Influence of depression and somatization on acute and chronic orofacial pain in patients with single or multiple TMD diagnoses

To examine whether psychological variables such as depression and non-specific physical symptoms (somatization) influence pain entity among acute and chronic TMD patients with one or more TMD diagnoses (muscle disorders, MD; disc displacements, DD; and arthralgia, arthritis, arthrosis, AAA). One hundred and fifty-four patients (37 male and 117 female; mean age, 39.0 +/- 14.5 years) with Research Diagnostic Criteria for Temporomandibular Disorders (RDC/ TMD) protocol were selected. Differences in mean depression and somatization scores between acute and chronic TMD patients, as well as TMD patients with one or multiple TMD diagnoses were compared by using the parametric T-test for independent samples. The majority of patients were acute TMD patients (81.8%), while the remaining 28 patients (18.2%) were chronic TMD patients. 62% of patients had only one TMD diagnosis (MD or DD or AAA), 31% of patients had two diagnoses (MD+DD, MD+AAA, DD+AAA) and, finally, 7% of patients had three diagnoses (MD+DD+AAA) according to the RDC/TMD protocol. According to the SCL-90 psychometric evaluation, 19.5% of patients presented a severe depression score (> 1.105), 27.3% of participants presented a severe somatization score with pain items included (> 1.000). The results of the t-test for independent samples showed statistically significant differences between acute and chronic TMD patients (p < 0.001), as well as between patients who were assigned one diagnosis (p = 0.019) and patients who had two or more diagnoses (p < 0.001); for mean levels of depression and somatization scores. Chronic TMD patients and patients with multiple TMD diagnoses had higher rates of depression and somatization in this study. These results could be used in a tailored strategy of TMD treatment.     

Relationship of stressful life events, anxiety and depression to hyperthyroidism in an asian population

BACKGROUND: Psychological disturbances are well-known disorders in patients with hyperthyroidism, with anxiety and depression being the most commonly described. Stressful life events may play an important role in the relationship of anxiety, depression and hyperthyroidism. We assessed the associations of these disorders by three-part rating scales, including the Hamilton Rating Scale for Anxiety (HAM-A) indicating anxiety, the Zung Self-Rating Depression Scale (Zung Scale) indicating depression and the Social Readjustment Rating Scale (SRRS) indicating external stress from life events in this study. METHODS: Eighty-six outpatients who visited an endocrine clinic with suspicion of thyroid disease and 18 healthy volunteers were enrolled in the study. In all of these individuals, thyroid functions were assessed and questionnaires were completed during an interview. RESULTS: The outpatients with hyperthyroidism (n = 39) had higher scores of HAM-A (15.7 +/- 1.1 vs. 8.0 +/- 0.8, p < 0.001), Zung scale (46.2 +/- 1.5 vs. 37.5 +/- 1.4, p < 0.001) and SRRS (92.9 +/- 13.5 vs. 56.9 +/- 8.4, p = 0.015) than those with euthyroidism (n = 47). The scores of the three-part rating scales were also higher in the outpatients with hyperthyroidism than in healthy volunteers (n = 18), with no significant differences between the outpatients with euthyroidism and healthy volunteers. CONCLUSION: In patients with hyperthyroidism, anxiety, depression and stressful life events were more severe than in those with normal thyroid function. There were no correlations between these psychological disorders and thyroid function tests of the subjects with hyperthyroidism. The role of psychotherapy in the development of hyperthyroidism deserves further investigations.     

Elevated Hair Cortisol Levels among Heroin Addicts on Current Methadone Maintenance Compared to Controls

Whether methadone maintenance treatment (MMT) can improve the basal function of the hypothalamic–pituitary–adrenal (HPA) axis, which is suppressed by long-term heroin consumption, is a matter of debate. The stress state and depression and anxiety symptoms may affect the basal activity of the HPA axis in MMT patients. However, the effect of psychological factors on HPA activity was not simultaneously controlled in previous studies. This study investigated differences in HPA basal activity between MMT patients and controls using psychological variables as covariates. The participants included 52 MMT patients and 41 age-matched, non-heroin-dependent controls. Psychological states were self-reported with the Perceived Stress Scale, Self-Rating Depression Scale and Self-Rating Anxiety Scale. The hair cortisol level was adopted as a biomarker of HPA basal activity and was determined with liquid chromatography tandem mass spectrometry. The results revealed that MMT patients had significantly higher hair cortisol levels than the controls (p<0.05), but the difference was not significant (p>0.05) when the perceived stress, depression and anxiety scores were used as covariates. We concluded that patients with long-term MMT showed higher basal activity of the HPA axis. The high chronic stress state and increase in depression and anxiety symptoms may mask the suppression effect of methadone on the HPA activity.     

