Emotional Reactivity and Emotion Regulation in Relation to Health-Related Quality of Life After Burn Injury: A Secondary Observational Analysis

<jats:p>Burn severity alone does not fully explain differences in health-related quality of life (HRQoL) after burn injury. This secondary observational analysis evaluated whether emotional reactivity and emotion-regulation strategies were associated with HRQoL beyond conventional measures of burn severity. Data from 256 adult patients with burn injury treated at the Vietnam National Burn Hospital, Hanoi, Vietnam, from October 2024 to January 2025, were analyzed. Total body surface area (TBSA) and burn depth represented clinical severity. Emotional reactivity was assessed using the Emotion Reactivity Scale (ERS), while cognitive reappraisal and expressive suppression were assessed using the Emotion Regulation Questionnaire–Short Form. Burn-specific HRQoL was measured using the Burn-Specific Health Scale–Brief (BSHS-B), and generic HRQoL using the EQ-5D-5L. Pearson correlations and hierarchical multivariable regression were performed. TBSA was positively associated with ERS (r = 0.30, p &amp;lt; 0.001), whereas burn depth was not significantly associated with ERS (p = 0.18). Higher ERS was associated with poorer BSHS-B Function (r = −0.34), Affect and Relations (r = -0.39), Skin Involvement (r = -0.28), and EQ-5D-5L (r = -0.32) scores (all p &amp;lt; 0.001). Cognitive reappraisal showed positive, whereas expressive suppression showed negative associations with HRQoL. In hierarchical regression, psychosocial variables increased adjusted R² from 0.168 to 0.291 (Δ adjusted R² = 0.123, p &amp;lt; 0.001). These findings indicate that psychosocial characteristics provide additional explanatory information beyond demographic and clinical measures of burn severity and support their consideration in multidimensional assessment and individualized burn rehabilitation.</jats:p>