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PTSD Among Motor Vehicle Accident Victims

Introduction

Motor vehicle accidents (VMAs) are one of the leading causes of morbidity and mortality across the globe. In the United States, for instance, more than 3.5 million people become victims of VMAs every year while in Israel 45,503 people were injured in VMAs in 1999 while 476 people died in the same year from road accidents (Butler, Moffic and Turkal 524-531). VMAs are a major source of concern because apart from affecting the morbidity and mortality rates, they cause a variety of mild and severe psychological problems (Blaszczynski et al. 111-121; Hepp et al. 376-388) to the victims. One such problem is post-traumatic stress disorder (PTSD).

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According to research by the National Safety Council which was done in 2004, motor vehicle accidents (VMAs) have been leading among the causes of PTSD (cited in Khouzam and Donnelly 60-78). Estimates show that more than 50 million MVA casualties occur annually. Among these, 28 of every 1000 of the casualties tend to develop PTSD. Given the high prevalence of MVA-related PSTD, it is imperative to diagnose PSTD in primary care settings where the victims receive medical attention (Beck, Coffey, and Paleo 289). Early intervention however necessitates a fast and reliable diagnostic instrument (Wittchen et al. 24-34). The literature review will discuss the predictors of PTSD, the assessment of PTSD, factors associated with PTSD, and screening and diagnosis of PTSD using the distress thermometer.

Literature Review

Predictors of PTSD

Several predictors of PTSD have been identified. One such predictor is the coping mechanism of victims of VMAs. Victims who have effective coping mechanisms (described as adaptive copers) portray fewer symptoms of PTSD, anxiety, or depression as compared to victims with less effective coping mechanisms, described as dysfunctional copers or interpersonally distressed victims. Patients with dysfunctional and interpersonally distressed coping characteristics have a higher chance of developing post-trauma difficulties after a grave motor vehicle accident (Beck, Gudmundsdottir and Shipherd 219-227).

PTSD can also be predicted using immediate reactions following a motor vehicle accident. This was examined by Frommberger et al. (316-321) who used a sample of 179 victims of road accidents who had been admitted to hospitals immediately after the incident. The researchers found that patients who developed PTSD had more serious injuries; exhibited more signs of anxiety and depression; and had longer hospital stays than their counterparts.

Other predictors of PTSD include peri-traumatic dissociation and acute stress disorder (ASD). Bryant and Harvey (226-229) were interested in determining the gender differences in the relationship between PTSD, ASD, and peri-traumatic dissociation. The researchers used a sample of 171 road accident victims who were examined for ASD 1 month following the accident and for PTSD 6 months after the incident. 8% of the male victims and 23% of the females showed signs of ASD whereas 57% of males and 92% of females were diagnosed with PTSD. In addition, peri-traumatic dissociation was more pronounced in females than in males.

The researchers concluded that ASD and peri-traumatic dissociation were better predictors of PTSD among females than in males. The researchers explained that the gender disparity could be a result of differences in response and biological makeup. This however does not mean that gender in itself is a predictor of PTSD.

Other studies that have focused on predictors of PTSD include McDermott and Cvitanovich (446-452) who found a high prevalence of psychopathology among patients who had suffered a road accident as well as the correlation between self-report of PTSD and clinical diagnosis of the same. Harvey and Bryant (519-525) found that predictors of acute stress disorder among MVA victims relate to the predictors of PTSD in the same population.

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On the same note, Ehlers et al. (508-519) identified some of the predictors of PTSD as the severity of the trauma, perception of threat, and dissociation during the incident. All the above studies point out some of the most common predictors of PTSD. The studies are therefore helpful in that they aid in the early diagnosis of patients who are at a high risk of developing PTSD following a motor vehicle accident.

Assessment of PTSD

The assessment of PTSD is crucial in determining patients who are at high risk of developing the condition to manage the condition earlier. PTSD can be assessed in different ways. Elevated heart rate (HR) immediately after a traumatic event is one of the predictors of the development of PTSD (Blanchard et al. 199-204). The researchers used a sample of 74 MVA survivors who were admitted to an emergency department.

On examination of the victims’ vital data, the researchers found that victims who had elevated HR had less likelihood of meeting the criteria for PTSD 13 months after the accident. They also exhibited fewer symptoms of PTSD, contrary to previous findings. The researchers explained that the contrast in the findings could be due to differences in the vital data obtained in the studies as well as differences in recording the physiological information. Despite the contrast, the researchers do not dispute the fact that vital data such as elevated HR and blood pressure can be used to assess for PTSD.

Besides vital data, PTSD can also be assessed using physiological responsiveness. Veazey et al. (51-62) were interested in examining differences in physiological responsiveness (heart rate reactivity) between MVA victims who had developed PTSD and those who had not. The researchers found a significant difference between victims who had developed chronic PTSD and those who had subsyndromal PTSD and non-PTSD. The researchers concluded that physiological responsiveness to situations that are reminiscent of the traumatic event is a useful tool for assessing patients who are at high risk of developing PTSD.

