Work potential of road accident survivors with post-traumatic stress disorder

doi:10.1016/j.brat.2004.03.008

Behaviour Research and Therapy

Volume 43, Issue 4, April 2005, Pages 475-483

https://doi.org/10.1016/j.brat.2004.03.008 Get rights and content

Abstract

Work potential in adult survivors of road accidents with and without post-traumatic stress disorder (PTSD) was examined at a mean of 8.6 months ( $SD = 3.77$ ) post-accident. All participants were working prior to their accident. Results showed that survivors with PTSD had significantly less work potential post-accident than survivors without PTSD. Specific barriers to employability for survivors with PTSD identified by this study included high levels of depression, reduced time-management ability, and an over-concern or anxiety with physical injuries. Respondents with PTSD, however, reported significantly greater extrinsic motivation to work than those without PTSD. Early intervention and referral to occupational rehabilitation programs that: (1) help address these barriers to employability and stimulate the existing motivation to return to work, and (2) work alongside clinical treatment programs, may assist in the reduction of poor work outcomes that people with PTSD following road accidents often experience.

Introduction

Post-traumatic stress disorder (PTSD) as defined in DSM-IV (APA, 1994) is characterized by intrusive, avoidance and hyperarousal symptoms that occur in response to experiencing a serious life event or threatening life circumstance. PTSD following road accidents has been reported as common, disabling and in some cases persistent over time (Blanchard & Veazey, 2001; Ursano et al., 1999). Some suggest that an individual with PTSD may experience 20 years of active symptoms and will experience almost 1 day per week of occupational impairment (Kessler, 2000).

While studies show that working contributes positively to post-trauma adjustment readjustment (Brown & Schulberg, 1995; Worthington, 1977), individuals with PTSD often have difficulties maintaining pre-trauma levels of work functioning (Blanchard et al., 1996a; Matthews, Chinnery, Blaszczynski, Silove, & Hillman, 2001). Some report that people with PTSD increase their work hours in an effort to hold off intrusive memories until their disorder makes it impossible to maintain employment (Bremner, Southwick, Darnell, & Charney, 1996). Others also provide evidence of people using their traumatic experience positively to motivate themselves to achieve in their careers (McFarlane & Yehuda, 1996).

Occupational psychologists and rehabilitation consultants who are involved in the provision of post-accident work adjustment services are increasingly being asked to provide occupational interventions and to suggest workplace accommodations that meet the specific needs of people with mental health disabilities (Houlihan & Reynolds, 2001). While there is a body of evidence identifying the negative influence of PTSD on occupational functioning generally (Blanchard et al., 1996a; Matthews et al., 2001; Mayou, Bryant, & Duthie, 1993), little empirical data exist on the components of work functioning that give rise to limitations in people with PTSD from which to develop such interventions (Matthews, 1999).

The present study investigated the components of work potential in people with PTSD with view to providing empirical data to both inform the conceptual development of work functioning in people with PTSD and to steer the development of appropriate early vocational interventions for this population.

Section snippets

Participants

Forty-six respondents (56% male) who had been admitted to a metropolitan public teaching hospital following a road accident during a retrospective 12 months period completed a postal survey on their recovery and work functioning at a mean of 8.6 months ( $SD = 3.77$ ) post-hospitalization. The respondents represented 41% of all road accident admissions to the hospital during a 12-months period that: (1) met eligibility criteria for the study, and (2) who did not have their invitation to participate

Post-traumatic stress responses

Blanchard, Jones–Alexander, Buckley, and Forneris (1996b) recommendations for diagnostic efficiency were used to identify PCL responses likely to be classified as PTSD ( $M = 52.17$ , $SD = 10.24$ ) and non-PTSD ( $M = 27.34$ , $SD = 7.90$ ). Table 1 provides the comparison of these groups on demographic and accident characteristics and includes the IES scores to corroborate the PCL groupings.

Groups were comparable on most of the variables except for pain where respondents with PTSD experienced significantly greater

Discussion

This study examined work potential in adult survivors of road accidents with PTSD approximately 8 months following their accident. Although a definite response rate could not be determined, the reported rate of 41% is similar to or higher than other Australian studies that have used postal surveys to gain information from hospital admission samples some months post-discharge (Bryant & Harvey, 1995; Jeavons, 1996). Importantly, respondents were obtained from a non-treatment-seeking,

