| Summary: | 碩士 === 國立臺灣大學 === 心理學研究所 === 107 === Background: Depressive Disorder and Posttraumatic Stress Disorder (PTSD) are the most prevalent psychiatric disorders following burn injury. Bbased on personal experiences, clinical observations and existing research, body appearance changes and perceived stigmatization could play important roles in causing difficultities for burn survivors following the trauma. Among theories, the cognitive-behavioral approach on body image is the most widely used perspectives, and studies reveal that body image dissatisfaction (BID) was significantly correlated with perceived stigmatization (PS); BID could predict depressive symptoms after burn traumas, and concerns for scars/appearances could predict PTSD; futhermore, gender, scar visibility and appearance importance might play moderated roles in the links. Accordingly, this study aimed to investigate: (1) the serial mediating effects of PS and BID on the relationships between subjective scar severity (SSS) and depressive/PTSD symptoms; (2) the moderated mediating effects of gender, scar visibility (facial burned) and appearance importance on this serial mediating model. Methods: Participants were 106 survivors of the Formosa Fun Coast Burn Accident that occurred in 2015, with mean age 23.97±4.1 years, mean total body surface area burned (TBSA) 50.5±19.4%, and 61.3% females. A two-wave prospective design was conducted, collecting data at two years (Time 1 [T1]) and three years (Time 2 [T2]) after the accident. Self-report scales were administered individually. The study examined: (1) the relationships between variables by Pearson’s correlation analyses; (2) the serial mediating effects by Hayes’ 2017 PROCESS macro for SPSS (Model 6); and (3) the moderated mediating effects by hierarchical regression analyses. Results: (1) T2 depressive and T1 PTSD symptoms were significantly positively correlated with T2 PTSD symptoms, and T2 depressive and PTSD symptoms were significantly positively correlated with T1 depressive symptoms, PS, and BID. (2) Process (Model 6) analyses indicated that, after controlling age, educational years, TBSA, and T1 depressive/PTSD symptoms, PS and BID fully moderated the relationship between SSS and depressive symptoms with significant serial mediating effect, while PS and BID can only partially moderated the relationship between SSS and depressive symptoms with no significant serial mediating effect. (3) Hierarchical regression analyses indicated that facial burned moderated the relationship between “SSS to PS” and “PS to BID”, and appearance importance moderated the relationship between “PS to depressive symptoms”, “SSS to PTSD symptoms” and “BID to to PTSD symptoms”, respectively. Discussion: The results together suggested that, in burn patients, body image (especially the attitude component) was influenced by body appearance changes (e.g., scars after burn) and interpersonal experiences (e.g., PS), and in turns,led to emotional symptoms (i.e., depression and PTSD symptoms). These findings may help to understand the etiology of post-burn psychological disorders. Futhermore, the finding that facial burns can moderate the association between PS and BID also support the visible hypothesis. Finally, clinical implications and directions for future research are suggested.
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