. 2021 Dec 14;21:2281. doi: 10.1186/s12889-021-12296-1

Table 1.

Results of the quantitative studies

Randomised Controlled Trials
Study authors, year, and country	Participant Description	Psychological outcomes/measures	Time since burn	Control/Comparator Group Outcomes	Treatment Group Outcomes	Other relevant findings	Effect size
Brown 2014, Australia	Range = 4–13 years N = 75	Anxiety and stress -VAS-A Child Trauma – CTSQ	None	VAS-A = 2.76	VAS-A = 2.60	–	Not reported
Chester 2018, Australia	Range = 4–16 years N = 64 Treatment group received hypnotherapy	Procedural anxiety - VAS-A PTSD - YCPC; PTSD symptoms only reported 3 months post intervention	None	VAS-A = 2.14 (3-months post-intervention)	VAS-A = 2.43 (3-months post-intervention)	–	Not reported
Hyland 2015, Australia	Range = 0–16 years N = 100 Treatment group received CLT	Children’s fear scale, parent/staff assessment of anxiety - VAS-A	0–5 days	Baseline anxiety = 2.0 Post intervention anxiety = 2.9	Baseline anxiety = 2.0 Post-intervention anxiety = 1.7	–	Not reported
Jeffs 2014, United States	Range = 10–17 years N = 28	Anxiety - STAIC, Procedural Behavior Checklist	None	STAIC state score = 31.5 (SD = 8.7) STAIC trait score = 34 (SD = 6.5)	STAIC state score = 31.5 (SD = 8.7) STAIC trait score = 34 (SD = 6.5)	Trait anxiety was negatively correlated with distraction engagement, indicating that as trait anxiety increased, engagement with distraction decreased.	Not reported
Maskell 2014, Australia	Range = 8–16 Mean = intervention = 12.23 (SD = 1.97), control = 13.31 (SD = 2.22) N = 63	QoL - PedsQL, psychological adjustment and psychopathology – SDQ self-concept - P-H SCS	Not reported beyond “burn past the acute stage of healing”.	PedsQL = 77.97 (SD = 15.66) SDQ = 12.57 (SD = 5.2) P-H SCS = 49.43 (SD = 10.51)	PedsQL = 80.12 (SD = 14.53) SDQ = 12.03 (SD = 6.31) P-H SCS = 50.82 (SD = 9.80)	Age and gender had significant interaction effects, with adolescent girls responding well to treatment.	Not reported
Parlak Gurol 2010, Other: Turkey	Range = 12–18 years N = 63 Treatment group received massage therapy	Anxiety - STAI	Mean = 3 days	STAI = 45.96 (SD = 7.02)	STAI = 46.71 (SD = 8.40)	Significance of difference between groups was p > .001	Not reported
Rezazadeh 2020, Other: Iran	Range = 6–12 years N = 60 Treatment groups received a music or painting based intervention	Anxiety (Spence Children’s Anxiety Scale), depression (Maria Kovacs Children’s Depression Inventory)	Not reported – intervention completed before discharge from hospital	Pre-intervention anxiety = 77.4 ± 13.8, depression = 28.9 ± 5.4	Music group pre-intervention anxiety = 84.8 ± 6.8, depression = 32.8 ± 5.4 Painting pre-intervention anxiety = 90.4 ± 5.4, depression = 38.7 ± 3.4	–	Not reported
Sharp 2010, United States	Mean = 6–7 years N = 363 Treatment group received propranolol	ASD - acute stress disorder symptom checklist, psychologist interview	< 30 days	5% required treatment for ASD	8% required treatment for ASD	No statistical difference was observed between groups
Stoddard 2011, United States	Range: 6–20 Mean = 12.35 years (SD = 3.7) N = 26	PTSD symptoms -Diagnostic Interview Schedule for Children and Adolescents, Children’s PTSD Inventory, Depression - CDI	Not reported	Baseline CDI = 10.7 Baseline parent-rated PTSD score = 7.0 Baseline child-rated PTSD score = 8.8	Baseline CDI = 6.5 Baseline parent-rated PTSD score = 10.2 Baseline child-rated PTSD score = 10	CDI difference was the only significant difference between groups (p = .076)	Not reported
Cohort Studies
Study authors, year, and country	Participant Description	Psychological outcomes/measures	Time since burn		Results	Effect size
Boles 2018, Canada	Range = 1–17 years N = 47	Depression (identified via hospital records)	1–10 years		15 participants (32%) had symptoms of depression with or without suicidal ideation at time of injury	None reported
