Prospective study of post-traumatic stress disorder in children involved in road traffic accidents

BMJ 1998;317:1619-1623 ( 12 December )

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Prospective study of post-traumatic stress disorder in children involved in road traffic accidents

Paul Stallard, clinical psychologist, Richard Velleman, director of research and development, Sarah Baldwin, research assistant.

Department of Child and Family Psychiatry, Bath Mental Health Care Trust, Royal United Hospital, Bath BA1 3NG

Correspondence to: Dr Stallard stallard_p{at}bath-mhct.swest.nhs.uk

Objective: To determine the prevalence of severe psychologicaltrauma $---$ that is, post-traumatic stress disorder $---$ in children involvedin everyday road trafficaccidents.
Design: 12 month prospectivestudy.
Setting: Accident and emergency department, Royal UnitedHospital,Bath.
Subjects: 119 children aged 5-18 years involved in roadtraffic accidents and 66 children who sustained sportsinjuries.
Main outcome measure: Presence of appreciable psychological distress;fulfilment of diagnostic criteria for post-traumatic stressdisorder.
Results: Post-traumatic stress disorder was found in41 (34.5%) children involved in road traffic accidents but onlytwo (3.0%) who sustained sports injuries. The presence of post-traumaticstress disorder was not related to the type of accident, age ofthe child, or the nature of injuries but was significantly associatedwith sex, previous experience of trauma, and subjective appraisalof threat to life. None of the children had received any psychologicalhelp at the time ofassessment.
Conclusions: One in three children involved in road trafficaccidents was found to suffer from post-traumatic stress disorderwhen they were assessed 6 weeks after their accident. The psychologicalneeds of such children after such accidents remain largelyunrecognised.

Key messages

One in three children involved in everyday road traffic accidents was found to suffer from post-traumatic stress disorder
Post-traumatic stress disorder was experienced by children of all ages, although girls were most likely to be affected
Neither the type of accident nor the nature and severity of the physical injuries were related to the presence of post-traumatic stress disorder
The child's personal appraisal of the accident was important, with those children perceiving the event as life threatening being more likely to develop post-traumatic stress disorder
The psychological needs of children involved in road traffic accidents largely remain unrecognised

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One third of children in road traffic accidents develop post-traumatic stress disorder
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