LONG-TERM OUTCOME OF MOTOR-VEHICLE ACCIDENT INJURY

Objective: To define the psychological outcome at 5 years of a sample of non-head-injured motor vehicle accident victims and identify baseli ne predictors. Methods: Self-report questionnaires were completed by i ll consecutive subjects who had been injured in a motor vehicle accide nt 5 years earlier and who had been assessed previously in a prospecti ve 1-year study. Results: Although most subjects reported a good outco me, a substantial minority described continuing social, physical, and psychological difficulties and a quarter of those studied suffered pho bic anxiety about travel as a driver or passenger. There was little ch ange in quality of life outcome and effects on travel between assessme nts at 3 months, 1 year, and 5 years. The prevalence of posttraumatic stress disorder remained approximately 10% throughout the follow-up; m ost early cases had remitted by 5 years, and a similar number of delay ed new onsets had occurred between 1 year and 5 years. PTSD at 5 years was predicted by physical outcome and by postaccident intrusive memor ies and emotional distress. Compensation proceedings were initiated by 66 subjects and were often prolonged and a cause of distress. There w ere no significant associations with outcome. Trends for a poor outcom e in claimants, especially those not settled at 5 years, may be due to their having more serious physical problems. Conclusion: Psychologica l complications are important and persistent after injury in a motor v ehicle accident, are associated with adverse effects on everyday activ ities, and pose a challenge for consultation-liaison psychiatry.