Collision Survivors Show High Rates of Psychiatric Disorders

Kathryn Foxhall

May 09, 2008

May 9, 2008 (Washington, DC) — Hospitalized survivors of transportation collisions have high rates of acute stress disorder, posttraumatic stress disorder (PTSD), depression, and anxiety symptoms that may affect their ability to recover, a new study shows.

The researchers, with first author Quinn Biggs, PhD, a research scientist with the Uniformed Services University of the Health Sciences, in Bethesda, Maryland, undertook mental health interviews in 100 such victims while they were still in a trauma center in south Chicago, 2 days to 3 weeks after their collision.

Twenty-two of the 100 had acute distress disorder, Dr. Biggs said. Although there had not been enough time since the incident to diagnose PTSD, depression, or anxiety, he found symptoms of PTSD in 27 people, depression symptoms in 26, and anxiety disorder symptoms in 20.

Trauma teams, trauma centers, and first responders "should be aware that patients are going to be having a high degree of psychological symptoms," Dr. Biggs told Medscape Psychiatry.

Serious Collisions

For the interviews, the authors used the Davidson Trauma Scale (DTS) for traumatic stress; the Center for Epidemiologic Studies Depression Scale (CES-D) for depression; the Beck Anxiety Inventory (BAI) for anxiety; and the Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-IV) diagnosis-related questions for acute stress disorder.

"Several variables were correlated to psychopathology, including history of treatment for psychological problems, alcohol/drug use, postcollision fear of dying, prior number of collisions in the past year, prior number of stressful events in the lifetime, greater perception of control of events that caused the collision, and collision-related guilt," the authors write.

Three-quarters of the patients had been in auto collisions, and the others had been in motorcycle, pedestrian, and other incidents.

Dr. Biggs noted, "The collisions that they had been through were quite serious. Sixteen percent had a rollover, and about a third of them were trapped or pinned in the wreckage. Some of them were trapped for over 45 minutes."

The trauma they sustained was also serious. Ninety of the 100 rated their injuries as moderate, severe, or life-threatening. Over half had lost consciousness, 23 had witnessed the serious injury of a known person, and 1 had witnessed the death of a known person. Another 14 had witnessed serious injury of an unknown person, and 3 had witnessed the death of an unknown person. Forty had thoughts that they themselves might die.

The authors pointed out that the correlations cannot indicate the cause and effect, and, in fact, there were indications many of these people had problems before the accident.

As one might expect, said Dr. Biggs, some were probably serious drinkers: "Five percent drank between 10 and 15 drinks per week in the past, and another 5% drank 23 or more drinks per week."

"About half, 49%, reported that they had had serious depression at least sometime in their life," said Dr. Biggs. The reports of serious depression or being treated for depression correlated well with the symptoms of depression on the symptom inventories, he noted.

In addition, the patients with more extremely stressful events in their lifetime or other collisions in the past year were more likely to have PTSD symptoms. Those symptoms also correlated with a factor Dr. Biggs said research has repeatedly found: "If you think you are going to die, you are more likely to have posttraumatic stress symptoms."

Something unique in the study, said Dr. Biggs, was its research on patients' feeling of control. Most people felt they had little or no control over the events that caused the collision, but those who did were more likely to have depressive symptoms and guilt.

Beyond that, he pointedout, "If the patient rated others as having a high degree of control over their recovery process, they were less likely to have depression symptoms." That makes sense, he said, because a patient who is confident in the doctors and nurses will probably feel better.

The authors stressed that "early identification of the personal and injury characteristics associated with psychopathology is vital to development of early interventions."

Early Screening and Early Intervention

The study has implications for early screening of survivors and early intervention and training of healthcare providers to identify psychopathology, said the authors. However, Dr. Biggs said, in his experience, health centers don't call in a mental health professional in trauma cases unless they can actually see someone has a problem.

He also pointed out that some collision victims go through a postcollision "honeymoon" period in which they are glad to be alive and they may feel the collision has changed their lives for the better. But people "this broken up" will continue to face adaptation challenges, he said: "So some people's symptoms are going to go down. I think some will probably go up. And I think that healthcare providers should watch for that."

There may also be points in the process for providers to talk to patients about safety, Dr. Biggs said.

American Psychiatric Association 161st Annual Meeting: Abstract NR6-114. Presented May 7, 2008.

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