Motor Vehicle Accident Survivors Research Articles

THE ROLE OF ATTRIBUTION OF TRAUMA RESPONSIBILITY IN POSTTRAUMATIC STRESS DISORDER FOLLOWING MOTOR VEHICLE ACCIDENTS

Motor vehicle accidents (MVAs) are highly prevalent and associated with adverse psychological outcomes. The present study used data from the National Comorbidity Survey-Replication (NCS-R) to examine the association between injury, role in an MVA (driver/nondriver), attributions of responsibility for the accident, and posttraumatic stress disorder (PTSD), amongst 165 MVA survivors. Findings indicated that drivers with external attributions of the MVA (i.e. who considered others to be at fault for the MVA) were significantly more likely to have a diagnosis of PTSD than drivers with internal attributions (i.e. considering themselves to be at fault) and nondrivers with external attributions of the accident. Further, serious injury sustained in the accident was related to greater likelihood of developing PTSD. External attributions for the MVA among drivers, as well as serious injury during the accident, were related to higher rates of PTSD. The present findings have implications for models that highlight the importance of posttraumatic cognitions in contributing to mental health following a traumatic event.

The validation of the Polish version of the Posttraumatic Diagnostic Scale and its factor structure

BackgroundPosttraumatic Diagnostic Scale (PDS) is a self-descriptive measure developed to provide information regarding posttraumatic stress disorder (PTSD) diagnosis and symptom severity.ObjectivesThe aim of this article is to report on the validation of the Polish version of PDS and to test its factor structure with reference to two models: an original three-factor model (Reexperiencing, Avoidance, and Arousal) and alternative five-factor model (Reexperiencing, Avoidance, Numbing, Dysphoric Arousal, and Anxious Arousal).MethodThe validation procedure included three studies conducted on samples of separate populations: university-level students (n=507), individuals who had experienced various traumas (n=320), and treatment-seeking survivors of motor vehicle accidents (MVA) (n=302). Various other measures of trauma-related psychopathology were administered to participants, as well as the PTSD module of the Structured Clinical Interview (SCID) in the case of MVA patients.ResultsPDS showed high internal consistency and test–retest reliability, good diagnostic agreement with SCID, good sensitivity but relatively low specificity. The satisfactory convergent validity was supported by a large number of significant correlations with other measures of trauma-related psychopathology. Confirmatory factor analysis (CFA) generally confirmed both the three-factor structure and the alternative five-factor structure of the questionnaire.ConclusionsThe results show generally good psychometric properties of the Polish version of PDS.

Written exposure as an intervention for PTSD: A randomized clinical trial with motor vehicle accident survivors

The present study examined the efficacy of a brief, written exposure therapy (WET) for posttraumatic stress disorder (PTSD). Participants were 46 adults with a current primary diagnosis of motor vehicle accident-related PTSD. Participants were randomly assigned to either WET or a waitlist (WL) condition. Independent assessments took place at baseline and 6-, 18-, and 30-weeks post baseline (WL condition not assessed at 30 weeks). Participants assigned to WET showed significant reductions in PTSD symptom severity at 6- and 18-week post-baseline, relative to WL participants, with large between-group effect sizes. In addition, significantly fewer WET participants met diagnostic criteria for PTSD at both the 6- and 18-week post-baseline assessments, relative to WL participants. Treatment gains were maintained for the WET participants at the 30-week post baseline assessment. Notably, only 9% of participants dropped out of WET and the WET participants reported a high degree of satisfaction with the treatment. These findings suggest that a brief, written exposure treatment may efficaciously treat PTSD. Future research should examine whether WET is efficacious with other PTSD samples, as well as compare the efficacy of WET with that of evidence-based treatments for PTSD.

Predictors of Chronic Trauma-Related Symptoms in a Community Sample of New Zealand Motor Vehicle Accident Survivors

This study examined 1,500 New Zealand community-residing adults for involvement in serious motor vehicle accident (MVA) and the development of trauma-related symptomatology. The incidence of MVA was 11 %. More than 50 % of the accident victim sub-sample reported hyperarousal, with exaggerated startle, intrusive recollections, situational avoidance, emotional reactivity, and cognitive avoidance. The high incidence of trauma-related symptoms is noteworthy given 59 % of victims reported sustaining no or mild accident injury, and only 27 % were admitted to hospital for severe injury. Trauma-related symptoms were related to measures of injury severity, psychological and social functioning, and persistent medical problems. Pre- and post-accident factors, that is, experience of additional trauma, experience of stressful life events and post-accident social contact were the most important predictors of trauma-related symptoms severity. This study discusses the importance of examining trauma-related symptoms rather than using categorical diagnostic criteria (i.e., post-traumatic stress disorder, PTSD) as a sole means of characterizing the psychological impact of MVA.

