Traumatic Stress and Motor Vehicle Accidents
A National Center for PTSD Fact Sheet
By Todd Buckley, Ph.D.
Introduction
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.
Links to Information about Motor Vehicle Accidents and Auto Safety
AAA Foundation for Traffic Safety
Advocates for Highway
and Auto Safety
DWI Statistics
National Highway Traffic Safety Administration
Links to Information about Treatment of Mental-Health Problems
American Psychological Association
Association for Advancement of Behavior Therapy
The International Society for Traumatic Stress
Studies
American Psychiatric Association
Related Fact Sheets
Chronic Pain
Explains what chronic pain is and how it's related to PTSD, describes treatment options for patients and
recommendations for health care providers
Common
reactions to trauma
An explanation of common reactions to trauma by Dr. Edna Foa
Epidemiology
Information about rates of PTSD in the United States among different populations
Treatment
Information on availble treatments for PTSD
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
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