Clinical correlates of chronotypes in young persons with mental disorders

While important changes in circadian rhythms take place during adolescence and young adulthood, it is unclear how circadian profiles during this period relate to emerging mental disorders. This study aimed to: (i) characterise morningness–eveningness preference in young people with primary anxiety, depression, bipolar or psychotic disorders as compared to healthy controls, and (ii) to investigate associations between morningness–eveningness preference and the severity of psychiatric symptoms. Four hundred and ninety-six males and females aged between 12 and 30 years were divided into five groups according to primary diagnosis. The Hamilton Depression Rating Scale and the Brief Psychiatric Rating Scale were administered by a research psychologist and participants completed the Kessler Psychological Distress Scale and the Horne–Östberg Morningness–Eveningness Questionnaire (ME). ME scores were significantly lower (i.e. higher levels of “eveningness”) in all patient diagnosis subgroups compared to the control group. The psychosis group had higher ME scores than the depression and anxiety groups. Compared to the control group, the anxiety, depression and bipolar subgroups had a significantly higher proportion of “moderate evening” types, with a similar trend for the psychosis group. The proportion of “extreme evening” types was significantly higher in the anxiety and depression subgroups than in the control group. Lower ME scores correlated with worse psychological distress in males from the bipolar group. Lower ME scores correlated with higher depression severity in females with depression and in males with bipolar disorder. These results suggest that young persons with various mental disorders, especially those with affective disorders, present with a stronger “eveningness” preference and higher rates of evening chronotypes than healthy controls from the same age group. Later chronotypes were generally associated with worse psychological distress and symptoms severity. These associations were modulated by sex and primary diagnosis.     

Psychological health and religious coping of Ghanaian women with infertility

Background

Infertility has been shown to have considerable psychological effects on the well-being of couples, especially women. Religion has been found as a resource used by infertile women to cope with their distress. Little research has examined the influence of religious coping on psychological distress among infertile women in Ghana. This study examines the relationship between positive and negative religious coping and psychological health for women with infertility problems in Ghana.

Methods

One hundred and fifty married women who were receiving assisted reproduction care in two specialized clinics were recruited for this study. Participants were administered with the Brief Symptom Inventory and Brief Religious Coping Scale to assess psychological health associated with infertility and religious coping respectively. A hierarchical regression was performed to examine the relative contribution of the domains of psychological health (i.e. somatization, anxiety and depression) in predicting negative religious coping and positive religious.

Results

The results showed that negative religious coping was significant and positively correlated with somatization, depression and anxiety. Furthermore, a positive relationship also existed between positive religious coping and somatization and anxiety but not depression. After controlling for age and duration of infertility, somatization and anxiety predicted positive religious coping whilst all the domains of psychological health (somatization, anxiety and depression) precited negative religious coping.

Conclusions

This study expanded on the existing literature by examining positive and negative religious coping with psychological distress associated with infertility for women. These results underscore the need for health professionals providing therapies for women with infertility to acknowledge and consider their religious beliefs as this influences their mental health.

     

Effect of 12 weeks of yoga training on the somatization, psychological symptoms, and stress-related biomarkers of healthy women

Background

Previous studies have shown that the practice of yoga reduces perceived stress and negative feelings and that it improves psychological symptoms. Our previous study also suggested that long-term yoga training improves stress-related psychological symptoms such as anxiety and anger. However, little is known about the beneficial effects of yoga practice on somatization, the most common stress-related physical symptoms, and stress-related biomarkers. We performed a prospective, single arm study to examine the beneficial effects of 12 weeks of yoga training on somatization, psychological symptoms, and stress-related biomarkers.

Methods

We recruited healthy women who had no experience with yoga. The data of 24 participants who were followed during 12 weeks of yoga training were analyzed. Somatization and psychological symptoms were assessed before and after 12 weeks of yoga training using the Profile of Mood State (POMS) and the Symptom Checklist-90-Revised (SCL-90-R) questionnaires. Urinary 8-hydroxydeoxyguanosine (8-OHdG), biopyrrin, and cortisol levels were measured as stress-related biomarkers. The Wilcoxon signed-rank test was used to compare the stress-related biomarkers and the scores of questionnaires before and after 12 weeks of yoga training.

