UNDIAGNOSED POSTTRAUMATIC-STRESS-DISORDER FOLLOWING MOTOR-VEHICLE ACCIDENTS

Objectives: To determine the pattern of emergence of post-traumatic stress disorder (PTSD) among motor vehicle accident victims and to examine the influence of PTSD on subsequent levels of disability. Design: A longitudinal study of motor vehicle accident victims one month and 18 months after the accident. Subjects: Twenty-four motor vehicle accident victims admitted by the trauma team at the Royal Adelaide Hospital. A 52% response rate was achieved. Main outcome measures: Post-traumatic stress disorder as diagnosed by the Diagnostic Interview Schedule and disability as measured with the Sickness Impact Profile. Results: Eighteen months after their accidents, six of the 24 subjects had clinically significant PTSD and one was considered borderline. None had been previously diagnosed or treated. The group with PTSD had higher scores on all measures of psychological distress one month after the accident and were more likely to use immature psychological defences. There was no association between physical outcome (measured with the modified Glasgow Outcome Scale) at six months and subsequent diagnosis of PTSD. However, the group with PTSD had higher levels of disability on assessment with the Sickness Impact Profile, particularly in the domain of social functioning. The results suggest PTSD was associated with work-related dysfunction equal to that associated with severe physical handicap. Conclusion: The data from this pilot study suggest that PTSD after motor vehicle accidents is an important cause of disability, which may also become the focus for damages in litigation. Thus, there is a need for further investigation of the early patterns of distress and to design preventive programs for victims of road accidents.