Burns and Mental Health: A Matched Cohort Study.

Abstract

To determine the association between burns and hospitalization for mental health disorders up to 3 decades later. Burns are associated with pain, disability, and scarring, but the long-term impact on mental health is unclear. We analyzed a cohort of 23,726 patients with burns aged ≥10 years who were matched to 223,626 controls from Quebec, Canada, between 1989 and 2022. The main exposure was admission for a burn. We followed patients during 3,642,206 person-years of follow-up to identify future hospitalizations for psychiatric disorders, substance use disorders, and suicide attempts. We estimated adjusted hazard ratios (HRs) with 95% CIs for the association between burns and subsequent mental health hospitalization using Cox proportional hazards regression. Patients with burns had a 1.76 times greater risk of mental health hospitalization over time (95% CI: 1.72-1.81), compared with controls. Associations were present regardless of burn site, but were greatest for burns covering ≥50% of the body (HR: 3.29, 95% CI: 2.61-4.15), third-degree burns (HR: 2.04, 95% CI: 1.94-2.14), and burns requiring skin grafts (HR: 2.00, 95% CI: 1.90-2.10). Compared with controls, patients with burns had more than two times the risk of hospitalization for eating disorders (HR: 3.14, 95% CI: 2.50-3.95), psychoactive substance use disorders (HR: 2.27, 95% CI: 2.17-2.39), and suicide attempts (HR: 2.42, 95% CI: 2.23-2.62). Risks were particularly elevated within 5 years of the burn but persisted throughout follow-up. Burns are associated with an increased risk of hospitalization for mental health disorders up to 30 years later.