Motor Vehicle Accident Survivors Research Articles

An internet based virtual reality intervention for preventing posttraumatic stress disorder

Introduction: Research examining the prevention of Posttraumatic Stress Disorder (PTSD) has shown that selective treatments to those with high symptom levels, using trauma focused CBT are relatively successful in reducing symptoms and preventing chronic PTSD. However, uptake of these early treatments is often low. This study aimed to provide an internet based Virtual Reality treatment to overcome some of these barriers to early treatment.Method: The study received IRB approval from Hadassah Hospital (HMO 0056-013); its ClinicalTrials.gov identifier is NCT01760213. Recent survivors of motor vehicle accidents (N = 1,500) were assessed by telephone and online questionnaires. Patients meeting study criteria were randomly assigned to a Virtual Reality internet-based trauma-focused cognitive behavioral therapy (CBT) or waitlist control.Results: the majority of subjects recruited did not meet study criteria or were unwilling to participate. 14 subjects were randomly assigned to treatment or waitlist control. Results indicate that both groups show a decline in PTSD symptoms at follow up, with no significant differences between groups.Discussion: prevention of PTSD is a challenging goal, and internet-based interventions may play a role in this. The current study was not able to recruit sufficient participants to draw conclusions regarding the efficacy of the treatment. Proving services via the internet may not reduce barriers to care in this population.Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT01760213?term=Freedman&cond=PTSD&cntry=IL&draw=2&rank=2, identifier NCT01760213.

Coping Strategies Adopted by Motor Vehicle Accident Survivors from a Hilly State of North India.

Dealing with trauma has always been challenging for people from all walks of life. Moreover, traumas like Motor Vehicle Accidents (MVA) are sudden and can be life-threatening, which further raises the concern and thus requires healthy adaptation. Considering the lack of data on the coping strategies of accident survivors in India, this study was undertaken to assess the coping strategies adopted by MVA survivors. Cross-sectional survey was conducted at tertiary care institution in Uttarakhand (India) during 2019-2020. A total of 250 MVA survivors were selected through total enumerative sampling and assessed for posttraumatic stress disorder (Posttraumatic Stress Disorder Checklist (PCL)-5), depression (Zung self-rating depression scale), and coping strategies (Brief COPE questionnaire). The mean score was highest for emotion-focused coping mechanism (32.84 ± 5.18) and lower for dysfunctional (26.18 ± 10.59) and problem-focused (18.47 ± 3.12) coping mechanisms. Religion (96.87%) and emotional support (87.25%) were among the frequently adopted coping styles, whereas denial and self-blame were the least adopted. A high correlation was found between depression and the three coping mechanisms (r = 0.83 [emotion-focused coping], 0.68 [problem-focused coping], 0.62 [dysfunctional coping]). Among the participants, 133 crossed the threshold for PTSD and/or depression. A commonly adopted coping strategy among MVA survivors is emotion-focused coping mechanism. Religion and emotional support are most prevalent because of family dynamics prevalent in countries like India.

The relationship of trauma-related guilt with PTSD symptoms in adult trauma survivors: a meta-analysis.

Posttraumatic stress disorder (PTSD) is a severe condition that is associated with trauma-related guilt. We aimed at providing a comprehensive quantitative systematic review on the relationship between trauma-related guilt and adult PTSD. Database searches in Medline, PsycINFO, PTSDpubs and Web of Knowledge resulted in the inclusion of 163 eligible studies with a total of 35 020 trauma survivors. The studies reported on 157 cross-sectional and 19 longitudinal data points. Overall, we included 135 studies not included in previous meta-analyses. Random-effect models yielded a moderate cross-sectional correlation (r = 0.38, 95% CI 0.35-0.42, p < 0.001, I2 = 90.3%) and a small to moderate predictive correlation (r = 0.21, 95% CI 0.13-0.29, p < 0.001, I2 = 66.7%). The association appeared to be stable over time and was robust to sensitivity analyses. All symptom clusters significantly correlated with guilt. No effects were found for military v. civilian populations or clinical v. non-clinical samples. Effects were smaller for high-quality studies and larger for instruments based on DSM-5. Further significant moderators were type of guilt measure and trauma type. The largest association was found among participants reporting war-related trauma (r = 0.44, 95% CI 0.36-0.51) and the smallest among survivors of motor-vehicle accidents (r = 0.18, 95% CI 0.02-0.33). The results underpin the role of trauma-related guilt in the onset and maintenance of PTSD symptoms, which have important clinical implications. Future studies should further explore the change interactions of guilt and PTSD symptoms.

