|Year : 2018 | Volume
| Issue : 1 | Page : 61-65
Symptoms of posttraumatic stress disorder and coping strategies among female burn victims: An exploratory study
Akhtar Bibi1, Muhammad Adnan Khalid2, Sumaira Jabeen1, Sidra Azim3
1 Department of Clinical Psychology and Psychotherapy, Mental Health Research and Treatment Center, Ruhr University, Bochum, Germany
2 Department of Psychology and Sport Sciences, Westfälische Wilhelms Universitat Munster, Münster, Germany
3 National University of Modern language, Islamabad, Pakistan
|Date of Web Publication||11-Mar-2019|
Ms. Akhtar Bibi
c/o Clinical Psychology and Psychotherapy, Massenbergstr.9-13, 44787 Bochum
Source of Support: None, Conflict of Interest: None
Objective: The current study aimed at investigating the relationship between symptoms of posttraumatic stress disorder (PTSD) and different coping strategies. Moreover, it is also aimed at exploring the differences in symptoms of PTSD among single and married female victims.
Methodology: A cross-sectional correlational research design was used. Fifty burn women, 18–45 years of age were recruited from different burn units and nongovernmental organizations of two adjacent cities. PTSD checklist (Weather, Litz, Herman, Huska and Keane, 1993) for civilians was used to assess the symptoms of PTSD, while Brief COPE Inventory (Carver, 1997) was used to measure the coping strategies of female burn victims.
Results: Results indicated that there is a negative relationship between symptoms of PTSD and self-distraction, use of emotional support, use of instrumental support, venting, positive reframing planning, humor, whereas self-blame and active coping are positively associated with symptoms of PTSD (P > 0.05).
Conclusion: The findings indicated that coping strategies are associated with PTSDs. Positive and adaptive coping strategies help the individuals to cope effectively with symptoms of PTSD as compare to negative/avoidant coping strategies. Moreover, it has been found that single and married burn victims experience the same level of PTSD symptoms. Limitations and suggestions are also discussed.
Keywords: Coping strategies, female burn victims, posttraumatic stress disorder
|How to cite this article:|
Bibi A, Khalid MA, Jabeen S, Azim S. Symptoms of posttraumatic stress disorder and coping strategies among female burn victims: An exploratory study. Indian J Burns 2018;26:61-5
|How to cite this URL:|
Bibi A, Khalid MA, Jabeen S, Azim S. Symptoms of posttraumatic stress disorder and coping strategies among female burn victims: An exploratory study. Indian J Burns [serial online] 2018 [cited 2019 Sep 18];26:61-5. Available from: http://www.ijburns.com/text.asp?2018/26/1/61/253841
| Introduction|| |
Burn injuries are normally related with dreadful life adversities, which are generally accidental and remarkably stressful. Burn trauma causes distress not only because of physical damages and long-term painful burn care but also because of number of psychological issues. Due to burn injuries, women develop different psychological disorders such as depression, stress, anxiety, and posttraumatic stress disorder (PTSD). Burn patients generally develop PTSD as a result of burn incidents, and experience different symptoms such as re-experiencing, avoidance, and hyperarousal (Diagnostic and statistical manual-V 2013). Existing literature indicated that age, gender, and total burnt surface can predict the severity of PTSD symptoms of burn victims.
Every year, 265,000 people lose their lives because of burn injuries, and most of these mortalities occur in developing countries. These burn injuries not only affect the victims but also affect their family socially and economically. According to the National Fire Protection Association, 78% death related to burn injuries happens at home in the United States. The American Burn Association reported that 32% females and 68% males experience burn injuries in America whereas in Pakistan, most of the women experience burn incidents in comparison to men mainly because of kitchen fire. In Pakistan, the most common causes of burn are naked flame burns, electrical, hot liquid, chemical burns, and acid burn. In Pakistan, acid burn attacks are common causes of burn trauma in women and are usually aimed at spoiling the women's romantic prospects, career, economic, and social status. Perpetrators use acid because it is easily available, easy to use, and have devastating influence on the individual than gun and knife. In general, women are more concerned about their appearance; therefore, it is difficult for many patients to accept their new looks and perform their routine tasks  About 31% burn victim find it difficult to return to work after burn trauma.
