Burns : journal of the International Society for Burn Injuries · 2026
Burn family caregivers' distress trajectories: Latent and mixed-effects analyses.
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Zhao SiNing, Wu Jun, Yu Yongpei, Frey Katherine P, Wegener Stephen T, Castillo Renan C
Аннотация
BACKGROUND: Family caregivers of burn survivors commonly experience psychological distress, yet longitudinal evidence describing heterogeneous adaptation patterns and the timing of clinically meaningful risk development remains limited.
METHODS: We analyzed 256 caregivers assessed at baseline and 6-, 12-, and 24-month follow-ups. Latent class growth analysis was used to identify caregiver distress trajectories based on Depression Anxiety Stress Scales-21 total scores. Baseline demographic, injury, treatment-burden, and psychological characteristics were compared across classes, and a prespecified piecewise mixed-effects model examined whether class separation changed over follow-up. PTSD and posttraumatic growth were summarized secondarily to contextualize adaptation under distress-defined classes.
RESULTS: Three distress trajectories were identified: Low distress & lower burn severity and burden (n = 201, 78.5%), Moderate distress & higher treatment burden (n = 23, 9.0%), and High distress & higher burn severity (n = 32, 12.5%). In the piecewise model, the 0-6 month slope was not significant (β=-0.243/month; p = 0.459). During 6-24 months, trajectories diverged: Moderate distress & higher treatment burden worsened (β=2.111/month; p < 0.001), high distress & higher burn severity phenotype improved (β=-2.831/month; p < 0.001), and low distress & lower burn severity and burden phenotype remained relatively stable with a slight increase (β=0.372/month; p = 0.004). Findings were robust to alternative time specification and adjustment for baseline time since injury and burn severity. PTSD mirrored the distress-defined patterns, whereas posttraumatic growth showed a distinct pattern.
CONCLUSIONS: Caregiver distress after burn injury is heterogeneous, and clinically meaningful separation emerged during later follow-up. Later worsening was observed in the phenotype characterized by higher treatment-burden indicators, supporting sustained monitoring and tailored psychosocial support beyond early follow-up.
METHODS: We analyzed 256 caregivers assessed at baseline and 6-, 12-, and 24-month follow-ups. Latent class growth analysis was used to identify caregiver distress trajectories based on Depression Anxiety Stress Scales-21 total scores. Baseline demographic, injury, treatment-burden, and psychological characteristics were compared across classes, and a prespecified piecewise mixed-effects model examined whether class separation changed over follow-up. PTSD and posttraumatic growth were summarized secondarily to contextualize adaptation under distress-defined classes.
RESULTS: Three distress trajectories were identified: Low distress & lower burn severity and burden (n = 201, 78.5%), Moderate distress & higher treatment burden (n = 23, 9.0%), and High distress & higher burn severity (n = 32, 12.5%). In the piecewise model, the 0-6 month slope was not significant (β=-0.243/month; p = 0.459). During 6-24 months, trajectories diverged: Moderate distress & higher treatment burden worsened (β=2.111/month; p < 0.001), high distress & higher burn severity phenotype improved (β=-2.831/month; p < 0.001), and low distress & lower burn severity and burden phenotype remained relatively stable with a slight increase (β=0.372/month; p = 0.004). Findings were robust to alternative time specification and adjustment for baseline time since injury and burn severity. PTSD mirrored the distress-defined patterns, whereas posttraumatic growth showed a distinct pattern.
CONCLUSIONS: Caregiver distress after burn injury is heterogeneous, and clinically meaningful separation emerged during later follow-up. Later worsening was observed in the phenotype characterized by higher treatment-burden indicators, supporting sustained monitoring and tailored psychosocial support beyond early follow-up.