DOI:10.6129/CJP.202212_64(4).0005
Chinese Journal of Psychology 2022, Vol.64, No.4, 515-540
Perceived Scar Severity and Social Anxiety Among Burn Patients: The Mediating Roles of Perceived Social Stigma and Body Image Dissatisfaction
Wan-Rou Lin(Graduate Institute of Behavioral Sciences, Chang Gung University; Department of Psychiatry, Tucheng Hospital), Yi-Jen Su(Graduate Institute of Behavioral Sciences, Chang Gung University; Department of Psychiatry, Linkou Chang Gung Memorial Hospital)
Abstract
Burn scars affect not only burn patients’ physical function but also their psychosocial adjustment. Encountering stigmatizing behaviors from others may increase burn patients’ negative evaluation of their appearance—that is, body image dissatisfaction (BID), which raises their anxiety and fear of social interactions. The current study examined the association between perceived scar severity and social anxiety symptoms as mediated by perceived stigmatization and BID. Participants comprised 108 burn survivors of the 2015 Formosa Fun Coast Water Park fire disaster, including 63% females with a mean age of 24.19 years old and a mean total body surface area burned of 50.15%. We conducted a two-wave design at two years (Time 1, T1) and three years (Time 2, T2) after the 2015 fire. Serial mediation analysis was used to determine whether perceived social stigma and BID mediate the association between perceived scar severity and social anxiety symptoms serially. Results show that three years after the 2015 fire, 22.2% of the participants met the DSM-IV criteria for probable social anxiety disorder. After controlling for depressive symptoms at T1, we observed a significant serial mediation effect of T1 perceived scar severity on T2 social anxiety symptoms via T1 perceived social stigma and T1 BID. Note however that the reverse serial mediation effect was nonsignificant. In cross-lagged analysis, we determined that T1 BID was significantly predictive of T2 perceived social stigma; however, T1 perceived social stigma was not significantly predictive of T2 BID. This result contradicts the pathway of the serial mediation model described above. Overall, a relatively high proportion of burn patients reported clinically significant symptoms of social anxiety three years after the 2015 fire. Our findings highlight the importance of body image and social stigma in the postburn adjustment process.
Keywords: burn patients; social anxiety; body image; social stigma; serial mediation
