Post-traumatic stress, anxiety, and depression after burn injury

Overview¶

Burn injury damages more than skin. Depression and post-traumatic stress are common psychiatric comorbidities following burn injury ^[1], and the broader list of psychological complications includes anxiety, sleep disturbance, phobias, guilt, suicidal thoughts, and personality changes ^[2]. These problems are not incidental to recovery. They impede rehabilitation and the patient's return to normal life ^[3], and they extend the definition of the injury well past the moment the wound heals.

What makes this domain hard is that the literature does not speak with one voice on how common these conditions are. The same patient population yields PTSD figures from the high teens to over half, and depression estimates that climb higher still, depending on whether you use a structured diagnostic interview or a self-report cutoff, and on whether you measure at one month or at two years ^[10,6,5]. A burn surgeon reading this page should come away less interested in a single prevalence figure and more interested in who is at risk, when to look, and what the evidence actually supports doing about it.

Epidemiology¶

PTSD prevalence after burns is best understood as a range, not a point. A tertiary-care series in Pakistan diagnosed PTSD in 52% (143 of 275) of burn-injured patients ^[6], while a study using the PCL-5 self-report instrument found that 18% of burned patients met probable PTSD status ^[10]. A screening study reported 13.4% positive for PTSD and 20.6% positive for depression in the same cohort ^[39]. The spread is real and it is methodological: instrument, threshold, etiology mix, and time since injury all move the number.

Depression estimates run higher and are just as instrument-dependent. A 2025 systematic review and meta-analysis put the overall depression prevalence at 60.7% (95% CI 44.5–74.8%) ^[5], while a single-center descriptive study found 31.9% of adult burn patients met criteria for depression, split across mild, moderate, and severe forms ^[13]. A long-running US cohort showed how depression persists rather than resolves: 54% of patients had moderate-to-severe depressive symptoms at one month, and 43% of responding patients still did at two years ^[11].

Burn size pulls in a less intuitive direction than many expect. In a large database analysis, PTSD incidence rose from 2.4% in patients with under 10% TBSA to 7.4% in the 30–59% range, then fell to 5.3% in those over 60% TBSA ^[7], so the dose-response relationship with burn size is non-monotonic and weaker than the raw severity of the injury would suggest. Prospective work tracks the time course directly: probable DSM-5 PTSD was met by 11.0%, 5.9%, and 7.6% of survivors at 6 months, 1 year, and 2 years post-burn ^[8], and probable major depression by 8.5%, 5.9%, and 4.2% at the same intervals, rising to 23.7%, 11.0%, and 5.9% when a lower PHQ-9 cutoff was applied ^[9]. An early landmark study found PTSD in 35.3% at 2 months, 40.0% at 6 months, and 45.2% at 12 months ^[12], illustrating that for a meaningful subset symptoms emerge or worsen over the first year rather than fading.

Etiology shapes the picture too. In one screening series, 75% of patients were diagnosed with clinical or subclinical PTSD, with the highest rates in scald (85.7%), flame (77.3%), and electrical (74.6%) injuries ^[4]. Electrical injury in particular carries a heavy long-term neuropsychiatric tail, with insomnia (68%), anxiety (62%), PTSD (33%), and major depressive disorder (25%) dominating outcomes in one cohort ^[15]. An early comparative study anchored the field's central observation: PTSD and major depression occurred in 33.9% and 7.1% of burn patients versus 18.5% and 7.4% of patients with digital amputation ^[14], pointing to disfigurement, not just tissue loss, as a driver.

Risk Factors and Predictors¶

The strongest predictors of post-burn psychopathology are characteristics the patient brings to the injury, not the burn itself. Female sex, a history of mental health problems or trauma, the type of injury, and the level of pain are among the strong risk factors for mental health problems after injury ^[17]. Pre-burn depression, the type and severity of baseline symptoms, anxiety related to pain, and the visibility of the burn injury all relate to PTSD risk ^[16]. A path-analysis study quantified the contributors: 42.3% of patients developed PTSD, with the model variance driven by intentional injury, dissociation at the time of trauma, baseline mental health, and prior life-threatening illness ^[18].