Bushroe 2018, United States	Range = 0–18 years N = 2208	Mental health diagnoses, psychotropic medication prescription, rates of diagnoses or medication pre- and post-injury	1 year		20.7% of the population were children who sustained burn injuries, The rate of children with any mental health-related visit increased postinjury to 156.7 per 1000 person-years from 95.9 per 1000 person-years pre-injury, resulting in a RR of 1.63 (95% CI 1.39, 1.92). After adjusting for race and ethnicity, the impact on mental health diagnoses for children with burn injuries was most in-creased for young patients, ages 0–4 years (aRR: age 0–4 years, 8.56, 95% CI 3.30–22.18), compared with the older children (aRR age 10–14 years, 1.02, 95% CI 0.26–4.07). Age at injury was most associated with mental health post injury- younger patients (0–4) were more likely to have increased mental health problems	Any mental health diagnosis = 0.90 Adjustment disorders = 5.41 Anxiety disorders = 1.13 ADHD = 0.61 Bipolar disorders = 1.13 Disruptive behavior disorders = 1.09 Eating disorders = 0.67 Learning/cognitive disorders = 1.54 Nonbipolar depressive disorders = 0.60 Pervasive developmental disorders = 0.60 Sleep disorders = 1.28 Substance use disorders = 0.23 Other disorders = 1.07 Any psychotropic prescription, regardless of mental health-related visits = 1.41 ADHD/stimulants = 1.03 Anti-anxiety = 2.36 Anticonvulsant = 2.08 Antidepressant = 1.52 Antipsychotic = 0.94 Bipolar disorder = 0.71 Any psychotropic prescription for those with previous mental health-related visits = **0.71
Chrapusta 2014, Other: Poland	Mean = 4.3 years (SD 1.2 years) or 10.4 years (SD 3.1 years) N = 120	Anxiety - VAS-A	3, 6, 12, & 18 months		Anxiety around wound treatment is higher in pre-school children when compared to school children and reduced across time (3–18 months). Younger children exhibited more anxiety. 3–7 year old children 3 months: mean = 47.50, SD = 24.26 6 months: mean = 37.92, SD = 24.13 12 months: mean = 42.08, SD = 25.57 18 months: mean = 30.83, SD = 23.38 8–13 year old children 3 months: mean = 20.50, SD = 9.46 6 months: mean = 18.83, SD = 8.65 12 months: mean = 19.17, SD = 7.76 18 months: mean = 15.83, SD = 6.19	Not reported
DeYoung 2012, Australia	Range = 1–6 years N = 130	PTSD, MDD, ADHD, ODD, SAD, and specific phobia modules of the DIPA	1–6 months		High rate of comorbidity (73% of the time) with PTSD at 1 month - more likely to have MDD, ODD, SAD and specific phobia. At 6 months, those with PTSD were more likely to have ADHD, ODD, SAD (in 85% of cases). 18% of children had recovering PTSD, 8% chronic PTSD, 2% delayed-onset PTSD. Post hoc tests indicated that at 1 month, children in the chronic group had significantly more PTSS than the recovery (p = .045) and resilient group (p < .001), and the recovery group had significantly more PTSS than children in the resilient group (p < .001). There was a significant reduction in PTSS across the 6 months for children in the resilient and recovery groups(p < .001), although children in the recovery group had a significantly higher mean number of symptoms at 6 months in comparison to the resilient group (p < .001). Children in the chronic group did not experience any significant reduction in symptoms (p = .725) and were experiencing significantly more PTSS than children in the other two groups at6 months (p < .001).	Rates of mental illness after in kids with PTSD after a 1-month follow-up: ODD = 9.57 SAD = 9.57 Specific phobia = 4.68 ^^ 6 month follow-up: ADHD = 12.55 ODD = 27.62 SAD = 7.39 Additionally, children with a new-onset non-PTSD diagnosis at 6 months had a minimum of on PTSS at 1 month and significantly more PTSS in comparison to children with no new onset disorders at 6 months: d = 1.05 DIPA interaction effect sizes PTSD: n² = .34 MDD: n² = .20 ADHD: n² = .05 ODD: n² = .12 SAD: n² = .15
