The development of psychological and associated mental health disorders after road traffic crashes and other injuries

Abstract

Injury contributes approximately 12% of the world’s burden of injury and there is increasing evidence that injury results in the new onset of a range of psychiatric disorders. Posttraumatic stress disorder (PTSD) is one of the more common psychiatric disorders after injury due to road crashes and other forms of traumatic injury. The incidence of PTSD in a number of well controlled studies has been reported at 10-25% but it has been reported to be less than 10% in other studies. In one large longitudinal study, where patients were followed up to 12 months after injury, 31% of patients had developed a psychiatric diagnosis at 12 months and 22% had a new psychiatric diagnosis. PTSD can occur in combination with other psychiatric disorders or as a single diagnosis. The most common new psychiatric disorders in the above study were depression, generalised anxiety disorder, PTSD and agoraphobia. Many patients with psychiatric symptoms after injury did not seek professional assistance and only a minority of patients (33%) sought mental health treatment at 12 months. Functional impairment (physical, psychological, social and environmental impairment) at 3 months has also been shown increase the risk of the development of a psychiatric disorder at 12 months. PTSD symptoms (intrusive thoughts, avoidance behaviour and hyper-arousal symptoms) may persist or become worse if not diagnosed and treated within the first 12 months. These symptoms can be extremely debilitating and lead to social isolation, relationship breakdown and ongoing psychological dysfunction. The presence of head injury, substance abuse, depression and other psychiatric disorders may further complicate the diagnosis and treatment of PTSD and other psychiatric disorders. The presence of mild Traumatic Brain Injury increases the risk of subsequent development of PTSD, panic disorders, agoraphobia and social phobia. A biological model of anxiety disorder suggests that fear is mediated by impaired regulation of the amygdala by the ventral medial prefrontal cortex and damage to this area may lead to increased vulnerability of the patient to develop anxiety and depression due to impaired neural regulation. The main issue associated with the diagnosis and treatment of patients with PTSD and other psychiatric disorders depends on appropriate presentation and available treatment options including cognitive behavioural therapy, desensitisation or drug treatment. It appears that up to 33% of patients may develop a psychiatric illness after a traumatic injury and this may lead to significant functional impairment and social dysfunction. Public health initiatives are required to address the mental health burden caused by these disorders. I will address some of the newer approaches to both the early identification and diagnosis of these disorders and suggest some early interventions for both the treatment and prevention of these debilitating psychiatric disorders.