The Aftermath of Road Accidents

Psychological, Social and Legal Consequences of an Everyday Trauma

Margaret Mitchell

• Publisher: Routledge
• Year: 2021
• Print ISBN: 9780415130530
• eBook ISBN: 9781000446036
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Accidents on the road are so common place in our lives today it's easy to believe that there are plenty of support systems in place for the victims. Death and injuries on the road are construed primarily as medico-legal phenomena, re-inforced both by the way accidents are described and by issues of insurance and compensation for damage and personal injury. But there are many profound psychological and social consequences that remain underestimated. Margaret Mitchell has compiled this collection from leading researchers to examine this neglected area for the unseen victims: the families who have to cope with bereavement or a disabled relative, the driver who has killed but is medically uninjured. It will be of great direct value to psychologists, psychiatrists and other health professionals and will serve as a useful reference for those in the legal profession, voluntary associations and those with personal experience of road, traffic, accidents needing advice about where to seek further help.

Part I

Psychological and psychiatric consequences

Chapter 3

The psychiatry of road traffic accidents

Richard Mayou

Although road traffic accidents are the leading cause of death in those aged under 40 years in developed countries and a major cause of morbidity, there has, until recently, been very little interest in their psychological and psychiatric consequences. This book is evidence of a change in interest and attitudes, which is resulting in increasing research and in opportunities for changes in clinical practice. This chapter begins with a critical review of the nature of the available evidence and then considers the various types of psychiatric complication. The final sections cover the special issue of compensation and consider the implications for clinical care, road safety and for the law.

Current evidence is sparse, and there are many unresolved issues about the extent and nature of psychiatric morbidity and the implications for the design of effective psychological intervention and its delivery to large numbers of people. Even so, it is now very clear that psychological and psychiatric complications are considerable and associated with very substantial adverse effects on quality of life. Changes in hospital and primary care of accident survivors should be vital immediate priorities for medicine and should not be delayed pending further research.

THE NATURE OF THE EVIDENCE

Evidence can be drawn from many sources (Table 3.1) even though there have been very few satisfactory studies concentrating on representative samples of road accident survivors. While information on general effects of physical illness, on other trauma and on a variety of selected subgroups of road accident survivors is informative, it is essential to be aware of the limitations of such evidence and to be cautious about generalisations from inadequate data. The findings must be considered in the light of what is known about psychiatric responses to trauma and to physical illness in general.Table 3.1.

Table 3.1 Sources of evidence

• General evidence on reactions to life events and physical disorders • Research on accidents in general (mixed groups, head injury, concussion) • Prospective and other studies of road accidents (psychological outcome and disability) • Research on Post Traumatic Stress Disorder • Studies of whiplash neck injury • Medicolegal series • General clinical experience

General evidence on life events and physical illness

There has been a great deal of carefully designed research on the general psychiatric consequences of life events and on numerous forms of physical disorder (Mayou and Sharpe 1995). The general nature, course and determinants of anxiety and depression are clear. In addition, it is evident that particular types of physical illnesses have specific psychiatric consequences. For instance, functional somatic symptoms, such as chest pain and palpitations, are frequent after a heart attack and phobic anxiety often occurs during cancer chemotherapy. The consequences of road traffic accidents should be considered in this broader context. There are three main aspects: emotional distress as seen after all illness; cognitive problems attributable to head injury and brain damage; and the specific effects of what is often a frightening trauma.

Trauma in general

Recent trauma research has focused on specific post-traumatic symptoms. It is apparent that there are very considerable differences in the immediate and longer-term responses to different types of trauma. Many accounts relate to extremely severe experiences either acute (such as rape) or long-continued (such as prolonged maltreatment as a prisoner of war). Most road accidents are experienced as being less threatening, both because the trauma may be very brief and because only a minority of accidents are life threatening. Even so, a minority of accidents involve prolonged and very frightening experiences, for example being trapped, being in severe pain, and then suffering prolonged and intensive care.

The very considerable research on trauma is relevant to understanding road accidents, but it is essential to keep in mind that there are continuing uncertainties about the validity of the condition post-traumatic stress disorder (PTSD), and about the relationship between post-traumatic symptoms and other psychiatric comorbidity. In successive editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) the nature of the stressor criteria has changed considerably. The original DSM-III (American Psychiatric Association 1980) version largely excluded road accident injury, whereas the DSM-IV (American Psychiatric Association 1994) revision is rather more broad, apart from a concentration on physical types of injury. There are uncertainties about the symptom criteria, particularly the treatment of numbing symptoms. It may well be that the numbing / re-experiencing syndrome should be separated from the phobic avoidance and perhaps from general anxiety symptoms (Foa et al. 1995). The precise definition has a substantial effect on estimates of prevalence and also on the way in which comorbidity with other major psychiatric disorder is viewed (Andreasen 1995).

Although trauma research has been largely concerned with post-traumatic symptoms, substantial comorbidity of other psychiatric disorder has always been noted. Patterns of comorbidity appear to differ with the type of trauma. We should be aware that anxiety and depressive disorders may not only be more frequent but may also be more disabling than PTSD.

Road traffic accidents

Table 3.1 lists sources of evidence about psychiatric complications of road traffic accidents. Unfortunately, there have been very few studies of representative patient groups using prospective designs and proven quantitative measures. Much of the evidence relates either to highly selected groups (especially whiplash neck injury and those involved in compensation proceedings) or to accident survivors in general in which no distinction is made between road accident and other types of injury. Although epidemiological studies suggest that road and other accidents are amongst the most common causes of post-traumatic symptoms, they have received very little attention compared to combat, disasters and assault.

Case reports and descriptions of highly selective samples are of interest in indicating the range of complications, but it is important to avpid drawing general conclusions. Even hospital attenders are unrepresentative in that many of those with minor injury do not seek medical help at all, or attend their primary care doctors rather than hospital emergency departments. For example, hospital attenders with whiplash neck injury may be very different from the total population of those who suffer whiplash symptoms, many of whom either do not consult their family doctors or do so at a later stage. There is clearly a need for prospective studies of road accident injury using methods proven in research on the consequences of other medical disorders, such as heart disease and cancer. Such research should be based on representative samples, use a range of proven measures and can be expected to show many similarities with the psychological impact of other physical conditions and also the specific consequences of trauma in terms of post-traumatic symptoms.

Inevitably, psychological research has concentrated on adult occupants of motor vehicles and motor cyclists. We know much less about the consequences of road accident injury for pedestrians, cyclists and those in public service vehicles or for children (see Chapter 5). Clinical experience suggests that although there are substantial demographic and other differences between these groups (Tunbridge et al. 1988), the patterns of psychiatric complications may be similar. This appears to be confirmed by the in...

Table of contents

• Cover
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of figures
• List of tables
• List of contributors
• Acknowledgements
• Introduction and background
• Part I Psychological and psychiatric consequences
• Part II Legal consequences
• Part III Social consequences, support and intervention
• References
• Index