DeYoung 2014, Australia	Range = 1–6 years N = 116	PTSD and PTSS- DIPA, emotional function CBCL	2 weeks – 6 months		Parent trauma history, child premorbid problems, TBSA, parent distress, parent PTSS all contributed to child PTSD at 6 months (R squared = .49). Premorbid CBCL and psychological functioning and concurrent parental PTSS contributed to higher child PTSS at 6 months.	1 month child PTSS predicting … CBCL: R² = .12 6 month child PTSS predicting … CBCL: R² = .14 PTSS: R² = .55 1 month parent PTSS predicts … Child PTSS: R² = .46 6 month parent PTSS predicts … Child PTSS: R² = .43
Duke 2018, Australia	Range = 0–17 years N = 11,967	Mental health conditions, self-harm, drug/alcohol abuse	≤32 years		The paediatric cohort with unintentional burns experienced elevated rates of post-burn admissions for a psychiatric condition at a rate of 2.6 times higher than the comparison uninjured cohort. Examination of burn severity (TBSA) found post-burn MH admission rates were at least twice as high (adjusted IRR between 2.00 and 2.81) for both severe and minor classifications when compared with the uninjured. While significantly elevated post-burn MH rates were found for all age groups, children between the age of 10 and 15 years at the burn admission experienced the highest admission rate at almost five times higher than that for uninjured children.	Not reported
Enlow 2019, United States	Range = 7–17 years N = 46	PTSS - CRIES, coping - Child Coping Strategies Checklist	> 1 month		Caregiver anxiety and months since injury predicted child PTSS and coping. Caregiver depression also predicted child PTSS and coping. Child mean PTSD score (CRIES) = 18.95 (SD = 17.04)	Hierarchical regression of youth coping and caregiver anxiety predicting youth PTSS: Step 1 Active: R² = .07 Avoidance: R² = .07 Distraction: R² = .07 Social support: R² = .07 Step 2: Active: R² = .20 Avoidance: R² = .31 Distraction: R² = .15 Social support: R² = .20 Step 3: Active: R² = .22 Avoidance: R² = .35 Distraction: R² = .22 Social support: R² = .19
Goodhew 2014, Australia	Range = 0–18 (mean = 4 years) N = 272	Psychiatric morbidity - WHO Composite International Diagnostic Interview version 2, burn-related distress - Impact of Events Scale, suicidality - Mini International Neuropsychiatric Interview, the impact of burn and current self-perceived level of disfiguration	21–31 years		44% had some sort of distress in relation to burn, 11% had reported lifetime suicide attempts, 42% met criteria for at least one DSM-IV disorder in their lifetime and 19% in the past month, 30% had met criteria for depression, 28% had met criteria for anxiety, most prevalent disorder was MSS (15%) and PTSD (12%). Females more likely than males to meet DSM criteria, and visible burn predictive of a DSM diagnosis. Distress predicted by perceived disfigurement and more days spent in hospital.	Predictors of any lifetime DSM disorder Relationship status: .30 Gender: 1.12 Perceived disfigurement: .56 Visible burn: .85 Number of surgical procedures: .61 Days hospitalised: .56 Predictors of lifetime PTSD Relationship status: .35 Gender: .65 Perceived disfigurement: .57 Visible burn: .71 Number of surgical procedures: .53 Days hospitalised: .54 Any lifetime depressive disorder Relationship status: .38 Gender: .87 Perceived disfigurement: .55 Visible burn: 1.08 Number of surgical procedures: .63 Days hospitalised: .56 Any lifetime anxiety disorder Relationship status: .27 Gender: 1.08 Perceived disfigurement: .56 Visible burn: .70 Number of surgical procedures: .72 Days hospitalised: .54
