Bridget Bryant

Psychological predictors of chronic posttraumatic stress disorder after motor vehicle accidents.

A prospective longitudinal study assessed 967 consecutive patients who attended an emergency clinic shortly after a motor vehicle accident, again at 3 months, and at 1 year. The prevalence of posttraumatic stress disorder (PTSD) was 23.1% at 3 months and 16.5% at 1 year. Chronic PTSD was related to some objective measures of trauma severity, perceived threat, and dissociation during the accident, to female gender, to previous emotional problems, and to litigation. Maintaining psychological factors, that is, negative interpretation of intrusions, rumination, thought suppression, and anger cognitions, enhanced the accuracy of the prediction. Negative interpretation of intrusions, persistent medical problems, and rumination at 3 months were the most important predictors of PTSD symptoms at 1 year. Rumination, anger cognitions, injury severity, and prior emotional problems identified cases of delayed onset.

Cognitive predictors of posttraumatic stress disorder in children: results of a prospective longitudinal study.

The present study explored whether cognitive factors specified in the Ehlers and Clark model (Behav. Res. Ther. 38 (2000) 319) of posttraumatic stress disorder (PTSD) predict chronic PTSD in children who had experienced a road traffic accident. Children were assessed at 2 weeks, 3 months, and 6 months after the accident. Data-driven processing during the accident, negative interpretation of intrusive memories, alienation from other people, anger, rumination, thought suppression and persistent dissociation at initial assessment predicted PTSD symptom severity at 3 and 6 months. On the basis of sex and stressor severity variables, 14% of the variance of PTSD symptoms at 6 months could be explained. The accuracy of the prediction increased to 49% or 53% when the cognitive variables measured at initial assessment or 3 months, respectively, were taken into account.

Posttraumatic stress disorder after motor vehicle accidents: 3-year follow-up of a prospective longitudinal study.

The paper presents a 3-year follow-up of a prospective longitudinal study of posttraumatic stress disorder (PTSD) after motor vehicle accidents (J. Abnormal Psychol., 107 (1998) 508). Participants were 546 patients who had been assessed when attending an emergency clinic shortly after a motor vehicle accident, and at 3 months and 1 year afterwards. The prevalence of posttraumatic stress disorder PTSD at 3 years was 11%. Maintaining psychological factors, i.e. negative interpretation of intrusions, rumination, thought suppression and anger cognitions, were important in predicting the persistence of PTSD at 3 years, as were persistent health and financial problems after the accident. Other predictors were female sex, hospital admission for injuries, perceived threat and dissociation during the accident, and litigation.

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 baseline predictors. Methods Self-report questionnaires were completed by 111 consecutive subjects who had been injured in a motor vehicle accident 5 years earlier and who had been assessed previously in a prospective 1-year study. Results Although most subjects reported a good outcome, a substantial minority described continuing social, physical, and psychological difficulties and a quarter of those studied suffered phobic anxiety about travel as a driver or passenger. There was little change in quality of life outcome and effects on travel between assessments at 3 months, 1 year, and 5 years. The prevalence of posttraumatic stress disorder remained approximately 10% throughout the follow-up; most early cases had remitted by 5 years, and a similar number of delayed new onsets had occurred between 1 year and 5 years. PTSD at 5 years was predicted by physical outcome and by postaccident intrusive memories and emotional distress. Compensation proceedings were initiated by 66 subjects and were often prolonged and a cause of distress. There were no significant associations with outcome. Trends for a poor outcome in claimants, especially those not settled at 5 years, may be due to their having more serious physical problems. Conclusion Psychological complications are important and persistent after injury in a motor vehicle accident, are associated with adverse effects on everyday activities, and pose a challenge for consultation-liaison psychiatry.

Psychological consequences of road traffic accidents for children and their mothers.

BACKGROUND Little is known about the psychological and behavioural consequences of road traffic accidents for children. The study aimed to determine the outcome of road traffic accidents on children and their mothers. METHOD A 1-year cohort study of consecutive child attenders aged 5-16 years at an Accident and Emergency Department. Data were extracted from medical notes and from interview and self-report at baseline, 3 months and 6 months. RESULTS The children had an excellent physical outcome. Fifteen per cent suffered acute stress disorder; 25% suffered post-traumatic stress disorder at 3 months and 18% at 6 months. Travel anxiety was frequent. Post-traumatic consequences for mothers were common. CONCLUSION Psychological outcome was poor for a minority of children and associated with disability, especially for travel. There were significant family consequences. There is a need for changes in clinical care to prevent, identify and treat distressing and disabling problems.

