Patients disfigured in traumatic incidents may experience significant social and behavioral problems

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Patients disfigured in traumatic incidents are much more likely to suffer post traumatic stress disorder, unemployment, marital problems, binge drinking and depression, according to a study by Yale School of Medicine researchers.

Although the study included only 20 subjects, the findings are significant and address an issue that has not been widely studied, said the senior author, John Persing, M.D., professor and section chief of plastic surgery in the Department of Surgery. The subjects had lacerations slightly over one inch or larger and/or a fractured facial bone that required surgery.

"Emotionally, these patients are reporting higher levels of depression, anxiety, and discomfort regarding their body image, as well as an overall lower satisfaction with their lives," Persing said. "Socially, they are reporting significantly higher levels of marital conflict. Behaviorally, they are reporting significantly greater problems with alcohol consumption, as well as significantly higher rates of legal problems and deficits in occupational functioning."

He said the data describes a patient population with clear rehabilitation needs. "Such a pattern of clinically relevant findings has not previously been reported in the scientific literature and suggests that there is a significant number of patients who are experiencing social and psychological deficits which are not currently being addressed," Persing said.

He said the rate of participation in the study was 18.5 percent, but that response rates of trauma patients are typically low. Also, about 20 percent more patients said they would participate, but missed numerous appointments before deciding they were not interested in participating. "The increased incidence of drinking, occupational difficulties and relationship problems in the trauma population would correspond with the inability to keep appointments and participate in this study," Persing said.

Persing said he next will look at the psychological impact of body deformities as a result of diseases such as breast cancer and the impact of subsequent reconstruction.

Co-authors include Elie Levine, M.D., Linda Degutis, Thomas Pruzinsky, and Joseph Shin, M.D. The research was supported in part by an Alpha Omega Alpha Student Research Fellowship.

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