title: Post-traumatic stress disorder associated with life-threatening motor vehicle collisions in the WHO World Mental Health Surveys.
abstract: Motor vehicle collisions (MVCs) are a substantial contributor to the global burden of disease and lead to subsequent post-traumatic stress disorder (PTSD). However, the relevant literature originates in only a few countries, and much remains unknown about MVC-related PTSD prevalence and predictors.
  
  
  
  Data come from the World Mental Health Survey Initiative, a coordinated series of community epidemiological surveys of mental disorders throughout the world. The subset of 13 surveys (5 in high income countries, 8 in middle or low income countries) with respondents reporting PTSD after life-threatening MVCs are considered here. Six classes of predictors were assessed: socio-demographics, characteristics of the MVC, childhood family adversities, MVCs, other traumatic experiences, and respondent history of prior mental disorders. Logistic regression was used to examine predictors of PTSD. Mental disorders were assessed with the fully-structured Composite International Diagnostic Interview using DSM-IV criteria.
  
  
  
  Prevalence of PTSD associated with MVCs perceived to be life-threatening was 2.5 % overall and did not vary significantly across countries. PTSD was significantly associated with low respondent education, someone dying in the MVC, the respondent or someone else being seriously injured, childhood family adversities, prior MVCs (but not other traumatic experiences), and number of prior anxiety disorders. The final model was significantly predictive of PTSD, with 32 % of all PTSD occurring among the 5 % of respondents classified by the model as having highest PTSD risk.
  
  
  
  Although PTSD is a relatively rare outcome of life-threatening MVCs, a substantial minority of PTSD cases occur among the relatively small proportion of people with highest predicted risk. This raises the question whether MVC-related PTSD could be reduced with preventive interventions targeted to high-risk survivors using models based on predictors assessed in the immediate aftermath of the MVCs.
authors.affiliation: Dept of Psychiatry and Mental Health, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa. Dan.Stein@uct.ac.za.
authors.forename: Dan J
authors.initials: DJ
authors.lastname: Stein
authors.affiliation: St George Hospital Medical Center, Balamand University, Faculty of Medicine, Institute for Development, Research, Advocacy & Applied Care, Beirut, Lebanon.
authors.forename: Elie G
authors.initials: EG
authors.lastname: Karam
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, USA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Shahly
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, USA.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Hill
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: King
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Petukhova
authors.affiliation: Department of Mental Health, Moi University School of Medicine, Eldoret, Kenya.
authors.forename: Lukoye
authors.initials: L
authors.lastname: Atwoli
authors.affiliation: Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, USA.
authors.forename: Evelyn J
authors.initials: EJ
authors.lastname: Bromet
authors.affiliation: National School of Public Health, Management and Professional Development, Bucharest, Romania.
authors.forename: Silvia
authors.initials: S
authors.lastname: Florescu
authors.affiliation: Parc Sanitari Sant Joan de Déu, Centros de Investigación Biomédica en Red de Salud Mental, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Haro
authors.affiliation: National Center for Public Health and Analyses, Sofia, Bulgaria.
authors.forename: Hristo
authors.initials: H
authors.lastname: Hinkov
authors.affiliation: Institute for Development, Research, Advocacy & Applied Care (IDRAAC), Beirut, Lebanon.
authors.forename: Aimee
authors.initials: A
authors.lastname: Karam
authors.affiliation: National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico.
authors.forename: María Elena
authors.initials: ME
authors.lastname: Medina-Mora
authors.affiliation: Subdirección General de Salud Mental, Servicio Murciano de Salud, Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Murcia, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Navarro-Mateu
authors.affiliation: National Institute of Health, Lima, Peru.
authors.forename: Marina
authors.initials: M
authors.lastname: Piazza
authors.affiliation: Department of Psychiatry, New York University Langone Medical Center, New York, USA.
authors.forename: Arieh
authors.initials: A
authors.lastname: Shalev
authors.affiliation: Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Torres
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, USA.
authors.forename: Alan M
authors.initials: AM
authors.lastname: Zaslavsky
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, USA.
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Kessler
mesh_terms: D000063:Accidents, Traffic / Q000523:psychology*; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D008016:Life Change Events; D008297:Male; D015995:Prevalence; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Motor vehicle collision; PTSD; Posttraumatic stress disorder