Psychosocial adjustment following burns: An integrative literature review

• Reviewed burns psychosocial adjustment literature, categorised as; ‘psychopathology’, ‘quality of life’, ‘return to work’, ‘interpersonal’, and ‘post-traumatic growth’.
• Coping style, premorbid psychopathology, and personality have the most significant influence on adjustment.
• Influence of burn characteristics, length of stay, age, gender and other demographics is less clear.
• Generally robust methodologies, with weaknesses in sample size, dropout rates, lack of comparable studies, and over-reliance on correlational design.
• Experimental design, clarifying the definition of psychosocial adjustment, and focus on interventions to improve adjustment would benefit both the literature and clinical practice.

IntroductionBurn care innovations have vastly reduced mortality rates and improved prognoses, fostering the need for multi-disciplinary input in holistic recovery. Consequently psychological and social considerations post-burn are included in National Burn Care Standards and have featured increasingly in burns literature.AimTo identify the key findings of the rapidly expanding literature base for psychosocial adjustment post-burn, highlighting the most important knowledge and future directions for both practice and research.MethodMEDLINE, CINAHL, EMBASE, PsycINFO, BNI, HMIC databases were searched from January 2003 to September 2013 using search terms regarding psychosocial adjustment post-burn. After exclusions 24 papers underwent critical appraisal.ResultsStudies were categorised by the element of adjustment that they examined; psychopathology, quality of life, return to work, interpersonal, post-traumatic growth. Strengths, weaknesses, and significant findings within each category were presented.DiscussionAlthough psychopathology and quality of life were well-researched compared to other categories, all would benefit from methodological improvements such as sample size or dropout rates. Coping strategies, premorbid psychopathology, and personality consistently featured as predictors of adjustment, although research should now move from identifying predictors, to clarifying the concept and parameters of psychosocial adjustment while developing and evaluating interventions to improve outcomes.