Results

After 12 weeks of yoga training, all negative subscale scores (tension-anxiety, depression, anger-hostility, fatigue, and confusion) from the POMS and somatization, anxiety, depression, and hostility from the SCL-90-R were significantly decreased compared with those before starting yoga training. Contrary to our expectation, the urinary 8-OHdG concentration after 12 weeks of yoga training showed a significant increase compared with that before starting yoga training. No significant changes were observed in the levels of urinary biopyrrin and cortisol after the 12 weeks of yoga training.

Conclusions

Yoga training has the potential to reduce the somatization score and the scores related to mental health indicators, such as anxiety, depression, anger, and fatigue. The present findings suggest that yoga can improve somatization and mental health status and has implications for the prevention of psychosomatic symptoms in healthy women.

Trial registration

University Hospital Medical Information Network (UMIN CTR) UMIN000007868.     

Evaluation of factors associated with the anxiety and depression of female infertility patients

Background

Because the primary aim of infertility treatment is to achieve pregnancy, mental health care during this treatment is often neglected. However, the inability to conceive children is stressful for couples throughout the world. Thus, the purpose of this study was to investigate factors related to the anxiety and depression of female infertility patients.

Methods

Participants included 83 Japanese women who initially visited the Reproduction Center of the Tokyo Dental College Ichikawa General Hospital to undergo testing and receive infertility treatment between February and April 2008. We administered two psychological tests, the Self-rating Depression Scale (SDS) test and the Hospital Anxiety and Depression Scale (HADS) test. We then examined the association of the test results with age, pregnancy and delivery history, employment status, duration of infertility, infertility treatment history, and male infertility.

Results

As patient age increased, total HADS and depression scores also increased. No correlation was observed between duration of infertility and SDS or HADS scores. Results were similar when the presence and absence of delivery history was compared. Patients who underwent infertility treatment were more likely to have high HADS depression scores compared to patients who had not undergone treatment. Additionally, patients whose husbands were infertile had significantly lower total HADS and anxiety scores than those whose husbands were not infertile.

Conclusions

Age and male infertility are factors that influence the presence of anxiety and depression in female infertility patients.     

Oral health related quality of life in Slovenian patients with craniomandibular disorders

Sixty eight consecutive Slovenian patients with craniomandibular disorders (CMD) participated as the study group and another 400 adults from the regional population sample participated as the control group. The aim was to determine the impact of craniomandibular disorders to the self-perceived oral health related quality of life (OHRQoL) and to compare the OHRQoL with a control group. The mean Oral Health Impact Profile (OHIP) summary scores were computed for all patients with the same diagnosis and for the same subgroups of the axis I according to the RDC/TMD exam protocol. The mean OHIP subscores for the seven domains of the OHIP questionnaire were compared between the study and the control group. Significantly higher OHIP summary scores and all the OHIP subscores were obtained in the CMD patients in comparison with the control group (p<0.05). Furthermore, in the CMD group, patients with two related diagnoses had significantly higher impaired OHRQoL than patients with a single one. The results revealed: 1. The CMD subjects are highly associated with the reduced OHRQoL, 2. Higher number of diagnoses of the axis I according to the RDC/TMD results in the more impaired OHRQoL, 3. The higher age of the patients revealed the more impaired OHRQoL.     

The prevalence of depression and anxiety in seafarers type 2 diabetic patients

Depression and anxiety are co-morbid condition in diabetes as disease-related psychological reactions on this chronic metabolic illness. This study was aimed to determine the occurrence of depression and anxiety in seafarer's type 2 diabetic patients. A random sample of 52 diabetic seafarers treated with diet and oral glucose lowering agents, and 56 healthy seafarers were screened for depression with The Beck Depression Inventory (BDI) and for anxiety with State-Trait Anxiety Inventory (STAI 1, STAI 2). Depression (BDI > 18.5) and anxiety (STAI < 28.5) was significantly higher in the group of diabetic seafarers than in control group (more than 30%). Significant correlation was noted between depression and duration of diabetes mellitus, degree of obesity and poor glycaemic control (HbA1C > 8%) and longer duration of shipping routes (over 6 months). The proportion of depression and anxiety was found higher in seafarer's type 2 diabetic patients than in the healthy seafarers.     