Graf 2011, Other: Switzerland	Range = 9–48 months N = 76	PTSD - PTSD semi-structured interview, emotional problems - CBCL	X = 15 months. Range: 3–48 months)		13.2% of infants/toddlers met full criteria for PTSD, 73.7% met criteria for re-experiencing, 64.5% for avoidance and emotional numbing, 19.7% for increased arousal. CBCL scores were lower than norms in this group. Trauma severity, maternal PTSD and quality of family relations related to PTSD symptoms.	Behaviour problems in children older than 18 months CBCL total score: d = −.33 CBCL internalising score: d = −.25 CBCL externalising score: d = −.41
Haag, 2017 Switzerland	Range = 1–4 years N = 138 (additionally, 138 mothers and 128 fathers)	Acute posttraumatic stress - DSM 5, Young Child PTSD Checklist	None		11.7% of children met full criteria for acute PTSD, while 15.3% met criteria for acute subsyndromal acute PTSD, 66.7% met criteria for intrusion, and 35% met criteria for avoidance and negative alterations in cognition and arousal. Maternal acute stress was significantly associated with higher acute stress in the child (p = .03)	Not reported
Laitakari 2015, Other: Finland	Mean = 7.1 years (SD = 1.4) N = 44	Health-related QoL - measured via 17D questionnaire developed for children aged 8–11 years	X = 6.3 years. Range = 5–9 years.		Perceived and expressed health-related QoL in the burned was comparable, or even better (.968) than that of the control population (.936). Among the study cohort, we noted a small but statistically significant difference between boys and girls, as girls fared better on the learning dimension.	Not reported
Maskell 2013, Australiax	Range = 8–17 years N = 66	QoL - The Paediatric Quality of Life Inventory, psychological adjustment and psychopathology - SDQ, self-concept - P-H SCS	Not explicitly reported. Appears to be about 7 years.		Children with burns have lower health-related QoL (except for physical health), and higher emotional conduct, peer, prosocial problems and hyperactivity, than norms. No differences in self-concept. Burned cohort QoL mean 78.87, SD = 15.10 Normative cohort QoL mean = 83.91, SD = 12.47	Not reported
Murphy 2015, United States	Range = 16–21.5 years (2.5–12.5 years post-burn) Mean = 8.3 years (SD = 3) N = 50	Level of disability and function - WHODAS, QoL - BSHS-B	2.5–12.5 years		No difference in 2.5–7.5 and 7.5–12.5 years post-burn functioning. Increased TBSA related to increased disability (except for cognition and self-care). Burns sustained after school entry (older) were associated with more disability.	Not reported
Nelson 2020, United States	Range = 6–16 years post-burn Mean = 11.97 years (SD = 3.11) N = 65	Depressive symptoms, anxiety -PROMISE pediatric profile, PTSD - Child PTSD symptom scale, PTG - Post-traumatic Growth Inventory for Children-Revised	6- and 12-months post-discharge from initial injury		A significant association between pain interference and intensity and depression and anxiety but not PTSD or PTG.	Time 1 with pain interference as the independent (predictor) variable Pain intensity: R² = .36 Physical functioning mobility: R² = .18 Time 1 with pain intensity as the independent (predictor) variable Physical functioning mobility: R² = .23
Nodoushani 2018, United States	Range = 5–18 years N = 836	Physical/psychosocial recovery - BOQ, Depressive symptoms or suicidal ideation - study-specific questionnaire	3–36 months post-discharge		Around 50% of patients maintained a ‘positive’ response from each successive time point. From baseline to 36 months, 45% of children had a ‘positive’ response for at least one-time point, while only 2% had a ‘positive’ response at all time points. Over all 7 time points, the majority (72%) of children with a ‘positive’ response were rated as being depressed ‘Some of the time’ and only a small percentage (4%) of patients with a ‘positive’ response were rated as being depressed ‘All of the time’. The prevalence of these symptoms is greatest at baseline and decreases until it tapers off around 12% at 2 to 3 years.	Not reported