P-984 - Plasma brain-derived neurotrophic factor predicts posttraumatic stress disorder in chinese motor vehicle accident survivors

Objective Brain-derived neurotrophic factor (BDNF) has an important role in learning, motivation and regulation of mood. A body of research indicates that dysregulation of BDNF is found in post-traumatic stress disorder (PTSD). The aim of this study was to investigate the association of baseline plasma BDNF and follow-up PTSD symptoms in Chinese motor vehicle accident survivors. Method Motor vehicle accident (MVA) survivors were recruited from one Emergency Room of Shanghai. BDNF plasma levels were measured in 24 hours after motor vehicle accident. The Clinician-Administered PTSD Scale (CAPS) was used to evaluated PTSD symptoms one month after accident. Totally, 60 MVA survivors participated in this study and 49 of them completed follow-up evaluation. Results In the one month follow-up interview, 14 of the MVA survivors met the PTSD diagnosis. The PTSD MVA survivors shown lower baseline BDNF plasma level when compare with non-PTSD participants (p Conclusions People who show lower plasma BDNF after traumatic event may be more susceptible to PTSD, and plasma BDNF could be a predictor of PTSD.

Search for a curvilinear relationship between the sense of coherence and the intensity of PTSD in MVA survivors

The relationship between the sense of coherence (SOC) and the intensity of posttraumatic stress disorder (PTSD) was examined in order to determine its nature and to resolve the inconsistencies between (1) a growing body of empirical research that indicates a linear relationship between these variables, and (2) the schema-based theories of PTSD that suggest a curvilinear relationship between cognitions and the intensity of PTSD. In this cross-sectional study an attempt was also made to identify some psychological factors that moderate this relationship. Participants were a sample of 1132 motor vehicle accident (MVA) survivors. The results showed that gender and temperamental predisposition to PTSD constituted moderator variables of the relationship between SOC and the intensity of PTSD. This supported both the empirical evidence on the linear and negative relationship between SOC and the intensity of PTSD and the theories that postulated the curvilinear relationship.

Readiness for Change Predicts Outcomes of Functional Rehabilitation Following Motor Vehicle Accident

Previous research has found pre-treatment motivational readiness to engage in pain self-management to be associated with completion of a rehabilitation program. This preliminary study examined this relationship, as well as the ability of pre-treatment readiness to change to predict clinical decisions of post-treatment functional work capacity. The sample consisted of 106 individuals involved in a tertiary functional rehabilitation program for motor vehicle accident (MVA) survivors. The Multidimensional Pain Inventory (MPI) and Pain Stages of Change Questionnaire (PSOCQ) were completed prior to treatment. Hierarchical logistic regression analyses revealed that PSOCQ profile scores (P = 0.008), including higher individual PSOCQ contemplation (OR = 5.30; P = 0.017) and action (OR = 5.16; P = 0.049) scores, significantly increased the likelihood of completing the functional rehabilitation program. Clinical decisions about functional work capacity were predicted by MPI profile scores (P = 0.001), and this model was significantly improved by the addition of PSOCQ scores (P = 0.037). Lower MPI interference (OR = 5.41; P = 0.002), and higher MPI affective distress (OR = 2.81; P = 0.010), MPI support (OR = 1.72; P = 0.027), and PSOCQ action (OR = 5.35; P = 0.038) scores were significant predictors of clinicians' decisions regarding functional work capacity in the final model that identified 88% of those judged capable of returning to work and 63% of those who were judged not capable of returning to work. This preliminary study suggests that readiness to self-manage pain is an important predictor of both completion of functional rehabilitation program and clinicians' decisions regarding functional work capacity after an MVA. The latter outcome appears to be more complex, influenced both by motivational readiness to engage in pain self-management and cognitive-behavioral adaptation to pain.

Ontario Psychological Association Guidelines for Assessment and Treatment in Auto Insurance Claims

The Ontario Psychological Association Guidelines for Assessment and Treatment in Auto Insurance Claims was published on the Ontario Psychological Association website in July, 2010 (Smith, A., and OPA Auto Task Force, 2010, Ontario Psychological Association Guidelines for Assessment and Treatment in Auto Insurance Claims. Ontario Psychological Association, Toronto, Ontario. Retrieved from http://www.psych.on.ca/files/members/OPA_Auto_Practice_Guidelines_July292010_July_30_2010.pdf). Excerpts are reproduced in the journal because of the comprehensive nature of the document. To our knowledge, this is the first time that state or provincial guidelines have included all the major psychological diagnoses in rehabilitation work with motor vehicle accident survivors (chronic pain, post-traumatic stress disorder, traumatic brain injury, depression). Space limitations preclude publishing of the full document, but it should be consulted. The present excerpt focuses on the nature of the psychological injuries and the best practices in treating them, along with cautions for assessment, comorbidities and polytrauma, litigation distress and barriers and complications in recovery.