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Biopsychosocial sequelae of chronically painful injuries sustained in motor vehicle accidents contributing to non-recovery: A retrospective cohort study
2022, Injury
Claimants with chronically painful injuries sustained in motor vehicle accidents (MVAs) undergo assessment and management influenced by insurance and medico-legal processes defined by a biomedical paradigm which is discordant with best evidence. We aim to demonstrate the impact of biopsychosocial factors on post-MVA sequelae which contribute to non-recovery.
This was a retrospective cohort study of medico-legal documents and reports on 300 consecutive claimants referred to a pain medicine physician over 7 years (2012-2018) for assessment of painful musculoskeletal injuries post-MVA. One hundred data items were extracted from the medico-legal documents and reports for each claimant and entered into an electronic database. Post-MVA sequelae were analysed using chi-square analysis (OR >2) for significant associations with demographic, pre-MVA and post-MVA variables. Factors with significant associations were entered into a logistic regression model to determine significant statistical predictors of post-MVA sequelae contributing to non-recovery.
The claimants were aged 17 to 80 years (mean age 42 years), and approximately half (53%, n=159) were female. The time from MVA to interview averaged 2.5 years. Widespread pain was present in 18% (n=54), and widespread somatosensory signs implying central sensitisation (OR=9.85, p<.001) was the most significant multivariate association. Long-term opiate use post-MVA (32%) was predicted by pre-MVA sleep disturbance (OR=5.08, p=.001), post-MVA major depressive disorder (MDD) (OR=3.02, p=.003) and long-term unemployment (OR=2.22. p=.007). Approximately half (47%, n=142) required post-MVA support from a psychologist or psychiatrist. Post-traumatic stress disorder (PTSD) was diagnosed by a psychiatrist or psychologist in 20% (n=59), yet early identification of risk of PTSD was rare. Pre-MVA, 89.4% (n=268) were studying or employed. Permanent unemployability post-MVA occurred in 35% (n=104) and was predicted by MDD (OR=3.59, p=.001) and antidepressant use (OR=2.17, p=.005). Major social change post-MVA (70%) was predicted by older age (OR=.966, p=.003), depressive symptoms (OR=3.71, p<.001) and opiate use (OR=2.00, p=.039).
Biomedical factors, including older age, impaired sleep and indicators of widespread central sensitisation, and psychological factors, including stress, anxiety and depression, were the most prominent multivariate associations as statistical predictors of major adverse sequelae contributing to non-recovery for claimants with chronic pain post-MVA.
The influence of emotion regulation on posttraumatic stress symptoms among Japanese people
2020, Journal of Affective Disorders
Citation Excerpt :
Second, many previous studies have examined a one-to-one association between specific ER skills (or a total score of various ER skills) and PTSS but do not consider the ER process. According to the Adaptive Coping with Emotions (ACE) model (Berking and Whitley, 2014), effective ER can be conceptualized as the situation-adapted interplay of the abilities to (a) be aware of emotions (e.g., Lischetzke and Eid, 2003; Subic-Wrana et al., 2005), (b) identify and label emotions (e.g., Barrett et al., 2001; Vine and Aldao, 2014), (c) correctly interpret emotion-related body sensations (e.g., Damasio, 1994; Marchesi et al., 2005), (d) understand the prompts of emotions (e.g., Southam-Gerow and Kendall, 2002), (e) actively modify negative emotions (e.g., Catanzaro and Greenwood, 1994; Salovey et al., 1995), (f) accept negative emotions when necessary (e.g., Braams et al., 2012; Leahy, 2002), (g) tolerate negative emotions when they cannot be changed (e.g., Kabat-Zinn, 2003; Kobasa et al., 1982), (h) confront (vs. avoid) distressing situations in order to attain important goals (e.g., Hayes et al., 1996; Margraf and Berking, 2005), and (i) compassionately support oneself when facing undesired emotions (e.g., Gilbert et al., 2006). A measure to assess these nine skills has been developed (Emotion-Regulation Skills Questionnaire: ERSQ; Berking and Znoj, 2008) and there is empirical evidence that these skills can be clustered in the two broader categories; (1) awareness and understanding skills (subscales a, b, c, d, and i of the above), and (2) acceptance and engagement skills (subscales e, f, g, and h of the above) (Fujisato et al., 2017).
Emotion regulation (ER) is associated with posttraumatic stress symptoms (PTSS). However, most findings are from cross-sectional studies and are hence unable to clarify whether deficits in ER longitudinally contribute to the worsening and maintenance of PTSS. In addition, no studies consider the process of how ER affects PTSS. To further clarify causal pathways, we tested prospective associations between ER and subsequent PTSS by gender in individuals who had experienced traumatic events.
We used data from an online survey of 1,794 Japanese participants aged 18–83 years who had experienced at least one traumatic event. They completed the Emotion Regulation Skills Questionnaire at baseline, as well as the PTSD Checklist for DSM-5 at baseline and four months later.
Multi-group structural equation modeling by gender revealed that participants’ ER predicted their PTSS four months later, even after controlling for symptoms at baseline. The findings indicate that identifying undesired emotions and then dealing with them decreases subsequent PTSS. ER had a greater effect on later PTSS in males than in females.