Neuroticism and PTSD symptoms: Gender moderates the mediating effect of peritraumatic emotions and dissociation.

Gender differences in posttraumatic stress disorder (PTSD) prevalence and severity are well established; there is also growing evidence that men and women develop PTSD symptoms differently. This article aims to examine gender differences in the relationship between PTSD symptoms and personality traits according to the Five Factor model (FFM), based on the data from different studies conducted in Poland. The meta-analysis method and path analyses were conducted on the data from seven studies, including 1,182 women and 1,150 men. Five studies were carried out among motor vehicle accident survivors, one from fire and flood victims. All of the studies had a cross-sectional design. All FFM traits were significantly related to PTSD symptoms. Neuroticism showed the strongest relationship. Further analyses revealed a moderated mediation of this relationship: It was stronger for men and mediated by peritraumatic emotions and dissociation for women. The results indicate that PTSD development is mediated by peritraumatic factors, but this mediation is moderated by gender. Men with higher Neuroticism are at particular risk of developing PTSD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Comparison of Motor Vehicle Accident (MVA) Survivors and Non-MVA Pain Patients Attending an Interdisciplinary Pain Management Program

Comparison of Motor Vehicle Accident (MVA) Survivors and Non-MVA Pain Patients Attending an Interdisciplinary Pain Management Program

Post-Traumatic Stress Disorder and Motor Vehicle Accidents in Tunisian Patients: An Observational Study

Background: Post-traumatic stress disorder (PTSD) remains underestimated and under-investigated by trauma specialists who are more likely to be sought for physical complaints than for emotional distress. Objectives: This paper aimed at: - specifying the clinical characteristics of a population of motor vehicle accidents (MVA) survivors.

Clinical Correlations of Posttraumatic Nightmares in Survivors of Motor Vehicle Accidents

Background: We evaluated the severity and clinical correlates of nightmares of persons injured in high impact motor vehicle accidents (MVAs).&#x0D; Method: De-identified data of 80 post-MVA patients (mean age 38.9 years, SD=12.8) were available and included scores on Item 2 of the PCL-5 (severity of repeated, disturbing dreams of the stressful event). Scores were also available on the Brief Pain Inventory (BPI), Morin’s Insomnia Severity Index (ISI), Rivermead Post-concussion Symptoms Questionnaire, Subjective Neuropsychological Symptoms Scale (SNPSS), Whiplash Disability Questionnaire, and on three questionnaire measures of driving anxiety (Steiner’s, Whetstone’s, and DAQ). The patients were assessed, on the average, 49.7 weeks (SD=36.3) after their MVA; all still experienced active post-MVA symptoms requiring therapy.&#x0D; Results: Clinically relevant levels of MVA nightmares were reported by 62.5% of post-MVA patients. Subjectively more aversive levels of MVA nightmares correlated with higher driving anxiety as measured by the Whetstone questionnaire and DAQ, with higher levels of average post-accident pain and insomnia, with post-accident neuropsychological symptoms as measured by the Rivermead and SNPSS, and with higher post-accident levels of depression, anger, and generalized anxiety.&#x0D; Discussion and Conclusions: Almost two-thirds of our post-MVA patients reported MVA nightmares and their level of subjectively aversive impact correlated with most variables within the typical polytraumatic symptom pattern of these patients.