PTSD can also be assessed through cognitive processes. In their study, Meiser-Stedman et al. (778-787) sought to determine whether cognitive processes can be used to predict PTSD in a sample of 59 child and adolescent victims of VMAs. The researchers discovered that PTSD was indeed associated with maladaptive appraisals and other cognitive processes such as subjective threat and memory procedures. This finding is important in that it offers support for psychological intervention of victims of VMAs and other traumatic events.

Factors Associated with PTSD

PTSD is associated with several factors which range from biological, psychological, physiological, and event-related factors. Victims with PTSD have been found to portray a greater incidence of depression and anxiety problems in comparison to non-PTSD victims (Kupchik et al. 244-250). This finding supports that of Mayou et al. (1231-1238). In addition, patients with PTSD exhibit alexithymia which may be explained as an adaptive way of dealing with stress rather than a maladaptive personality trait that predisposes patients to stress (Alvarez and Shipko 317-319).

Unlike other studies which viewed gender as a risk factor for PTSD (Ursano et al. 589-595), the study by Kupchik et al. and others like Jeavons (499-508) found that gender has no association with PTSD. Other studies assert that PTSD is not associated with past traumatic experiences (Koren, Amon, and Klein 367-373) or premorbid psychiatric conditions (Ursano et al. 589-595). These studies contradict other studies which found that PTSD is significantly associated with a history of psychiatric morbidity (Kuch, Cox and Evans 429-434; Irish et al. 377-384), anxiety disorders, psychiatric treatment, and experience of motor vehicle accidents (Koren et al. 367-373; Harvey and Bryant 519-525).

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Some scholars such as Jeavons (499-508) argue that it is individuals’ unique experience with the event and coping mechanism rather than features of the event that influence their subsequent reaction to a traumatic incident. On the other hand, there is a possibility that experience with a traumatic event such as the death of a loved one acts as a cushion against later development of PTSD in the event of another traumatic event such as an MVA.

The explanation given for this is that past traumatic experiences may have enabled the individual to develop effective coping mechanisms against trauma. This is well illustrated by the higher IES scores among the PTSD group than the non-PTSD group in the study by Kupchik et al. (244-250). Participants in the group that developed PTSD, later on, attributed it to the impact of the MVA while their counterparts did not.

Anxiety Screening and Diagnosis: The Distress Thermometer

PTSD is a psychological disorder that is linked to other psychological problems such as anxiety and depression. To screen and diagnose PTSD, the physicians must screen the MVA victims for other psychological problems. This can be done using several tools. The Distress Thermometer (DT) was developed to recognize distress among cancer patients (Ransom, Jacobsen, and Booth-Jones 604-612).

According to the National Comprehensive Cancer Network (344-374) and Roth et al. (1904-1908), the DT “addresses the need for a quick, easily understood measure of distress in medical populations.” Although initially meant for cancer patients, the DT can also be used to measure distress among MVA victims and thus help to diagnose PTSD. Research shows that the DT is more effective than other instruments in screening for distress among patients (Jacobsen et al. 1494-1502; Roth et al. 1904-1908; Trask et al. 917-925; Akizuki et al. 2605-2613; Hoffman et al. 792-799).

Patients who score high on the DT are highly anxious, have greater depression, and portray poor performance status. Patients who score at or higher than the cutoff score of 4 also suffer from a variety of physical, emotional, psychological, and social problems (Mitchell 4675). Those scoring as low as 4 should not be ignored because they may also have substantial distress levels and should thus be granted a psychosocial evaluation (Ransom et al. 610).

Conclusion

Post-traumatic stress disorder is a common problem among victims of traumatic events such as motor vehicle accidents. Unfortunately, many cases of PSTD go undiagnosed or are diagnosed months and even years after the accident. The literature review conducted in this paper has shown that there are many predictors and factors associated with PSTD. It is thus important for clinicians to be aware of these factors so that an early diagnosis can be made and intervention given as required. On the other hand, clinicians can make use of the distress thermometer which is a fast and reliable instrument used to measure distress levels among patients. Early diagnosis of PTSD is indeed crucial in not only controlling the illness but also in enhancing the quality of life of the patients.

Works Cited

Akizuki, Nobuya et al. “Development of a brief screening interview for adjustment disorders and major depression in patients with cancer.” Cancer 97 (2003): 2605–2613.

Alvarez, Adolfo, and Stuart Shipko. “Alexithymia and posttraumatic stress disorder.” J Clin Psychiatry 52 (1991): 317–319.

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Beck, Gayle, Berglind Gudmundsdottir, and Jillian Shipherd. “PTSD and emotional distress symptoms measured after a motor vehicle accident: Relationships with pain coping profiles.” Journal of Psychopathology and Behavioural Assessment 25.4 (2003), 219-227.

