Dear Editor,

I read the article by Rubab et al. with considerable interest [1]. The study assessing self-esteem and depression in burn afflicted women should be regarded as an important aspect in the welfare of the patients and is commendable on what the study has tried to achieve in this aspect. The findings showed that depression is dependent on burn status, religion, age and marital status of the patient, whereas selfesteem is dependent on burn status. I would like to point out some points or suggestions, I noticed in methodology and term used in the article.

The first part in the methodology caught my attention as the study was conducted in two tertiary care private institution in an urban metropolitan area of Pakistan. Having participants from the private institution makes it very avid that the family is supportive and are willing to pay for the treatment. Patients who lack sufficient health care insurance, financial matters, access and even knowledge become an integral part for the considerations for treatment in private institutions. It would have given a clearer picture of assessment of selfesteem and depression had a public institution been included along with a private one for the study instead of including two tertiary care private institutions. Including patients from both public and private institutions may also point a view on how the access, care and services available from these two different health care institutions can affect depression and self-esteem of the burn afflicted women.

The terms like the “type of burn” explained in this study were divided into accidental or non-accidental, which seemed more of the nature or cause of burn. Whereas when we talk of type of burns or those given in the literature, it commonly refers the type of burn to the degree of burn or type of burns where the layers of skin are involved [2].

It is important to understand how or whether the site of burn could have an impact on self-esteem and depression on patients and especially more in women, as a previous study had concluded that the site of burns and burn depth, all have a great role in the development of psychiatric problem. It is also emphasized that facial burns in women are associated with greater risk of depression since women are found to be vulnerable to the outcome of disfigurement [3].

In this study majority of women (82.9%) were burnt accidentally and the reasons stated here in the article for being burnt “accidental” seemed more “intentionally” rather than being “accidentally”.

Family conflict, marriage proposal rejection and financial matters are the examples that have been mentioned in this study to be cause of “accidental” burns. Such examples have been stated to be intentional and not accidental, since a motive or an “intention” is involved in such kind or cause of burn [4,5]. Knowing the cause or kind whether intentional or accidental becomes important as the cause of any underlying stress or depression or lack of self-esteem can be better evaluated, and an insight is provided if the event of burn has aggravated such mental state of depression or lack of self-esteem.

Nil.

There are no conflicts of interest.