Predictors of Mental Health Outcomes in Road Traffic Accident Survivors

[Prevalence and predictors of post-traumatic stress disorder in road traffic accidents]

Introduction

trauma-related disorders following a road accident have both a health and an economic impact.

Methods

we conducted a prospective study to determine the prevalence of these disorders, and to identify risk factors in subjects victims of road accidents and hospitalized in the Department of Orthopedic Surgery and Traumatology of the University Hospital Center of Sfax-Tunisia.

Results

a total of sixty-ten subjects were included in this study. The prevalence of acute stress disorder was 37.1% and was associated with female sex, low educational level, previous medical and surgical history, passivity during the accident, severity of injuries and the presence of anxious and depressive symptoms. Post-traumatic stress disorder was observed in 40% of subjects and was associated with urban residential environment, passivity during the accident and anxious and depressive symptoms. Low scores for functional coping strategies and high scores for dysfunctional coping strategies were significantly associated with both disorders. Low educational level, urban residential environment, high levels of anxiety and depression, and denial coping strategy appear to be independent risk factors for acute stress and post-traumatic stress disorder.

Conclusion

It is therefore important to determine the profile of people at greater risk of post-traumatic stress disorder, to enable early diagnosis in victims of road accidents.

Frailty and Other Factors Associated With Early Outcomes in Middle-to Older Age Trauma Patients: A Prospective Cohort Study

OBJECTIVES

To prospectively investigate associations of frailty and other predictor variables with functional recovery and health outcomes in middle-aged and older patients with trauma.

DESIGN

Single-center prospective cohort study.

SETTING

Emergency department of Wan Fang Hospital in Taiwan.

PARTICIPANTS

Trauma patients aged 45 and older.

MEASUREMENTS

Frailty was assessed with the Clinical Frailty Scale (CFS). Injury mechanisms, pre-existing diseases, and fracture locations were recorded at baseline. The primary outcome was functional recovery assessed using the Barthel Index (BI). Secondary outcomes were new care needs, unscheduled return visits, and falls 3 months postinjury.

RESULTS

A total of 588 participants were included in the final analysis. For every one-point increase in the CFS, the multivariable-adjusted odds ratio (OR, 95% confidence interval [CI]) of failure to retain the preinjury BI was 1.34 (1.16-1.55); associations were consistent across levels of age and injury severities. Significant joint associations of frailty and age with poor functional recovery were observed. CFS was also associated with new care needs (OR for every one-point increase, 1.36, 95% CI, 1.17-1.58), unscheduled return visits (OR 1.26, 95% CI, 1.04-1.51), and falls (OR 1.23, 95% CI, 1.01-1.51). Other variables associated with failure to retain preinjury BI included road traffic accident and presence of hip fracture.

CONCLUSION

Frailty was significantly associated with poor functional and health outcomes regardless of injury severity in middle-aged and older patients with trauma. Injury mechanisms and fracture locations were also significant predictors of functional recovery postinjury.

Prevalence and Risk Factors of Post-Traumatic Stress Disorder in Survivors of a Cohort of Road Accident Victims in Benin: Results of a 12-Month Cross-Sectional Study

Purpose

Post-traumatic stress disorder (PTSD) is a frequent psychiatric complication in road accident survivors. However, it remains under-explored and is not taken into account in health policies in Benin. The purpose of this study was to determine the prevalence and risk factors of PTSD after a road traffic accident. This will help to improve its diagnosis and management in Benin hospitals.

Materials and Methods

An institution-based cross-sectional study was conducted from November 2020 to January 2021. Consenting victims of road traffic accidents from three hospitals across Benin, aged 18 years and above, living in the south of the country, were administered various questionnaires at 12-month follow-up. Data on PTSD were collected using a pre-tested, structured and standardized post-traumatic stress disorder questionnaire, the PTSD Checklist (specific version) (PCL-S). A logistic regression model was fitted to identify factors associated with PTSD. An adjusted odds ratio (AOR) followed by a 95% confidence interval was calculated to determine the level of significance with a p-value less than 0.05.

Results

Out of 865 patients in the cohort eligible for the 12-month follow-up, 734 (85%) participated in the study. The prevalence of PTSD was 26.43% (95% CI: 23.36–29.75). Factors associated with PTSD on multivariate analysis were female gender (adjusted odds ratio (AOR) = 2.14, 95% CI: 1.38–3.33), hospitalization (AOR = 1.87, 95% CI 1.21–2.89), negative impact of the accident on income (AOR = 4.22, 95% CI: 2.16–8.25), and no return to work (AOR = 3.17, 95% CI: 1.99–5.06).