Burn injuries also influence the individual's capability to cope with stressful life events and communication with the external world. Coping refers to the cognitive and behavioral strategies involved in efforts to master, reduce, and tolerate demands caused by the stress. It has been found that coping strategies influence the development of PTSD symptoms,, individuals with active coping skills experience less symptoms of PTSD. As a matter of fact, coping strategies are associated with psychological distress and effect the development of psychological disorders., Cheng et al. investigated coping behaviors of severely burnt patients with PTSD and found that mostly PTSD patients with severe burn injuries adopt passive coping styles to deal with the stress. During the extensive rehabilitation process, burn patients experience depression, feelings of hopelessness, and helplessness because of painful burn treatment. The way people cope with their symptoms and stress influences their progress in rehabilitation.
Burn trauma has disastrous impact on the victim's life which is not seriously considered in Pakistan. Thus, the present study focuses on examining the symptoms of PTSD and importance of coping strategies among burnt women. This study would be helpful for health professionals, psychologists, psychiatrists, and social workers in reducing the PTSD symptoms and improving the coping strategies of burn patients. Coping strategies play significant role in traumatic situations, and are useful in decreasing the damaging effects of mental health problems. For the present study, following hypotheses have been formulated: (1) there would be positive relationship between symptoms of PTSD and avoidant/negative coping strategies such as self-distraction, denial, substance abuse, behavioral disengagement, self-blame among female burn victims, (2) there would be a negative relationship between symptoms of PTSD and active coping, use of emotional support, use of instrumental support, venting, positive reframing, planning, humor, acceptance, religion among female burn victims, and (3) single female burn victims would experience more symptoms of PTSD than married burn victims.
| Methodology|| |
In the present study, convenient purposive sampling technique was applied. In a sample of 50 burn women, 30 burn women were recruited from different burn units, and 20 women with acid burn attack were recruited from different nongovernmental organizations of two adjacent cities. The age range of participants was 18–45 years. Questionnaires were typed in the patients' local language. Inclusion criteria included consent of participation, duration of burn injury not less than a month, with 10%–30% total burn surface area, normal cognition, and no previous psychiatric history. Participants were recruited regardless of their level of education, marital status and socioeconomic background.
Following scales were used in the present study:
- PTSD Check List-Civilian Version (PCL-C) (Weather, Litz, Herman, Huska and Keane, 1993): PCL-C  was used to assess the PTSD symptoms of burn patients such as re-experiencing, avoidance, and hyperarousal Participants responded the items on five-point Likert scale. High scores indicate high symptoms of PTSD. In this sample, Cronbach's alpha reliability coefficient of the PCL-C was 0.89
- Brief COPE Inventory (Carver, 1997): Brief COPE  inventory was used to assess the coping strategies of the participants. It has 28 items and 14 subscales self-distraction, denial, substance abuse, use of emotional support, behavioral disengagement, self-blame, active coping, use of instrumental support, venting, positive reframing, planning, humor, acceptance, religion. Participant rated it on 4-point Likert scale. In this sample, Cronbach's alpha reliability coefficient of the brief cope inventory was 0.84.
Cross-sectional correlational research design was used in the present study. Ethical approval was obtained from the Ethical Committee of the National University of Modern Languages, Islamabad, Pakistan. Participants were told about the informed consent, purpose of study, anonymity and confidentiality issues. Participants were free to the leave the study at any time. Each participant took approximately 20 min to complete the survey.
Statistical analysis plan
The statistical package for social sciences version 18 was used to analyze the data. Frequencies were calculated for demographic variables whereas correlations analysis was applied to assess the association between symptoms of PTSD and coping strategies among burn patients. t-test was used to compare the married and single burn women on the symptoms of PTSD.
| Results|| |
Demographic characteristics of the patients
There were no missing values in the data set. Frequencies and percentages of demographic variables are presented in [Table 1]. The major cause of burn injury was acid burn attack and gas explosion.
Correlation between posttraumatic stress disorder and coping strategies among burn patients
Association between symptoms of PTSD and coping strategies was analyzed. Results showed that avoidance and hyperarousal symptoms of PTSD were negatively associated with self-destruction, whereas re-experiencing, avoidance, and hyperarousal symptoms were positively associated with self-blame. Moreover, symptoms of PTSD are not statistically significant with denial, substance abuse, and behavioral disengagement coping strategies among female burn patients [Table 2].
|Table 2: Correlation between symptoms of posttraumatic stress disorder and coping strategies among female burn victims (n=50)|
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Avoidance and hyperarousal symptoms of PTSD were negatively associated reframing, planning. Re-experiencing symptoms of PTSD were negatively associated with use of emotional support and venting. Hyperarousal is negatively associated with humor and acceptance whereas active coping was positively associated with avoidance and hyperarousal. Religion is not statistically associated with PTSD symptoms [Table 2].
