Prevalence of acute stress disorder among road traffic accident survivors: a meta-analysis

Wenjie Dai,Atipatsa C Kaminga,Zhiwei Lai,Jing Deng,Jianzhou Yang,Aizhong Liu,Shi Wu Wen

doi:10.1186/s12888-018-1769-9

Abstract

BackgroundRoad traffic accident (RTA), an unexpected traumatic event, may not only lead to death and serious physical injuries, but also could put survivors at an increased risk for a wide range of psychiatric disorders, particularly acute stress disorder (ASD). Early assessment of trauma-related psychological responses is important because acute trauma responses in the early post-traumatic period are among the robust predictors of long-term mental health problems. However, estimates of the prevalence of ASD among RTA survivors varied considerably across studies. Therefore, this meta-analysis aimed to identify the pooled prevalence of ASD among RTA survivors.MethodsA systematic literature search in the databases of PubMed, PsycINFO, PsycARTICLES, Embase and Web of Science was performed from their inception dates to December 2017. Subject headings were used to identify relevant articles, and the search strategy was adjusted across databases. Heterogeneity across studies was evaluated by Cochran’s χ2 test and quantified by the I2 statistic. Subgroup analyses were performed to identify the pooled prevalence in relation to the country of study, instrument used to identify ASD, age, gender and traumatic brain injury. When significant heterogeneity was observed, the influence of some potential moderators was explored using meta-regression analyses.ResultsThirteen eligible studies conducted in 8 countries were included. A total of 2989 RTA survivors were assessed, of which 287 were identified with ASD. The overall heterogeneity was high across studies (I2=96.8%, P < 0.001), and the pooled prevalence of ASD among RTA survivors was 15.81% (95% confidence interval: 8.27–25.14%). Subgroup analyses indicated that the prevalence of ASD among RTA survivors differed significantly with regard to the country of study, instrument used to identify ASD, age and gender (P < 0.05). Meta-regression analyses showed that mean age of participants and quality assessment score were significant moderators for heterogeneity (P < 0.05).ConclusionsNearly one-sixth of RTA survivors suffer from ASD, indicating the need for regular assessment of early trauma responses among RTA survivors, as well as the importance of implementing early psychological interventions.

Highlights

Road traffic accident (RTA), an unexpected traumatic event, may lead to death and serious physical injuries, and could put survivors at an increased risk for a wide range of psychiatric disorders, acute stress disorder (ASD)
Eligibility criteria Studies were included in this meta-analysis if they meet the following criteria: (1) the study design was observational; (2) the target population focused on or included RTA survivors; (3) the ASD diagnosis was made from two days to four weeks following RTA with specific reference to RTA; (4) the instrument used to identify ASD was based on the Diagnostic and statistical manual of mental disorders (DSM)-IV criteria with a binary outcome of “yes” or “no”;(5) information about the sample size and the prevalence of ASD among RTA survivors was provided; and (6) full article was written in English
The overall heterogeneity was high across studies (I2=96.8%, P < 0.001), and the pooled prevalence of ASD among RTA survivors was 15.81% by a random effects model (Fig. 2)

Summary

Introduction

Road traffic accident (RTA), an unexpected traumatic event, may lead to death and serious physical injuries, and could put survivors at an increased risk for a wide range of psychiatric disorders, acute stress disorder (ASD). Accumulated evidence has shown that RTA, an unexpected traumatic event, may lead to death and serious physical injuries, and could put survivors at an increased risk for a wide range of psychiatric disorders, acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) [4,5,6]. ASD has been reclassified into Trauma- and Stressor-Related Disorders, and according to the DSM-V criteria, ASD is defined by five symptom clusters namely intrusion, negative mood, dissociation, avoidance, and arousal [11]

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