabilitation and raise the risk of psychological disorders. Prior studies estimates that approximately one-third of burn patients suffered from PTSD. The prevalence of PTSD does not significantly decrease during the two-year period (McKibben et al., 2008), and delayed trajectories has been observed in a noticeable proportion of burn survivors, which is distinguished from pattern of recovery of other common traumas. Bonanno (2004) posited four distinct trajectories of mental health outcomes following trauma: chromic, resilience, recovery, and delayed distress, among which resilience is theorized as the model health outcome following trauma. However, resilience trajectory has not been observed in survivors of sexual assault (e.g., Armour et al., 2011) and prolonged and repeated trauma. Considering that burn injury poses long-term rehabilitation challenges, we hypothesized that multiple trajectories of posttraumatic adjustment are manifested in burn survivors and the proportions of different trajectories are distinguished from those of the common trauma (i.e., resilience: relatively lower; chronic & delayed: relatively higher for burn survivors). Regarding the predictors of burn-related PTSD and differentiating factors of burn-related symptom trajectories, we will reexamine the predictive effects of previously examined variables given the inconsistent results. Meanwhile, we will also explore the contribution of cognitive variables derived from cognitive theories of PTSD and several positive personality traits (e.g., trait mindfulness) given their theoretical importance. Using a multi-wave prospective design, this three-year study intends to recruit 200 burn survivors of Taiwan Water Park Explosion, who will be surveyed at 6, 12, 18, 24, and 36 months after the trauma. The goals of the study are threefold: (1) to investigate the percentage change of PTSD, its risk factors, and the risk pathways of PTSD during the three-year period after the burn trauma; (2) based on the symptom changes of PTSD and depressive at five time points, to investigate the nature and percentage of different trajectories of posttraumatic adjustment and their differentiating factors as well as the empirical status of chronic, recovery, resilience, and late distress trajectories; and (3) to explore the process of change in PTG and its predictors, the cross-sectional and longitudinal association between PTG and PTSD, and the concurrent and dialectical relationship between trajectories of PTG and different symptom trajectories. We hope this three-year endeavor will increase our understanding of pathological process of burn-related psychological disorder and variety of psychological adjustment after burn trauma, thereby suggesting some direction for future psychological assistance after burn.

Project ID:PF10601-0257
External Project ID:MOST105-2410-H182-001-MY3