Psychosocial factors and traffic injuries. With special emphasis on consequences, risk factors for complications, influence of alcohol and benefits of intervention

Sammanfattning: Little attention has been paid to the significance of mental and social factors after traffic accidents, and to the psychosocial complications these accidents can entail, until during the past few years. The programmes that have so far been used in order to reduce the risk of such complications have only in a few cases had a positive effect. The primary purpose of this thesis was to pinpoint mental and social complications following traffic accidents, and also psychosocial and accident-related circumstances for cyclists injured under the influence of alcohol. In addition, an intervention programme, developed with the intention of reducing negative psychosocial consequences of traffic accidents, was evaluated. The thesis is based upon four studies of individuals injured in traffic between 1985 and 1996. These individuals were interviewed by telephone 1½-3 years after the injury. Study I describes psychosocial consequences for individuals aged between 10 and 80 with moderate to severe injuries, treated at a county hospital. Study II describes psychosocial consequences and factors influencing the rehabilitation of individuals aged 25 to 60 also with lighter injuries, treated at a university hospital. Study III describes psychosocial consequences for two groups of individuals aged 16 years or more with injuries of all degrees of severity, treated at two county hospitals, where one group was subject to a psychosocial intervention programme and the other constituted a control group. Study IV compares circumstances and psychosocial consequences for two groups of individuals aged 16 or more, injured in bicycle accidents, and treated at a university hospital; the first group was sober, and the second was under the influence of alcohol. Structured questionnaires were used in all the studies for information on family, housing, work/school, personal economy, leisure time, need of assistance, circumstances surrounding the injurious event, and mental residual states. In study III, the Impact of Event Scale (IES) questionnaire was also used. Study III was prospective, while the others were retrospective.Study I showed that more than a quarter of those injured was afflicted by significant psychosocial consequences. Severe consequences were seen in all age groups, but individuals who were 60 and older were affected to a greater extent in more respects. Study II showed that significant mental and social consequences might also afflict individuals with minor injuries. Prognoses were worse for women, for those married or cohabitant, for parents, for those lacking medical information and psychosocial support, in cases following neck sprain and if the injured person was insured. Study III confirmed the greater part of the results in studies I and II. Being mentally affected with intrusive impressions of the injurious event afflicted females more often than males. The intervention programme did not appear to reduce the risk of psychosocial complications. Study IV displayed differences between sober cyclists and those under the influence of alcohol in terms of time of accident, experience of the road or path, the bicycle and its equipment, use of helmet, purpose of the ride, as well as type of accident and injury. Cyclists under the influence of alcohol had in greater numbers had their driving licence withdrawn and been through a divorce. The psychosocial residual states were the same. The thesis demonstrates that psychosocial complications are common following traffic accidents and that such complications occur also in the event of slight injuries. Individuals responsible for children seem to be more often afflicted by complications, as do females. Proper medical information and psychosocial support are important for the rehabilitation. This should be taken into account and combined with preventive guidelines. Early attention should be paid to problems with insurance matters.