Treatment Gap in Mental Health Care for Victims of Road Traffic Accidents.

Road traffic accidents (RTAs) are among the most frequent negative life-events. About one in five RTA survivors is susceptible to posttraumatic stress disorder (PTSD). Knowledge about needs for, and usage of, mental health services (MHSs) may improve options for care for RTA victims. The current study aimed to assess rates of victims using different MHSs, including psychotherapy, pharmacotherapy and support groups, and to explore correlates of needs for and use of these MHSs. Further, we aimed to estimate the treatment gap in post-RTA care, defined as including people with probable PTSD who did not use MHSs and people wanting but not getting help from MHSs. Dutch victims of nonlethal RTAs (N = 259) completed self-report measures on needs for and use of MHSs and PTSD. Results showed that 26% of participants had utilized care from psychotherapy, pharmacotherapy or support groups. Among people with probable PTSD, this was 56%. Increased posttraumatic stress was the strongest correlate of MHS use. Forty-eight participants (17.8%) had an unmet care need and represented the treatment gap. Commonly reported reasons and barriers preventing MHS use were perceptions that problems were limited or would disappear without care and financial worries. Regarding possible future care, participants reported a preference for face-to-face (over online) help from a psychologist (over other professionals). The treatment gap for Dutch RTA victims may be limited. However, a significant number of RTA victims need care but do not obtain this care. Care options may be improved by reducing practical barriers to MHSs and increasing mental health literacy and acceptability of different forms of care (besides face-to-face care).

Investigating the dynamics of collective behavior among pedestrians crossing roads: A multi-user virtual reality approach.

The utility maximization theory, based on the rationality of human beings, has proven effective in modeling pedestrians' decision-making processes while crossing roads. However, there are still unexplained variations in crossing behavior, and deviations from the rational utility model frequently occur in real-life scenarios. This experimental study sheds new light on the presence of inter-individual interactions among pedestrians and the nature of collective behaviors during road crossings. The present study develops a multi-pedestrian virtual reality simulator specifically designed to investigate the impact of social interaction on pedestrians' eye-scanning patterns, perceived responses, crossing behaviors, and the associated crash risk. Our findings indicate that the collective behavior significantly influences pedestrians' behaviors by diverting their attention from essential eye-scanning patterns that reflect their cognitive processes. Pedestrians in pairs exhibit a higher tendency to fixate on each other, spend less time in the decision phase, walk at a slower pace during the crossing phase, and consequently face a higher degree of exposure to dangerous situations compared to when crossing alone. Encouraged by these findings on the effects of social interaction, we discuss preventive strategies to mitigate the negative impacts of collective behavior and foster pedestrians' safety awareness.

A systematic review of the impact of brain tumours on risk of motor vehicle crashes.

PURPOSE: Brain tumours are associated with neurocognitive impairments that are important for safe driving. Driving is vital to maintaining patient autonomy, despite this there is limited research on driving capacity amongst patients with brain tumours. The purpose of this review is to examine MVC risk in patients with brain tumours to inform development of clearer driving guidelines. METHODS: A systematic review was performed using Medline and EMBASE. Observational studies were included. The outcome of interest was MVC or measured risk of MVC in patients with benign or malignant brain tumours. Descriptive analysis and synthesis without meta-analysis were used to summarise findings. A narrative review of driving guidelines from Australia, United Kingdom and Canada was completed. RESULTS: Three studies were included in this review. One cohort study, one cross-sectional study and one case-control study were included (19,135 participants) across United States and Finland. One study evaluated the incidence of MVC in brain tumour patients, revealing no difference in MVC rates. Two studies measured MVC risk using driving simulation and cognitive testing. Patients found at higher risk of MVC had greater degrees of memory and visual attention impairments. However, predictive patient and tumour characteristics of MVC risk were heterogeneous across studies. Overall, driving guidelines had clear recommendations on selected conditions like seizures but were vague surrounding neurocognitive deficits. CONCLUSION: Limited data exists regarding driving behaviour and MVC incidence in brain tumour patients. Existing guidelines inadequately address neurocognitive complexities in this group. Future studies evaluating real-world data is required to inform development of more applicable driving guidelines. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO 2023 CRD42023434608.

What Are the Predictors of Post-traumatic Stress Disorder Among Road Traffic Accident Survivors: A Systematic Review.