Post‐traumatic growth as outcome of a cognitive‐behavioural therapy trial for motor vehicle accident survivors with PTSD

Treatment effects on post-traumatic growth (PTG) and its subdomains were investigated together with predictors of the Janus-face model of PTG. Effects were investigated within a randomized controlled trial of cognitive-behavioural therapy (CBT) for post-traumatic stress disorder (PTSD). Forty motor vehicle accident survivors were randomly assigned to a treatment or waiting condition. PTG was measured by the Post-traumatic Growth Inventory and complemented by its possible predictors (optimism, openness). The CBT treatment proved to be highly effective in terms of PTSD symptom reduction. In contrast to previous findings, however, there was no treatment effect on PTG in general. The CBT group showed, however, increases in PTG subdomains 'new possibilities' and 'personal strength'. The results of this study caution researchers to naively expect PTG as a uniformly positive outcome to evaluate treatment effectiveness.

Enhanced priming for trauma-related words predicts posttraumatic stress disorder.

There is preliminary evidence that enhanced priming for trauma-related cues plays a role in posttraumatic stress disorder (PTSD). A prospective study of 119 motor vehicle accident survivors investigated whether priming for trauma-related stimuli predicts PTSD. Participants completed a modified word-stem completion test comprising accident-related, traffic-related, general threat, and neutral words at 2 weeks post-trauma. Priming for accident-related words predicted PTSD at 6 months follow-up, even when initial symptom levels of PTSD and depression and priming for other words were controlled. The results are in line with the hypothesis that enhanced priming for traumatic material contributes to the development of chronic PTSD.

Longitudinal relationships between self‐efficacy, post‐traumatic distress and salivary cortisol among motor vehicle accident survivors

AbstractThe present study tested if post‐traumatic distress following a motor vehicle accident (MVA) and MVA‐related self‐efficacy beliefs were associated with diurnal salivary cortisol in the early post‐traumatic period. Cortisol was collected upon awakening and at 1, 4 and 12 h after waking. Collection days were 1 week, 1 month and 3 months after MVA. A total of 30 participants provided their cortisol samples across all measurement points. Two methods for computing the area under the cortisol curve were used. Higher post‐traumatic distress at 1 month predicted lower cortisol area under the curve (AUC) with respect to increase (AUCI, reflecting changes in cortisol secretions during daytime) at 3 months. AUC with respect to ground (AUCG, reflecting total cortisol release during daytime), measured at 1 month after trauma, predicted higher post‐traumatic distress at 3 months. The results showed that self‐efficacy at 1 week indirectly predicted 3‐month AUCI through 1‐month post‐traumatic distress. These findings highlight the importance of self‐efficacy and post‐traumatic distress in explaining longitudinal diurnal patterns of cortisol secretion after trauma. Copyright © 2011 John Wiley & Sons, Ltd.

Gender differences in PTSD symptoms: An exploration of peritraumatic mechanisms

Females are at higher risk than males for developing posttraumatic stress disorder symptoms (PTSS) following exposure to trauma, which may stem from gender differences in initial physiological and psychological responses to trauma. The present study aimed to examine a number of peri- and initial posttraumatic reactions to motor vehicle accidents (MVAs) to determine the extent to which they contributed to gender differences in PTSS. 356 adult MVA survivors (211 males and 145 females) reported on peritraumatic dissociation, perception of life threat and initial PTSS. In addition, heart rate and urinary cortisol levels were collected in-hospital. 6 weeks and 6 months later, PTSS were assessed via clinical interviews. Results suggested that initial PTSS and peritraumatic dissociation were marginally significant mediators at 6-week follow-up and significant mediators at 6-month follow-up, providing partial support for the hypothesis that initial responses to trauma may account for observed gender differences in PTSS development.

