Acute stress response and posttraumatic stress disorder in traffic accident victims: A one-year prospective, follow-up study

Objective: This study was designed to assess the natural course of posttrau matic symptoms formation, as well as the degree to which acute stress react ions predict later posttraumatic stress disorder (PTSD) in injured traffic accident victims. Method: A prospective, 1-year follow-up study was carried out on 74 injured traffic accident victims and a comparison group of 19 pa tients who were hospitalized for elective orthopedic surgery. Participants were interviewed within the first week following the accident, and follow-u p interviews were performed 1, 3, 6, and 12 months after the accident. At 1 2 months, a structured clinical interview was administered to determine a f ormal DSM-III-R diagnosis of PTSD, Results: Twenty-four (32%) of the 74 tra ffic accident victims, but none of the 19 comparison subjects, met DSM-III- R criteria for PTSD at 1 year. Traffic accident victims who developed PTSD had higher levers of premorbid and comorbid psychopathology. Levels of post traumatic symptoms were significantly higher from the outset in the subject s who developed PTSD and worsened progressively over the first 3 months, in contrast to subjects without PTSD, who manifested gradual amelioration of symptoms during this time. Existence of posttraumatic symptoms immediately after the accident was a better predictor of later PTSD than was accident o r injury severity. Conclusions: In this study, a significant portion of inj ured traffic accident victims manifested PTSD 1 year after the event. The d evelopment of PTSD at 1 year can be predicted as early as 1 week after the accident on the basis of the existence and severity of early PTSD-related s ymptoms. However, the first 3 months following the accident appear to be th e critical period for the development of PTSD.