Phantom Brake Phenomenon in Survivors of Car Accidents

Background: Survivors of high impact car accidents, when traveling in cars as passengers, may exhibit the phantom brake reaction. The reaction consists of involuntarily pressing the foot on the floor of the car in a reflexive attempt "to brake", even though there is no brake pedal in front of the passenger seat. This study examines the incidence and correlates of this special phenomenon.&#x0D; Method: De-identified data of 114 survivors (37 men, 77 women; mean age 38.6, SD=12.4) of high impact motor vehicle accidents (MVAs) were available, with their responses to the Brief Pain Inventory, Insomnia Severity Index, Rivermead Post-Concussion Symptoms Questionnaire, Subjective Neuropsychological Symptoms Scale (SNPSS), PTSD Checklist for DSM-5 (PCL-5), ratings of depression and of generalized anxiety, and 3 questionnaire measures of driving anxiety, i.e., Whetstone’s, Steiner’s, and the Driving Anxiety Questionnaire (DAQ). One item of the DAQ assesses the phantom brake phenomenon on a 4-point scale (0=No, 1=Mild, 2=Moderate, 3=Severe): this is the key variable in the present study.&#x0D; Results: Mild to severe forms of the phantom brake reaction were reported by 92.1% of the post-MVA patients. Significant correlations (p&lt;0.05, 2-tailed) were found of the intensity of phantom brake reaction to the intensity of post-MVA pain (rs from 0.20 to 0.33), insomnia (r=0.40), the Rivermead post-concussion scale (r=.29), other post-concussive and whiplash symptoms as measured by the SNPSS (r=0.19), depression (r=0.30), generalized anxiety (r=0.32), and to DAQ (r=0.47) and Whetstone’s (r=0.50) measures of driving anxiety. No significant relationships were found of the phantom brake reaction to age and gender.&#x0D; Discussion and Conclusion: The phantom brake reaction was reported by almost all post-MVA patients and can be considered as a part of their post-MVA polytraumatic symptom pattern.

Symptom Profile of Injured Motorists on the Structured Inventory of Malingered Symptomatology

Background: Recent extensive content analyses demonstrated that the items of the Structured Inventory of Malingered Symptomatology (SIMS) have no capacity to differentiate malingerers from legitimate medical patients: all items list or assess legitimate medical symptoms. We examined which SIMS items are the most frequently endorsed by injured motorists. Method: De-identified archival data of 23 survivors (mean age=38.0, SD=12.8) of high impact motor vehicle accidents (MVAs) contained their SIMS scores, their responses to the Brief Pain Inventory, Morin’s Insomnia Severity Index, Rivermead Post-Concussion Symptoms Questionnaire, and to the Post-MVA Neurological Symptoms scale. Results: All SIMS items which were endorsed by more than 43% of the patients in the directions scored by the SIMS as indicative of “malingering” were selected. Twenty-five items met this criterion. On a closer examination, all these 25 items are legitimate psychological and neuropsychological symptoms typically experienced by injured motorists, such as depression, impaired sleep, and postconcussive symptoms (memory and concentration problems, impaired balance) and whiplash symptoms (numbness in the limbs, instances of reduced muscular control over some of the limbs). Discussion and Conclusions: The 25 endorsed items are consistent with the polytraumatic symptom profile of injured patients. In a travesty of psychological assessment, these symptoms are scored in the SIMS as denoting “malingering”.

Validity of Steiner’s Automobile Anxiety Inventory

Background: Steiner’s Automobile Anxiety Inventory (AAI) is a 23 item questionnaire which provides a quantitative measure of vehicular anxiety (amaxophobia), common in survivors of motor vehicle accidents (MVAs). The present study examines criterion and convergent validity of the AAI. Method: De-identified data from a sample of 50 patients (mean age=39.1, SD=12.1; 17 men, 33 women) injured in high impact MVAs included the scores on Steiner’s AAI, as well as the pain ratings on the Brief Pain Inventory (BPI), scores on the Insomnia Severity Index (ISI), the Rivermead Post-Concussion Symptoms Questionnaire, Subjective Neuropsychological Symptoms Scale (SNPSS), Whetstone Vehicle Anxiety Questionnaire, and on Driving Anxiety Questionnaire (DAQ). The patients’ scores were compared to de-identified AAI data of 22 normal controls (mean age=45.9, SD=21.3; 10 men, 12 women). Results: Mean score of the patients on Steiner’s AAI (mean=15.0, SD=2.5) was significantly higher than the one of normal controls (mean=3.2, SD=3.8) in a t-test (t=15.6, df=70, p&lt;.001). The underlying correlation is very high (r=.88): this indicates an excellent criterion validity. Satisfactory convergent validity is suggested by significant correlations (p&lt;.001) of Steiner’s AAI scores to the Whetstone Vehicle Anxiety Questionnaire (r=.58) and Driving Anxiety Questionnaire (r=.52). The AAI correlated at p&lt;.001 with post-accident neuropsychological impairments as measured by Rivermead (r=.89) and SNPSS (r=.72). Internal consistency of the AAI is satisfactory (Cronbach alpha=.95). Discussion and Conclusion: The results indicate satisfactory criterion and convergent validity of the Automobile Anxiety Inventory.

