Tebble NJ, Thomas DW, Price P. (2004) Journal Of Advanced Nursing, 47(4), 417-426

Abstract:

Background: Although minor facial injuries are relatively common, their psychological impact is an area neglected in the literature. For physiologically major injuries (such as facial cancers, burns and fractures), the face has been suggested to be a psychologically significant area of the body and disfigurement has been found to have numerous potential social consequences for patients.

Aims: This paper reports the findings of an inquiry that explored the psychological impact of minor facial injuries and the influence of patient and scar characteristics in relation to self-consciousness and anxiety levels.

Method: Data were collected in 2001 in an accident and emergency unit from patients with a visible laceration over 1.5 cm that was treatable in an outpatient setting. The Derriford Appearance Scale (with general and social self-consciousness subscales) and the State-Trait Anxiety Inventory were administered to 63 patients 1 week later; data on 50 patients were also available 6 months after the injury.

Results: Larger scar size, living alone and aetiology of injury were significantly related to self-consciousness and anxiety levels, although gender, age, socioeconomic group, location of scar, satisfaction with appearance and number of scars were not. General self-consciousness improved at 6 months but social self-consciousness and anxiety remained the same. Patient factors were not related to changes in general self-consciousness over time.

Conclusions: Minor facial scars can have significant psychological impact for some people. Awareness training for health professionals, social skills training for affected patients and a patient information leaflet are recommended.

Rumsey N, Clarke A, White P, Wyn-Williams M, Garlick W, (2004) Journal Of Advanced Nursing, 48(5), 443-453

Abstract:

Aim: The aim of this paper is to report a study to establish the extent and type of psychosocial needs of outpatients attending for treatment of a wide range of disfiguring conditions.

Background: Visible disfigurements can be associated with extensive psychosocial difficulties. The majority of research to date has been carried out with people identified by themselves or others as experiencing difficulties. Little is known about levels of distress in the broader population of patients receiving treatment for a range of disfiguring conditions.

Methods: A cross-sectional survey was conducted, with a convenience sample. Participants (n = 458) drawn from 15 outpatient clinics completed standardized measures of anxiety and depression (Hospital Anxiety and Depression Scale), social anxiety and avoidance (Derriford Appearance Scale short-form) and quality of life (World Health Organization Quality of Life Brief Scale). A semi-structured interview was used to generate further quantitative and qualitative data about individual concerns, and satisfaction with the provision of care. Staff views about levels of psychosocial distress were elicited through group discussions.

Results: The results revealed high levels of psychological distress in the sample, compared with normative values. The majority of difficulties related to problems experienced in social situations. Patient satisfaction with care was generally high; however, and 71% of participants expressed a moderate to strong desire for a health care professional with training to deal with their appearance-related concerns. Nursing staff felt unable to address patients’ appearance-related difficulties because of time constraints, lack of an environment conducive to the discussion of patients’ concerns, and lack of appropriate knowledge and training.

Conclusion: A significant proportion of participants experienced psychosocial distress in relation to their visible difference. Psychosocial needs were poorly met in current outpatient care provision, and a range of options could be considered to address these more effectively.

Moss, T. P. (2005) Body Image: An International Journal Of Research, 2, 151-159

Abstract

Although the role of the objectively and subjectively rated severity of appearance problems is often debated, the impact of severity upon psychological adjustment has yet to be explored fully. In this study, 400 patients with a range of physical differences in appearance were recruited through general plastic surgery outpatient clinics and waiting lists. Patients completed the Derriford Appearance Scale 24 (DAS24), a measure of psychological distress and behavioural dysfunction related to self-consciousness of appearance. Severity in the outpatient group was objectively rated by plastic surgeons, and severity amongst the waiting-list group was subjectively rated by the patients themselves. Multiple regression modelling demonstrated a linear relationship between subjective adjustment and severity, with greater perceived severity associated with poorer adjustment. Similar modelling demonstrated a weak but statistically significant quadratic relationship between objectively rated severity and adjustment for normally visible, but not for normally non-visible differences of appearance. Moderate, rather than mild or severe objective severity was most related to poor adjustment.