Anxiety and depression in pregnant women with previous history of spontaneous abortion

Spontaneous abortion is the most common adverse pregnancy outcome, and stress has been suggested to be important factor. We hypothesized that those female pregnant women with previous spontaneous abortion will have higher anxiety and depression than female pregnant women without previous spontaneous abortion and controls (healthy non-pregnant women). Age and socio-demographic parameters did not differ significantly between the three groups of participants. Anxiety and depression levels were assessed with the Beck Depression Inventory and the Beck Anxiety Inventory. There were no significant differences in the scores on Beck Depression Inventory between three groups of participants at the week 10 of gestation-1st assessment and week 20 of gestation-2nd assessment. Contrary of these results, pregnant women with history of spontaneous abortion have had statistically significant higher anxiety score than pregnant women without history of spontaneous abortion and control group-non-pregnant women, on both assessment of anxiety. Negative correlations between months passed form the last spontaneous abortion and anxiety on both assessment, emphasize the role of psychological support for the women who have experienced spontaneous abortion.     

术前抑郁和焦虑对腹部择期手术患者术后认知功能的影响

目的:探讨紧张和焦虑对手术患者术后认知功能的影响。方法:100例腹部择期手术病人术前1天用汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)、简易智能测试量表(MMSE)、数字广度对病人进行测试。术后7天分别用MMSE、数字广度进行神经心理学测试,术后MMSE结果低于术前一个标准差则视为术后认知障碍(POCD)。结果:术前焦虑、抑郁以及同时发生焦虑和抑郁的阳性率分别为30%、50%和10%。女性患者术后7天POCD的发生率为30%,男性患者术后7天POCD的发生率为20%;女性患者焦虑得分为7.2±4.0,高于男性患者4.5±3.3,P=0.05女性患者的抑郁得分为6.5±3.6,明显高于男性患者4.2±3.4(P=0.1),术前焦虑与POCD的相关性不显著,术前焦虑与MMSE、数字广度的Pearson’s相关系数分别为-0.50(P=0.2)和-0.20(P=0.1)。术前抑郁与POCD存在显著的相关性,其中术前抑郁与MMSE的Pearson’s相关系数为-0.61(P=0.01),术前抑郁与数字广度的Pearson’s相关系数为-0.72(P=0.03)。结论:术前抑郁的患者术后容易发生POCD;相对于男性患者,女性更容易出现POCD;而术前焦虑对POCD没有重要的影响。     

Electromyographic indices, orofacial myofunctional status and temporomandibular disorders severity: A correlation study

This study examined whether there is an association between surface electromyography (EMG) of masticatory muscles, orofacial myofunction status and temporomandibular disorder (TMD) severity scores. Forty-two women with TMD (mean 30 years, SD 8) and 18 healthy women (mean 26 years, SD 6) were examined. According to the Research Diagnostic Criteria for TMD (RDC/TMD), all patients had myogenous disorders plus disk displacements with reduction. Surface EMG of masseter and temporal muscles was performed during maximum teeth clenching either on cotton rolls or in intercuspal position. Standardized EMG indices were obtained. Validated protocols were used to determine the perception severity of TMD and to assess orofacial myofunctional status. TMD patients showed more asymmetry between right and left muscle pairs, and more unbalanced contractile activities of contralateral masseter and temporal muscles (p<0.05, t-test), worse orofacial myofunction status and higher TMD severity scores (p<0.05, Mann-Whitney test) than healthy subjects. Spearman coefficient revealed significant correlations between EMG indices, orofacial myofunctional status and TMD severity (p<0.05). In conclusion, these methods will provide useful information for TMD diagnosis and future therapeutic planning.     

