Road accidents pose a serious health threat, not only due to their physical impact but also because of significant psychological consequences. While injuries and fatalities are the most visible effects, survivors often experience long-term mental health issues that affect their quality of life and ability to return to daily activities. Nearly one in five accident victims can be diagnosed with acute stress reaction, while one in four shows mental health problems within a year of the incident [1, 2].

The Psychological Consequences of Road Accidents

Studies indicate that individuals involved in road accidents frequently develop disorders such as post-traumatic stress disorder (PTSD), anxiety, depression, and driving-related phobias. Research suggests that up to 25% of accident survivors experience PTSD symptoms, including intrusive memories, avoidance of accident-related stimuli, and heightened anxiety levels [3]. Additionally, depression and anxiety disorders are common among both victims and their families, leading to social withdrawal and difficulties in professional life.

IMPROVA Project – Identifying and Reviewing Psychological Long-Term Consequences (LTCs)

As part of the IMPROVA project, we have analysed various psychological consequences of road accidents and methods for assessing them. The first step was to define what long-term psychological consequences are and how long they must persist to be considered chronic.

What is the Definition (Timeframe) of Long-Term Psychological Consequences?

Long-term psychological consequences refer to persistent mental health effects that last well beyond the initial exposure to stress or traumatic events. The exact duration for classifying consequences as “long-term” depends on one’s mental condition prior to the event and the subjective definition of long-term. However, some assumptions may be based on diagnostic classifications describing diseases with etiology related to a significant stressor, such as a road accident.

Variations in Diagnostic Classifications

Existing diagnostic classifications such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 by APA [4]) and the International Classification of Diseases (ICD-11 by WHO [5]) differ in defining the time criteria for the diagnosis, rarely indicating when a disorder can be defined as long-term and differ in this respect between their versions [6], e.g. [7].

• Post-traumatic Stress Disorder (PTSD, ICD-10: F43.1 [9]) – symptoms lasting longer than 1 month (according to DSM-5) or several weeks (ICD-10 and 11) allow for diagnosis, but only one of these classifications defines long-term effects in the form of chronic PTSD (F43.12 in ICD-10 [9]). In ICD-11, PTSD refers only to cases of experiencing multiple traumas and does not apply to the case of a single experience of an accident. Clinical practice [9] shows that PTSD symptoms persisting for 6-12 months after the trauma are considered long-term;
• Enduring personality change after catastrophic experience (ICD-10: F62.0 [9]) – persistent personality changes that follow the disaster-related experiences and persist for at least 2 years. Posttraumatic stress disorder (ICD-10: F43.1 [9]) may precede this type of disorder;
• Depression – a depressive episode itself as a mood disorder can be diagnosed when symptoms persist for at least two weeks. However, depression can co-occur with PTSD or be a result of it, and depressed mood can be one of its symptoms. Dysthymia is sometimes considered a chronic form of depressed mood;
• Anxiety disorders (ICD-10: F40–F41 [9]) – according to DSM-5 the duration of symptoms justifying the diagnosis is six months, while in ICD-10 the symptoms must be recognized for at least four weeks. This applies to both generalized anxiety and specific (isolated) forms of phobia (ICD-10: F40.2 [9]), e.g. fear of traveling by car;
• Prolonged grief disorder– in the case of the loss of a loved one as a result of an accident, time criteria are also necessary to determine the duration of grief. Although this state is defined as natural up to one year after the loss, all forms of complex grief, including its extension, are usually premises of classification change, e.g. to chronic depression (ICD-11 6 months; DSM-5-TR at least 12 months for adults and 6 months for minors).

Criteria used in IMPROVA to define Psychological Effects of Road Accidents

The listed diagnosis are not a complete set of long-term psychological consequences following a road traffic accident, and individual reactions to trauma may vary. The aim is to show the discrepancies in existing definitions. Based on diagnostic classifications and data from clinical practice, it was decided that the systematic review conducted in the IMPROVA project included studies referring to the period of at least six months after the accident.