Rimmer 2014, United States x	Range = 8–17 years N = 63	Anxiety - SCARED	Not reported		Panic disorder/significant somatic symptoms (4.9, SD = 4.8), GAD (5.2, SD = 4.3), Separation anxiety disorder (4.2, SD = 3.9), Social anxiety disorder (5.0, SD = 3.6), Significant school avoidance (1.8, SD = 1.8), total (21.1, SD = 14.7). Children reported significantly higher scores than their parents on all subscales. The largest (for social anxiety disorder) indicated that parent and youth report shared only 16% of their variance.	Not reported
Rimmer 2014b, United States x	Range = 8–17 years N = 197	Anxiety - SCARED	Appears to be a mean of about 6 years, given mean age at time of burn was 5.8 and mean current age was 12.4		Seventy-seven participants (39%) screened positive for the possible presence of an anxiety disorder with total SCARED scores of at least 25; 55 (28%) scored 30 or more. A total score of 30 or greater is more specific to the likely presence of anxiety disorder. Nearly half of the youth, 87 (44%), had mean scores 5 on the Separation Anxiety subscale, indicating the presence of separation anxiety symptoms, whereas 55 survivors (28%) had mean scores of 7 on the Panic subscale, indicating the presence of panic disorder or significant somatic symptoms. Finally, 55 youth (28%) had mean scores of 7 on the School Avoidance subscale, indicating the presence of significant school avoidance, 47 (24%) had mean scores of 8 on the Social Anxiety subscale, indicating the presence of social anxiety disorder, and 23% had mean scores of 9 on the Generalized Anxiety Disorder subscale, indicating the presence of generalized anxiety disorder. Significant sex differences were observed for anxiety and somatic complaints, with girls scoring higher in total anxiety and on each anxiety subscale including generalized anxiety, separation anxiety, social phobia, and school phobia.	Not reported
Riobueno-Naylor 2020, United States	Range = 12–17 Mean = 14.84 years (SD = 1.92) N = 78	Psychosocial functioning – PSC-17, social functioning and anxiety – SAS-A, the Perceived Stigmatization Questionnaire, Harter’s SPPA, the Body Image Life Engagement Questionnaire	X = 4.54 years		Prevalence of general psychosocial problems within the participant sample as measured by the PSC-17 overall risk score was 15.3%. Participants who reported appearance concerns had significantly more severe symptoms related to fear of negative evaluation on the SAS-A (Mdn = 17.00) compared with those who did not report appearance concerns (Mdn = 11.50; U = 302.50, P < .01). Reports of appearance concerns were also significantly associated with lower ratings of self-worth on the SPPA (Mdn = 3.20) compared with participants who did not report appearance concerns (Mdn = 3.60, U = 277.00, P < .01). Results indicated that the overwhelming majority (70.0%) of adolescents receiving follow-up care for burn injuries reported appearance concerns. No significant differences in median scores were found when comparing scores on measures of social functioning and anxiety across groups based on participant burn size, location, or sex.	Not reported
Rosenberg 2015, United States	Mean = 15.5 years (SD = 4.6) N = 67	DSM diagnosis, effective and cognitive difficulties (physician’s records, neurology consults, psychology records, and psychiatric records from the initial acute hospitalization- Clinical assessment, Acute Stress Disorder Checklist, Impact of Events Scale, CDI, BDI, CBCL	X = 2.8 years		Acute presentation: No differences between EI and control patients in GAD (45 and 52%), depression (19 and 12%), grief (34 and 36%), but there was a difference in ASD/PTSD (51 and 31%) 10% of EI had cognitive difficulties vs. 1% of controls A minority and equal number of the patients in both groups had documented behavioural problems (7 and 9%) Follow-up: GAD (14 and 10%), PTSD (5 and 7%), depression (19 and 13%), grief (14 and 23%), cognitive difficulties (10 and 3%), behaviour problems (7 and 10%).	Not reported