ABSTRACT: Traffic accidents put tremendous burdens on the psychosocial aspects of communities. Post-traumatic stress disorder (PTSD), after an accident, is one of the most prevalent and incapacitating psychiatric conditions worldwide. In this systematic review, we aimed to investigate the predictors of PTSD in traffic accident victims. Primary search was conducted in November 2021 and updated in 2023. Studies were excluded if they used any analysis except regression for predictors. Cumulatively, primary and update searches retrieved 10,392 articles from databases, and of these, 87 studies were systematically reviewed. The predictors were categorized into sociodemographics, pretrauma, peritrauma, and post-trauma factors. The PTSD assessment time varied between 2 weeks and 3 years. Being a woman, having depression and having a history of road traffic accidents pretraumatically, peritraumatic dissociative experiences, acute stress disorder diagnosis, rumination, higher injury severity, and involvement in litigation or compensation after the trauma were significant predictors of PTSD.

The impact of perceptual complexity on road crossing decisions in younger and older adults.

Cognitive abilities decline with healthy ageing which can have a critical impact on day-to-day activities. One example is road crossing where older adults (OAs) disproportionally fall victim to pedestrian accidents. The current research examined two virtual reality experiments that investigated how the complexity of the road crossing situation impacts OAs (N = 19, ages 65-85) and younger adults (YAs, N = 34, ages 18-24) with a range of executive functioning abilities (EFs). Overall, we found that OAs were able to make safe crossing decisions, and were more cautious than YAs. This continued to be the case in high cognitive load situations. In these situations, safe decisions were associated with an increase in head movements for participants with poorer attention switching than participants with better attention switching suggesting these groups developed compensation strategies to continue to make safe decisions. In situations where participants had less time to make a crossing decision all participants had difficulties making safe crossing decisions which was amplified for OAs and participants with poorer EFs. Our findings suggest more effort should be taken to ensure that road crossing points are clear of visual obstructions and more speed limits should be placed around retirement or care homes, neither of which are legislated for in the UK and Australia.

Road crossing behavior and preferences among pedestrians: From the lens of the theory of interpersonal behavior.

OBJECTIVE: As a major safety intervention, infrastructural facilities such as footbridges, underpasses or signals are provided for pedestrians to remove their direct interactions with vehicles and consequently ensure safe crossing as they attempt to cross roadways. Interestingly, it is evident that even within the proximity of footbridges or underpasses, some individuals are more willing to take the risk of crossing at-grade even where there are no signals or crosswalk markings to separate their movement from vehicles. These crossing alternatives may have different utilization depending on location and road user types. Therefore, sustainable crossing facilities are needed to meet pedestrian needs. This study attempts to investigate the factors that influence pedestrians to avoid provided footbridges and engage in at-grade crossing behaviors. METHODS: The crossing point preference is an interpersonal behavior which is a multifaceted and complex phenomenon involving conscious (intentions) and subconscious (habits) factors. This study employs Triandis' Theory of Interpersonal Behavior (TIB) as a theoretical framework and structural equation modeling to achieve study objectives. Pedestrians were intercepted randomly and socio-demographics, trip characteristics and perceptions data collected through a stated preference survey. RESULTS: Perceived consequence, affect, and social factors were found as significant antecedents of at-grade crossing intentions. Habits and facilitating conditions significantly moderate the impact of crossing intentions on actual at-grading crossing behavior. Pedestrians' perceived consequence was found to significantly mediate the impact of social factors and affective factors on intention to cross at-grade. Apart from gender, age, satisfaction with footbridge features, work trips, and crossing frequency were all significant determinants of actual crossing at-grade behavior. CONCLUSIONS: The study findings can help road safety agencies provide acceptable sustainable facilities that will be used by pedestrians to ensure that the purpose of investments toward pedestrian crossing safety is achieved. Effective road safety education and awareness campaigns on negative consequences of crossing at-grade, while highlighting the benefits of using provided footbridges are suggested to be undertaken by government agencies.

Drivers' Comprehensive Emotion Recognition Based on HAM.