Conclusion

The prevalence of PTSD is high in road accident survivors in Benin. The results of this study highlight the need for early diagnosis and a multidisciplinary approach to the management of PTSD patients in Benin’s hospitals.

The contribution of pre-injury vulnerability to risk of psychiatric morbidity in adults injured in a road traffic crash: Comparisons with non-injury controls

People who sustain injury in a road traffic crash (RTC) have significant risk of psychiatric morbidity, but effective screening for identifying at-risk individuals soon after the RTC is lacking. We investigated whether pre-injury vulnerability can assist as an early screen to manage this risk. We recruited 120 adults who sustained physical injury in a RTC and admitted to an emergency department (ED). They were comprehensively assessed for acute and long-term presence of psychiatric disorder/morbidity and disability over 12-months after the injury, with comparisons to a non-injury control. Propensity matching based on six pre-injury vulnerability factors (age, sex, education, socioeconomic status, prior mental health, prior physical health) with the control group was used to determine membership of high vulnerability (HV) and low vulnerability (LV) injury sub-groups. Compared to the LV sub-group and controls that had similar pre-injury vulnerability, the HV sub-group had a worrying post-RTC recovery profile, with significantly higher rates of long-term psychiatric morbidity (42.2% vs. 23.1% and 15.9% respectively, p = .002) including post-traumatic stress disorder and/or depression, and poorer psychological adjustment over the 12-months. In contrast, the HV and LV sub-groups were similar in injury-related characteristics and post-injury physical (pain, fatigue, physical functioning) and participation outcomes. Findings provide preliminary evidence that pre-injury vulnerability, primarily prior mental health status, is a promising screen for early identification of people at risk of psychiatric morbidity post-RTC. It is suggested this screen could be implemented in ED to prevent chronicity and improve recovery following a traumatic injury. Further research is warranted to enhance the screen's effectiveness.

Different Patterns of Mental Health Outcomes among Road Traffic Crash Survivors: A Prospective Cohort Study

This study aimed to investigate factors associated with the symptoms of mental disorders following a road traffic crash (RTC). A prospective cohort of 200 people was followed for 6 months after experiencing an RTC. The cohort was comprised of uninjured survivors and injured victims with all levels of road traffic injury (RTI) severity. Multivariable logistic regression analyses were performed to evaluate the associations between the symptoms of depression, posttraumatic stress disorder and anxiety one and six months after the RTC, along with sociodemographic factors, health status before and after the RTC, factors related to the RTI and factors related to the RTC. The results showed associations of depression, anxiety, and posttraumatic stress disorder symptoms with sociodemographic factors, factors related to the health status before and after the RTC and factors related to the RTC. Factors related to the RTI showed associations only with depression and posttraumatic stress disorder symptoms. Identifying factors associated with mental disorders following an RTC is essential for establishing screening of vulnerable individuals at risk of poor mental health outcomes after an RTC. All RTC survivors, regardless of their RTI status, should be screened for factors associated with mental disorders in order to successfully prevent them.

Quality of Life in Road Traffic Accident Survivors

Introduction

The loss of quality of life is the major consequence following a non-fatal road traffic accident (RTA). Previous research regarding quality of life did not include uninjured RTA survivors. The research aim was thus to evaluate the quality of life of the RTA survivors regardless of whether or not they sustained injures, and to identify factors associated with decreased quality of life after the RTA.

Methods

A cohort of 200 RTA survivors with and without injuries was followed after experiencing an RTA. The quality of life and mental health outcomes were assessed 1 month following RTA. A vast range of sociodemographic, pre-RTA health-related, RTA related, RTA injury-related, compensation-related factors and mental health outcomes were investigated.

Results

Decreased quality of life following an RTA showed an association with the low socioeconomic status of the RTA victims, poor pre-RTA health, injury-related factors, compensation-related factors and psychological disorders after the RTA.

Conclusions

Identifying predictors of decreased quality of life following an RTA will enable planning interventions targeting the most important factors that influence recovery of RTA victims. Assessing and recording of self-reported quality of life should be a part of the routine protocol in RTA survivors’ health-care.