Social participation, social support, and body image in the first year of rehabilitation in burn survivors: A longitudinal, three-wave cross-lagged panel analysis using structural equation modeling

Introduction: Psychosocial outcomes of burn survivors m the first year of rehabilitation are not well studied. Considering the interrelationships among psychosocial processes in burn survivors, we assessed three psychosocial variables (i.e., social support, social participation, and body image) simultaneously in a longitudinal study. Aims: This study aimed at identifying the developmental trajectory of the main study variables and also discovering the causal pathways between social support, body image, and social participation of burn survivors in the first year of rehabilitation. Methods: One hundred individuals were enrolled in the study. The analysis was based on three waves of data collected at the time of discharge, 6 months after discharge, and 12 months after discharge. We used MSPSS, SWAP, and the p-scale for measuring the variables social support, body image, and social participation, respectively. A repeated-measures analysis of variance (ANOVA) was performed to identify the major differences in the mean levels of the main study variables across the three evaluation times. A structural equation modeling (SEM) approach was implemented in four hypothesized cross-lagged models (M1, M2, M3, and M4) to evaluate the bidirectional relationships among the main variables. All hypothesized models were tested, and their goodness-of-fit indexes were compared to identify the best fitting model. Results: All three main variables worsen during the first six months after burn and then do not return to their earlier level. The M4 (final model) chosen to represent the data showed the best goodness-of-fit indexes (x(2) (9) = 51.76, p< .01, RMSEA=0.060, IFI = 0.97, and CFI=0.98) among all hypothesized models. The effect of social participation on body image, and vice versa, seems to be relatively constant and steady. Social support at the time of discharge predicted social participation at 12 months after burn, with the relationship mediated by body image at 6 months after burn. Conclusion: Our study findings suggest that persistent care should be provided for burn survivors even after discharge. (C) 2018 Elsevier Ltd and ISBI. All rights reserved.