Dissociation during the event is a particularly robust signal. PTSD at 6 months occurred in 42% of patients and was directly related to peritraumatic dissociation (odds ratio 3.1; 95% CI 1.6–5.9) ^[24]. A longitudinal study identified the most accurate predictors of PTSD as being burned in a motor vehicle crash, risk of social exclusion, low body-image adjustment, anterior trunk location, and life-threat perception during the burn-shock period ^[19]. Burn severity does carry independent weight in large-cohort data: TBSA of 30% or more and third- or fourth-degree burns each conferred about a 1.5-fold adjusted hazard of being diagnosed with a mental disorder ^[20]. Scar-related body image is its own pathway, with pooled analyses showing female gender, greater number and size of scars, and increased scar visibility consistently associated with poorer body image outcomes ^[54].

Pathophysiology¶

Post-burn psychopathology is multifactorial and incompletely understood. The cognitive model has the most direct support: in a prospective study, theory-derived cognitive factors explained an additional 15.9%, 17.2%, and 17.7% of the variance in DSM-5 PTSD symptoms at 6 months, 1 year, and 2 years post-burn ^[8]. A pathway model in burn-injured children found that the combined pathways accounted for almost 60% of the variance in PTSD symptoms with excellent model fit ^[26]. There is also a neurobiological signal: adult burn patients with PTSD, and trauma-exposed burn patients without PTSD, both had significantly smaller right hippocampal volumes than non-traumatized comparison subjects ^[27], consistent with the broader PTSD neuroimaging literature.

The picture remains incomplete by the field's own admission; understanding of the pathophysiology of depression among survivors of severe burn injury is described as far from complete ^[28]. Burn injury itself, beyond the psychological experience, may leave a biological imprint: in a murine model, even non-severe burn injury produced sustained molecular changes in the brain, and pediatric burn patients including those with non-severe burns carry an increased risk of mental health admission for years, even when too young at the time to remember the event ^[48].

Assessment¶

The case for routine screening rests on a recurring finding: most burn patients report low distress, but a clinically important minority do not, and they are not reliably identifiable without a tool. In an outpatient burn-clinic implementation, the majority endorsed low to no psychosocial distress (69.7%), about one-third reported moderate distress, and 1.1% endorsed acute distress ^[31]. A pediatric psychosocial screener showed the same shape: 85% scored low-risk, 11% moderate, and 4% acute ^[34]. Screening instruments in common use include the Hospital Anxiety and Depression Scale, on which 12.4% met the anxiety cutoff and 15.2% the depression cutoff in one series, with 11.1% screening positive for PTSD ^[32], and the PCL-5 used in adult prevalence work ^[10].

Screening is only useful if it changes management. A study of what happens after a positive outpatient screen found 20.6% screened positive for depression and 13.4% for PTSD ^[39], underscoring that a positive screen identifies a real and sizable group who then need a referral pathway. Symptom clusters can also be characterized: a factor analysis of burn survivors identified a psychological-distress cluster (28% of variance, loading on anxiety and depression), a pain-related cluster (22%), and an itch-related cluster (16%) ^[36], which helps explain why distress, pain, and itch so often travel together at follow-up.

Management¶

The strongest peri-injury signal is for aggressive acute pain control. In a randomized controlled study in children, the incidence of PTSD within one month was 3.12% in a stepwise pain-management group versus 14.43% in a traditional pain-management group ^[33], linking the quality of early analgesia to later psychiatric outcome. Procedural distress can also be reduced with non-pharmacologic adjuncts during wound care: a meta-analysis found virtual reality reduced both pain (SMD −1.44, 95% CI −2.03 to −0.85) and anxiety (SMD −0.61, 95% CI −0.93 to −0.29) in pediatric burn wound care ^[40].