Russell 2013, United States	Range = 18–28 years (time of burn < 18 years) N = 82	Self-concept - Tennessee Self-Concept Scale, 2nd edition, psychiatric illness - Structured Clinical Interview for DSM-IV Disorders, emotion problems - Young Adult Self-Report	> 2 years		Lower self-esteem than norms. As self-concept scores diminished, emotional and behavioral problem scores increased. Participants diagnosed with current anxiety disorders had significantly lower scores for the total self-concept scale, (P = .0017), the personal scale (P = .0004), and each of the three supplementary scales (identity, P = .0018; satisfaction, P = .0018; and behavior, P = .0004). Participants diagnosed with current anxiety disorders had significantly lower scores for the total self-concept scale, (P = .0017), the personal scale (P = .0004), and each of the three supplementary scales (identity, P = .0018; satisfaction, P = .0018; and behavior, P = .0004).	Not reported
Sveen 2012, Other: Sweden	Range = 5–18 years N = 144	Emotional health - BOQ, fear and avoidance, psychological health - SDQ	Between 4 and 12 years		Fear-avoidance was positively associated with measures of pain, itch, and parental concern and was negatively associated with appearance, emotional health, and school re-entry. Emotional health = 89, SD = 18. Itching is associated with psychosocial distress.	Not reported
Thomas 2012, United States	Range = 18–30 years (burn occurred < 16 years old) N = 98	Personality disorder symptoms and diagnosis - Structured Clinical Interview for the DSM-IV-TR Axis II Personality Disorders	Not reported		48 participants (49%) met the criteria for diagnosis with one or more personality disorders. Paranoid Personality Disorder was the most frequent diagnosis found overall (19.4%). Passive Aggressive Personality Disorder was the next most frequent diagnosis overall (18.4%) and the most common personality disorder among women (27.5%). Antisocial Personality Disorder was almost as frequent (17.3%) and the most common personality disorder among men (22.4%). Depressive Personality Disorder (11.2%) and Borderline Personality Disorder (9.2%) were the next most frequent diagnoses. Of those meeting criteria for personality disorder, 21 (43.8%) met criteria for two or more personality disorder diagnoses. Women significantly more likely to meet criteria for Borderline, Avoidant, Passive Aggressive, and Depressive Personality Disorders and men significantly more likely to meet criteria for Antisocial Personality Disorder.	Not reported
Warner 2012, United States	Range = 0–18 years N = 678	Psychological status, appearance, satisfaction, compliance, emotional health - BOQ	< 4 years		Patients with facial burns had significantly slower recovery in the domains of upper extremity function, pain, itch, appearance, satisfaction, emotional health, and family disruption (p < 0.05). Patients with burns involving greater than or equal to 20%TBSA had slower improvement in upper extremity function, pain, itch, satisfaction, emotional health, family disruption, and parental concern when compared with patients with burns involving less than 20% TBSA.	Not reported
Weedon 2011, Other: South Africa	Range = 2–12 years N = 70	Quality of life -PedsQL	Not reported		Mean quality of life scores one-week post-discharge from the burns unit were 152.63 (SD = 20.41) and 180.87 (SD = 31.31) three months after discharge. A score of 200 is expected for an optimal quality of life in children using the PedsQL. Bathing, helping to pick up own toys, pain, and energy levels in the physical section and an emotional component (worrying) in the psychosocial section explains why there was a shift within the total score. Children sustaining hot water burns scored lower quality of life scores than children sustaining flame burns.	Not reported