Prevalence and determinants of posttraumatic stress disorder and depression among survivors of motor vehicle accidents from a hilly Indian state

Background:Motor vehicle accidents (MVAs) are the leading cause of death and have also been proven debilitating for their survivors. In India, with poor road infrastructure and low maintenance, MVAs are quite apparent. With a significant focus of treatment on physical health, psychological consequences linked to these traumas are often neglected.Aim:The aim of this study was to estimate the prevalence of posttraumatic stress disorder and depression, as well as the determinants of these disorders among survivors of MVAs.Materials and Methods:An institution-based, cross-sectional descriptive study was conducted among 250 survivors of MVA visiting a tertiary care center in Uttarakhand (India) during December 2019, recruited using total enumerative sampling. Data were collected with standardized and validated tools that consisted of sociodemographic information, Posttraumatic Stress Disorder Checklist 5, and Zung Self-Rating Depression Scale. Data were analyzed using SPSS version 23, including descriptive (frequency, percentage, mean, and mean percentage) and inferential statistics (Mann–Whitney, Kruskal–Wallis, and binary logistic regression).Results:The prevalence of posttraumatic stress disorder (PTSD) was found to be 32.4%, and mild and moderate depressions were present among 14.4% and 6.4% of the study population, respectively. Witnessing death (odds ratio [OR] = 5.52; 95% confidence interval [CI] = 0.92–3.06), loss of valuables (OR = 2.62; 95% CI = 0.78–9.04), self-blame (OR = 6.06; 95% CI = 1.15–31.91), and perceived death threat (OR = 9.98; 95% CI = 5.89–46.85) acted as determinants in the occurrence of PTSD and depression.Conclusion:A considerably large proportion of the population suffered from psychiatric disorders following the trauma. These must be addressed with an urgent development of multidisciplinary teams incorporating mental health services across all hospitals' trauma units.

Convergent validity of Leon Steinerrsquo;s measure of amaxophobia

Background: Steiner’s Automobile Anxiety Inventory is a 23 item questionnaire of which 18 can be scored as a measure of vehicular anxiety (amaxophobia) as common in survivors of motor vehicle accidents (MVAs). Method: Scores on Steiner’s questionnaire were available for 33 survivors of car accidents (mean age 39.5 years, SD=12.8, 9 men, 24 women). Their scores on the Driving Anxiety Questionnaire and on Whetstone Vehicle Anxiety Questionnaire were also available, as well as scores on measures of PTSD (PCL-5), and of post-concussive and whiplash symptoms, pain, insomnia, depression, and anxiety. Results and Discussion: Significant correlations of moderate size were found of Steiner’s questionnaire to the Driving Anxiety Questionnaire (r=.50) and Whetstone questionnaire (r=.45) and also to the PCL-5 measure of PTSD symptoms (r=.57). Steiner’s scores were significantly, but on a weaker level, correlated with scales of post-concussive and whiplash symptoms, but not with age, gender, measures of pain or insomnia, or with number of prior MVAs or with number of weeks since the MVA. Conclusion: The results indicate an acceptable convergent validity of Steiner’s Automobile Anxiety Inventory as a brief screening tool for amaxophobia in clinical settings

Assessment of sleep quality, post-traumatic stress disorder, and locus of control in motor vehicle accident survivors

Assessment of sleep quality, post-traumatic stress disorder, and locus of control in motor vehicle accident survivors

Influence of affective distractors on working memory capacity in relation to symptoms of posttraumatic stress disorder