For established symptoms, psychological therapy carries the most support. A CBT-based intervention significantly reduced anxiety and depression scores compared with standard care in elderly patients with extensive burns ^[37], and CBT is described in the pediatric trauma literature as the best-validated therapeutic approach for children and adolescents with trauma-related anxiety or mood symptoms ^[38]. Pharmacologic prophylaxis is far less settled. A meta-analysis found that ketamine was not only ineffective in treating early PTSD but led to exacerbation of the disease (risk ratio 2.45, 95% CI 1.33–3.58) ^[41], even though an observational burn series found, contrary to expectation, that service members receiving perioperative ketamine had a lower prevalence of PTSD than those who received none despite larger and more severe burns ^[42]. A narrative review reconciles these by timing: perioperative ketamine may confer protective benefit, while immediate post-trauma administration may worsen dissociative and acute stress responses ^[43]. Propranolol has been studied as acute prophylaxis in children with large burns admitted to pediatric intensive care, but as an investigational question rather than an established practice ^[44].

Complications and Comorbidity¶

Psychological distress after burns is not a separate silo from physical recovery. Compared with patients without PTSD, patients with PTSD carried a significantly higher risk of opioid use across all TBSA cohorts ^[29], and reported significantly more physical skin symptoms at follow-up, including xerosis (74% vs 50%), numbness (63% vs 33%), and skin tightness (82% vs 52%) ^[30]. At the population level, burn patients carried more than twice the risk of hospitalization for eating disorders (HR 3.14), psychoactive substance use disorders (HR 2.27), and suicide attempts (HR 2.42) ^[23]. Burn injury also independently increased the risk of persistent insomnia (hazard ratio 1.95; 95% CI 1.47–2.59) among survivors of traumatic injury ^[25]. These comorbidities mean a burn patient's mental health and physical recovery have to be managed together, not in sequence.

Special Populations¶

Self-inflicted burns are a distinct and high-acuity group. Suicide by burns occurred at an overall incidence of 2.9 per 100,000 person-years in one Iranian provincial study, with women affected at nearly four times the male rate ^[45]. Self-immolation accounts for roughly 16% of burn admissions in Iran, with victims predominantly women and the young ^[46]. The psychiatric load in these patients is heavy: in one case-control series, 67% of self-immolation patients had adjustment disorder, alongside substance abuse, dysthymia, and personality disorders ^[47]. More broadly, 66% of severely burned patients in one cohort carried at least one lifetime psychiatric diagnosis, led by major depression (41%) and alcohol abuse or dependence (32%) ^[49], which is why a lifetime psychiatric history belongs in the acute assessment.

Children and their families form a second special population. Parental distress is a significant risk factor for children's traumatic symptoms, behavior problems, and worse health outcomes, with mothers most affected ^[50]. Among parents of burn-injured children, child burn severity, residence, and parental education independently shaped parental post-traumatic growth ^[51]. The injury's reach extends to partners as well: acute PTSD symptoms in the clinical range were reported by 30% of burn survivors' partners, decreasing to 4% by 18 months post-burn ^[52].

Outcomes¶

The trajectory of post-burn psychopathology is heterogeneous, and recovery is the modal but not universal path. A longitudinal study identified four symptom trajectories: resilient, recovery, delayed, and chronic ^[35], which captures why population averages understate the burden on the chronic subgroup. Long-term disaster cohorts show durable symptoms: five years after the 2015 Formosa Fun Coast water park fire, 13.1% and 14.1% of survivors met probable DSM-5 PTSD and MDD, while 51.5% reported significant post-traumatic growth ^[53]. That growth finding is not incidental; among Chinese burn patients the mean post-traumatic growth score was 56.7, with 46% to 74% scoring above moderate depending on threshold ^[55], indicating that adverse psychiatric outcomes and positive psychological change coexist in the same population.