Negative emotions of drivers may lead to some dangerous driving behaviors, which in turn lead to serious traffic accidents. However, most of the current studies on driver emotions use a single modality, such as EEG, eye trackers, and driving data. In complex situations, a single modality may not be able to fully consider a driver's complete emotional characteristics and provides poor robustness. In recent years, some studies have used multimodal thinking to monitor single emotions such as driver fatigue and anger, but in actual driving environments, negative emotions such as sadness, anger, fear, and fatigue all have a significant impact on driving safety. However, there are very few research cases using multimodal data to accurately predict drivers' comprehensive emotions. Therefore, based on the multi-modal idea, this paper aims to improve drivers' comprehensive emotion recognition. By combining the three modalities of a driver's voice, facial image, and video sequence, the six classification tasks of drivers' emotions are performed as follows: sadness, anger, fear, fatigue, happiness, and emotional neutrality. In order to accurately identify drivers' negative emotions to improve driving safety, this paper proposes a multi-modal fusion framework based on the CNN + Bi-LSTM + HAM to identify driver emotions. The framework fuses feature vectors of driver audio, facial expressions, and video sequences for comprehensive driver emotion recognition. Experiments have proved the effectiveness of the multi-modal data proposed in this paper for driver emotion recognition, and its recognition accuracy has reached 85.52%. At the same time, the validity of this method is verified by comparing experiments and evaluation indicators such as accuracy and F1 score.

The Italian adaptation of the Driving Anger Scale (DAS): examining measurement invariance and the role of blaming others as a mediator of the relationship between trait driving anger and aberrant driving behavior.

High levels of trait driving anger have been linked to aberrant driving behavior and higher proneness to be involved in a car crash. In the present study, we assessed the psychometric properties of the Italian adaptation of the Driving Anger Scale (DAS) in a large (>2000; 72% males) sample of Italian drivers examining measurement invariance across gender and age. Also, we examined whether the association between trait driving anger and aberrant driving behavior is mediated by a maladaptive form of cognitive emotion regulation, namely blaming others. The results showed that the six-factor structure of the DAS was overall confirmed with a few variations compared to the original scale. Weak measurement invariance was supported across gender and age, while strong and strict invariance were partially confirmed. Finally, the tendency to cope with negative events by blaming others mediated the association between driving anger and aberrant driving behavior in the male but not in the female sample. For both men and women, however, blaming others was positively associated with violations. Thus, attributions of blame to others could be targeted by clinical interventions for high-anger drivers and driver education courses in the attempt to reduce aberrant driving behavior and improve road safety.

PTSD malingering detection in damage claim cases: Diagnostic accuracy in cases of personal injury as a result of motor vehicle accidents.

This study aimed to assess the accuracy of post-traumatic stress disorder (PTSD) diagnoses made by mental health experts in people reporting post-traumatic stress symptoms related to traffic accidents. Data were collected from sixty participants: 30 with possible traumatic experiences and 30 who had never experienced this or other types of traumatic events. Six professional diagnosticians examined the participants with Structured Clinical Interview for the Study of Axis I Disorders (SCID-I for DSM-IV-TR) in conditions similar to those typical of judicial cases related to traffic accident damage claims. There was no significant difference in the number of PTSD diagnoses between malingerers and non-malingerers. Some PTSD symptoms were more frequently recognized in malingerers. This study demonstrates that even professional diagnosticians with clinical and jurisprudence experience have significant difficulty identifying PTSD malingering. This difficulty can be linked to the limitations of diagnoses based on introspective reports.

A longitudinal assessment of posttraumatic stress symptoms and pain catastrophizing after injury.

PURPOSE/OBJECTIVE: Identifying individuals with high levels of pain catastrophizing (PC) may inform early psychological interventions to prevent the transition from acute to chronic post-injury pain. We examined whether pre-and post-injury posttraumatic stress symptoms (PTSS) predict post-injury PC among emergency department (ED) patients following acute motor vehicle crash (MVC). RESEARCH METHOD/DESIGN: This study represents secondary data analysis of a randomized clinical trial (NCT03247179) examining the efficacy of the PTSD Coach app on post-injury PTSS (PTSSpost). Among 63 injured ED patients (63% female; 57% non-White; average age = 37) with moderate pain (≥4 of 10), we assessed recall of pre-injury PTSS (PTSSrecall: stemming from preexisting exposures) and baseline PC within 24 hr post-MVC; PTSSpost stemming from the MVC was assessed 30-days later, and the outcome of PC was assessed at 90-days post-injury. We controlled for group assignment (intervention vs. control) in all analyses. RESULTS: Results revealed that at baseline and 90-days, PC was higher among non-White versus White participants. After adjusting for relevant covariates, PTSSrecall uniquely predicted post-injury PC and each subscale of PC (helplessness, magnification, and rumination). Similarly, after controlling for PTSSrecall and relevant covariates, PTSSpost uniquely predicted total and subscale post-injury PC. Intervention group participants reported less rumination than control group participants. CONCLUSIONS/IMPLICATIONS: These novel findings highlight that injured Black patients may be vulnerable to post-injury PC, and that both PTSSrecall and PTSSpost significantly predict post-injury PC. Brief PTSS assessment in the ED can identify high-risk patients who may benefit from early intervention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Correlation between visuo-cognitive tests and simulator performance of commercial drivers in the United States.