SummarySymptoms evoked in individuals with posttraumatic stress disorder (PTSD) when processing trauma‐relevant material arguably impair higher order cognitive functions. An example is working memory capacity (WMC), which has been shown to be disrupted by affective distractors. However, it is unknown whether this association varies across different types of PTSD symptoms. This study explored the association between WMC performed in affective (relative to neutral) contexts in relation to different symptoms of PTSD (avoidance, re‐experiencing, hyperarousal). Motor vehicle accident survivors with PTSD and without PTSD completed a delayed‐match‐to‐sample task including trauma‐related, neutral, and scrambled distractors in the interval between the presentation of the memoranda and the recognition target. The results showed that there was support for an indirect pathway between PTSD diagnosis and WMC performed in affective (versus neutral) contexts through re‐experiencing and avoidance symptoms. The findings suggest that avoidance symptoms in particular may benefit from interventions directed at improving WMC.

Criterion validity of low intelligence scale of the Sims

Objective: The Structured Inventory of Malingered Symptomatology (SIMS) is a widely used test. We evaluated the criterion validity of SIMS Low Intelligence scale (LI). Our previous study showed that the LI scale consists only of arithmetic tasks, logical tasks and tasks evaluating general knowledge and no tasks assessing non-verbal intelligence. None of these tasks appeared suited to differentiate malingerers from patients with cognitive impairment such as impairments documented in survivors of high impact car accidents. Method: We used ANOVA to compare SIMS LI scores from four samples: 23 survivors of high impact motor vehicle accidents (MVA), Capilla Ramírez‘s data of 30 persons instructed to malinger whiplash symptoms, Parks’s data of 26 undergraduates instructed to feign post-concussive symptoms and data of 34 normal controls published in SIMS manual. Results: In the ANOVA, LI scores of the 23 injured survivors of high impact MVAs were significantly higher than scores of 30 malingerers of whiplash and of normal controls, but they were not significantly different from Parks’s malingerers of post-concussive symptoms, i.e., from malingerers of cognitive impairment. Conclusions: Patients with intense post-concussive symptoms are likely to obtain LI score levels similar to persons instructed to malinger post-concussive symptoms. Both the legitimately injured patients and the malingerers of post-concussive symptoms are likely to score higher on the LI scale than normal controls. This is further evidence that the SIMS and its scales constitute a pseudo psychological test without capacity to differentiate malingerers from legitimate patients.

Validity of the Sims scales of neurologic impairment and amnestic disorder

Background: The Structured Inventory of Malingered Symptomatology (SIMS) has never been scientifically validated to demonstrate that it adequately differentiates legitimate patients from malingerers. Method: We evaluated the content validity of the Amnestic Disorder (AM) and Neurologic Impairment (NI) scales of the SIMS via expert ratings by 11 experts (7 psychiatrists, 2 psychologists, and 2 neuroscientists). As the next step, SIMS scores of 23 patients injured in high impact car accidents were selected: seminal research of Bennet Omalu suggests that such collisions would rarely occur without cerebral micro vascular trauma and axonal shearing. Such patients typically suffer from neurological symptoms in the post-concussion whiplash spectrum. Criterion validity of AM and NI scales was assessed by statistical comparisons of AM and NI data of these 23 presumably legitimate patients to published SIMS data on instructed malingerers (30 malingerers of whiplash and 26 malingerers of post-concussive symptoms) and also to published SIMS data on relatively healthy normal controls responding honestly (N=34). Results: The review of item content of the AM and NI scales by the 9 expert clinicians and 2 neuroscientists indicated that all their items represent potentially legitimate medical symptoms: none was being judged as specific to malingering. The SIMS AM and NI scores diagnosed close to 75% of our 23 survivors of high impact motor vehicle accidents (MVAs) as “malingerers:” it is unlikely that there were so many true positives. An ANOVA of NI scores showed that neither malingerers of whiplash nor malingerers of post-concussive symptoms differed significantly from legitimate patients (p&gt;.05) and that normal controls had significantly lower NI scores than both groups of malingerers and also lower scores than the legitimate patients (p&lt;.0001). An ANOVA of AM scores showed that legitimate patients obtained higher AM scores than malingerers of whiplash (p=.0002), but lower scores than malingerers of post-concussive symptoms (p=.0008). In this ANOVA, normal controls had significantly lower AM scores than legitimate patients and also lower scores than malingerers of post-concussive symptoms (p&lt;.001), but did not differ significantly from malingerers of whiplash (p&gt;.05). Conclusions: The SIMS NI and AM scales obviously lack both in content and criterion validity, i.e., the NI and AM scales list legitimate neuropsychological symptoms and cannot adequately differentiate malingerers from legitimate patients.

