The road to recovery : coping with the impact of traffic crashes

This research project examined the nature of physical and psychological disability associated with being injured in traffic crashes. Of particular interest were changes in general health status, the ability to perform activities of daily living, pain outcomes, and acute and post-traumatic stress disorder. The major theoretical orientation of this research project was the influence of appraisals, personality and coping on psychological health outcomes. A key question was the role that these factors played in post-crash adaptation, and the validity of a model of personality and coping that integrates the strengths of Lazarus and Folkman’s (1984) contextual perspective and that of trait-based theorists. To this end, a cohort of 62 injured persons aged 18-59 years involved in traffic crashes and admitted to a Major Trauma hospital and two metropolitan teaching hospitals were interviewed on three occasions: prior to discharge; 2-months post-discharge, and 6-8 months post-discharge. The study included drivers, vehicle passengers, motorcyclists, cyclists and pedestrians. An epidemiological examination of the injury population was undertaken to set the scene for the research findings. Using the Admitted Episodes Database for Victoria, it was seen that males represented 62% of all admissions due to traffic crashes, and those aged younger than 44 years represented at least 57% of admissions depending on the roaduser category. These findings further confirm that younger people are over-represented in the burden of injury related to traffic crashes. The results relating to general health status and functional disability among this sample of road users indicated that by 8-months post-crash, few participants rated their health as excellent, only 14-15% stated their medical problems had resolved completely, and 11.5% of males and 14.8% of females were unable to resume normal employment or study. General health status was found to be significantly impaired, while functional disability and pain at all follow-up times was common. Some gender differences in these outcomes were evident, and potential explanations for these differences were explored. Anxiety from the crash during the in-patient interviews was common and severe. Approximately 18% met the criteria for Acute Stress Disorder (ASD), while the Post-traumatic Stress Disorder (PTSD) rate of 5% 2-months post-crash and 3% 8-months post­ crash was low relative to past research. Young females and older males were also found to be at risk of high levels of post-traumatic stress symptoms, however no gender differences in acute stress symptoms were apparent. Perceived responsibility, length of stay and persistent pain were associated with depression severity. The subjective appraisals of threat-to-life and perceived control were associated with acute and post-traumatic stress disorder.

The influence of personality and coping on post-crash distress represented a major focus of this research. Neuroticism was associated with acute stress but not post-traumatic stress symptoms. Generalised coping responses had little predictive value; although emotion-focused coping and social diversion coping was associated with acute stress symptoms. These personality and coping findings shared a number of theoretically sound and important correlations. The overall findings of this research project support the integrated framework of personality, coping, and stress proposed by Moos and Holahan (2003). After adjusting for age, gender and pre-crash health, extraversion, conscientiousness and agreeableness seemed to be somewhat protective against post-traumatic stress. Persistent pain and ASD were however potent predictors of post-traumatic stress. The addition of generalised coping responses to the regression model developed here had no predictive value, although situation specific emotion-focussed coping was significantly associated with a higher level This research project examined the nature of physical and psychological disability associated with being injured in traffic crashes. Of particular interest were changes in general health status, the ability to perform activities of daily living, pain outcomes, and acute and post-traumatic stress disorder. The major theoretical orientation of this research project was the influence of appraisals, personality and coping on psychological health outcomes. A key question was the role that these factors played in post-crash adaptation, and the validity of a model of personality and coping that integrates the strengths of Lazarus and Folkman’s (1984) contextual perspective and that of trait-based theorists. To this end, a cohort of 62 injured persons aged 18-59 years involved in traffic crashes and admitted to a Major Trauma hospital and two metropolitan teaching hospitals were interviewed on three occasions: prior to discharge; 2-months post-discharge, and 6-8 months post-discharge. The study included drivers, vehicle passengers, motorcyclists, cyclists and pedestrians. An epidemiological examination of the injury population was undertaken to set the scene for the research findings. Using the Admitted Episodes Database for Victoria, it was seen that males represented 62% of all admissions due to traffic crashes, and those aged younger than 44 years represented at least 57% of admissions depending on the roaduser category. These findings further confirm that younger people are over-represented in the burden of injury related to traffic crashes. The results relating to general health status and functional disability among this sample of road users indicated that by 8-months post-crash, few participants rated their health as excellent, only 14-15% stated their medical problems had resolved completely, and 11.5% of males and 14.8% of females were unable to resume normal employment or study. General health status was found to be significantly impaired, while functional disability and pain at all follow-up times was common. Some gender differences in these outcomes were evident, and potential explanations for these differences were explored. Anxiety from the crash during the in-patient interviews was common and severe. Approximately 18% met the criteria for Acute Stress Disorder (ASD), while the Post-traumatic Stress Disorder (PTSD) rate of 5% 2-months post-crash and 3% 8-months post­ crash was low relative to past research. Young females and older males were also found to be at risk of high levels of post-traumatic stress symptoms, however no gender differences in acute stress symptoms were apparent.

Perceived responsibility, length of stay and persistent pain were associated with depression severity. The subjective appraisals of threat-to-life and perceived control were associated with acute and post-traumatic stress disorder. The influence of personality and coping on post-crash distress represented a major focus of this research. Neuroticism was associated with acute stress but not post-traumatic stress symptoms. Generalised coping responses had little predictive value; although emotion-focused coping and social diversion coping was associated with acute stress symptoms. These personality and coping findings shared a number of theoretically sound and important correlations. The overall findings of this research project support the integrated framework of personality, coping, and stress proposed by Moos and Holahan (2003). After adjusting for age, gender and pre-crash health, extraversion, conscientiousness and agreeableness seemed to be somewhat protective against post-traumatic stress. Persistent pain and ASD were however potent predictors of post-traumatic stress. The addition of generalised coping responses to the regression model developed here had no predictive value, although situation specific emotion-focussed coping was significantly associated with a higher level of post-traumatic stress severity (PTSS). A key contribution of this research project is the finding that particular personality domains were associated with PTSS, as well as demonstrating the changing nature and influence of coping responses on post-crash distress. These findings have important theoretical implications for explaining patient outcomes. The findings of this research project are discussed in the context of past research that examined post-crash physical and psychological health, as well as a theoretical framework for explaining the role of personality and coping styles in response to stress. The strengths and limitations of this research project are outlined, and future research directions are discussed. In summary, the results of this research project demonstrate the significant on­ going physical and psychological disability associated with traffic crashes. It is imperative therefore that governments and society stop thinking of the road toll as simply the number of people being killed on our roads, and consider the total burden of injury when planning a safe road transport system.

This thesis was scanned from the print manuscript for digital preservation and is copyright the author.

Author requested conversion to open access 27 Oct 2022