Outcome 3 years after a road traffic accident

BACKGROUND Road traffic accidents are known to have significant consequences for mental state and quality of life in the ensuing year that are largely unrelated to the nature of the injuries. Little is known of longer-term outcome in a representative population. METHODS Questionnaires covering mental state and social adjustment were sent to 770 subjects who had previously participated in a prospective study of consecutive attenders at an emergency department following a road traffic accident and who had completed questionnaires at baseline, 3 months and 1 year. Outcomes were not predicted by measures related to injury type or severity but were predicted by baseline and later non-injury variables. RESULTS Replies were received from 507 (66%) subjects. Although 76% of injuries were medically minor bruises and lacerations, 132 (26%) reported symptoms of psychiatric disorder and 104 (21 %) moderate or severe pain at 3 years. There was little evidence of improvement in prevalence between 1 and 3 years, with continuing physical symptoms, psychiatric disorder and reported consequences for everyday life. There was a significant reduction in the number of cases of post-traumatic stress disorder (PTSD) despite there being 21 late onset cases. Psychiatric outcomes and pain were unrelated to the severity of injury and were largely predicted by post-accident variables. CONCLUSIONS Road traffic accidents have much greater consequences than would be expected from the largely minor nature of the physical injuries. There is a need for changes in medical care and in socio-legal procedures.

The Treatment of Social Failure A Comparison of Anxiety-Reduction and Skills-Acquisition Procedures on Two Social Problems

The differential response of two forms of social failure-primary and secondary-to two forms of treatment—a skills-acquisition procedure and an anxiety-reduction technique-was studied. Twenty socially unskilled (primary) patients and 20 socially phobic (secondary) patients were given either systematic desensitization (SD) or social skills training (SST). The unskilled patients responded more to SST, as predicted, in that they reported significantly less difficulty in social situations, went out more, and improved on their personal behavioral deficits. The phobic patients responded equally well to both therapies. The success of SST in both kinds of problems is explained in terms of an unpredicted dual role, in that it reduced anxiety as well as facilitated behavior change. This is discussed in the light of current theories of anxiety reduction.

Quality of life in non-insulin-dependent diabetes and a comparison with insulin-dependent diabetes.

The reported effects of diabetes on quality of life have been assessed in two groups of attenders at out-patient clinics: 1. One hundred and twenty-one non-insulin-dependent diabetic patients randomly allocated to diet, tablet or ultralente insulin therapy; 2. Fifty-seven patients with insulin-dependent diabetes consecutively attending an out-patient clinic. The overall picture for those with non-insulin-dependent diabetes was of relatively little disruption to most areas of life, but 27% reported considerable loss of enjoyment and reduction in social life. High fasting plasma glucose was significantly associated with fatigue and leisure difficulties. The type of therapy, tablet, diet or insulin, made little difference to psychological, social or attitude variables. Those with insulin dependent diabetes showed similar psychological morbidity, but described a rather different pattern of social consequences with more effects on work and less on leisure.

Social skills training and psychotherapy: a comparative study

A comparison is made between two forms of treatment for patients with interpersonal difficulties—one, an established treatment in the form of brief psychotherapy, and the other, social skills training, a form of behaviour modification designed to provide or improve the social skills necessary for successful social interaction. In a pilot study using social skills training, six out of seven patients showed marked clinical and social improvement. In the controlled trial, there was evidence that both types of treatment improved behaviour, but that social skills training tended to maintain its effect for longer, even though psychotherapy patients had more than twice the number of therapy hours.

A survey of social inadequacy among psychiatric outpatients.

An investigation into the extent and nature of social inadequacy among outpatients diagnosed as neuroses and personality disorders was undertaken on patients aged 18-49 attending one clinic over a six-month period. A feature of this survey was that each patient took part in a standard social interaction test, and their performance was assessed by two psychologists. A relatively high proportion of patients, one in six on the most conservative estimate, and probably over one in four, were judged by psychologists and psychiatrists to be socially inadequate, and the results showed a clear pattern of behavioural, social and personality factors associated with these judgements. Implications for assessment and treatment are discussed.