燒傷患者的知覺疤痕嚴重度與社交焦慮：知覺社會汙名與身體意象不滿之中介角色

Perceived Scar Severity and Social Anxiety Among Burn Patients: The Mediating Roles of Perceived Social Stigma and Body Image Dissatisfaction

燒傷疤痕不僅影響燒傷患者的生理機能，亦可能干擾傷者的心理社會適應。旁人對燒傷患者外觀的汙名反應，可能增加他們對外觀的負向知覺—即身體意象不滿，進而促進對社會互動情境的焦慮與懼怕。本研究旨在探討燒傷後知覺疤痕嚴重度與社交焦慮症狀之間的關連，聚焦於知覺社會汙名與身體意象不滿在上述關聯中的中介角色。參與者為108 位八仙塵燃事故的燒傷倖存者，平均24.19 歲，女性占63%，平均體表燒傷面積50.15%。本研究採兩波前瞻性設計，在八仙事故後兩年（時間點一，T1）及三年（時間點二，T2）進行追蹤，並用序列中介分析檢驗知覺疤痕嚴重度對社交焦慮症狀的預測關係，是否經由知覺社會汙名及身體意象不滿中介。結果顯示：(1) 八仙塵燃事故三年後，倖存者中22.2% 符合DSM-IV 可能社交焦慮症；(2) 控制T1 憂鬱症狀後，T1 知覺疤痕嚴重度經由T1知覺社會汙名與T1 身體意象不滿影響T2 社交焦慮症狀的序列中介效果顯著，但反向序列中介效果不顯著；以及(3)交叉延宕分析顯示T1 身體意象不滿顯著預測T2 知覺社會汙名，但T1 知覺社會汙名無法預測T2 身體意象不滿，與前述序列中介模型中的路徑相左。整體而言，本研究發現八仙塵燃事故三年後仍有相對高比例的燒傷患者出現臨床上顯著的社交焦慮症狀，並且凸顯身體意象與社會汙名在燒傷後適應與臨床介入上的重要性。

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.