Pain, itch, and psychological distress symptom clusters in burn survivors: A factor analysis

Background: Burn survivors can experience overlapping symptoms; identifying clusters may improve care. This study examined chronic symptom clusters six months post-burn and their predictors and psychosocial impacts.

Methods: Data from the Burn Model System (2015–2022) were analyzed using factor analysis of post-burn symptoms. Linear regression assessed associations between factor scores and psychosocial outcomes.

Results: The sample included 405 patients (66 % male; mean age 45.4; median burn size 14 % TBSA; 60.2 % fire/flame). A three-factor solution was identified: (1) Psychological distress (28 % variance) with high loadings for anxiety and depression, moderate for sleep disturbance; (2) Pain-related symptoms (22 %) with high pain interference and intensity, moderate fatigue; (3) Itch-related symptoms (16 %) with high itch interference, moderate itch intensity. Rehabilitation days were associated with all factors; surgeries with Factors 1 and 2. Women scored higher on Factor 1, while %TBSA predicted Factor 3. Higher Factor 1 scores were linked to poorer mental health, greater PTSD burden, and lower life satisfaction and higher Factor 2 scores to worse physical and mental health.

Conclusion: At six months post-burn, symptoms clustered into psychological distress, pain, and itch factors. Pain and distress, but not itch, were associated with poorer physical, mental, and social functioning.