Prevalence and correlations with depression, anxiety, and other features in outpatients with chronic obstructive pulmonary disease in China: a cross-sectional case control study

ABSTRACT: BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) often experience depression and anxiety, but little information is available regarding Chinese patients with these conditions. The present study assessed depression and anxiety in Chinese patients with COPD. METHODS: A case--controlled study was designed with 1100 patients with COPD enrolled in the case group and1100 residents without COPD and respiratory symptoms selected as the control group. Anxiety and depression in both groups were evaluated using the Hospital Anxiety and Depression Scale (HADS). The body mass index,degree of airflow obstruction, dyspnea, and exercise capacity (BODE ) index was used to assess COPD severity. Binary logistic regression models were used to test the association between anxiety and depression. RESULTS: The patients with COPD were more likely than controls to experience depression (cases, HADS 10.5 +/- 3.6, prevalence 35.7%; controls, HADS 8.7 +/- 2.7, prevalence 7.2%) and anxiety (cases, HADS 10.4 +/- 3.1, prevalence 18.3%; controls, HADS 8.6 +/- 2.1, prevalence 5.3%). Subjects with anxious and depressive symptoms had poorer health outcomes including a higher BODE index, a shorter 6-minute-walk distance (6MWD), more dyspnea, and a higher St George's respiratory questionnaire (SGRQ) score. The prevalence of anxious and depressive symptoms increased with increasing BODE scores. On the basis of binary logistic regression, the BODE index was significantly correlated with anxiety (OR = 1.47, p < 0.001) and depression (OR = 1.51, p < 0.001). Anxious and depressive symptoms were also associated with several factors including younger age, female sex, higher education level, lower household income and history of smoking. CONCLUSIONS: This study confirmed the high prevalence of anxiety and depression in Chinese outpatients with COPD. Patients with COPD who had anxiety and/or depression had a poorer health-related quality of life.Trial registrationChinese Clinical Trials Registration(ChiCTR-TRC-12001958).     

Psychological distress and personality factors in takotsubo cardiomyopathy

Background

Takotsubo cardiomyopathy (TCC) is a transient condition characterised by severe left ventricular dysfunction combined with symptoms and signs mimicking myocardial infarction. Emotional triggers are common, but little is known about the psychological background characteristics of TCC. This study examined whether patients with TTC have higher levels of psychological distress (depressive symptoms, perceived stress, general anxiety), illness-related anxiety and distinct personality factors compared with healthy controls and patients with heart failure.

Methods and Results

Patients with TCC (N = 18; mean age 68.3 ± 11.7 years, 77.8?% women) and two comparison groups (healthy controls: N = 19, age 60.0 ± 7.6, 68.4?% women and patients with chronic heart failure: N = 19, age 68.8 ± 10.1, 68.4?% women) completed standardised questionnaires to measure depression (PHQ?9), perceived stress (PSS-10), general anxiety (GAD-7), illness-related anxiety (WI-7) and personality factors (NEO-FFI and DS-14). Psychological measures were obtained at 23 ± 18 months following the acute TTC event. Results showed that patients with TCC had higher levels of depressive symptoms (5.2 ± 5.2 vs. 2.5 ± 2.4, p = 0.039) and illness-related anxiety (2.1 ± 1.7 vs. 0.7 ± 1.3, p = 0.005) compared with healthy controls. Patients with TCC did not display significantly elevated perceived stress (p = 0.072) or general anxiety (p = 0.170). Regarding personality factors, levels of openness were lower in TCC compared with healthy controls (34.2 ± 4.3 vs. 38.2 ± 5.6, p = 0.021). No differences between TCC and heart failure patients were found regarding the psychological measures.

Conclusions

TCC is associated with higher levels of depressive symptoms, more illness-related anxiety and less openness compared with healthy controls. These data suggest that TCC is associated with adverse psychological factors that may persist well after the acute episode.

     

Combined Healthy Lifestyle Is Inversely Associated with Psychological Disorders among Adults

Background and Aims

Joint association of lifestyle-related factors and mental health has been less studied in earlier studies, especially in Middle Eastern countries. This study aimed to examine how combinations of several lifestyle-related factors related to depression and anxiety in a large group of middle-age Iranian population.

Methods

In a cross-sectional study on 3363 Iranian adults, a healthy lifestyle score was constructed by the use of data from dietary intakes, physical activity, smoking status, psychological distress and obesity. A dish-based 106-item semi-quantitative validated food frequency questionnaire (FFQ), General Practice Physical Activity Questionnaire (GPPAQ), General Health Questionnaire (GHQ) and other pre-tested questionnaires were used to assess the components of healthy lifestyle score. The Hospital Anxiety and Depression Scale (HADS) was applied to screen for anxiety and depression.