Emotion regulation mediates the effects of temperament traits and posttraumatic stress disorder symptoms on affect in motor vehicle accident survivors

ObjectivesThe aim of the present study was to investigate the associations among temperament traits postulated by the Regulative Theory of Temperament (RTT), posttraumatic stress disorder symptoms (PTSD symptoms), emotion regulation strategies, and affect in the 280 motor vehicle survivors (MVA). MethodsTemperament was measured with the Formal Characteristics of Behaviour–Temperament Inventory (FCB-TI), the level of posttraumatic stress disorder symptoms was assessed by the PTSD Clinical Inventory (PTSD-C), emotion regulation was tested with the Polish adaptation of the Inventory of Cognitive Affect Regulation Strategies (ICARUS), and affect was evaluated by the Polish version of the Positive and Negative Affect Scale (PANAS). ResultsGreater emotional reactivity was associated with grater negative affect (also by maladaptive regulation) and lower positive affect whereas greater activity was linked to grater positive affect (also via adaptive regulation). Furthermore, greater PTSD symptoms were related to greater negative affect (also through maladaptive regulation) and lower positive affect. However, PTSD symptoms were not linked to adaptive regulation strategies. ConclusionThe findings significantly extends our current knowledge on the associations among temperament traits, PTSD symptoms, emotion regulation strategies, and affect in the motor vehicle survivors.

Assessing the Post-Traumatic Stress Among Survivors of Motor Vehicle Accidents in Hoshiarpur (Punjab)

Motor vehicle accidents are one of the leading causes of deaths, disabilities and hospitalisations. The present non-experimental descriptive research study, undertaken to assess post-traumatic stress among survivors of motor vehicle accidents, had sample size of 60 survivors of motor vehicle accidents after one month of accident attending OPD on follow-up basis. Assessment of posttraumatic stress was done with the help of standardised rating scale Impact Event Scale- Revised (IES-R) and assessment of severity of injury was done with Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS). Analysis showed that subjects had mild level of post-traumatic stress and as per subscales of post-traumatic stress, patients had highest mean percentage of posttraumatic stress score in hyper arousal subscale.

Brachial plexus injuries in adults

As the number of survivors of motor vehicle accidents and extreme sporting accidents increases, more people must live with brachial plexus injuries. Brachial plexus injuries also occur in multiple trauma patients and can be debilitating. Although the injured limb will never return to normal, an impr...

Assessing accident phobia in mild traumatic brain injury: The Accident Fear Questionnaire.

Despite a documented prevalence of accident phobia in almost 40% of motor vehicle accident (MVA) survivors, the onset of accident phobia after traumatic brain injury (TBI) remains poorly understood. There is currently a body of knowledge about posttraumatic stress disorder (PTSD) in patients with TBI, but less is known about accident phobia following TBI, particularly in cases of mild TBI (mTBI). Accident phobia can impede safe return to driving or motor vehicle travel, inhibiting return to daily functioning. In addition, pain complaints have been found to correlate positively with postinjury anxiety disorders. The present study sought to determine the reliability and validity of the Accident Fear Questionnaire (AFQ), a measure used to assess accident phobia, in 72 patients with mTBI using secondary data analysis and the subsequent development of accident phobia postinjury. Furthermore, we sought to examine the impact of pain, anxiety, and depression complaints on the AFQ. Results reveal convergent validity and reliability in mTBI populations. Additionally, pain, anxiety, and depression measures were significantly correlated with scores on the AFQ. Psychometrically, the phobia avoidance subscale of the AFQ is a reliable measure for use with mTBI populations, although some limitations were found. In particular, the accident profile (AP) subscale was not found to be reliable or valid and could be eliminated from the AFQ. Collectively, the present study contributes to the small body of published literature evaluating accident phobia in patients with mTBI and the impact of pain on the development of postinjury anxiety disorders. (PsycINFO Database Record