Comparison between single and married burn victims
We applied t-test to compare the single and married burn victims for re-experiencing, avoidance, and hyperarousal symptoms of posttraumatic stress disorder. Results did not indicate statistical significant differences between single and married burn victims for re-experiencing, avoidance, and hyperarousal symptoms of posttraumatic stress disorder [Table 3].
|Table 3: Mean, standard deviation, and t-test of re-experiencing, avoidance, and hyperarousal symptoms of posttraumatic stress disorder among single female burn victims and married burn victims (n=50)|
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| Discussion|| |
The present study aimed at examining the relationship between symptoms of PTSD and different coping strategies among burn women. We hypothesized that there would be a positive relationship between avoidant/negative coping strategies and PTSD symptoms. Results indicated that avoidance and hyperarousal symptoms of PTSD were negatively associated with self-distraction whereas re-experiencing, avoidance, and hyperarousal symptoms were positively associated with self-blame. It indicates that women who adopt self-distraction coping strategies experienced less symptoms of PTSD. There is possible explanation that because of the denial state, patients do not accept the traumatic situation and use distractive activities to avoid the thoughts of trauma, consequently experience less symptoms of PTSD. Tuncay et al. reported that burn patients usually use more negative coping styles similar to patients with chronic illness, and experience stress during the extended recovery period.
In addition, results indicated that women who blame themselves for trauma, experience more re-experiencing, avoidance, and hyperarousal symptoms. This could be because of the feelings of guilt, helplessness, and hopelessness. They might have a feeling that they are responsible for all incidents and sufferings, and thus experience severe stress. These coping strategies are not useful to cope with the stress and influence their prognosis. Moreover, results indicated that symptoms of PTSD are not significantly associated with denial, substance abuse, and behavioral disengagement coping strategies. It could be because avoidant strategies are kind of escape from problems and patients do not frequently think about their trauma.
We also hypothesized that there would be a negative relationship between active coping strategies and symptoms of PTSD. We found that avoidance and hyperarousal symptoms of PTSD were negatively associated with reframing and planning. Moreover, reexperiencing symptoms were negatively associated with the use of emotional support and venting. It could be because individuals, who employ reframing and planning, experience less symptoms of PTSD. This can be because adjusted and solution-based strategies help individuals in overcoming their fear and actively dealing with the stress in comparison to maladaptive coping strategies. Similarly, venting and the use of emotional support diminish the re-experiencing of trauma because of catharsis and active emotional support.
Furthermore, results indicated that active coping is positively associated with PTSD symptoms. It may be due to the confrontation of trauma. Confrontation brings more memories of trauma, and thus, patients experience more symptoms of PTSD. In addition to it, the result showed that the use of instrumental support is negatively associated with avoidance symptom of PTSD. It shows that individuals who seek advice and support from others can actively deal with the trauma. These results are consistent with the previous studies which also reported the relationship between coping styles and psychological health of individuals., Besides, burn patients who accepted their trauma and used humor coping style to deal with distress did not develop hyperarousal symptoms. However, religion did not have any effect on the symptoms of PTSD, but it could be attributed to the severity of trauma.
In addition, we also hypothesized that single female burn victims would experience more symptoms of PTSD than married burn victims. Results indicated no considerable differences in symptoms of PTSD among single and married burn victims. A solid body of research claims that burn victims are usually young married girls and perpetrators usually their husbands and inlaws. The motive behind these burn fatalities is to get rid of the women to get married again without any social objections and to have more financial gains in the form of dowry., Similar to Masood et al., in this study, most of the burn victims were married, belonged to the low socioeconomic class and the common cause of burn was gas explosion.
In spite of much strength, the current study also has some limitations. First, sample size was small which inhibits the generalization of results. Second, data were collected from Islamabad and Rawalpindi. Collecting data from other cities of Pakistan would have added to the generalizability of the study. Third, self-report inventories were used which could lead to biased responses.
This study has practical implications for burn specialists, mental health professionals, social workers, and policymakers to address the mental health problems of burn women, improving their coping strategies and social support systems. Family support and appropriate treatment care can improve their quality of life and rehabilitation process.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]