Willebrand 2011, Other: Sweden	Range = 3–18 years N = 181	Emotional problems - SDQ, anxiety and depression - Hospital Anxiety and Depression Scale.	0.3–9 years		For Emotional symptoms, Hyperactivity/Inattention and Prosocial behaviour the percentage of caseness ranged from 11 to 14%, which is close to the norm (10%). For Conduct problems, Peer relationship problems and the Total difficulties score the proportion of indicated cases varied between 18 and 20%. For the Impact score, a cut-off of 1 identified 20% as potential cases, while the cut-off at 2 identified 15% as potential cases. Eight children had pre-burn problems with attention/behaviour, two reported depression and one had sleep problems. Age, visible scars, parents HADS scores, fathers education, and the variable change in living arrangements, together explaining 40% of the variance in emotional problems	Not reported
Cross-Sectional Studies
Study authors, year, and country	Participants	Study design	Psychological outcomes/measures	Time since burn		Results
Nicolosi 2013, Other: Brazil	Range = 12–20 years N = 63	Depression - BDI, self-esteem - RSE	Not reported	Mean BDI score was 7.63 (SD 8.72), suggesting that, at most, participants were not or only slightly depressed. Participant answers yielded a mean self-esteem score of 8.41 (SD 4.74), showing that, in general, this group has an adequate degree of self-esteem. Average BDI and RSE scores for teenagers who had sustained burns on their head (n = 43) versus those who did not (n = 20) were statistically the same (BDI: P = 0.26; RSE: P = 0.21). The scores also were not statistically significantly different between persons who did (n = 38) compared to those who did not (n = 25) sustain burns on their hands (BDI: P = 0.10; RSE: P = 0.28).		Not reported
Pardo 2010, Other: Spain	Range = 1–17 years N = 139	Anxiety - State-Trait Anxiety in Children, Scale for Anxiety Behavior Observation During Hospitalisation, emotion problems - CBCL	Not reported	State anxiety higher than norms (35.88, SD = 7.85), trait lower than norms (33.93, SD = 6.46), CBCL total scores higher than norms (internalizing and externalizing syndromes (10.52, SD = 6.174; 14.14, SD = 9.139, respectively) and also in the following sub-scales, anxious/depressed (5.70, SD = 3.414), rule-breaking, and aggressive behavior (4.82,SD = 3.872; 9.32, SD = 5.790, respectively)). “boys experience more anxiety (T = 2.011, P = .047), while it can also be seen that flames are the cause of significantly higher levels of anxiety in these children (T = 2.089, P = .040), higher averages correspond to older children (F = 4.577, P = .016; F = 3.710, P = .033; and F = 4.990, P = .012). CBCL- these scales are significant in relationship to the gender variable (T = 2.128, P = .040; T = 2.237, P = .031) in that boys are those who show some kind of behavioral anomaly associated with attention and belligerent behavior”.		Not reported
Quezada 2016, Other: Mexico	Range = 7–18 years N = 51	Resilience - the Resilience Questionnaire for Children and Adolescents	6 years	According to the clinical cut-off points established for the resilience questionnaire for children and adolescents, patients showed a high level of resilience (mean = 128.31, SD = 21.63) with scores ranging between 105 and 157. The variable with the largest effect on the resilience of patients was age at the time of burn, followed by intrusion symptoms of caregiver		Not reported
Other Studies