British Journal Of Plastic Surgery, 54 (3): 223-226 Harris D.L., & Carr AT, (2001).

Abstract

Using information gathered in the introductory sections of the Derriford Appearance Scales (DAS24 and DAS59), the prevalence and epidemiological characteristics of concern about physical appearance have been determined for a carefully constructed sample of the general population of southwest Devon (rural and urban). In all, 2108 usable replies were received from a postal survey of a targeted population of 5400 men and women, aged 18 and over and randomly selected with constraints for age, sex acid socio-economic status. The prevalence of concern about physical appearance was highest among women through to age 60 and younger men. There was no association with socioeconomic status or living status. Concerns about the nose, weight and skin disorders were reported most frequently by both men and women and additionally concerns about breasts and abdomen were reported by women and premature balding by men. The mean DAS24 and DAS59 full-scale scores of 19% of male and 25% of female responders who were concerned about appearance exceeded the mean scores of preoperative patients undergoing reconstructive and cosmetic plastic surgery. Concern about appearance is widespread in the general population. More often than not, concern is about one feature only, which runs counter to the hypothesis that concern about appearance reflects a neurotic trait. The high levels of measured psychological distress and dysfunction found in a substantial minority of those in the general population who are concerned about appearance highlight the need for appropriate services.

Objectives. To develop a psychometrically robust and widely applicable short form of the Derriford Appearance Scale (DAS59) which (i) will reliably and validly assess the distress and difficulties experienced in living with problems of appearance (ii) is acceptable to clinical and non- clinical populations and (iii) facilitates research and clinical decision-making through good standardisation and sensitivity.

Design. Cross-sectional survey designs using clinical (outpatient and inpatient) and general population samples.

Method. 25 items were selected initially from the 59 items of the original Derriford Scale. These were refined to 24 through item analyses and the scale was standardised on 535 patients with a range of problems of appearance and on a representative general population sample (1107)

Results. All 24 items contributed well to the total score and internal consistency was high (alpha = .92). Test retest reliability (six months) was good (.82) and criterion validity (with the DAS59) was excellent (.88). Good construct validity was demonstrated in differences between patient and general population samples and between members of the general population concerned and not-concerned about their appearance, and in patterns of convergent and divergent correlations with a range of established scales. The general population data revealed widespread concerns about appearance.

Conclusion. The DAS24 provides a widely applicable and acceptable short form of the original DAS59. It is psychometrically robust and discriminates well between patient groups, between clinical and non- clinical populations and, within the general population, between those concerned and those not-concerned about their appearance.

The DAS59 has been designed and developed to meet the need for an objective measure of the spectrum of psychological distress and dysfunction that is characteristic of disfigurements, deformities and aesthetic problems of appearance. Content validity has been assured by basing the scale’s items on a detailed autobiographical study of representative patients. Internal consistency is high (0.98) and test-retest reliabilities are good (general population: 0.75; clinical population: 0.86). Correlations with other appropriate standardised tests show good criterion validity and good construct validity. Factor analysis of 2741 data sets (general population and clinical population) identified three factors that are not feature specific and two that are (bodily and sexual features, facial features). The DAS59 thus generates a full-scale score and five factorial sub-scale scores. The DAS59 has been standardised on the clinical population across a range of patient groups and on the general population subdivided into those concerned and those not concerned about appearance. The DAS59 is highly sensitive as a measure of change following treatment with large and significant preoperative-postoperative reductions in full-scale and factorial scores of patients treated for facial features or bodily/sexual features. The DAS59 offers benefits for patient selection in both cosmetic and reconstructive plastic surgery and in the evaluation of outcome. It provides valid and reliable data for clinical audit and governance and for evaluating the merits of one treatment protocol against another.