Depression, Functional Dependence, Quality of Life and Return to Work Among Hospitalized Burn Patients in Wuhan, China

Burn injuries are devastating in both the acute and chronic phases. Survivors face life-lasting effects from such injuries, often decreasing general health, quality of life and employment status. With increased survival rates post-burn injury, increased research is needed to evaluate the recovery status of patients post discharge, and to identify residual patient needs.

This study measured depression, functional dependence in activities of daily living, quality of life (QoL) and return to work (RTW) 3- and 6-months, and identified factors associated with poor outcomes. Inpatients at Wuhan Third Hospital were asked to join the study as they were being discharged. 280 participants completed the baseline survey, where depression severity and functional dependence were measured using Patient Health Questionnaire-9 and the Barthel Index, respectively. QoL was measured using the Burn Specific Health Survey Brief (BSHS-B) 3- and 6-month, and RTW was collected at the same time-points. Factors associated with each outcome were identified through hypothesis tests and logistic regression models.

Nearly 15% of participants met the depression cut-off score, but over 70% required at least some assistance in daily living according to the BI results. Longer length of stay (LOS) resulted in greater odds of having a depressive PHQ-9 score. LOS, along with older age, female gender and full-thickness burns was significantly associated with functional dependence. 64.7% and 70.3% of participants reported a good QoL at 3- and 6- month follow-ups, respectively. Larger total body surface affected by burn and longer

LOS greatly decreases participant odds of having a good QoL at both time points. Three iv

months after hospital discharge, 66.4% of participants returned to work, and increased to 67.2% 6 months after discharge. Significant differences in RTW rate existed by age, education level, burn depth, LOS and BI score. Participants with LOS longer than two weeks had nearly 7 times lower odds of returning to work than those with stays one week or shorter, even after adjusting for burn depth and size.

There does not appear to be a large residual need for mental health services for burn injury patients at Wuhan Third Hospital, and high percentage of participants with favorable high QoL is reassuring that current burn care largely addresses patient needs. The percentage of patients reporting need for assistance in daily activities and lack of RTW demand the most attention in future rehabilitation interventions. The study reveals that participants with LOS longer than two weeks have much higher odds of having poor outcomes compared to patients with shorter stays. Further research should be carried out to establish the direction of the relationship between LOS and recovery outcomes to form plans to mitigate modifiable determinants. This would affect multiple adverse burn injury outcomes.