Results

After adjustment for potential confounders, we found that individuals with the highest score of healthy lifestyle were 95% less likely to be anxious (OR: 0.05; 95% CI: 0.01–0.27) and 96% less likely to be depressed (OR: 0.04; 95% CI: 0.01–0.15), compared with those with the lowest score. In addition, non-smokers had lower odds of anxiety (OR: 0.64; 95% CI: 0.47–0.88) and depression (OR: 0.62; 95% CI: 0.48–0.81) compared with smokers. Individuals with low levels of psychological distress had expectedly lower odds of anxiety (OR: 0.13; 95% CI: 0.10–0.16) and depression (OR: 0.10; 95% CI: 0.08–0.12) than those with high levels. Individuals with a healthy diet had 29% lower odds of depression (OR: 0.71; 95% CI: 0.59–0.87) than those with a non-healthy diet.

Conclusion

We found evidence indicating that healthy lifestyle score was associated with lower odds of anxiety and depression in this group of Iranian adults. Healthy diet, psychological distress, and smoking status were independent predictors of mental disorders.     

慢性乙肝患者的心理健康情况调查分析

目的:本文针对乙肝患者存在的心理障碍,提出相应的干预方法,为提高乙肝患者的心理健康水平及治疗效果提供理论依据。方法:选取2011年1月-2012年11月在我院接受治疗的慢性乙型肝炎患者80例作为研究组,另选取80位同期在我院接受体检的健康人群为对照组。针对两组对象的焦虑、抑郁、偏执等心理问题设计问卷调查,统计并分析调查结果。结果:观察组患者的焦虑及抑郁评分明显高于对照组,差异具有统计学意义(P0.05);观察组中,病情重的患者焦虑及抑郁评分高于病情轻、中度的患者,差异具有统计学意义(P0.05)。结论:慢性乙型肝炎患者的心理压力对治疗有影响,医护人员应积极的对乙肝患者进行心理疏导,帮助其树立自信、摆脱心理障碍,以积极的心态配合治疗,从而获得良好的疗效。     

实习护生学历与心理健康状况相关性研究

目的：了解不同学历实习护生心理健康状况及存在的心理健康问题,分析其与学历之间的关系,为实施干预提供依据。方法：采用症状自评量表（SCL-90）,对100名不同学历实习护生进行问卷调查。结果：不同学历实习护生SCL-90量表测试所得强迫症状、抑郁、焦虑、恐惧等因子分均高于常模组具体得分,不同学历SCL-90量表测试所得抑郁、焦虑、敌对、恐惧精神病性等因子分有差异。结论：强迫症状、抑郁、焦虑、敌对是不同学历实习护生最主要的心理问题,研究生、本科学历实习护生更为严重,不同学历心理问题的严重程度不同。     

离退休老干部心理健康调查

目的：了解离退休老干部的心理健康情况,解决离退休老干部心理疾病,提高老干部生活质量,为更好的老干部保健提供依据。方法：采用症状自评量表（SCL-90）对海军某干休所146名离退休老干部心理健康情况进行调查评估,并进行统计学分析。结果：与中国成人常模比较,离退休老干部的总体心理健康水平偏低（P〈0．05）。离退休老干部躯体化、强迫、抑郁和焦虑因子明显高于全国常模,其他因子之间无统计学差异。离退休男干部的躯体化、强迫、抑郁和焦虑因子得分低于离退休女干部。结论：离退休老干部存在着不同的心理问题,需要重视其心理健康。我们可以采取心理教育和疏导、丰富老干部日常生活以及药物治疗、心理治疗等多种措施．预防和治疗老干部心理问题。     

The relationships between burn pain, anxiety and depression

This study examined the interrelationships between anxiety, depression and pain in burn injured patients. Seventy patients with severe burns were interviewed within two weeks of their burn trauma. The short form of McGill Pain Questionnaire and a visual analog scale were employed to measure the pain experienced at rest. Anxiety and depression levels were assessed with the Beck Depression Inventory and Beck Anxiety Inventory. The results showed that significant number of patients had suffered from depressive and anxious symptomatology. Higher levels of anxiety and depression were associated with higher pain scores. Percent of total body surface burned was associated with increased pain scores, anxiety and depression. The authors emphasises the need for accurate multidisciplinary assessment and treatment of pain and psychological disorders in burn injured patients which needs to be highly individualized and frequently adjusted according to the patients specific needs.