Clinical and psychiatric characteristics of self-inflicted burn patients in the United States: comparison with a nonintentional burn group.

The main objective of the present study was to examine whether self-inflicted burn patients would differ from nonintentional, nonwork related burn patients on psychiatric and personality characteristics. Sociodemographic and injury related factors were also compared. Self-inflicted (N = 15) and nonintentional (N = 178) burn patient samples were drawn from a larger study examining physical and psychosocial outcomes following major burn. Psychiatric/personality factors included self-reported psychiatric treatment history, alcohol/drug use, preburn mental health (Short Form Health Survey-12 MCS) and neuroticism (NEO five factor inventory). Sociodemographic factors and injury related factors were obtained through medical records. Comparisons between the self-inflicted and the nonintentional groups were made using Fisher's exact tests for categorical variables and Wilcoxon rank-sum tests for continuous variables. The self-inflicted group was 11.5 times more likely to report prior psychiatric treatment relative to the nonintentional burn group (P < .001) and 4.3 times more likely to have previously abused alcohol (P = .02). Compared to nonintentional burn patients, self-inflicted burn patients reported worse preburn mental health (P < .001). There were no differences on TBSA (P = .52) or sociodemographic characteristics (P values > .08). Relative to survivors of nonintentional burns, self-inflicted burn patients in the United States demonstrate high psychiatric comorbidity. Standards of care must be developed to optimize treatment procedures and recovery outcomes in this subgroup.

Self-inflicted burns: a systematic review of the literature.

Suicide attempts by self-immolation are relatively rare in North America, but the physical, psychological, and social effects on the patients, families, and staff are significant. An understanding of the characteristics of the self-inflicted burn population is imperative to better inform acute, postacute, and long-term care. The goal of the present systematic review is to summarize existing literature findings on self-inflicted burns in the United States. Seven databases were searched for articles published between 1970 and 2011 in the English language, which investigated self-burning. Thirty-two articles met selection criteria for inclusion. Review of the literature revealed that published studies on self-inflicted burns are scarce, inconclusive, and weak in design. Most studies contained limited contextual information and limited data on the long-term outcomes of survivors of self-inflicted burn injuries. Despite lack of consistency in data-collection methods and contradictory findings across studies, this review provides insight into both the characteristics of self-immolators and the context in which self-immolation events occur. A picture emerged of a group of individuals who act impulsively in the context of psychiatric and or alcohol/drug disorder, and individuals who may be reacting to stressful life events and loss. Although sparse, the existing data examining long-term outcomes in the self-inflicted burn population indicate that survivors can be successfully rehabilitated, provided that early and intense psychiatric and social interventions are in place. Future investigations are needed to further inform the development of best practices for every phase of treatment and recovery of self-inflicted burn survivors.

The role of the social worker in the adult critical care unit: a systematic review of the literature.

Social workers provide care to patients and families in the adult critical care unit. We conducted a systematic review of the literature to more clearly identify the role of the social worker practicing in the intensive care unit. We conducted a comprehensive search of the literature using the Pubmed, Embase, ISI, Scopus, and Social Work Abstracts databases using the terms "intensive care," "critical care," and "social work." Articles were selected for review if they met the following criteria: formal studies or opinion papers whose primary focus was the role or scope of practice of the social worker in the adult critical care unit. Articles were selected and reviewed independently by two social work investigators. Our search retrieved 550 potentially relevant articles. Twelve full-text articles were deemed eligible for abstracting. Three of the articles were studies that examined different aspects of social work practice including implementation of a family assistance program, social work response to anxiety levels of families in critical care and common activities of critical care social workers. Nine articles were primarily opinion pieces. All of the opinion articles described psychosocial support and counseling as a primary role of critical care social work. Other frequently identified roles were crisis intervention, psychosocial assessment, facilitating communication, end-of-life care, and practical assistance. There is little empiric data describing the role of the critical care social worker. Consistent themes from the articles identified include the role of social workers as counseling professionals, facilitators of communication, and resource agents. Further research to identify formal assessment tools and outcome studies of specific counseling techniques will provide important information for best practice guidelines in this area.