Risk of psychiatric disorders in patients with burn injury after rehabilitation therapies: a nationwide population-based cohort study in Taiwan.

BACKGROUND

Burn injury (BI) is associated with substantial psychosocial burden and an increased risk of psychiatric disorders. However, the potential role of post-BI rehabilitation, particularly the association between physical and occupational therapies (PT/OT) and risk of psychiatric disorders, remains unclear.

METHODS

Using data from the Taiwan's National Health Insurance Research Database (NHIRD), we conducted a nationwide, register-based retrospective cohort study. Patients with BI between 2000 and 2015 were identified and categorized according to receipt of PT/OT. A comparison cohort of BI patients without PT/OT was established using 1:1 age-, sex- and index year-matching.

RESULTS

A total of 2525 patients were included in each group. During follow-up, 305 vs 403 per 100,000 person-years in the PT/OT-group and non-PT/OT group, respectively, developed psychiatric disorders, corresponding to incidence rates of 1564.23 and 2040.19 per 100,000 person-years, respectively. Kaplan-Meier analysis demonstrated a significantly lower cumulative incidence of psychiatric disorders in the PT/OT group (log-rank p < 0.001). In Fine and Gray's competing risk model, PT/OT was associated with a lower risk of psychiatric disorders (adjusted sub-distribution hazard ratio [asHR] = 0.710 [95% CI: 0.568─0.836, P < 0.001]). This association remained consistent regardless of burn severity, including total body surface area burned (TBSA%) and burn degree. Additionally, both lower and higher PT/OT frequencies were associated with a lower psychiatric disorder risk, demonstrating a dose-response relationship.

CONCLUSIONS

In this large-scale nationwide cohort study, receipt of PT/OT after burn injury was associated with a significantly lower risk of subsequent psychiatric disorders.