Findings from the Systematic Review

A systematic review focused on the previously defined long-term psychological health effects of being involved in or witnessing a road accident. Initial searches identified over 14,000 studies related to psychological LTCs. After rigorous screening, 397 studies on psychological LTCs were selected for a full-text review. Various psychological variables (including PTSD, anxiety, depression, and phobias) and overall quality of life were assessed. Additionally, the review aimed to identify predictive factors influencing the occurrence and severity of these psychological effects, considering a period of at least six months after the accident.

Key Long-Term Psychological Consequences Identified

The most commonly literature-identified Long-Term Psychological Consequences of accidents include:

• PTSD (or subclinical symptoms, e.g., travel anxiety, nightmares, fear for one’s own life and health, etc.),
• mood disorders (including depression, dysthymia)
• anxiety disorders (including generalised anxiety disorder, panic disorder, specific forms of phobias)
• changes in the sense of life purpose
• complicated patterns of grief
• substance dependence
• sleep disorders
• somatization

The psychological effects mentioned in the analyses so far have been categorised into four areas:

1. Stress-related disorders (e.g. PTSD, adjustment disorders)
2. Anxiety Disorders and Phobias
3. Mood disorders (affective) e.g. depression
4. Other functioning disorders (deficits in the area of mental health, meaning in life, etc.)

Research findings emphasise the necessity of comprehensive psychological assessments in the care process for accident victims. Despite advancements in road safety, psychological support for affected individuals remains an area requiring further development.

What’s next in the IMPROVA Project?

Our project goes beyond literature review. In the next stages, we plan to:

• Analysis of scales used to measure variables related to LTCs;
• Identify key parameters for collecting new data on psychological LTCs,
• Standardise assessment methods for psychological consequences to enable comparability across studies,
• Develop recommendations for future research and psychological support for accident victims,
• Analyse new field study data to verify and potentially adjust existing LTC assessment scales.

We regularly consult our actions and concerns with experts in road safety and psychology to understand the long-term psychological consequences of trauma better.

 

---

1. Zawadzki B., Popiel A., Post-Traumatic Stress Disorder After Road Accidents, Medical Tribune 2008, No. 12, p. 25.
2. Kenardy, J., Edmed, S. L., Shourie, S., Warren, J., Crothers, A., Brown, E. A. & Heron-Delaney, M. (2018). Changing patterns in the prevalence of posttraumatic stress disorder, major depressive episode and generalized anxiety disorder over 24 months following a road traffic crash: Results from the UQ SuPPORT study. Journal of affective disorders, 236, 172-179.
3. Lin, W., Gong, L., Xia, M., & Dai, W. (2018). Prevalence of Post-Traumatic Stress Disorder Among Road Traffic Accident Survivors: A PRISMA-Compliant Meta-Analysis. Medicine, 97(3), e9693.
4. American Psychiatric Association (APA) (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC.
5. World Health Organization: International Statistical Classification of Diseases and Related Health Problems. 11th ed., World Health Organization, (2019). Available from: https://icd.who.int/browse/2025-01/mms/en
6. Gaebel, W., Stricker, J., & Kerst, A. (2020). Changes from ICD-10 to ICD-11 and future directions in psychiatric classification. Dialogues in clinical neuroscience, 22(1), 7–15. https://doi.org/10.31887/DCNS.2020.22.1/wgaebel
7. Brewin, C. R., Cloitre, M., Hyland, P., Shevlin, M., Maercker, A., Bryant, R. A., … & Reed, G. M. (2017). A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD. Clinical psychology review, 58, 1-15.
8. World Health Organization: International Statistical Classification of Diseases and Related Health Problems. 10th ed., World Health Organization, (2019). Available from: https://icd.who.int/browse10/2019/en#/V
9. Yehuda, R., Hoge, C. W., McFarlane, A. C., Vermetten, E., Lanius, R. A., Nievergelt, C. M., … & Hyman, S. E. (2015). Post-traumatic stress disorder. Nature reviews Disease primers, 1(1), 1-22.