The use of an online survey and the exclusive use of self-report instruments might limit the generalizability of our results and the validity of the assessment.
Deficits in ER likely contribute to worsening and maintenance of PTSS. The process of identifying and subsequently dealing with emotions may be important for the clinical suppression of PTSS.
Factors associated with physical, psychological and functional outcomes in adult trauma patients following Road Traffic Crash: A scoping literature review
2019, Transportation Research Interdisciplinary Perspectives
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Anxiety (Alghnam et al., 2015; Mayou and Bryant, 2002; Seethalakshmi et al., 2006), depression (Mayou and Bryant, 2002; Seethalakshmi et al., 2006), PTSD (Barth et al., 2005; Koren et al., 2001; Matthews, 2005; Seethalakshmi et al., 2006), limitations in daily life activity (Alghnam et al., 2015; Kelley-Quon et al., 2010), and pain (Alghnam et al., 2015; Nolet et al., 2010) have been associated with poor recovery following a crash. Further, physical injury, depression, over concern, anxiety, and reduced time management ability were barriers to gaining employment after an RTC (Matthews, 2005). Mental health issues (PTSD and depression) were associated with pain severity post the crash (Valentine et al., 2016).
Road Traffic Crashes (RTCs) are a major cause of disability globally, with millions of people being injured or disabled each year. This study aims to identify the factors reported in the literature that are associated with physical, psychological and functional outcomes of adult trauma patients following an RTC.
A scoping literature review was conducted. Peer-reviewed articles were retrieved from MEDLINE, EMBASE, and CINAHL. These databases were chosen as the MeSH and Emtree thesauri allow for high specificity searches. Moreover, these databases index the major biomedical/health journals in the field.
Thirty-one studies from 10 countries are reported in a PRISMA chart and summarized in a matrix. This review identified a number of factors that are clustered into six categories; (i.) injury characteristics and hospital predictive factors; (ii.) demographic factors; (iii.) family and social support; (iv.); compensation system process and fault in the RTC (v.); pre-injury health status. A final category was used to represent the range of (vi.) psychological and functional outcomes.
These findings highlight the multiple and diverse contributors that influence a person's outcomes following an RTC. These factors are intrinsic and extrinsic and commence from the time of injury as well as highlighting the importance for ongoing support after acute care discharge to enable a quick return to optimal wellbeing. Research examining RTC outcomes must integrate information about the crash response and health care system while simultaneously measuring other factors to appropriately quantify the relative contribution of each variable to psychological and functional outcomes.
Factors associated with non-return to work in the severely injured victims 3 years after a road accident: A prospective study
2017, Accident Analysis and Prevention
Citation Excerpt :
In the present study, PTSD was significantly associated with non-return to work, in agreement with the literature. According to Matthews, survivors with PTSD were found to have significantly less work potential than those without PTSD (Matthews, 2005). Moreover, according to Opsteegh et al., pain, if uncontrolled and prolonged, may be an important stressor that could result in the development of PTSD (Opsteegh et al., 2009).
Road accidents may impact victims' physical and/or mental health and socio-occupational life, particularly the capacity to return to work. The purpose of our study is to assess modifiable medical and socio-occupational factors of non-return to work in the severely injured 3 years after a road accident. Among1,168 road accidents casualties in the Rhône administrative Département of France followed for five years, 141 of the 222 severely injured (Maximal Abbreviated Injury Scale ≥ 3) aged more than 16 years who were in work at the time of the accident, reported whether they had returned to work in the 3 years following the accident. The subgroups of those who had (n = 113) and had not returned to work (n = 28) were compared for socio-occupational (gender, age, educational level, marital status, socio-occupational group) accident-related medical factors (type of road user, type of journey, responsibility in the accident, initial care) and post-accident medical factors (pain intensity, post-traumatic stress disorder, physical sequelae, quality of life) by using standardized tools. Severity of initial head, face and lower-limb injury, intense persistent pain, post-traumatic stress disorder, poor self-assessed quality of life and health status at 3 years were associated with non-return to work on univariate analysis. On multivariate analysis, severity of initial head and lower-limb injury, intense persistent pain at 3 years and post-traumatic stress disorder were significantly associated with non-return to work 3 years following severe road-accident injury. Post-traumatic stress disorder and chronic pain were essential modifiable medical determinants of non-return to work in the severely injured after a road accident: early adapted management could promote return to work in the severely injured. Improve early adapted treatment of pain and PTSD in the rehabilitation team should help the severely injured return to work following a road accident.
