Silent Scars: Distinguishing the Psychiatric Morbidities Following Burn Injuries Between Males and Females

Burns have profound impacts on long-term psychiatric health. This retrospective cohort study aims to explore the relationship between biological sex and psychiatric morbidities among burned patients. Adult patients with burn injuries (≥18 years) from 2004 to 2024 were stratified by the biological sex using the TriNetX United States Collaborative Network database. Patients were propensity matched based on age, race, ethnicity, socioeconomic factors, total body surface area, and region of burn injury. Outcomes examined included posttraumatic stress disorder (PTSD), anxiety, depression, suicidal ideation and attempts, adjustment disorders, and substance use disorders at both 3 months and 1 year after burn. Risk ratios (RRs) were calculated with 95% confidence intervals. From the 1:1 matched analysis between 248 258 females and 271 987 males, females exhibited significantly higher risks of anxiety (RR = 1.60), depression (RR = 1.47), PTSD (RR = 1.23), and adjustment disorder (RR = 1.15) but presented significantly lower risks of suicide (RR = 0.85) and substance use disorders (RR = 0.62) compared to males at 3 months after burn injury. After 1 year, females remained with significantly increased risks of anxiety (RR = 1.78), depression (RR = 1.60), PTSD (RR = 1.39), and adjustment disorders (RR = 1.40) and continued with lower risk of suicide (RR = 0.91) and substance abuse disorders (RR = 0.73) compared to males. All results were significant with P < .05. Following burn injury, significant differences in psychiatric outcomes were found between males and females at 3 months and 1 year. Hence, these findings emphasize the consideration for sex-specific mental health interventions in burn care.