Effect of PERMA Model on Anxiety, Depression, Post-Traumatic Stress Symptoms and Quality of Life in Patients With Scar Plastic Surgery After Burn

Abstract

Background: This study aimed to explore how Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment (PERMA)-based nursing anxiety, depression, post-traumatic stress symptoms (PTSD) and quality of life in patients with post-burn scar plastic surgery.

Methods: A retrospective cohort study was conducted using data from patients who underwent scar plastic surgery for burn-related scar at our hospital between January 2023 and January 2025. Based on the type of nursing care they received, we divided patients into two groups: 51 patients who received PERMA-based nursing were assigned to the PERMA nursing group, and 51 patients who received routine nursing only were assigned to the routine nursing group. Both groups received 12 weeks of nursing care. We assessed all outcome measures, including the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), PTSD Checklist-Civilian Version (PCLC), Simplified Coping Style Questionnaire (SCSQ), SelfAcceptance Questionnaire (SAQ), and Generic Quality of Life Inventory-74 (GQOL-74), were assessed at baseline and again after the 12-week nursing period in both groups. Pearson correlation analysis was performed to evaluate the relationships among the psychological improvement scores.

Results: After the nursing intervention, both groups showed decreases in SAS scores, SDS scores, PCL-C scores, and negative coping scores of both groups decreased after the nursing, and those of the PERMA nursing group were lower (p < 0.05). The positive coping scores and SAQ scores of both groups increased, and those of the PERMA nursing group were higher (p < 0.05). The GQOL-74 scores of both groups increased after the nursing, and those of the PERMA nursing group were higher (p < 0.05). Correlation analysis revealed that anxiety relief (∆SAS) was significantly tied to improvements in both depression and PTSD symptoms. Furthermore, reductions in negative coping strategies (∆negative coping) acted as a key factor that correlated with lower levels of anxiety and traumatic stress.

Conclusions: PERMA-based nursing is associated with reduced anxiety, depression, and PTSD symptoms, as well as improved coping strategies, self-acceptance, and improved quality of life in patients undergoing scar plastic surgery after burn.