Researchers are looking more closely at motor vehicle accidents
(MVAs) as a common cause of traumatic stress. In one large study,
accidents were shown to be the traumatic event most frequently
experienced by males (25%) and the second most frequent traumatic
event experienced by females (13%) in the United States. Over 100
billion dollars are spent every year to take care of the damage
caused by auto accidents. Survivors of MVAs often also experience
emotional distress as a result of such accidents. Mental-health
difficulties such as posttraumatic stress, depression, and anxiety
are problems survivors of severe MVAs may exhibit. This fact sheet
addresses important issues related to MVAs, including how many
people experience serious MVAs, how many people develop MVA-related
Posttraumatic Stress Disorder (PTSD) and other psychological
reactions, what the risk factors are for MVA-related PTSD, and what
kind of treatments help MVA-related PTSD.
How many people experience serious motor vehicle
accidents?
One unfortunate consequence of the high volume of commuter and
personal travel in the U.S. is the number of accidents that result
in personal injury and fatalities. In any given year, approximately
1% of the U.S. population will be injured in motor vehicle
accidents. Thus, MVAs account for over 3 million injuries annually
and are one of the most common traumas individuals experience.
How many people develop MVA-related PTSD and other
psychological reactions?
Research on individuals seeking treatment and individuals in the
general population suggests that the majority of those who survive
a serious MVA do not develop mental-health problems that warrant
professional treatment. However, a substantial minority of MVA
survivors suffer from mental-health problems, the most common of
which are Posttraumatic Stress Disorder (PTSD), Major Depression,
and Anxiety Disorders.
Studies of the general population have found that approximately
9% of MVA survivors develop PTSD. Rates are significantly higher in
samples of MVA survivors who seek mental-health treatment. Studies
show that between 14% and 100% of MVA survivors who seek
mental-health treatment have PTSD, with an average of 60% across
studies. In addition, between 3% and 53% of MVA survivors who seek
treatment and have PTSD also have a mood disorder such as Major
Depression. Finally, in one large study of MVA survivors who sought
treatment, 27% had an anxiety disorder in addition to their PTSD,
and 15% reported a phobia of driving.
What are the risk factors for MVA-related PTSD?
Recent research has identified variables that have predictive
value when trying to determine who might experience PTSD after a
serious accident. The use of such research allows clinicians to
identify individuals at risk for long-term mental-health problems
secondary to their accident.
The research focusing on identifying at risk individuals has
been directed at three sets of variables: characteristics about the
individual that were present prior to the MVA, accident-related
variables, and postaccident variables.
Pre-accident variables such as poor ability to cope in
reaction to previous traumatic events, the presence of a
pre-accident mental-health problem (e.g., depression), and poor
social support have all been linked to the development of PTSD
following severe MVAs.
With respect to accident-related variables, the amount of
physical injury, potential life-threat, and loss of significant
others have been predictive of the development of mental-health
problems such as PTSD. That is, as the amount of physical injury
and fear of dying increase, the chance of developing PTSD also
increases.
Postaccident variables that are predictive of PTSD following
MVAs are: the rate of physical recovery from injury, the level of
social support from friends and family, and the level of active
reengagement in both work and social activities. To the extent
that physical limitations will allow, survivors of MVAs should be
encouraged to maintain as much of their pre-accident lifestyle as
possible, with as much support from family and friends as
possible. Such coping strategies appear to be linked with
positive mental-health outcomes.
What treatments are available for MVA-related PTSD?
One aspect of MVA-related PTSD that is different from PTSD
caused by other traumas is the increased likelihood of being
injured or developing a chronic pain condition following the
trauma. As a result, many people who have been in an MVA present
first to their primary care physicians for treatment and do not
consider psychological treatment for some time. Unfortunately,
studies have shown that of the people who develop PTSD and do not
seek psychological treatment, approximately half continue to have
symptoms for more than six months or a year. Therefore, it is
important to identify the symptoms early on and seek appropriate
psychological treatment.
A number of different treatment approaches have proven effective
for MVA-related PTSD. Treatments include behavior therapy,
cognitive therapy, and medications. In addition, it may be useful
to work with a chronic pain specialist to help manage the physical
pain caused by the injury. Sometimes these treatments are provided
in conjunction with one another. Readers who are interested in more
extensive information regarding treatment and provider contacts
will find the websites listed below to be useful.
Additional Information
Readers can find a full exposition of the personal and
accident-related characteristics associated with poor mental-health
outcomes after MVAs in an excellent book,
After the Crash, by Blanchard and Hickling (1997). This book
also explains a comprehensive approach to treatment for clinicians
working with severe accident survivors.
Suggested Readings on Psychosocial Research and Motor
Vehicle Accidents
Blanchard, E.B., & Hickling, E.J. (1997).
After the crash. Washington, DC: American Psychological
Association.
Blanchard, E.B., Hickling, E.J., Barton, K.A., Taylor, A.E.,
Loos, W.R., & Jones-Alexander, J. (1996). One-year prospective
follow-up of motor vehicle accident victims.
Behaviour Research and Therapy, 34, 775-786.
Blanchard, E.B., Hickling, E.J., Forneris, C.A., Taylor, A.E.,
Buckley, T.C., Loos, W.R., & Jaccard, J. (1997). Prediction of
remission of acute Posttraumatic Stress Disorder in motor vehicle
accident victims.
Journal of Traumatic Stress, 10, 215-234.
Blanchard, E.B., Hickling, E.J., Taylor, A.E., & Loos, W.R.
(1995). Psychiatric morbidity associated with motor vehicle
accidents.
Journal of Nervous and Mental Disease, 183, 495-504.
Bryant, R.A., & Harvey, A.G. (1995). Avoidant coping style
and posttraumatic stress following motor vehicle accidents.
Behaviour Research and Therapy, 33, 631-635.
Buckley, T.C., Blanchard, E.B., & Hickling, E.J. (1996). A
prospective examination of delayed onset PTSD secondary to motor
vehicle accidents.
Journal of Abnormal Psychology, 105, 617-625.
Ehlers, A., Mayou, R.A., & Bryant, B. (1998). Psychological
predictors of chronic Posttraumatic Stress Disorder after motor
vehicle accidents.
Journal of Abnormal Psychology, 107, 508-519.
Kuch, K., Cox, B.J., & Evans, R.J. (1996). Posttraumatic
Stress Disorder and motor vehicle accidents: A multidisciplinary
overview.
Canadian Journal of Psychiatry, 41, 429-434.
Taylor, S., & Koch, W.J. (1995). Anxiety disorders due to
motor vehicle accidents: Nature and treatment.
Clinical Psychology Review, 15, 721-738
