title: Psychological distress and physical disability in patients sustaining severe injuries in road traffic crashes: Results from a one-year cohort study from three European countries.
abstract: The current study aimed to follow-up a group of road crash survivors for one year and assesses the impact of injury on their psychological and physical condition. All crash survivors that were admitted to the intensive or sub-intensive care units of selected hospitals in Greece, Germany and Italy over one year period (2013-2014), were invited to participate in the study and were interviewed at three different time-points as follows: (a) at one month (baseline data), (b) at six months, and (c) at twelve months. The study used widely recommended classifications for injury severity (AIS, MAIS) and standardized health outcome measures such as the Disability Assessment Schedule II (WHODAS 2.0) to measure disability, "Impact of Event Scale" (IES-R) to measure Post-Traumatic Stress Disorder (PTSD), Center for Epidemiological Studies Depression Scale (CES-D Scale) to measure depression. A total of 120 patients were enrolled in the study in all the partner countries and 93 completed all follow up questionnaires. The risk of physical disability was 4.57 times higher [CI 1.98-2.27] at the first follow up and 3.43 times higher [CI 1.43-9.42] at the second follow up as compared with the time before the injury. There was a 79% and an 88% lower risk of depression at the first and the second follow up respectively, as compared with the baseline time. There was also a 72% lower risk of Post-Traumatic Stress at the second follow up as compared with the baseline time. A number of factors relevant to the individuals, the road crash and the injury, were shown to distinguish those at higher risk of long-lasting disability and psychological distress including age, marital status, type of road user, severity and type of the injury, past emotional reaction to distress. The study highlights the importance of a comprehensive and holistic understanding of the impact of injury on an individual and further underlines the importance of screening and treating psychological comorbidities in injury in a timely manner.
authors.affiliation: Laboratory of Health and Road Safety, Department of Social Work, School of Health and Social Welfare, Technological Educational Institute of Crete, Estavromenos, P.C. 71004, Heraklion, Greece. Electronic address: mpapadakaki@yahoo.gr.
authors.forename: Maria
authors.initials: M
authors.lastname: Papadakaki
authors.affiliation: Centre of Study and Research on Road Safety, Medical School, University of Pavia, Via Forlanini 2, 27100 Pavia, Italy. Electronic address: ottavia.ferraro@unipv.it.
authors.forename: Ottavia Eleonora
authors.initials: OE
authors.lastname: Ferraro
authors.affiliation: Centre of Study and Research on Road Safety, Medical School, University of Pavia, Via Forlanini 2, 27100 Pavia, Italy. Electronic address: chiaraorsi@gmail.com.
authors.forename: Chiara
authors.initials: C
authors.lastname: Orsi
authors.affiliation: Accident Research Unit, Hannover Medical University, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. Electronic address: Otte.Dietmar@mh-hannover.de.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Otte
authors.affiliation: Laboratory of Health and Road Safety, Department of Social Work, School of Health and Social Welfare, Technological Educational Institute of Crete, Estavromenos, P.C. 71004, Heraklion, Greece. Electronic address: gtzamalouka@gmail.com.
authors.forename: Georgia
authors.initials: G
authors.lastname: Tzamalouka
authors.affiliation: Accident Research Unit, Hannover Medical University, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. Electronic address: vondergeest.marco@mh-hannover.de.
authors.forename: Marco
authors.initials: M
authors.lastname: von-der-Geest
authors.affiliation: Suomalainen liikennetutkimuskeskus, Traffic Research Centre of Finland, Helsinki, Finland. Electronic address: timo@metu.edu.tr.
authors.forename: Timo
authors.initials: T
authors.lastname: Lajunen
authors.affiliation: Suomalainen liikennetutkimuskeskus, Traffic Research Centre of Finland, Helsinki, Finland. Electronic address: ozturker@metu.edu.tr.
authors.forename: Türker
authors.initials: T
authors.lastname: Özkan
authors.affiliation: Centre of Study and Research on Road Safety, Medical School, University of Pavia, Via Forlanini 2, 27100 Pavia, Italy. Electronic address: anna.morandi@unipv.it.
authors.forename: Anna
authors.initials: A
authors.lastname: Morandi
authors.affiliation: Department of Health Care & Social Units Administration, Technological Educational Institute of Athens, Greece. Electronic address: msaris@gmail.com.
authors.forename: Markos
authors.initials: M
authors.lastname: Sarris
authors.affiliation: Department of Health Care & Social Units Administration, Technological Educational Institute of Athens, Greece. Electronic address: gpier@otenet.gr.
authors.forename: George
authors.initials: G
authors.lastname: Pierrakos
authors.affiliation: Laboratory of Health and Road Safety, Department of Social Work, School of Health and Social Welfare, Technological Educational Institute of Crete, Estavromenos, P.C. 71004, Heraklion, Greece. Electronic address: jchlia@staff.teicrete.gr.
authors.forename: Joannes
authors.initials: J
authors.lastname: Chliaoutakis
mesh_terms: D000063:Accidents, Traffic / Q000523:psychology* / Q000706:statistics & numerical data*; D000223:Adaptation, Psychological; D000328:Adult; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology*; D036262:Empirical Research; D005260:Female; D005858:Germany / Q000453:epidemiology; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology*; D017741:Survivors / Q000523:psychology*; D014947:Wounds and Injuries / Q000503:physiopathology* / Q000523:psychology*
keywords: Depression; Disability; Injury severity; Intensive care unit; Post-traumatic stress disorder; Road traffic crash