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Introduction
Researchers are looking more closely at motor
vehicle accidents (MVAs) as a common cause of
traumatic stress. In one large study, accidents
were shown to be the traumatic event most frequently
experienced by males (25%) and the second most
frequent traumatic event experienced by females
(13%) in the United States. Over 100 billion
dollars are spent every year to take care of
the damage caused by auto accidents. Survivors
of MVAs often also experience emotional distress
as a result of such accidents. Mental health
difficulties such as posttraumatic stress, depression,
and anxiety are problems survivors of severe
MVAs may exhibit. This fact sheet addresses
important issues related to MVAs, including
how many people experience serious MVAs, how
many people develop MVA-related Posttraumatic
Stress Disorder (PTSD) and other psychological
reactions, what the risk factors are for MVA-related
PTSD, and what kind of treatments help MVA-related
PTSD.
How many people experience
serious motor vehicle accidents?
One unfortunate consequence of the high volume
of commuter and personal travel in the U.S.
is the number of accidents that result in personal
injury and fatalities. In any given year, approximately
1% of the U.S. population will be injured in
motor vehicle accidents. Thus, MVAs account
for over 3 million injuries annually and are
one of the most common traumas individuals experience.
How many people develop
MVA-related PTSD and other psychological reactions?
Research on individuals seeking treatment and
individuals in the general population suggests
that the majority of those who survive a serious
MVA do not develop mental health problems that
warrant professional treatment. However, a substantial
minority of MVA survivors suffer from mental
health problems, the most common of which are
PTSD, Major Depression, and Anxiety Disorders.
Studies of the general population
have found that approximately 9% of MVA survivors
develop PTSD. Rates are significantly higher
in samples of MVA survivors who seek mental-health
treatment. Studies show that between 14% and
100% of MVA survivors who seek mental-health
treatment have PTSD, with an average of 60%
across studies. In addition, between 3% and
53% of MVA survivors who seek treatment and
have PTSD also have a mood disorder such as
Major Depression. Finally, in one large study
of MVA survivors who sought treatment, 27% had
an anxiety disorder in addition to their PTSD,
and 15% reported a phobia of driving.
What are the risk factors
for MVA-related PTSD?
Recent research has identified variables that
have predictive value when trying to determine
who might experience PTSD after a serious accident.
The use of such research allows clinicians to
identify individuals at risk for long-term mental
health problems secondary to their accident.
The research focusing on identifying
at-risk individuals has been directed at three
sets of variables: characteristics about the
individual that were present prior to the MVA,
accident-related variables, and postaccident
variables.
- Pre-accident variables such
as poor ability to cope in reaction to previous
traumatic events, the presence of a pre-accident
mental health problem (e.g., depression),
and poor social support have all been linked
to the development of PTSD following severe
MVAs.
- With respect to accident-related
variables, the amount of physical injury,
potential life-threat, and loss of significant
others have been predictive of the development
of mental health problems such as PTSD. That
is, as the amount of physical injury and fear
of dying increase, the chance of developing
PTSD also increases.
- Postaccident variables that
are predictive of PTSD following MVAs are:
the rate of physical recovery from injury,
the level of social support from friends and
family, and the level of active reengagement
in both work and social activities. To the
extent that physical limitations will allow,
survivors of MVAs should be encouraged to
maintain as much of their pre-accident lifestyle
as possible, with as much support from family
and friends as possible. Such coping strategies
appear to be linked with positive mental health
outcomes.
What treatments are
available for MVA-related PTSD?
One aspect of MVA-related PTSD that is different
from PTSD caused by other traumas is the increased
likelihood of being injured or developing a
chronic pain condition following the trauma.
As a result, many people who have been in an
MVA present first to their primary care physicians
for treatment and do not consider psychological
treatment for some time. Unfortunately, studies
have shown that of the people who develop PTSD
and do not seek psychological treatment, approximately
half continue to have symptoms for more than
six months or a year. Therefore, it is important
to identify the symptoms early on and seek appropriate
psychological treatment.
A number of different treatment
approaches have proven effective for MVA-related
PTSD. Treatments include behavior therapy, cognitive
therapy, and medications. In addition, it may
be useful to work with a chronic pain specialist
to help manage the physical pain caused by the
injury. Sometimes these treatments are provided
in conjunction with one another. Readers who
are interested in more extensive information
regarding treatment and provider contacts will
find the websites listed below to be useful.
Additional Information
Readers can find a full exposition of the personal
and accident-related characteristics associated
with poor mental health outcomes after MVAs
in an excellent book, After the Crash: Psychological
Assessment and Treatment of Survivors of Motor
Vehicle Accidents, by Blanchard and Hickling
(2003). This book also explains a comprehensive
approach to treatment for clinicians working
with severe accident survivors.
References
1.Blanchard, E.B., & Hickling, E.J. (2003).
After the Crash: Psychological Assessment and
Treatment of Survivors of Motor Vehicle Accidents
(2nd ed) Washington, DC: American Psychological
Association.
2.Blanchard, E.B., Hickling,
E.J., Barton, K.A., Taylor, A.E., Loos, W.R.,
& Jones-Alexander, J. (1996). One-year prospective
follow-up of motor vehicle accident victims.
Behaviour Research and Therapy, 34, 775-786.
3.Blanchard, E.B., Hickling,
E.J., Forneris, C.A., Taylor, A.E., Buckley,
T.C., Loos, W.R., & Jaccard, J. (1997).
Prediction of remission of acute Posttraumatic
Stress Disorder in motor vehicle accident victims.
Journal of Traumatic Stress, 10, 215-234.
4.Blanchard, E.B., Hickling,
E.J., Taylor, A.E., & Loos, W.R. (1995).
Psychiatric morbidity associated with motor
vehicle accidents. Journal of Nervous and Mental
Disease, 183, 495-504.
5.Bryant, R.A., & Harvey,
A.G. (1995). Avoidant coping style and posttraumatic
stress following motor vehicle accidents. Behaviour
Research and Therapy, 33, 631-635.
6.Buckley, T.C., Blanchard,
E.B., & Hickling, E.J. (1996). A prospective
examination of delayed onset PTSD secondary
to motor vehicle accidents. Journal of Abnormal
Psychology, 105, 617-625.
7.Ehlers, A., Mayou, R.A.,
& Bryant, B. (1998). Psychological predictors
of chronic Posttraumatic Stress Disorder after
motor vehicle accidents. Journal of Abnormal
Psychology, 107, 508-519.
8.Kuch, K., Cox, B.J., &
Evans, R.J. (1996). Posttraumatic Stress Disorder
and motor vehicle accidents: A multidisciplinary
overview. Canadian Journal of Psychiatry, 41,
429-434.
9.Taylor, S., & Koch, W.J.
(1995). Anxiety disorders due to motor vehicle
accidents: Nature and treatment. Clinical Psychology
Review, 15, 721-73
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