Background Post-traumatic stress disorder is a well recognised conditi
on which can have long-term consequences. A rail accident to commuter
trains in south London provided an opportunity, within the context of
a Psychological Therapies Service, to study the prevalence and associa
tions of the condition in a follow-up study. Method Postal questionnai
res were completed by 187 survivors (52% response rate) 10 to 22 month
s after the accident, and their symptoms were compared with a commuter
control group. Results The accident group scored significantly higher
on the Impact of Events scale (IES) than the control group. Severity
of physical injury was significantly associated with high IES scores.
Thirty per cent of those moderately or severely injured showed high le
vels of intrusion or avoidance symptoms (sub-scores of 20 or more). Th
irty per cent of those nearest the accident focus had high sub-scores,
associated variables being the accident experience of risk of death,
feeling trapped and seeing death. For those less directly involved the
proportions with symptoms were similar to those of controls. Conclusi
ons It is recommended that disaster services should provide for long-t
erm psychological effects, particularly for those survivors who are in
jured, who experience risk of death, feeling trapped or who witness de
ath.