Depression and PTSD in Accident Victims

Depression & PTSD in Injury Victims

When a family member or members are seriously injured in an accident, the ramifications of that accident may extend beyond the physical injuries.

Depression and Post-Traumatic Stress Disorder (PTSD) can easily affect injury victims, especially when active, independent lifestyles are brought to sudden halts, either temporarily or permanently. In addition to constant and often severe pain, traumatic injury victims often experience significant frustration with their limited mobility and increased dependence on others, acute anxiety over lost wages and financial difficulties, and worry about their recovery and their family's well being.

It is important for families to understand that for the injured individual in Illinois, the effects of and treatment for depression and PTSD are eligible for financial compensation as part of the injury claim.

Friends, relatives, and co-workers of the injured and/or his or her family members should watch for the most common signs of depression following an accident and throughout recovery:

  • Fatigue, exhaustion, or other tired feeling
  • Headaches
  • Anxiety
  • Lack of interest in people
  • Trouble sleeping
  • Difficulty eating
  • Trouble making decisions
  • Lack of concentration and difficulty thinking
  • Guilt
  • Suicidal thoughts or thinking about death
  • A constant feeling of sadness
  • Feeling hopeless and/or worthless

In an article in the Journal of Trauma and Acute Care Surgery, researchers discussed the rate of serious depression and post-traumatic stress disorder (PTSD) among hospitalized victims of serious accident injuries at 6 months and 12 months post-injury. According to the article, "The emergence of these mental disorders following physical trauma is associated with poor long-term health outcomes including impaired physical functioning and disability and lower self-reported quality of life." The authors found that at 6-months, 31% of participants met screening criteria for probable PTSD and 31% met criteria for probable depression. At 12-months, 28% and 29% met criteria for PTSD and depression, respectively. There were also high rates of both depression and PTSD: 21% of individuals at 6-months and in 19% of patients at 12-months met the criteria for both depression and PTSD.

The researchers note that higher odds of depression at 6- or 12-months are associated with losing consciousness, more severe injury, longer hospitalizations, and pre-existing disabilities. Victims suffering more severe injuries and longer hospitalizations are also associated with greater odds of PTSD. In a PTSD study published in American Family Physician, doctors from the University of Wisconsin Medical School and Medical College of Wisconsin faculty report that traffic accidents are the leading cause of non-military PTSD.

Patients with PTSD experience disabling memories and anxiety related to the traumatic event. Early diagnosis is critical for treating existing symptoms and preventing greater impairment and restriction. PTSD may be diagnosed in injury victims who meet the following criteria, as designated by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders:

A. The person has been exposed to a traumatic event in which both of the following were present:
1. The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others. For instance, someone involved involved in a serious auto accident, a roofer who falls, or a child who is mauled by a dog.
2. The person's response involves intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior.

B. The traumatic event is persistently re-experienced in one or more of the following ways:
1. Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
2. Recurrent distressing dreams of the event.
3. Acting or feeling as if the traumatic event were recurring. This includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes.Note: In young children, trauma-specific reenactment may occur.
4. Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. For instance, a car accident victim may exhibit signs of emotional distress when traveling where his or her accident occurred, or on a road or highway similar to that of the accident.
5. Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event. For example, a car accident victim may experience increased heart rate, sweating, trembling, and other physical reactions when traveling under conditions similar to those of the accident (location, type of road, weather conditions, traffic pattern, etc.).

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three or more of the following:
1. Efforts to avoid thoughts, feelings, or conversations associated with the trauma;
2. Efforts to avoid activities, places, or people that arouse recollections of the trauma;
3. Inability to recall an important aspect of the trauma;
4. Markedly diminished interest or participation in significant activities;
5. Feeling of detachment o estrangement from others;
6. Restricted range of affect (e.g., unable to have loving feelings);
7. Sense of foreshortened future (e.g., a sense of impending doom, or does not expect to have a career, marriage, chidren, or a normal life span).

D. Persistent symptoms of increased arousal/stimulation (hyperarousal) that were not present before the traumatic event, as indicated by two or more of the following:
1. Difficulty falling or staying asleep;
2. Irritability or outbursts of anger;
3. Difficulty concentrating;
4. Hypervigilance;
5. Exaggerated startle response.

E. Symptoms in Criteria B, C, and D that last more than one month.

F. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

According to an American Family Physician article, an estimated 9% of survivors of serious accidents develop significant PTSD symptoms and that many other survivors have PTSD-like reactions. The authors report that some clinicians and researchers have identified a variation of PTSD among victims of motor vehicle accidents, referred to as subsyndromal or partial PTSD. These victims tend to have high levels of hyperarousal (see D above) and re-experiencing (see B above) symptoms but few or no symptoms of avoidance or emotional numbing. This often offers a better prognosis for symptom remission at 6 months post-injury than persons with full PTSD.

Once depression and/or PTSD is diagnosed, affected injury patients can get the help they need, which may include education, relaxation therapy, psychotherapy, and/or medication.

Sources:
1 American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, D.C.: American Psychiatric Association, 1994:427-9.
2 Butler, Dennis, J., PhD, Moffic, H. Steven, MD, Turkal, Nick W., MD. Post-traumatic stress reactions following motor vehicle accidents. American Family Physician. Aug 1, 1999; 60(2):524-530. 3 Shih, Regina A., PhD, Schell, Terry L., PhD, Hambarsoomian, Katrin, MS, et al. Prevalence of PTSD and Major Depression Following Trauma-Center Hospitalization. Journal of Trauma and Acute Care Surgery. Dec 2010; 69(6): 1560-1566.

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