Heart rate measured in the acute aftermath of trauma can predict post-traumatic stress disorder: A prospective study in motor vehicle accident survivors

Objective To determine whether increased physiological arousal immediately after trauma or at emergency admission can predict post-traumatic stress disorder (PTSD) in motor vehicle accident (MVA) survivors with physical injuries. Methods We included 119 MVA survivors with physical injuries. In this prospective cohort study, heart rate (HR) and blood pressure (BP) were assessed during ambulance transport (T1) and at hospital admission (T2). One and four months after the accident, we assessed patients for PTSD (Davidson trauma scale, confirmed with the structured clinical interview for DSM-IV axis I disorders). Multivariate logistic regression models assessed the relationship between HR or BP and PTSD. Results PTSD was diagnosed in 54 (45.4%) patients at 1 month and in 39 (32.8%) at 4 months. In the multivariate analysis, HR at T1 or at T2 predicted PTSD at 1 month (OR=1.156, 95% CI [1.094;1.221] p < 0.0001). Only HR at T1 (not at T2) predicted PTSD at 4 months (OR=1.059, 95% CI [1.013; 1.108] p = 0.012). Injury severity predicted PTSD at 4 months (OR=1.207, 95% CI [1.085; 1.342] p = 0.001). A cut-off of 84 beats per minute yielded a sensitivity of 62.5% and a specificity of 75.0% for PTSD. Conclusions HR measured at the scene of MVA and severity of injury predicted PTSD 4 months later.

Posttraumatic growth, posttraumatic stress disorder and resilience of motor vehicle accident survivors

BackgroundAlthough some previous studies have suggested that posttraumatic growth (PTG) is comprised of several factors with different properties, few have examined both the association between PTG and posttraumatic stress disorder (PTSD) and between PTG and resilience, focusing on each of the factors of PTG. This study aimed to examine the hypothesis that some factors of PTG, such as personal strength, relate to resilience, whereas other factors, such as appreciation of life, relate to PTSD symptoms among Japanese motor vehicle accident (MVA) survivors.MethodsThis cross-sectional study was performed with 118 MVA survivors at 18 months post MVA. Data analyzed included self-reporting questionnaire scores on the Posttraumatic Growth Inventory (PTGI), the Impact of Event Scale- Revised (IES-R), and the Sense of Coherence (SOC) scale, which is one of the most widely used scales for measuring resilience. Correlations between scores on the PTGI and IES-R, the PTGI and SOC scale, and the IES-R and SOC scale were established by calculating Spearman's correlation coefficients.ResultsPTGI was positively correlated with both SOC and PTSD symptoms, in spite of an inverse relationship between SOC and PTSD symptoms. Relating to others, new possibilities, and personal strength on the PTGI were correlated positively with SOC, and spiritual change and appreciation of life on the PTGI were positively correlated with PTSD symptoms.ConclusionsSome factors of PTG were positively correlated with resilience, which can be regarded as an outcome of coping success, whereas other factors of PTG were positively correlated with PTSD symptoms, which can be regarded as signifying coping effort in the face of enduring distress. These findings contribute to our understanding of the psychological change experienced by MVA survivors, and to raising clinicians' awareness of the possibility that PTG represents both coping effort coexisting with distress and outcome of coping success.

Current Concepts of the Treatment of Adult Brachial Plexus Injuries

As the number of survivors of motor vehicle accidents and extreme sporting accidents increases, the number of people having to live with brachial plexus injuries increases. Although the injured limb will never return to normal, an improved understanding of the pathophysiology of nerve injury and repair, as well as advances in microsurgical techniques, have enabled the upper extremity reconstructive surgeon an opportunity to improve function in these life-altering injuries. The purpose of this review is to detail some of the current concepts of the treatment of adult brachial plexus injuries and give the reader an understanding of the nuances of the timing, available treatment options, and outcomes of treatment.

Peritraumatic Distress Inventory as a predictor of post‐traumatic stress disorder after a severe motor vehicle accident

The aim of this study was to examine the utility of the Peritraumatic Distress Inventory (PDI) as a predictor of subsequent post-traumatic stress disorder (PTSD) in severe motor vehicle accident survivors. Patients consecutively admitted to the intensive care unit were assessed immediately and 1 month after accidents in this prospective study. The predictive value for post-traumatic stress symptoms at 1 month of the PDI at initial assessment was examined by using multivariate regression analysis. Moreover, the accuracy of the PDI as a predictor of PTSD was determined using receiver operator characteristic curve analysis. Post-traumatic stress symptoms were assessed using the Impact of Event Scale - Revised questionnaire, and PTSD was assessed using the Clinician-Administered PTSD Scale. Seventy-nine patients completed the Impact of Event Scale - Revised questionnaire, and 64 patients participated in a structured interview. Of 64 patients, 13 met the diagnostic criteria of full or partial PTSD. The PDI was an independent predictor of post-traumatic stress symptoms (P = 0.003). The data indicated that a cut-off score of 23 maximized the balance between sensitivity (77%) and specificity (82%) in this study. Compared with negative predictive value (93%), positive predictive value was not high (53%). The study suggests the predictive usefulness of the PDI for subsequent PTSD in accident survivors. Its adequate usage should be further elaborated.

