Warren R. Loos

Who develops PTSD from motor vehicle accidents

Within 1 to 4 months of their motor vehicle accident (MVA), we assessed 158 MVA victims who sought medical attention as a result of the MVA. Using the Clinician-Administered PTSD Scale (CAPS: Blake, Weathers, Nagy, Kaloupek, Klauminzer, Charney & Keane, 1990. National Center for Post-Traumatic Stress Disorder, Boston, MA)., we found that 62 (39%) met DSM-III-R (American Psychiatric Association, 1987. Washington, DC: American Psychiatric Press) criteria for Post-Traumatic Stress Disorder. Using variables from the victims account of the accident and its sequelae, pre-MVA psychosocial functioning, demographic variables, pre-MVA psychopathology and degree of physical injury, we found that 70% of the subjects could be classified as PTSD or not with 4 variables: prior major depression, fear of dying in the MVA, extent of physical injury and whether litigation had been initiated. Using multiple regression to predict the continuous variable of total CAPS score, as a measure of post-traumatic stress symptoms, we found that 8 variables combined to predict 38.1% of variance (Multiple R = 0.617).

Psychiatric morbidity associated with motor vehicle accidents

The primary purpose of this report was to determine the extent of psychiatric morbidity and comorbidity among a sample of recent victims of motor vehicle accidents (MVAs) in comparison to a nonaccident control population. Victims of recent MVAs (N = 158), who sought medical attention as a result of the MVA, were assessed in a University-based research clinic, 1 to 4 months after the accident for acute psychiatric and psychosocial consequences as well as for pre-MVA psychopathology using structured clinical interviews (Clinician-Administered PTSD Scale, SCID, SCID-II, LIFE Base). Age-and gender-matched controls (N = 93) who had had no MVAs in the past year served as controls. Sixty-two MVA victims (39.2%) met DSM-III-R criteria for posttraumatic stress disorder (PTSD), and 55 met DSM-IV criteria. The MVA victims who met the criteria for PTSD were more subjectively distressed and had more impairment in role function (performance at work/school/homemaking, relationships with family or friends) than the MVA victims who did not meet the PTSD criteria or the controls. A high percentage (53%) of the MVA-PTSD group also met the criteria for current major depression, with most of that developing after the MVA. A prior history of major depression appears to be a risk factor for developing PTSD after an MVA (p = .0004): 50% of MVA victims who developed PTSD had a history of previous major depression, as compared with 23% of those with a less severe reaction to the MVA. A prior history of PTSD from earlier trauma also is associated with developing PTSD or a subsyndromal form of it (25.2%) (p = .0012). Personal injury MVAs exact substantial psychosocial costs on the victims. Early intervention, especially in vulnerable populations, might prevent some of this.

Psychological morbidity associated with motor vehicle accidents

Fifty victims of recent motor vehicle accidents (MVAs), who had sought medical attention after their accidents, were assessed for possible psychological morbidity as a result of the accident. Forty age, gender-matched controls were also assessed with the same instruments. Forty-six percent of the MVA victims met the criteria for current post-traumatic stress disorders (PTSD) as a result of the accident while 20% showed a sub-syndromal version (the reexperiencing symptom cluster plus either the avoidance/numbing cluster or the over-arousal cluster) of PTSD. Although all MVA victims showed some form of driving reluctance, only 1 S met the criteria for driving phobia. Those MVA victims who met the criteria for PTSD or sub-syndromal PTSD were significantly more likely to have experienced previous trauma, other than a serious MVA, and were more likely (P = 0.008) to have previously met the criteria for PTSD as a result of that trauma. Forty-eight percent of MVA victims who met the criteria for current PTSD also met the criteria for current major depression. Significantly more current MVA-PTSDs had suffered previous major depressive episodes.

One-year prospective follow-up of motor vehicle accident victims

One-hundred and thirty-two victims of motor vehicle accidents (MVAs), who sought medical attention as a result of the MVA, were assessed at three points in time: 1-4 months post-MVA, 6 months later, and 12 months later. Of the 48 who met the full criteria for Post-Traumatic Stress Disorder (PTSD) initially, half had remitted at least in part by the 6-month follow-up point and two-thirds had remitted by the 1-yr follow-up. Using logistic regression, 3 variables combined to correctly identify 79% of remitters and non-remitters at the 12-month follow-up point: initial scores on the irritability and foreshortened future symptoms of PTSD and the initial degree of vulnerability the subject felt in a motor vehicle after the MVA. Four variables combined to predict 64% of the variance in the degree of post-traumatic stress symptoms at 12 months: presence of alcohol abuse and/or an Axis-II disorder at the time of the initial assessment as well as the total scores on the hyperarousal and on avoidance symptoms of PTSD present at the initial post-MVA assessment.