Controversies and Evidence Gaps¶

The most consequential unsettled question is how much of post-burn psychopathology is caused by the burn versus carried into it. One longitudinal population-based study found the burn group had elevated pre-burn depression (16.6% vs 7.8%) and substance use disorders (8.9% vs 3.2%), and that once pre-existing mental illness was accounted for, there was no significant change in mental health problems comparing the burn group to controls over time ^[21]. A separate cohort found documented psychiatric comorbidity in 27.4% of burn patients, comparable to the 25–30% estimated in the general population ^[22]. A nationwide study went further, finding no differences in anxiety or depression incidence between burn and reference groups at 12 or 24 months ^[57]. These findings sit in tension with the high prevalence estimates above and argue against attributing all post-burn distress to the burn itself.

Prognostic assumptions are also contested. A Burn Model System study found that psychosocial recovery over the first 24 months does not worsen in proportion to injury severity, indicating that injury severity alone should not define prognosis ^[58]. The largest gap is therapeutic: a scoping review found only 7.0% of studies assessed an intervention for PTSD or depression, indicating a lack of focus on treatment modalities ^[56]. The result is a literature rich in prevalence and risk-factor description but thin on tested treatment, and the variability across prevalence studies itself reflects unresolved questions about which screening instruments are even appropriate for burn patients ^[3].

References¶

[1] Stockly OR, Wolfe AE, Goldstein R, et al. "Predicting Depression and Posttraumatic Stress Symptoms Following Burn Injury: A Risk Scoring System." Journal of burn care & research : official publication of the American Burn Association 2022. PMID: 34751379. ↩

[2] Ali MB, Ali MB. "Psychological and Physiological Complications of Post-Burn Patients in Pakistan: A narrative review." Sultan Qaboos University medical journal 2022. PMID: 35299810. ↩

[3] Tian BW, Sun YX. "[Research advances on depression and anxiety disorders in burn patients]." Zhonghua shao shang za zhi = Zhonghua shaoshang zazhi = Chinese journal of burns 2020. PMID: 33238693. ↩

[4] Gardner PJ, Knittel-Keren D, Gomez M. "The Posttraumatic Stress Disorder Checklist as a screening measure for posttraumatic stress disorder in rehabilitation after burn injuries." Archives of physical medicine and rehabilitation 2012. PMID: 22365477. ↩

[5] Elameen AM, Dahy AA, Gad AA. "The Risk of Depression Among Burn Injury Survivors; A Systematic Review and Meta-analysis." Journal of epidemiology and global health 2025. PMID: 41272346. ↩

[6] Khan MH, Haseeb A, Nadeem M, et al. "Prevalence of Post-traumatic Stress Disorder in Adult Burn Patients: A Study From Urban Tertiary Care Hospitals in Pakistan." Cureus 2025. PMID: 40351975. ↩

[7] Iglesias N, Campbell MS, Dabaghi E, et al. "Post-traumatic stress disorder in burn patients - A large database analysis." Burns : journal of the International Society for Burn Injuries 2024. PMID: 38233276. ↩

[8] Su YJ. "Predicting DSM-5 PTSD symptomatology 6 months to 2 years after burn: The role of early psychological risk factors." Burns : journal of the International Society for Burn Injuries 2024. PMID: 38705779. ↩

[9] Su YJ, Liang SH. "Unravelling the impact of prior depression and trauma-related cognitive processes on depression following trauma: A 2-year prospective study of burn survivors." General hospital psychiatry 2024. PMID: 39197230. ↩

[10] Younes M, Saba J, Nasr M, Salameh P, Naja W. "Psychological assessment of adults with burn injuries in Lebanon." Burns : journal of the International Society for Burn Injuries 2025. PMID: 40367698. ↩

[11] Wiechman SA, Ptacek JT, Patterson DR, Gibran NS, Engrav LE, Heimbach DM. "Rates, trends, and severity of depression after burn injuries." The Journal of burn care & rehabilitation 2001. PMID: 11761394. ↩