BACKGROUND: Driving commercial vehicles requires intact visuo-cognitive skills. Approximately 13% of all fatal motor vehicle crashes in the United States involve commercial drivers. The ability to accurately predict risk factors for unsafe commercial driving is essential for public safety. Accurate prediction tools will advance the field of commercial driver science, provide policy guidance for driver testing and assist healthcare providers during testing. Prior studies have correlated clinical tools to roadway safety; translating these results to commercial drivers has not yet been done. OBJECTIVE: This study aimed to identify specific demographic, driving history and visuo-cognitive test results that correlate with driving simulator performance. Using the Cumulative Simulator Score (CSS) as a surrogate for driving ability, the objective was to correlate both sets of data (self-reported and visuo-cognitive testing) with the CSS to identify screening tools for unsafe driving in commercial drivers. PRINCIPAL RESULTS: Baseline assessments of 120 variables were collected from October 2020 to January 2022. Of the 31 participants, 3 were female and 28 were male with a mean age of 53 years. Average BMI was 32, blood pressure 136/84, 32 years of CDL driving experience, 36,500 annual CDL mileage, 11,000 annual personal mileage, 14 years of education, average number of medications: 2, average number of medical conditions: 2, six participants with personal and/or commercial crashes or tickets in past five years, MOCA 27/30, Trails B time 66 s, UFOV Speed of Processing 15 ms, Stroke Disease Severity Assessment pass rate 94 %. The Cumulative Simulator Score (CSS), correlated significantly with education (r = 0.42; p = 0.02), commercial driving experience (r = 0.42; 0 = 0.02), and number of tickets as a commercial driver (Spearman rho = 0.40; p = 0.02). In a stepwise multivariable linear regression analysis, the number of tickets as a CDL driver in the past five years and years of education were retained as significant variables in the multivariable linear regression model, explaining 38 % of the variance of total scores on the CSS. MAJOR CONCLUSIONS: Descriptive and self-reported driving characteristics correlate better with the Cumulative Simulator Score in CDL drivers than visuo-cognitive tests. Since simulator performance has been shown to be a reliable surrogate for driving performance, the number of tickets as a CDL driver in the past five years and years of education can be considered as additions to annual physicals for policy makers and health care providers to help assess their on-the-road safety.

An evidence-based approach to emergency department patients at risk for posttraumatic stress disorder symptoms.

Approximately one-quarter of emergency department patients who are injured or experience medical emergencies will develop clinically significant posttraumatic stress disorder (PTSD) symptoms, which can evolve into PTSD. Emergency clinicians and rapid response teams (eg, trauma, cardiac, stroke) can play a critical role in recognizing symptoms of posttraumatic stress and providing early distress management techniques, screening, and referral to services that may mitigate the development of PTSD. This review summarizes the existing literature on psychological distress related to events that trigger the need for emergency care and synthesizes cutting-edge approaches that may impact patient outcomes.

A Systematic Review of the Risks of Motor Vehicle Crashes Associated with Psychiatric Disorders.

OBJECTIVE: Psychiatric disorders and their treatments have the potential to adversely impact driving skills. However, it is unclear to what extent this poses a public health risk by increasing the risk of motor vehicle crashes (MVCs). The aim of this systematic review was to synthesize and critically appraise evidence on the risk of MVC for drivers with psychiatric disorders. METHOD: We conducted a systematic review of the MVC risk associated with psychiatric disorders using seven databases in November 2019. Two reviewers examined each study and extracted data. The National Heart, Lung, and Blood Institute Quality Assessment tools were used to assess each study's quality of evidence. RESULTS: We identified 24 studies that met the inclusion criteria, including eight cohort, 10 case-control, and six cross-sectional designs. Quality assessment ratings were "Good" for four studies, "Fair" for 10, and "Poor" for 10. Self-report or questionnaires were used in place of objective measures of either MVC, psychiatric disorder, or both in 12 studies, and only seven adjusted for driving exposure. Fifteen studies reported an increased risk of MVC associated with psychiatric disorders, and nine did not. There was no category of disorder that was consistently associated with increased MVC risk. CONCLUSION: The available evidence is mixed, not of high quality, and does not support a blanket restriction on drivers with psychiatric disorder. An individualized approach, as recommended by international guidelines, should continue. Further research should include objective assessments of psychiatric disorders and MVC risk and adjust for driving exposure.

