Posttraumatic Syndromes in Children and Adolescents after Road Traffic Accidents – A Prospective Cohort Study

Abstract

Background: The impact of road traffic accidents (RTAs) on the physical health of children is well recognized, but their psychological consequences have only recently become a topic of research. While other traumatic experiences in childhood are well studied, this kind of trauma has been poorly investigated to date. Sampling and Methods: A prospective cohort study was conducted of 8- to 18-year-old children and adolescents who were involved in RTAs in a large urban area during a 6-month period. The children and adolescents were interviewed within 1 week after the accident and, again, 3 months later. In total, 72 children and adolescents took part in the study. Symptoms of posttraumatic stress, depression and anxiety were assessed by a structured clinical interview and standardized questionnaires. Results: One week after the accident, 11% of the children met the diagnostic criteria for posttraumatic stress disorder (PTSD) according to ICD-10 and a further 13% met the criteria for ‘subsyndromal PTSD’. Complex syndromes consisting of subsyndromal posttraumatic stress, (separation) anxiety and depression were common among those children. Isolated cases of anxiety and depression symptoms were also observed but rarely reached an impairing level. Three months after the accident, 25% of the children reported persistence of the PTSD symptoms (measured by the Impact of Event Scale – Revised). The strongest predictor of the extent of posttraumatic stress after 3 months was proven to be the initial level of PTSD symptoms. This predictor alone accounted for 38% of its variance. Conclusions: Our results provide evidence that even after ‘everyday’ RTAs, psychological consequences are common. Special attention should be paid to the common occurrence of subsyndromal psychological disturbances and more complex syndromes. The results further indicate the limitations of the PTSD concept in the assessment of posttraumatic disturbances in childhood and adolescence.

Peritraumatic reactions and posttraumatic stress disorder in psychiatrically impaired youth

“…However, trait dissociation was related to questionnaireassessed PTSD severity on a multivariate basis, suggesting that trait and peritraumatic dissociation may each independently contribute to PTSD severity. These results contrast with findings in adults that trait dissociation fully accounts for the relationship between peritraumatic dissociation and PTSD Schafer, Barkmann, et al, 2006). Whereas Briere and colleagues' (2005) finding that trait dissociation accounted for the effects of peritraumatic dissociation was based on categorical PTSD diagnosis, another study with adults that used a continuous measure of PTSD severity (Hetzel & McCanne, 2005) found that peritraumatic dissociation was predictive independent of trait dissociation.…”

“…Witnessing domestic (Teicher et al, 2006) or community violence (McKelvey et al, 2011), and exposure to traumatic accidents (Schafer, Barkmann, Riedesser, & Schulte-Markwort, 2006) are associated with PTSD. Therefore, these additional exposures were included in this study.…”

The independent predictive value of peritraumatic dissociation for PTSD symptomatology after type I trauma: A systematic review of prospective studies

“…Only 2 studies focused exclusively on males (Marshall & Schell, 2002) or females (Engelhard, van den Hout, Kindt, Arntz, & Schouten, 2003). Only 1 of the selected studies focused on children (Schäfer, Barkmann, Riedesser, & Schulte-Markwort, 2006). Eight studies had a relatively small sample size of 86 or less.…”

“…No studies with positive outcomes (and only 1 study with negative outcomes, Schäfer et al, 2006) included children affected by a traumatic event. Only 1 positive (16.7%) and 3 negative (27.3%) studies included teenagers.…”

“…Once again, PD added no significant explanation of variance of PTSD severity in multiple regression analyses. In the only study which included a (small) sample of children (Schäfer et al, 2006), stepwise regression analyses revealed that only PTSD symptomatology 1 week post-event significantly predicted PTSD severity 3 months after the traffic accident (38% explained variance).…”