UNDIAGNOSED POSTTRAUMATIC-STRESS-DISORDER FOLLOWING MOTOR-VEHICLE ACCIDENTS

Objectives: To determine the pattern of emergence of post-traumatic st ress disorder (PTSD) among motor vehicle accident victims and to exami ne the influence of PTSD on subsequent levels of disability. Design: A longitudinal study of motor vehicle accident victims one month and 18 months after the accident. Subjects: Twenty-four motor vehicle accide nt victims admitted by the trauma team at the Royal Adelaide Hospital. A 52% response rate was achieved. Main outcome measures: Post-traumat ic stress disorder as diagnosed by the Diagnostic Interview Schedule a nd disability as measured with the Sickness Impact Profile. Results: E ighteen months after their accidents, six of the 24 subjects had clini cally significant PTSD and one was considered borderline. None had bee n previously diagnosed or treated. The group with PTSD had higher scor es on all measures of psychological distress one month after the accid ent and were more likely to use immature psychological defences. There was no association between physical outcome (measured with the modifi ed Glasgow Outcome Scale) at six months and subsequent diagnosis of PT SD. However, the group with PTSD had higher levels of disability on as sessment with the Sickness Impact Profile, particularly in the domain of social functioning. The results suggest PTSD was associated with wo rk-related dysfunction equal to that associated with severe physical h andicap. Conclusion: The data from this pilot study suggest that PTSD after motor vehicle accidents is an important cause of disability, whi ch may also become the focus for damages in litigation. Thus, there is a need for further investigation of the early patterns of distress an d to design preventive programs for victims of road accidents.