Hamid, Ahmad Rizal Abdul
(2020)
The psychological impact of facial trauma.
Masters thesis, Pusat Pengajian Sains Perubatan.
Abstract
Introduction: Facial wounds are among the common injuries dealt by plastic and
reconstructive surgeons. A healed wound will leave a scar which may alter the facial
appearance of an individual dan could possibly have a psychological impact on the
individual. This study aims to assess the psychological impact as a result of traumatic
facial scars and determine the correlation between subjective patient assessment of their
scars and their psychological status.
Methodology: This is a cross-sectional study involving patients admitted to Hospital
Universiti Sains Malaysia and Hospital Kuala Lumpur who had sustained facial injuries
and underwent surgical intervention by the Plastic and Reconstructive Surgery
Department. The Malay version of the Hospital Anxiety and Depression Scale (HADS)
was used to assess the psychological aspects of patient. The Patient and Observer Scar
Assessment Scale (POSAS) was used to assess the facial scar which consisted of and
observer and patient rated scar severity component.
Results: This study involved 63 patients. The mean age of patients was 26 years old with
the majority of patients in the age group of 18 to 40 years old. There was a higher
percentage of male patients (n=40, 63.5%). Malay patients were the most predominant
group, accounting for 90.5% of the study population with main aetiology of injury was
caused by road traffic accidents (87.3%). The mean scar length over the face measured
4.68 centimetres (cm). For psychological assessment, 17.4% of patients showed to have
mild to moderate levels of anxiety while 20.7% of patients showed mild to moderate
levels of depressive symptoms. Mean scar rating severity for patients was 25.14 (SD
13.06) while observer rated scar severity was 20.38 (SD 9.31). Patients also had a higher
overall scar opinion as compared to the observer in which the mean score for patient
overall scar opinion was 5.59 (SD 2.79) and observer 3.67(SD 1.78). There was no
statistically significant correlation between the patient and observer overall scar opinion
(r=0.234, n=63, p=0.065). There was statistically significant but weak correlation
between anxiety score and patient rated scar severity score (r = 0.257, n=63, p< 0.05).
There was statistically significant but weak correlation between the depression score and
the patient rated scar severity score (r= 0.278, n=63, p< 0.05).
Conclusion: This study indicates minor facial trauma patients developed mild to
moderate psychological effects in the form of anxiety and depression in one-fifth of the
study population. Patient rated scar severity and patient overall opinion of the scar was
shown to have higher scores compared to the observer rating for both parameters. Our
study also suggests that there is a weak correlation between anxiety and depressive
symptoms and self-reported facial scar severity based on the results of the statistical
analysis. Therefore, it is important to incorporate a psychological screening as well as to
take into account the patients input on their scar to identify any possible patients at risk
of psychological distress. Early detection may help in providing optimal treatment for a
better quality of life.
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