Evidence of risky driving in Korean older adults: A longitudinal cohort.

OBJECTIVES: The aim of this study was to determine the differences in the risk factors for dangerous driving between older adults with normal cognition and those with cognitive impairment. DESIGN: The driving risk questionnaire (DRQ) that was applied to a community-dwelling older adult cohort and 2 years of accident/violation records from the National Police Agency were analyzed. We conducted regression analyses with the presence or absence of risky driving based on records (accidents + violations) 2 years before and after evaluation as a dependent variable and dichotomized scores of each risky driving factor as independent variables. RESULTS: According to four identified factors-crash history, safety concern, reduced mileage, and aggressive driving-significant associations were found between risky driving over the past 2 years and crash history and for aggressive driving in the normal cognition group. In the cognitive impairment group, only crash history was significantly associated, although safety concerns showed a trend toward significance. CONCLUSIONS: In this study, it was suggested that the factors of DRQ have a significant association with actual risky driving. Our results are expected to contribute to establishing the evidence for evaluating and predicting risky driving and advising whether to continue driving in clinics.

Negative mood mind wandering and unsafe driving in young male drivers.

OBJECTIVE: Road traffic crash fatalities disproportionately affect young male drivers. Driver distraction is a leading contributor to crashes. Mind wandering (MW) is a prevalent form of driver distraction that is linked to certain unsafe driving behaviours that are associated with increased crash risk (e.g., faster driving). Negative mood can lead to MW, and thus may represent a causal pathway to MW-related unsafe driving. This preliminary pre-post (T1, T2), randomized, controlled, single-blinded experiment tested whether negative mood, compared to neutral mood, increases MW while driving as well as unsafe driving and emotional arousal during MW. It also tested the moderating contribution of trait rumination and inhibitory control to this proposed causal pathway. METHODS: Forty healthy male drivers aged 20 to 24 were randomly allocated to a negative or neutral mood manipulation involving deception. Individual differences in trait rumination and inhibitory control were measured at T1. At T1 and T2, participants drove in a driving simulator measuring driving speed, headway distance, steering behaviour, and overtaking. Heart rate and thought probes during simulation measured emotional arousal and MW, respectively. RESULTS: Negative mood exposure led to more MW while driving (Odds Ratio = 1.79, p = .022). Trait rumination positively moderated the relationship between negative mood and MW (Odds Ratio = 2.11, p = .002). Negative versus neutral mood exposure led to increases in headway variability (Cohen's d = 1.46, p = .026) and steering reversals (Rate Ratio = 1.33, p = .032) during MW relative to focused driving. Between-group differences in emotional arousal were not significant. CONCLUSION: Results support a causal pathway from negative mood to unsafe driving via MW, including the moderating contribution of trait rumination. If replicated, these preliminary findings may inform the development of interventions targeting this potential crash-risk pathway in vulnerable young driver subgroups.

A dynamical traffic flow model for a cognitive drivers' sensitivity in Lagrangian scope.

A new microscopic traffic flow model is established based on heterogeneous driver's sensitivity; in this new model, the driver's sensitivity is defined as being dependent on the headway distances to the preceding vehicle, similar to Bando's optimal velocity function. We introduce the formulation of this cognitive driver's sensitivity utilizing a modified form of Bando's optimal velocity function. A simple methodology, which is used for improving Bando's optimal velocity function, has been implemented for developing the cognitive driver's sensitivity function, which establishes a correlation between the flow field's density and human drivers' responses. The model is highly advanced for introducing a human-driven traffic flow field considering the driver's mental behavioral activity. Using the linear stability condition, we elucidate a neutral stability condition. A series of numerical simulations indicates how the present model describes dynamics that differ from the conventional model, which assumes a constant driver's sensitivity.

