Introduction

Burns are one of the most common household injuries, illustrated by severe skin damage. ¹ Over 96% of fatal fire-related injuries occur in low- and middle-income countries, also result in many disabilities and disfigurements, leading to social stigma. ² Around 10-15,000 burn-related injuries occur in Germany annually out of which one-third of the cases need serious attention due to severity. ³ In the United States, burn injuries are one of the foremost causes of injury, causing 3,275 deaths per year⁴ and 40,000 annual hospitalisations in diverse health centres. ⁵
Noticeable burn scars may have an impact on an individual\\\'s behaviour leading to social withdrawal. ⁶ Ones unpleasant physical appearances can have negative impact on one\\\'s self-esteem⁷ that is an emotional estimation of one\\\'s personal worth. ⁸ Burn injuries can be a distressing experience, possibly leading to disabilities and have a pessimistic impact on different facets of life. ⁹
The susceptibility model states that people with near to ground self-esteem are expected to underestimate themselves and might seek out negative comments from others to authenticate their negative self-concept. ¹⁰ Facial burns may increase vulnerability of  worse reactions from other people that can contribute in negative influence on self-esteem and may lead to depression.
The current paper is an effort to measure the level of self-esteem among severely burned adult patients. A further aim was to find the existence of difference in self-esteem among men and women victims.

Methods and Results

A cross-sectional study was conducted from March 2015 to April 2016. Purposive sampling technique was used and in-patients five different public and private hospitals of Lahore and Faisalabad were approached, including Allied Hospital, Faisalabad; DHQ Hospital, Faisalabad; Jinnah Hospital, Lahore; Ganga Ram Hospital, Lahore; and Shafe Burn Care, Lahore. Verbal informed consent was obtained from the participants prior to the study. A total of 40 patients with third-degree burns, with age ranging from 20 to 40 years were included in this survey. Unavailability, difficulty to approach and refusal of consent by several participants restricted the sample size to this minimal value.
The Urdu version of the 29-item self-esteem scale developed by Rifai F was used to quantify self-esteem. ¹¹ The overall self-esteem can be computed using the whole score, while four sub-scales, namely self-acceptance, self-competence, social and physical self-acceptance, and academic self-acceptance, can be calculated using the different items of the 29-point scale. The score was scaled on a 5-point Likert scale, as described in other study. ¹¹
SPSS version 21 was used for data analysis, and Pearson product-moment correlation and independent sample t-test was used for evaluating data. 
Out of a total of 40 patients, 25 (62.5%) were men and 15 (37.5%) were women with a mean age of 28.28±4.60 years (range 20-40 years). A total of 32 patients (80%) had received a university degree, while 8 patients (20%) were only educated up to Matriculation level.



Table-1 notes the further demographic details of the patients. Face and chest were affected in 7 (17.5%) patients while the body, excluding the face, was burned in 33 (82.5%) patients. A total of 27 (67.5%) patients were injured by fire while 13 (32.5%) were injured with hot water.
A positive co-relation was found between different sub-scales of self-esteem: self-acceptance and self-competence r=0.55, p<0.01; self-acceptance and academic self-competence r=0.47, p<0.01; self-acceptance and social and physical acceptance r=0.57, p<0.01; self-competence and academic self-competence r=0.48, p<0.01; self-competence and social and physical acceptance r=0.50, p<0.01; and academic self-competence and social and physical acceptance r=0.45, p<0.01. Table-2



demonstrates this relation. A significant difference between men and women was found in self-competence aspect of self-esteem (t=2.18, p<0.05), demonstrating that severely burned men have higher self-competence compared to severely burned women. However, no significant gender difference was found with regards to self-acceptance, academic self-competence, and social and physical acceptance (Table-3).



Overall, no significant difference in self-esteem was observed with reference to age, education, marital status, profession, birth order, living area, proportion of injured area, and injury type.

Discussion

The current study was an effort to assess the gender difference in self-esteem among severely burned adult patients. A significant difference was noted among men and women on the self-competence sub-scale of self-esteem. The result is consistent with an earlier study conducted in Karachi which indicated existence of higher self-esteem in male victims of burn injuries. ¹² Another study noted that male burn injury patients had higher scores of self-evaluation, social capacity, and appearance, as well as wider ranging scores compared to females. ¹³ A study conducted in Brazil reported higher self-esteem scores among men compared to women. ¹⁴

Recommendations

The medical practitioners must focus on the psychological state of the Burn-related patients while dealing with their physical state. Identification of self-esteem with reference to more specific skin diseases can be considered. Further its explorable to identify the causes of insignificant difference between self-esteem and demographic variables.

Limitations

This study is less generalizable due to limited sample from two cities only. An adapted scale used for assessment, that should replace with indigenous.

Conclusion

Moderate level of self-esteem was observed on the overall self-esteem score including all the four sub-scales among severely burned victims. A significant gender difference was noted on the self-competency sub-scale of self-esteem.

Disclaimer: None to declare.
Conflict of Interest: None to declare.
Funding Disclosure: None to declare.

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