Study authors, year, and country	Participants	Study design	Psychological outcomes/measures	Time since burn	Results	Effect size
Brown 2014, Australia	Range = 4–13 years N = 77	Other: a longitudinal study on data collected through RCT	Anxiety - VAS-A, Child Trauma - CTSQ	None	Higher SAA during wound change procedures associated with higher scores on CTSQ (for 1 point increase on CTSQ SAA increased by 6.79 U/ml (CI = 1.79, 11.78, p = .008), mean Child Trauma Screening Questionnaire (CTSQ) at 3 months post-injury was 3.47 (SD = 2.45). More stress during wound dressing associated with higher PTSD symptoms at 3 months post injury.	Not reported
Conn 2017, United States	Range = 6–12 years N = 40	Non-randomised experimental study	Somatic and cognitive anxiety - yoga evaluation questionnaire	Not reported	Somatic and cognitive anxiety were lower after the intervention. Mean somatic anxiety = 2.7 (SD 2.2), mean cognitive anxiety = 2.9 (SD 2.2)	Somatic anxiety: d = .77 Cognitive anxiety: d = .76
Khadra 2018, Canada	Range = 9 months - 2.4 years N = 15	Other: quasi-experimental pilot study	Anxiety - modified Smith Scale, Procedural Behavior Checklist	None	Average level of anxiety was low and no difference across time periods. Percentage of population experiencing anxiety levels: Anxiety level 0 = 53.3% Anxiety level 1 = 33.3% Anxiety level 2 = 6.7% Anxiety level 3 = 6.7% There was a strong positive correlation between pain and procedural anxiety.	Not reported
Tropez-Arceneaux 2017, Other: Nicaragua	Range = 12–25 years N = 33	Non-randomised experimental study	Self-esteem - RSE, self-concept, socializing skills, depression - BDI, CDI, anxiety - Beck Anxiety Scale	5 years	Decrease in anxiety, depression and parent depression, and increase in self-esteem. anxiety = 32, self-esteem = 32, depression = 29	Not reported

Note: Visual Analog Scale-Anxiety (VAS-A), Child Trauma Screening Questionnaire (CTSQ), Quality of life (QoL), Child Depression Inventory (CDI), State-Trait Anxiety Inventory (STAI/STAIC), Piers-Harris Self-Concept Scale (P-H SCS), Strengths and Difficulties Scale (SDQ), The Paediatric Quality of Life Inventory (PedsQL), Young Child PTSD Checklist (YCPC), Post Traumatic Stress Disorder (PTSD), Randomised controlled trial (RCT), Acute Stress Disorder (ASD)

Note: Visual Analog Scale – Anxiety (VAS-A), adjusted Risk Ratio (aRR), Attention Deficit Hyperactivity Disorder (ADHD), Major Depressive Disorder (MDD), Post-Traumatic Stress Disorder (PTSD), Oppositional Defiance Disorder (ODD), Social Anxiety Disorder (SAD), Diagnostic Infant Preschool Assessment (DIPA), Post-Traumatic Stress Symptoms (PTSS), Total Body Surface Area (TBSA), Child Behavior checklist (CBCL), Incidence rate ratio (IRR), Children’s Revised Impact of Event Scale (CRIES), World Health Organisation (WHO), Strengths and Difficulties Questionnaire (SDQ), Piers-Harris Self-Concept Scale (P-H SCS), World Health Organisation Disability Assessment Schedule (WHODAS), Burn Specific Health Scale – Brief Instrument (BSHS-B), Parent Reported Outcomes Measurement Information System (PROMIE), Post-Traumatic Growth (PTG), Burn Outcomes Questionnaire (BOQ), Screen for Anxiety Related Disorders (SCARED), Pediatric Symptom Checklist (PSC-17), Social Anxiety Scale (SAS), Self-perception Profile for Adolescents (SPPA), Diagnostic and Statistical Manual of Mental Disorders (DSM), Children’s Depression Inventory (CDI), Beck Depression Inventory (BDI), General Anxiety Disorder (GAD)

Note: ** Indicates a transformation of the odds ratio reported in the original study by dividing by 1.81, as described in Chinn (2000), Beck Depression Inventory (BDI), Rosenberg’s Self-esteem Scale (RSE)

Note: Visual Analog Scale – Anxiety (VAS-A), Randomised Controlled Trial (RCT), Childhood Trauma Questionnaire (CTQ), salivary alpha-amylase (SAA), Post-Traumatic Stress Disorder (PTSD)