[12] Perry S, Difede J, Musngi G, Frances AJ, Jacobsberg L. "Predictors of posttraumatic stress disorder after burn injury." The American journal of psychiatry 1992. PMID: 1609874. ↩

[13] Ali H, Pervaiz M. "Depression in adults post burn injury: a descriptive study conducted in the burn centre of a tertiary care hospital in Karachi." Annals of burns and fire disasters 2019. PMID: 31285732. ↩

[14] Fukunishi I. "Relationship of cosmetic disfigurement to the severity of posttraumatic stress disorder in burn injury or digital amputation." Psychotherapy and psychosomatics 1999. PMID: 10026459. ↩

[15] Radulovic N, Mason SA, Rehou S, Godleski M, Jeschke MG. "Acute and long-term clinical, neuropsychological and return-to-work sequelae following electrical injury: a retrospective cohort study." BMJ open 2019. PMID: 31092649. ↩

[16] Van Loey NE, Van Son MJ. "Psychopathology and psychological problems in patients with burn scars: epidemiology and management." American journal of clinical dermatology 2003. PMID: 12680803. ↩

[17] Sareen J, Erickson J, Medved MI, et al. "Risk factors for post-injury mental health problems." Depression and anxiety 2013. PMID: 23408506. ↩

[18] Michaels AJ, Michaels CE, Zimmerman MA, Smith JS, Moon CH, Peterson C. "Posttraumatic stress disorder in injured adults: etiology by path analysis." The Journal of trauma 1999. PMID: 10568714. ↩

[19] Fidel-Kinori SG, Eiroa-Orosa FJ, Giannoni-Pastor A, Tasqué-Cebrián R, Arguello JM, Casas M. "The Fenix II study: A longitudinal study of psychopathology among burn patients." Burns : journal of the International Society for Burn Injuries 2016. PMID: 27233675. ↩

[20] Peng F, Chung CH, Koh WY, Chien WC, Lin CE. "Risks of mental disorders among inpatients with burn injury: A nationwide cohort study." Burns : journal of the International Society for Burn Injuries 2024. PMID: 38519375. ↩

[21] Logsetty S, Shamlou A, Gawaziuk JP, et al. "Mental health outcomes of burn: A longitudinal population-based study of adults hospitalized for burns." Burns : journal of the International Society for Burn Injuries 2016. PMID: 27049068. ↩

[22] Christ A, Resch A, Staud CJ, et al. "The Influence of Pre-Existing Psychiatric Conditions on the Incidence and Mortality of Severe Burn Injuries." Journal of clinical medicine 2025. PMID: 41464592. ↩

[23] Kang-Auger G, Borsuk DE, Low N, Ayoub A, Auger N, Buteau S. "Burns and Mental Health: A Matched Cohort Study." Annals of surgery 2025. PMID: 38506043. ↩

[24] Michaels AJ, Michaels CE, Moon CH, et al. "Posttraumatic stress disorder after injury: impact on general health outcome and early risk assessment." The Journal of trauma 1999. PMID: 10498298. ↩

[25] Haynes ZA, Collen JF, Poltavskiy EA, et al. "Risk factors of persistent insomnia among survivors of traumatic injury: a retrospective cohort study." Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine 2021. PMID: 33928909. ↩

[26] Saxe GN, Stoddard F, Hall E, et al. "Pathways to PTSD, part I: Children with burns." The American journal of psychiatry 2005. PMID: 15994712. ↩

[27] Winter H, Irle E. "Hippocampal volume in adult burn patients with and without posttraumatic stress disorder." The American journal of psychiatry 2004. PMID: 15569889. ↩

[28] Chokshi SN, Powell CM, Gavrilova Y, Wolf SE, Ozhathil DK. "A Narrative Review of the History of Burn-Related Depression and Stress Reactions." Medicina (Kaunas, Lithuania) 2022. PMID: 36295556. ↩

