The psychological impact of facial trauma

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