Prediction of remission of acute posttraumatic stress disorder in motor vehicle accident victims

One hundred forty five individuals who sought medical attention as a result of a motor vehicle accident (MVA), and who were initially assessed 1 to 4 months post-MVA, were followed up prospectively for 6 months to determine how many of the 55 with posttraumatic stress disorder (PTSD) and the 43 with sub-syndromal PTSD would remit and what variables would predict remission. Thirty (55%) of those with initial PTSD had remitted at least in part by 6 months while 67% of those with sub-syndromal PTSD had remitted (and 5% had worsened). Four variables, including severity of initial symptoms, degree of initial physical injury, relative degree of physical recovery by 4 months and whether a close family member suffered a trauma during the follow-up interval, combined to classify 6-month clinical status of 84% of those with initial PTSD secondary to MVAs.

Short-term follow-up of post-traumatic stress symptoms in motor vehicle accident victims

Ninety-eight victims of recent motor vehicle accidents (MVA), who sought medical attention as a result of the MVA, were followed up prospectively 6 months after the initial assessment, using Keller, Lavori, Friedman, Nielsen, Endicott, McDonald-Scott and Andreasens (Archives of General Psychiatry, 44, 540-548, 1987) LIFE methodology so that month-by-month changes in post-traumatic stress disorder (PTSD) symptoms could be determined. For the 40 MVA victims who initially met the full criteria for PTSD, 10 no longer met the criteria 4 months after the initial assessment, a decrease significant at the P < 0.01 level, and 20 no longer met the full criteria at 6 months (P < 0.001). On a symptom-by-symptom basis, there were significant declines among the fraction of those who initially met the criteria for PTSD for all avoidance and numbing symptoms by the 6-month follow-up, whereas most of the hyperarousal symptoms did not show significant declines.

Effects of varying scoring rules of the Clinician-Administered PTSD Scale (CAPS) for the diagnosis of post-traumatic stress disorder in motor vehicle accident victims

We examined the effects of varying the scoring rules for the CAPS (Clinician Administered PTSD Scale) on the diagnosis of PTSD in a sample of 100 victims of recent motor vehicle accidents. This was done by assessing, for each scoring rule, the rate of categorical diagnosis and the effect on group mean scores on measures of subjective distress and role impairment. Changing from the most liberal to the most conservative scoring rule results in a change in diagnosis of PTSD from 44% to 29% of the sample. Comparisons of those included as PTSD under the most conservative scoring criteria vs those excluded (who had previously been included) reveal significantly greater subjective distress and role impairment among those who continue to be included in the PTSD category. Thus, changes in scoring rules have clinically significant effects on the incidence and severity of diagnosed PTSD. This indicates that the selection of scoring rules has important implications for epidemiological estimates of the prevalence of PTSD, and that PTSD studies using different scoring rules as inclusion criteria may be using somewhat different samples.

The psychophysiology of motor vehicle accident related posttraumatic stress disorder

Fifty victims of recent motor vehicle accidents (MVAs) and 40 non-MVA controls participated in a psychophysiological assessment in which heart rate (HR), systolic and diastolic blood pressures, forehead EMG and electrodermal activity were measured during mental arithmetic, idiosyncratic audiotaped descriptions of the victims own MVA, and a standard videotape of MVAs. The MVA victims were subdivided into 23 with full posttraumatic stress disorder (PTSD), 10 with sub-syndromal PTSD, and 17 without PTSD. HR response to the idiosyncratic audiotape reliably ( p

Effects of Litigation Settlements on Posttraumatic Stress Symptoms in Motor Vehicle Accident Victims

In order to investigate the effects of the initiation of litigation and its settlement on victims of motor vehicle accidents (MVAs), we followed up 132 MVA victims from an initial assessment 1 to 4 months post-MVA for 1 year. Of the 67 who had initiated litigation. 18 (27%) settled within the 12 months, while 49 still had litigation pending; 65 never initiated litigation. Those who initiated litigation had more severe injuries and higher initial levels of posttraumatic stress (PTS) symptoms. All three groups improved in major role function and had reduced PTS symptoms over the 1 year follow-up. Those whose suits were still pending, as well as those whose suits had been settled, showed no reduction in measures of anxiety or depression, whereas the nonlitigants did show improvement on these measures.

A Non-Pharmacological Treatment of Vascular Headache During Pregnancy

SYNOPSIS