[29] Lewis J, Pride LC, Lee S, et al. "Examining the role of post-traumatic stress disorder, chronic pain and opioid use in burn patients: A multi-cohort analysis." Scars, burns & healing 2024. PMID: 39665049. ↩

[30] Klimitz FJ, Aman M, Neubauer H, et al. "Post-Traumatic Stress Disorder (PTSD) Is Associated with Increased Physical Skin Symptom Burden Following Severe Burn Injuries: Subgroup Analysis of a Multicenter Prospective Cohort." European burn journal 2025. PMID: 40843803. ↩

[31] Thomas BD, Ford CG, Addicks SH, et al. "Implementation of a Psychosocial Screener for Adults in an Outpatient Burn Clinic." Journal of burn care & research : official publication of the American Burn Association 2019. PMID: 30806462. ↩

[32] Berg L, Meyer S, Ipaktchi R, Vogt PM, Müller A, de Zwaan M. "[Psychosocial Distress at Different Time Intervals after Burn Injury]." Psychotherapie, Psychosomatik, medizinische Psychologie 2017. PMID: 27685256. ↩

[33] Wang YQ, Huang JQ, Wu ZH, Chen JJ. "[Effects of stepwise acute pain management on acute pain and post-traumatic stress disorder in children with burns: a prospective randomized controlled study]." Zhonghua shao shang za zhi = Zhonghua shaoshang zazhi = Chinese journal of burns 2021. PMID: 33706428. ↩

[34] Williford DN, Jackson CB, Durkin K, Langholz A, Aballay A, Duncan CL. "Utility of a Pediatric Psychosocial Screener in an Outpatient Burn Clinic." Journal of burn care & research : official publication of the American Burn Association 2024. PMID: 38050330. ↩

[35] Sveen J, Ekselius L, Gerdin B, Willebrand M. "A prospective longitudinal study of posttraumatic stress disorder symptom trajectories after burn injury." The Journal of trauma 2011. PMID: 21841510. ↩

[36] Nakad L, Biswas A, Leoutsakos JM, et al. "Pain, itch, and psychological distress symptom clusters in burn survivors: A factor analysis." Burns : journal of the International Society for Burn Injuries 2026. PMID: 41314038. ↩

[37] Yu HM, Wang L, Pan CZ. "The impact of cognitive behavioural therapy-based psychological intervention on emotional improvement in elderly patients with extensive burns." International wound journal 2024. PMID: 38379217. ↩

[38] Caffo E, Belaise C. "Psychological aspects of traumatic injury in children and adolescents." Child and adolescent psychiatric clinics of North America 2003. PMID: 12910820. ↩

[39] Carmean M, Grigorian A, Stefan J, Godes N, Burton K, Joe VC. "What Happens After a Positive Screen for Depression and Posttraumatic Stress Disorder in the Outpatient Burn Clinic?." Journal of burn care & research : official publication of the American Burn Association 2019. PMID: 30942875. ↩

[40] Lou J, Xiang Z, Li J, et al. "The beneficial impact of virtual reality in the burn wound care of pediatric patients: An updated systematic review and meta-analysis." Burns : journal of the International Society for Burn Injuries 2025. PMID: 40763481. ↩

[41] Du R, Han R, Niu K, et al. "The Multivariate Effect of Ketamine on PTSD: Systematic Review and Meta-Analysis." Frontiers in psychiatry 2022. PMID: 35356723. ↩

[42] McGhee LL, Maani CV, Garza TH, Gaylord KM, Black IH. "The correlation between ketamine and posttraumatic stress disorder in burned service members." The Journal of trauma 2008. PMID: 18376165. ↩

[43] Malik MA, Halasa M, Chia J, et al. "The impact of ketamine on posttraumatic stress disorder (PTSD) symptomatology in trauma-exposed populations: a narrative review." Journal of trauma and injury 2026. PMID: 41922107. ↩