Beck, Jackson, Gregory Coffey, and Stuart Palyo. ‘Psychometric properties of the Posttraumatic Cognitions Inventory (PTCI): A replication with motor vehicle accident survivors.’ Psych Assess 16 (2004): 289–298.

Blanchard, Edward et al. “Emergency room vital signs and PTSD in a treatment seeking sample of motor vehicle accident survivors.” Journal of Traumatic Stress 15.3 (2002): 199-204.

Blaszczynski, Alex et al. “Psychiatric morbidity following motor vehicle accidents: A review of methodological issues.” Compr Psychiatry 39 (1998): 111–121.

Bryant, Richard, and Allison Harvey. “Gender differences in the relationship between acute stress disorder and posttraumatic stress disorder following motor vehicle accidents.” Australian and New Zealand Journal of Psychiatry 37 (2003): 226-229.

Butler, Dennis, Steven Moffic, and Nick Turkal. “Post-traumatic stress reactions following motor vehicle accidents.” Am Fam Physician 60 (1999):524–531.

Ehlers, Anke, Richard Mayou, and Bridget Bryant. “Psychological predictors of chronic posttraumatic stress disorder after motor vehicle accidents.” Journal of Abnormal Psychology 107.3 (1998), 508-519.

Frommberger, Ulrich et al. “Prediction of posttraumatic stress disorder by immediate reactions to trauma: a prospective study in road traffic accident victims.” Eur Arch Psychiatry Clin Neurosci 248 (1998): 316-321.

Harvey, Allison, and Richard Bryant. “Predictors of acute stress following motor vehicle accidents.” Journal of Traumatic Stress 12.3 (1999): 519-525.

Hepp, Urs et al. “Post-traumatic stress disorder in serious accidental injury: 3-year follow-up study.” British Journal of Psychiatry 192.5 (2008): 376-383.

Hoffman, Benson et al. “Screening for distress in cancer patients: The NCCN rapid-screening measure.” Psycho-Oncology 13 (2004): 792–799.

Irish, Leah, and Sarah Ostrowski. “Trauma history characteristics and subsequent PTSD symptoms in motor vehicle accident victims.” Journal of Traumatic Stress 21.4 (2008): 377-384.

Jacobsen, Paul et al. “Screening for psychological distress in ambulatory cancer patients.” Cancer 103 (2005): 1494–1502.

Jeavons, Sue. “Predicting who suffers psychological trauma in the first year after a road accident.” Behav Res Ther 38 (2000):499–508.

Khouzam, Hogan, and Nelson Donnelly. “Posttraumatic stress disorder: safe, effective management in the primary care setting.” Postgrad Med 110 (2001): 60–78.

Koren, Danny, Isaac Arnon, and Ehud Klein. “Acute stress response and posttraumatic stress disorder in traffic accident victims: A one-year prospective, follow-up study.” Am J Psychiatry 156 (1999): 367–373.

Kuch, Klaus, Brian Cox, and Ramon Evans. “Posttraumatic stress disorder and motor vehicle accidents: A multidisciplinary overview.” Can J Psychiatry 41 (1996):429–434.

Kupchik, Marina et al. “Demographic and clinical characteristics of motor vehicle accident victims in the community general health outpatient clinic: A comparison of PTSD and non-PTSD subjects.” Depression and Anxiety 24 (2007): 244-250.

Mayou, Rena, Richard Bryant, and Anke Ehlers. “Posttraumatic stress disorder and motor vehicle accidents: A multidisciplinary overview.” Am J Psychiatry 158 (2001): 1231–1238.

McDermott, Brett, and Anita Cvitanovich. ‘Posttraumatic stress disorder and emotional problems in children following motor vehicle accidents: an extended case series.” Australian and New Zealand Journal of Psychiatry 34 (2000): 446–452.

Mitchell, Allison. “Pooled results from 38 analyses of the accuracy of distress thermometer and other ultra-short methods of detecting cancer-related mood disorder.” J Clin Oncol 25 (2007): 4670-4681.

National Comprehensive Cancer Network. “Distress management clinical practice guidelines.” J Natl Comp Cancer Network 1 (2003): 344–374.

Ransom, Sean, Paul Jacobsen, and Margaret Booth-Jones. “Validation of the distress thermometer with bone marrow transplant patients.” Psycho-Oncology 15 (2006): 604-612.

Roth, Nathan et al. “Rapid screening for psychological distress in men with prostate carcinoma: A pilot study.” Cancer 82 (1998): 1904–1908.

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Ursano, Robert et al. “Acute and chronic posttraumatic stress disorder in motor vehicle accident victims.” Am J Psychiatry 156 (1999): 589–595.

Veazey, Connie et al. “Physiological responsiveness of motor vehicle accident survivors with chronic posttraumatic stress disorder.” Applied Psychophysiology and Biofeedback 29.1 (2004): 51-62.

Wittchen, Houston et al. “Generalized anxiety and depression in primary care: prevalence, recognition, and management.” J Clin Psychiatry 63.8 (2002): 24–34.

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