title: Incidence and predictors of acute psychological distress and dissociation after motor vehicle collision: a cross-sectional study.
abstract: OBJECTIVE
  We examined the incidence and predictors of peritraumatic distress and dissociation after one of the most common forms of civilian trauma exposure: motor vehicle collision (MVC).
  
  
  METHODS
  In this study, patients presenting to the emergency department after MVCs who were without serious injury and discharged to home after evaluation (n = 935) completed an emergency department interview evaluating sociodemographic, collision-related, and psychological characteristics.
  
  
  RESULTS
  The incidence and predictors of distress (Peritraumatic Distress Inventory score ≥23) and dissociation (Michigan Critical Events Perception Scale score >3) were assessed. Distress was present in 355 of 935 patients (38%), and dissociation was present in 260 of 942 patients (28%). These outcomes showed only moderate correlation (r = .45) and had both shared and distinct predictors. Female gender, anxiety symptoms prior to the MVC, and vehicle damage severity predicted both distress and dissociation. Higher socioeconomic status (higher education, higher income, full-time employment) had a protective effect against distress but not dissociative symptoms. Better physical health and worse overall mental health were associated with increased risk of dissociation but not distress. Distress but not dissociation was associated with lower patient confidence in recovery and a longer expected duration of recovery.
  
  
  CONCLUSIONS
  There are unique predictors of peritraumatic distress and dissociation. Further work is needed to better understand the neurobiology of peritraumatic distress and dissociation and the influence of these peritraumatic outcomes on persistent psychological sequelae.
authors.affiliation: a TRYUMPH Research Program , University of North Carolina , Chapel Hill , North Carolina , USA.
authors.forename: Gemma C
authors.initials: GC
authors.lastname: Lewis
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Platts-Mills
authors.forename: Israel
authors.initials: I
authors.lastname: Liberzon
authors.forename: Eric
authors.initials: E
authors.lastname: Bair
authors.forename: Robert
authors.initials: R
authors.lastname: Swor
authors.forename: David
authors.initials: D
authors.lastname: Peak
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Jones
authors.forename: Niels
authors.initials: N
authors.lastname: Rathlev
authors.forename: David
authors.initials: D
authors.lastname: Lee
authors.forename: Robert
authors.initials: R
authors.lastname: Domeier
authors.forename: Phyllis
authors.initials: P
authors.lastname: Hendry
authors.forename: Samuel A
authors.initials: SA
authors.lastname: McLean
mesh_terms: D000063:Accidents, Traffic / Q000523:psychology* / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004213:Dissociative Disorders / Q000175:diagnosis / Q000453:epidemiology*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D015994:Incidence; D007407:Interviews as Topic; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012737:Sex Factors; D012923:Social Class; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
keywords: dissociation; distress; motor vehicle collision; posttraumatic stress disorder; trauma