**Peritraumatic Distress in Accident Survivors: An Indicator for Posttraumatic Stress, Depressive and Anxiety Symptoms, and Posttraumatic Growth**

Daisuke Nishi1,2, Masato Usuki1,2,4 and Yutaka Matsuoka1,3

*1National Disaster Medical Center, 2Japan Science and Technology Agency, 3National Center for Neurology and Psychiatry, 4Kyushu University, Japan* 

### **1. Introduction**

96 Post Traumatic Stress Disorders in a Global Context

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In 1997, the Global Burden of Disease Study (Murray, 1997) predicted that by 2020 motor vehicle accident would be the third biggest contributor to worldwide burden of disease. With more than 50 million people reported in 2007 to be injured each year in road traffic accidents worldwide (Derriks & Mark, 2007), motor vehicle accidents are indeed contributing highly to burden of disease. Moreover, such accidents are regarded as one of the leading causes of posttraumatic stress disorder in today's world. As advances in injury care systems have increased the number of seriously injured people who are able to survive their injuries (MacKenzie et al., 2006 ), this has drawn increasing attention to psychiatric morbidity after injury among such survivors.

Recent studies have shown that accident-related posttraumatic stress disorder is fairly common. The prevalence of posttraumatic stress disorder determined by structured clinical interviews with injured patients consecutively admitted to the intensive care unit or emergency department ranges from 5–30% at 0–3 months after injury to 2–23% at 4–12 months after it (Bryant et al., 2010; Hamanaka et al., 2006; Hepp et al., 2008; Matsuoka et al., 2008; Matsuoka, Nishi, Yonemoto, Nakajima et al., 2010; O'Donnell et al., 2004; Schnyder, Moergeli, Klaghofer et al., 2001; Schnyder et al., 2008; Shalev et al., 1998). Recent large epidemiological studies using questionnaires have reported a 17–23% point prevalence of clinically significant posttraumatic stress disorder symptoms at 4–12 months after injury (Zatzick et al., 2007; Mayou et al., 2001). It is well known that this disorder can be associated with higher psychiatric comorbidity, attempted suicide, and physical illnesses such as asthma, hypertension, and peptic ulcer (Davidson et al., 1991), as well as carry high healthcare costs ( O'Donnell et al., 2005; Walker et al., 2003). It remains, therefore, a serious public health problem that needs to be addressed (Kessler et al., 1995; Kessler et al., 2005.)

Peritraumatic Distress in Accident Survivors: An Indicator for

loss. Ultimately, 130 patients participated in this study.

**2.2 Procedures** 

participation (1,000 JPY [12 USD]).

**2.3.1 The Peritraumatic Distress Inventory** 

immediately after a motor vehicle accident.

**2.3 Measures** 

Posttraumatic Stress, Depressive and Anxiety Symptoms, and Posttraumatic Growth 99

1) diffuse axonal injury, brain contusion, and subdural and subarachnoidal bleeding detected by either computed tomography or magnetic resonance imaging or both (with the exception of concussion), because the presence of traumatic brain injury creates considerable difficulties when assessing psychological responses to injury; 2) cognitive impairment, defined as a score of <24 on the Mini Mental State Examination; 3) currently suffering from schizophrenia, bipolar disorder, drug dependence or abuse, or epilepsy before the accident; 4) marked serious symptoms such as suicidal ideation, self-harm behavior, dissociation, or a severe physical condition preventing the patient from tolerating the interview; and 5) living

or working at a location more than 40 km from the National Disaster Medical Center.

The above-mentioned study was conducted between 30 May 2004 to 8 January 2008, and the present study is part of that larger study. Patients with motor vehicle accident-related physical injury were consecutively admitted to the intensive care unit of the National Disaster Medical Center between 18 August 2005 and 8 January 2008. Of the 221 patients who met the inclusion criteria, 189 agreed to participate in the study. Fifty-nine patients were excluded because their peritraumatic distress could not be assessed due to memory

The study protocol was approved by the Institutional Review Board and Ethics Committee of the National Disaster Medical Center. After providing a complete description of the study to the subjects, written informed consent was obtained from them. The median number of days between the motor vehicle accident and the initial assessment was 2 days (range, 0–23 days). The initial assessment was conducted after cognitive function was assessed by a

In a structured interview, data was collected on general socio-demographics, the motor vehicle accident in detail, injury severity score (Baker & O'Neill, 1976), Glasgow Coma Scale score (Teasdale & Jennett, 1974), status during the accident (e.g., vehicle driver), vital signs first recorded on admission to the emergency room, lifestyle, and family history of psychopathology. Also, the Peritraumatic Distress Inventory was conducted at initial assessment. Follow-up assessments were performed at 1 month (median, 37 days, range, 24- 76 days) and 18 months (median, 561.5 days, range, 442-700 days) after the accident. The Impact of Event Scale-Revised and the Hospital Anxiety and Depression Scale were conducted at 1 month post accident, and the Posttraumatic Growth Inventory was conducted at 18 month post accident. The participants were asked to visit the National Disaster Medical Center or to return the completed self-report questionnaires in a stampaddressed envelope. After each assessment, participants were given a gift voucher for their

The Peritraumatic Distress Inventory is a 13-item self-report questionnaire which assesses not only any threat to life experienced but various emotional responses experienced during and immediately after a critical incident (Brunet et al., 2001). Responses are provided on a 5 point Likert scale ranging from 0 to 4 (0, not at all to 4, extremely true). It typically takes only several minutes to complete all of the items, meaning the Inventory can be used

trained research nurse or psychiatrist using the Mini Mental State Examination.
