Post-traumatic stress disorder associated with life-threatening motor vehicle collisions in the WHO World Mental Health Surveys.

Dan J Stein,Maria Petukhova,Yolanda Torres,Victoria Shahly,Ronald C Kessler,Silvia Florescu,Aimee Karam,Eric D Hill,Lukoye Atwoli,María Elena Medina-Mora,Hristo Hinkov,Andrew King,Evelyn J Bromet,Marina Piazza,Josep Maria Haro,Arieh Shalev,Alan M Zaslavsky,Fernando Navarro-Mateu,Elie G Karam

doi:10.1186/s12888-016-0957-8

Abstract

BackgroundMotor vehicle collisions (MVCs) are a substantial contributor to the global burden of disease and lead to subsequent post-traumatic stress disorder (PTSD). However, the relevant literature originates in only a few countries, and much remains unknown about MVC-related PTSD prevalence and predictors.MethodsData come from the World Mental Health Survey Initiative, a coordinated series of community epidemiological surveys of mental disorders throughout the world. The subset of 13 surveys (5 in high income countries, 8 in middle or low income countries) with respondents reporting PTSD after life-threatening MVCs are considered here. Six classes of predictors were assessed: socio-demographics, characteristics of the MVC, childhood family adversities, MVCs, other traumatic experiences, and respondent history of prior mental disorders. Logistic regression was used to examine predictors of PTSD. Mental disorders were assessed with the fully-structured Composite International Diagnostic Interview using DSM-IV criteria.ResultsPrevalence of PTSD associated with MVCs perceived to be life-threatening was 2.5 % overall and did not vary significantly across countries. PTSD was significantly associated with low respondent education, someone dying in the MVC, the respondent or someone else being seriously injured, childhood family adversities, prior MVCs (but not other traumatic experiences), and number of prior anxiety disorders. The final model was significantly predictive of PTSD, with 32 % of all PTSD occurring among the 5 % of respondents classified by the model as having highest PTSD risk.ConclusionAlthough PTSD is a relatively rare outcome of life-threatening MVCs, a substantial minority of PTSD cases occur among the relatively small proportion of people with highest predicted risk. This raises the question whether MVC-related PTSD could be reduced with preventive interventions targeted to high-risk survivors using models based on predictors assessed in the immediate aftermath of the MVCs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-0957-8) contains supplementary material, which is available to authorized users.

Highlights

Motor vehicle collisions (MVCs) are a substantial contributor to the global burden of disease and lead to subsequent post-traumatic stress disorder (PTSD)
MVCs perceived as life-threatening represented a weighted 14.3 % of these occurrences, making them the fourth most common traumatic experience, exceeded only by unexpected death of a loved one, being mugged, and witnessing a serious injury or death, (More detailed information on distributions of traumatic experienced are presented in Additional file 1: Table S2) A MVC considered by the respondent as life-threatening was the randomly selected traumatic experience for 649 respondents across the 13 surveys, ranging from a low of 17 in Lebanon to a high of 168 in the United States
Preliminary analysis found that prior exposure to other traumatic experiences (55.6 % of all MVCs) was not associated consistently with PTSD either when we considered the 20 prior traumatic experiences found to be associated with at least one case of PTSD in a multivariate equation or when we created an aggregate measure of number of such prior experiences (0, 1, 2, 3+). (Detailed results are presented in Additional file 1: Table S4)

Summary

Introduction

Motor vehicle collisions (MVCs) are a substantial contributor to the global burden of disease and lead to subsequent post-traumatic stress disorder (PTSD). Perhaps the most fundamental of these is that the vast majority of existing studies examining MVCrelated PTSD come from a few high-income countries, making it unclear whether similar findings hold elsewhere. This is an especially important limitation given that 90 % of traffic deaths occur in low- and middleincome countries, with fatality rates more than twice as high in these regions as in high-income countries [8]

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Conclusion