Predictors of non-return to work 2 years post-injury in road traffic crash survivors: Results from the UQ SuPPORT study
2017, Injury
Individuals who have sustained an injury from a road traffic crash (RTC) are at increased risk for long lasting health problems and non-return to work (NRTW). Determining the predictors of NRTW is necessary to develop screening tools to identify at-risk individuals and to provide early targeted intervention for successful return to work (RTW). The aim of this study was to identify factors that can predict which individuals will not RTW following minor or moderate injuries sustained from a RTC.
Participants were 194 claimants (63.4% female) within a common-law “fault-based” system from the UQ SuPPORT cohort who were working prior to their RTC. Participants were assessed at 6 months on a variety of physical and mental health measures and RTW status was determined at 2 years post-RTC. RTW rate was 78.4%.
Univariate predictors of NRTW included being the driver or passenger, having a prior psychiatric diagnosis, high disability level, low mental or physical quality of life, predicted non-recovery, high pain, low function, high expectations of pain persistency, low expectations about RTW, having a psychiatric diagnosis, elevated depression or anxiety. The final multivariable logistic regression model included only two variables: disability level and expectations about RTW. Seventy-five percent of individuals who will not RTW by 2 years can be identified accurately at an early stage, using only these two predictors.
The results are promising, because they suggest that having information about two factors, which are easily obtainable, can predict with accuracy those who will require additional support to facilitate RTW.
Life quality and rehabilitation after a road traffic crash: A literature review
2016, Transportation Research Part F: Traffic Psychology and Behaviour
Road traffic injuries continue to pose a worldwide threat to health and well-being of people. In European Union, for example, each year more than 25,000 people are killed and 1.4 million people are injured or disabled in road traffic crashes (RTCs). Additionally, families of RTC victims and their lives are affected emotionally, socially, psychologically, and economically. It should be noted that as in the beginning of 1990s, however, the majority of available literature is focused on the pre-RTC factors (e.g., prevention) rather than the post-RTCs (e.g., the rehabilitation of severely injured) period. As a result, disproportionally greater weight is attached on the pre-RTCs internationally whereas little is known about the psycho-social and economic burden of the post-RTCs period. In this paper, a literature review including the years 1990–2013 was conducted on the publications about post-RTCs period to investigate the possible problems that prevents studying the life quality and rehabilitation after RTCs. Trauma, traffic, injury, rehabilitation, and satisfaction (related to the services and process) were used as keywords and Scopus database (www.scopus.com) was used for searching. In the first step, 443 publications were obtained. Among 443 publications, 75 publications were recorded as relevant. In addition, three publications were suggested by co-authors and 37 publications were obtained by a book source suggested by the reviewer. A total number of 114 publications are presented and evaluated under different components or “stages” of the post-RTCs’ period related to rehabilitation as (a) service utilization indicators (e.g., length of care) and service satisfaction indicators (e.g. satisfaction from services), (b) morbidity indicators (e.g., injury patterns), (c) quality of life indicators (e.g., physical and psychological well-being indicators), (d) social network indicators (e.g., type and frequency of informal care provided by family members), and (e) cost indicators (e.g., overall expenditure). The overall evaluation of the publications in literature, possible implications, suggestions, and future directions were discussed.

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Work potential of road accident survivors with post-traumatic stress disorder

Abstract

Introduction

Section snippets

Participants

Post-traumatic stress responses

Discussion

Behaviour Research & Therapy

Behaviour Research & Therapy

General Hospital Psychiatry

Australian Journal of Public Health

Australian & New Zealand Journal of Public Health

Australian standard classification of occupations

Diagnostic and statistical manual of mental disorders (DSM)

Clinician-administered PTSD scale

Mental disorders resulting from road traffic accidents

Current Opinion in Psychiatry

Chronic PTSD in Vietnam combat veteransCourse of illness and substance abuse

American Journal of Psychiatry

Estimating premorbid IQ from demographic variablesA comparison of a regression equation vs. clinical judgement

British Journal of Clinical Psychology

Posttraumatic stress disorder and the use of health services

Psychosomatic Medicine

Abbreviated injury scale and injury severity scoreA scoring chart

The Journal of Trauma

Stress response syndromes and their treatment

Impact of event scaleA measure of subjective stress

Psychosomatic Medicine