Trauma Type and Posttrauma Outcomes: Differences Between Survivors of Motor Vehicle Accidents, Sexual Assault, and Bereavement

Research examining posttrauma pathology indicates negative outcomes can differ as a function of the type of trauma experienced. Such research has yet to be published when looking at positive posttrauma changes. Ninety-four survivors of trauma, forming three groups, completed the Posttraumatic Growth Inventory and Impact of Events Scale-Revised. Groups comprised survivors of (a) sexual abuse, (b) motor vehicle accidents, and (c) bereavement. Results indicated differences in growth between the groups, with the bereaved reporting higher levels of growth than other survivors and sexual abuse survivors demonstrating higher levels of posttraumatic stress disorder symptoms than the other groups. However, this did not preclude sexual abuse survivors from also reporting moderate levels of growth. Results are discussed with relation to fostering growth through clinical practice.

Virtual Reality Treatment of Posttraumatic Stress Disorder Due to Motor Vehicle Accident

Posttraumatic stress disorder (PTSD) is a complex, multifaceted disorder encompassing behavioral, emotional, cognitive, and physiological factors. Although PTSD was only codified in 1980, there has been an increasing interest in this area of research. Unfortunately, relatively little attention has been given to the psychological treatment of motor vehicle accident survivors, which is remarkable because vehicular collisions are deemed the number one cause of PTSD. As the emotional consequences of vehicular collisions prevail, so does the need for more effective treatments. Randomized controlled clinical trials have identified exposure-based therapies as being the most efficacious for extinguishing fears. One type of exposure-based treatment, called virtual reality exposure therapy (VRET), provides a safe, controlled, and effective therapeutic alternative that is not dependent on real-life props, situations, or even a person's imagination capabilities. This modality, while relatively new, has been implemented successfully in the treatment of a variety of anxiety disorders and may offer a particularly beneficial and intermediary step for the treatment of collision-related PTSD. In particular, VRET combined with physiological monitoring and feedback provides a unique opportunity for individuals to objectively recognize both anxiety and relaxation; learn how to manage their anxiety during difficult, albeit simulated, driving conditions; and then transfer these skills onto real-life roadways.

Maladaptive cognitive appraisals mediate the evolution of posttraumatic stress reactions: A 6-month follow-up of child and adolescent assault and motor vehicle accident survivors.

A prospective longitudinal follow-up study (n = 59) of child and adolescent survivors of physical assaults and motor vehicle accidents assessed whether cognitive processes predicted posttraumatic stress symptomatology (PTSS) at 6 months posttrauma in this age group. In particular, the study assessed whether maladaptive posttraumatic appraisals mediated the relationship between initial and later posttraumatic stress. Self-report measures of PTSS, maladaptive appraisals, and other cognitive processes, as well as structured interviews assessing for acute stress disorder and posttraumatic stress disorder (PTSD), were completed at 2-4 weeks and 6 months posttrauma. PTSS and PTSD at 6 months were associated with maladaptive appraisals and other cognitive processes but not demographic or objective trauma severity variables. Only maladaptive appraisals were found to associate with PTSS/PTSD after partialing out initial symptoms/diagnosis and to mediate between initial and later PTSS. It was argued that, on this basis, maladaptive appraisals are involved in the development and maintenance of PTSS over time, whereas other cognitive processes (e.g., subjective threat, memory processes) may have an effect only in the acute phase. The implications of this study for the treatment of PTSS in youths are discussed.

Short-term psychological consequences of car accidents: an empirical study

Aim of this study is to investigate short-term (3 and 5 months) psychological consequences of severe motor-vehicle accidents. The sample under investigation is composed of two groups: 8 survivors of severe motor-vehicle accidents with spinal cord injuries (SCI) hospitalized in a Spinal Cord Unit, and 6 survivors who did not require hospitalization. All subjects were assessed twice, three and five months after the accident, on a variety of measures including the CAPS and the BDI-SF. Prevalence of PTSD in the total sample was, 3 months after the accident, 14% with no significant differences between the two groups; some peculiarities in the symptomathological profile emerged as much as subjects with SCI experience avoidance of trauma-related stimuli more frequently. An overall decline in frequency and severity of post-traumatic symptoms between the two assessments was observed in the total sample, though some components (Criterion C symptoms) showed no relevant variations over time. Finally, depressive symptoms, which were characterized by higher severity in the SCI group, showed a significant decline between the two assessments. Our data, although based on a limited sample, might help in tailoring psychological interventions for prevention and treatment of PTSD in survivors of severe motor accidents.