Background People who suffer facial injury, whether from accidents or interpersonal violence, face a range of psychosocial issues as a result. Though standards of oral and maxillofacial surgery (OMFS) to restore function and appearance continue to improve, psychological problems may be overlooked in busy wards and clinics. Major trauma patients are known to be at risk of high levels of acute stress disorder (ASD), as well as depression and anxiety and, in the longer term, may develop post-traumatic stress disorder (PTSD); however, there has been limited exploration of the experience of OMFS trauma patients. Changes to appearance can be distressing and can impede the return to normal life; they can also exacerbate problems by reminding patients of traumatic events. This study aims to establish the prevalence of psychological distress (ASD, depression, anxiety, appearance concerns) in facial injury patients.
Methods This prospective study recruited injury patients being treated at the Royal London Hospital by OMFS, and discussed at bi-weekly multidisciplinary meetings. Participants completed standardised self-completion questionnaires within two weeks of injury: these assessed symptoms of ASD (ASDS: Acute Stress Disorder Scale), psychological distress (HADS: Hospital Anxiety and Depression Scale) and appearance concerns (DAS24: Derriford Appearance Scale). Patients were excluded on the basis of cognitive impairment; self-harm leading to admission; and insufficient understanding of English.
Results Data from 106 patients show that a high proportion of patients experienced clinically significant symptoms of distress. Twenty nine (29) percent of patients experienced symptoms indicative of ASD on the ASDS, which is associated with subsequent PTSD. Twenty nine (29) percent and 48 percent respectively experienced symptoms of depression and anxiety, using the HADS to assess clinically significant symptoms. Those experiencing clinically significant levels of distress on the ASDS or HADS had higher levels of appearance concern on the DAS24 (mean=40, SD=13.6), compared with those without significant distress (mean=26, SD=7.6). Refusal rates were low (>10%), however in this diverse East London population, English language requirements excluded many otherwise eligible patients (22%).
Discussion There are high levels of psychological distress and unmet needs in this cohort. Rehabilitation involves a return to normal psychosocial functioning as well as physical function and appearance, and there is a need for a simple, practical means of assessing distress. These psychological conditions are treatable, however, and the ability to identify those at risk would enable healthcare practitioners to provide important interventions.
- acute stress
- appearance concerns
- facial trauma