[44] Rosenberg L, Rosenberg M, Sharp S, et al. "Does Acute Propranolol Treatment Prevent Posttraumatic Stress Disorder, Anxiety, and Depression in Children with Burns?." Journal of child and adolescent psychopharmacology 2018. PMID: 29161523. ↩

[45] Lari AR, Joghataei MT, Adli YR, Zadeh YA, Alaghehbandan R. "Epidemiology of suicide by burns in the province of Isfahan, Iran." Journal of burn care & research : official publication of the American Burn Association 2007. PMID: 17351450. ↩

[46] Amidi B, Yoosefi Lebni J, Naderi N. "Trapped in fire: A qualitative systematic review and meta-synthesis of causes, challenges, and responses after self-immolation in Iran." Burns : journal of the International Society for Burn Injuries 2026. PMID: 42127697. ↩

[47] Ahmadi A, Mohammadi R, Schwebel DC, Yeganeh N, Hassanzadeh M, Bazargan-Hejazi S. "Psychiatric disorders (Axis I and Axis II) and self-immolation: a case-control study from Iran." Journal of forensic sciences 2010. PMID: 20070465. ↩

[48] Allahham A, Chaudhari N, Walsh S, et al. "Non-severe burn injury leads to sustained molecular changes in the brain in a murine model." Scientific reports 2026. PMID: 42000783. ↩

[49] Dyster-Aas J, Willebrand M, Wikehult B, Gerdin B, Ekselius L. "Major depression and posttraumatic stress disorder symptoms following severe burn injury in relation to lifetime psychiatric morbidity." The Journal of trauma 2008. PMID: 18469660. ↩

[50] Santos M, Ferraz A, Pereira MG. "Parental distress following pediatric burn injuries: a systematic review of 33 years of research." Psychology & health 2025. PMID: 41084346. ↩

[51] Sui J, Lu L, Xu M, Wang Y. "Post-traumatic growth among parents of burn-injured children: A cross-sectional survey." Burns : journal of the International Society for Burn Injuries 2026. PMID: 42114458. ↩

[52] Boersma-van Dam E, van de Schoot R, Geenen R, Engelhard IM, Van Loey NE. "Prevalence and course of posttraumatic stress disorder symptoms in partners of burn survivors." European journal of psychotraumatology 2021. PMID: 34025925. ↩

[53] Su YJ, Liang SH. "Long-term mental health outcomes of severe burn injury: A 5-year follow-up of the 2015 Formosa Fun Coast Water Park fire disaster." General hospital psychiatry 2022. PMID: 35085876. ↩

[54] Quong WL, Hadžimustafić N, Borkhoff CM, Drucker AM, Fish JS. "Associations between skin scars and body image - A systematic review and meta-analysis." Social science & medicine (1982) 2026. PMID: 41579699. ↩

[55] Zhao S, Yu Y, Frey KP, Wegener ST, Castillo RC. "Posttraumatic growth of Chinese burn patients: Prevalence, comparison, and predictors." Burns : journal of the International Society for Burn Injuries 2025. PMID: 40945160. ↩

[56] Wang S, Cannata B, Vallurupalli M, Yenikomshian HA, Gillenwater J, Stoycos SA. "A Scoping Review of PTSD and Depression in Adult Burn Patients: A Call for Standardized Screening and Intervention Research." Journal of burn care & research : official publication of the American Burn Association 2024. PMID: 38895848. ↩

[57] Nilsson A, Orwelius L, Sveen J, et al. "Anxiety and depression after burn, not as bad as we think-A nationwide study." Burns : journal of the International Society for Burn Injuries 2019. PMID: 31378623. ↩

[58] Kaur S, DeGrauw X, Grobowski J, et al. "Mental and Social Health Recovery after Major Burn Injuries: A Burn Model System Study." Journal of burn care & research : official publication of the American Burn Association 2026. PMID: 42308409. ↩