Rotterdam and Amsterdam, The Netherlands From the Department of Plastic and Reconstructive Surgery, Erasmus University Medical Center; Department of Medical Psychology and Psychotherapy, Erasmus University Medical Center, Netherlands Institute for Health Sciences; and the Department of Psychology and Education, VU University.
Plast Reconstr Surg. 2012 Jan;129(1):110-117. doi: 10.1097/PRS.0b013e3182361f64.
In adults with severe congenital facial disfigurement, assessment of long-term psychological impact remains limited. This study determines the long-term psychological functioning in these patients and evaluates differences compared with patients with acquired facial disfigurement and a non-facially disfigured reference group. Also explored is the extent to which psychological functioning of the congenital group is related to satisfaction with facial appearance, fear of negative appearance evaluation by others, self-esteem, and severity of the facial deformity.
Fifty-nine adults with severe congenital facial disfigurement, 59 adults with a traumatically acquired facial deformity in adulthood, and 120 non-facially disfigured adults completed standardized psychological, physical, and demographic questionnaires, including the Fear of Negative Appearance Evaluation Scale, the Rosenberg Self-Esteem Scale, the Hospital Anxiety and Depression Scale, the Achenbach Adult Self-Report, the 36-Item Short-Form Health Survey, and a visual analogue scale.
Adults with severe congenital facial disfigurement had relatively normal psychological functioning but appeared more prone to internalizing problems than the non-facially disfigured adults. Compared with patients with an acquired facial deformity, the congenital group displayed fewer problems on the physical component score of quality of life only. Satisfaction with facial appearance, fear of negative appearance evaluation, and self-esteem were good predictors of the different aspects of psychological functioning, with the exception of the physical component score of quality of life.
Improving satisfaction with facial appearance (by surgery), enhancing self-esteem, or lowering fear of negative appearance evaluation (by psychological support) may enhance long-term psychological functioning. Future research should focus on the individual patient and risk factors for maladjustment.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
在患有严重先天性面部畸形的成年人中，对长期心理影响的评估仍然有限。本研究旨在确定这些患者的长期心理功能，并评估与后天性面部畸形患者和非面部畸形对照组之间的差异。还探讨了先天性组的心理功能与对面部外观的满意度、对他人负面外貌评价的恐惧、自尊以及面部畸形的严重程度之间的关系。
59 名患有严重先天性面部畸形的成年人、59 名成年后患外伤性面部畸形的成年人和 120 名非面部畸形的成年人完成了标准化的心理、生理和人口统计学问卷，包括负面外貌评价恐惧量表、罗森伯格自尊量表、医院焦虑和抑郁量表、Achenbach 成人自我报告、36 项简明健康调查问卷和视觉模拟量表。
患有严重先天性面部畸形的成年人的心理功能相对正常，但比非面部畸形的成年人更容易出现内化问题。与后天性面部畸形患者相比，先天性组仅在生活质量的生理成分评分上表现出较少的问题。对面部外观的满意度、对负面外貌评价的恐惧和自尊是心理功能不同方面的良好预测指标，但生活质量的生理成分评分除外。
改善对面部外观的满意度（通过手术）、提高自尊或降低对负面外貌评价的恐惧（通过心理支持）可能会增强长期的心理功能。未来的研究应关注个体患者和适应不良的风险因素。
临床问题/证据水平：风险，II 级。
