Psychological morbidity from motor vehicle accidents is frequently appreciated in phobic disorders, post traumatic stress disorder (PTSD), and depression. But what are the long-term prospects for these accident victims? A British team studied the psychosocial outcomes of 111 non-head-injured motor crash victims at baseline, 3 months, 1 year, and 5 years. (Psychosomatic Medicine 59:11 pp. 578-584).

At five years, 44% of subjects reported that they were fully recovered physically. No subject who reported being physically back to normal was diagnosed as having PTSD. All but 1 of the 5 subjects diagnosed as suffering PTSD at 1 year were improved at 5 years, while 8 of the 9 subjects with a 5-year diagnosis of PTSD previously had not been diagnosed as such. At 5 years, no subject who could not remember the accident reported PTSD. PTSD was not associated with perceived fault, progress of compensation proceedings, having an additional major vehicle accident, evidence of pre-accident psychological problems, or alcohol intake.

PTSD at 5 years was also predicted by initial intrusive memories, but immediate emotional distress after the accident was also a significant predictor after adjustment, as was patient report of continuing medical problems at 5 years.

Results show that, overall, there were few changes between evaluations done at 3 months, 1 year, and 5 years in the prevalence of travel anxiety. Seventy-three percent of those with major physical problems reported travel anxiety. This phobia was not predicted by any factor other than immediate emotional distress. The study clearly showed that concern about travel was associated with considerable distress, behavioral change, and disability that was unrelated to the progress of compensation proceedings.

At 5 years, 79% of the compensation claims had been settled. Most claimants were highly dissatisfied and thought that legal problems were an additional stressful consequence of the accident. Settlement, however unsatisfactory, was generally seen as a relief from stress, which enabled people to put the past behind them.

This study underscores the importance of assertive early diagnosis and treatment for physical injuries, as well as for travel anxiety, in minimizing the long-term psychological morbidity of motor vehicle accidents.