Alcohol dependence before burn injuries: A driver of long-term psychiatric morbidity and mortality

Alcohol use disorder is prevalent among burn patients, with studies estimating that 30-50% present with intoxication or a history of dependence at the time of injury. However, there is a paucity of literature detailing alcohol dependence and mental health after burn injury. This study evaluated the association of alcohol dependence among burn patients with onset of psychiatric disorders as well as mortality.

A retrospective analysis was conducted of a multi-institutional database of burn patients between April 2010 and June 2025. Two burn cohorts were identified: pre-existing alcohol-dependent patients and those without alcohol dependence. Individuals with pre-existing psychiatric disorders were excluded. Cohorts were 1:1 propensity-score matched for demographics, comorbidities, concurrent substance use, total body surface area burned, and procedural interventions. Risk ratios (RRs) were calculated for development of psychiatric disorders, readmission, and mortality at 3 months and 12 months post-burn, with significance set at p < 0.05.

Following matching, each cohort had 6928 burn patients. At 3 months post-burn, alcohol-dependent patients had significantly higher rates of readmission (RR 1.87) as well as onset of opioid-use disorder (RR 1.91), depression (RR 2.68), anxiety (RR 2.13), PTSD (RR 2.35), adjustment disorder (RR 1.77), suicidal ideation (RR 2.82), and sleep disorders (RR 1.56) (all p < 0.05). At 12 months post-burn, all outcomes remained significant, with the addition of increased mortality (RR 1.27; p < 0.001).

Alcohol dependence was associated with significant risk of developing new-onset psychiatric morbidities among burn patients without preceding psychiatric diagnosis.