Reviewed by Reza Lankarani M.D

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Published online June 2025

DOI: 10.1097/SLA.0000000000006270

Annals of Surgery

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This large-scale matched cohort study investigates the long-term association between burn injuries and mental health hospitalizations over 33 years. Analyzing 23,726 burn patients and 223,626 controls from Quebec, Canada, the study found that burn survivors had a 1.76-fold increased risk of mental health hospitalization compared to controls, with risks persisting up to 30 years post-injury. Severe burns (≥50% body surface area, third-degree burns, skin graft requirements) were linked to higher risks (HR: 2.00–3.29). Notably, burn patients exhibited elevated risks for eating disorders (HR: 3.14), substance use disorders (HR: 2.27), and suicide attempts (HR: 2.42), particularly within the first 5 years after injury.

Comprehensive Data Linkage:

- Utilizing population-based registries allowed for accurate tracking of hospitalizations and covariates, including socioeconomic status and preexisting conditions. This reduces selection bias and enhances generalizability within publicly funded healthcare systems.

Subgroup Analyses:

- Detailed stratification by burn severity (e.g., body surface area, degree, graft requirements) and mental health outcomes strengthens the validity of associations. For example, severe burns requiring grafts showed a 2-fold higher risk of hospitalization, highlighting the dose-response relationship between injury severity and mental health outcomes .

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Comparison with Recent Studies:

- Short-Term vs. Long-Term Risk:

Earlier studies (e.g., Bich et al., 2021) reported elevated psychiatric risks up to 5 years post-burn , while this study extends the timeline to 30 years, corroborating longitudinal data from Abouzeid et al. (2022) on chronic mental health decline .

- Severity Gradient:

Consistent with Logsetty et al. (2016), severe burns requiring grafts showed the highest mental health risks, emphasizing the need for targeted interventions in this subgroup .

- Substance Use Disorders:

The observed 2.14-fold increased risk for alcohol-related hospitalizations aligns with Mason et al. (2017), who linked burn-related chronic pain and opioid prescriptions to substance misuse .

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In conclusion, this study exemplifies the value of population-based cohort designs in uncovering the chronic impacts of surgical conditions. It sets a foundation for future research aimed at improving holistic burn care. Burn units should adopt lifelong mental health monitoring protocols, with intensified surveillance in the first 5 years post-injury. Pain management strategies must balance efficacy with addiction prevention to mitigate substance use risks .

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Reza Lankarani M.D

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