Factors associated with long term work incapacity following a non-catastrophic road traffic injury: analysis of a two-year prospective cohort study.

BACKGROUND: Road traffic injuries (RTIs), primarily musculoskeletal in nature, are the leading cause of unintentional injury worldwide, incurring significant individual and societal burden. Investigation of a large representative cohort is needed to validate early identifiable predictors of long-term work incapacity post-RTI. Therefore, up until two years post-RTI we aimed to: evaluate absolute occurrence of return-to-work (RTW) and occurrence by injury compensation claimant status; evaluate early factors (e.g., biopsychosocial and injury-related) that influence RTW longitudinally; and identify factors potentially modifiable with intervention (e.g., psychological distress and pain). METHODS: Prospective cohort study of 2019 adult participants, recruited within 28 days of a non-catastrophic RTI, predominantly of mild-to-moderate severity, in New South Wales, Australia. Biopsychosocial, injury, and compensation data were collected via telephone interview within one-month of injury (baseline). Work status was self-reported at baseline, 6-, 12-, and 24-months. Analyses were restricted to participants who reported paid work pre-injury (N = 1533). Type-3 global p-values were used to evaluate explanatory factors for returning to 'any' or 'full duties' paid work across factor subcategories. Modified Poisson regression modelling was used to evaluate factors associated with RTW with adjustment for potential covariates. RESULTS: Only ~ 30% of people with RTI returned to full work duties within one-month post-injury, but the majority (76.7%) resumed full duties by 6-months. A significant portion of participants were working with modified duties (~ 10%) or not working at all (~ 10%) at 6-, 12-, and 24-months. Female sex, low education, low income, physically demanding occupations, pre-injury comorbidities, and high injury severity were negatively associated with RTW. Claiming injury compensation in the fault-based scheme operating at the time, and early identified post-injury pain and psychological distress, were key factors negatively associated with RTW up until two years post-injury. CONCLUSIONS: Long-term work incapacity was observed in 20% of people following RTI. Our findings have implications that suggest review of the design of injury compensation schemes and processes, early identification of those at risk of delayed RTW using validated pain and psychological health assessment tools, and improved interventions to address risks, may facilitate sustainable RTW. TRIAL REGISTRATION: This study was registered prospectively with the Australian New Zealand Clinical Trials Registry (ACTRN12613000889752).

The relationship between self-reported ability emotional intelligence and risky driving behaviour: Consequences for accident and traffic ticket rate.

Road safety represents one of the main public health issues worldwide, and risky driving behaviour is one of the most predominant factors in traffic road accidents. The primary objective of this research was to clarify the relationship between emotional intelligence (EI) abilities and the probability of engaging in risky behaviour during driving. Previous literature linking these constructs is limited, and research has yielded mixed findings. In the present study, 555 drivers from a Spanish community sample (Mage = 39.34, ranging from 18 to 79 years old; 49.19% women) were assessed on risky driving behaviour using the Dula Dangerous Driving Index while self-reported ability EI was measured using the Wong and Law Emotional Intelligence Scale. Gender, age, and driving experience were controlled. The results of this study revealed that a higher self-reported ability EI, particularly the ability to regulate emotions, was related to a lower tendency to engage in risky driving behaviours. In turn, self-reported ability EI was negatively and indirectly related to the number of road accidents and traffic tickets through the mediating effect of risky driving. The regulation of emotions (via direct and indirect effect) and the appraisal of the emotions of others (via direct effect) were the EI abilities that better predicted the number of accidents and traffic tickets. We discuss the practical implications of these findings, along with suggested future lines of research.

Biopsychosocial sequelae of chronically painful injuries sustained in motor vehicle accidents contributing to non-recovery: A retrospective cohort study.

BACKGROUND: Claimants with chronically painful injuries sustained in motor vehicle accidents (MVAs) undergo assessment and management influenced by insurance and medico-legal processes defined by a biomedical paradigm which is discordant with best evidence. We aim to demonstrate the impact of biopsychosocial factors on post-MVA sequelae which contribute to non-recovery. METHODS: This was a retrospective cohort study of medico-legal documents and reports on 300 consecutive claimants referred to a pain medicine physician over 7 years (2012-2018) for assessment of painful musculoskeletal injuries post-MVA. One hundred data items were extracted from the medico-legal documents and reports for each claimant and entered into an electronic database. Post-MVA sequelae were analysed using chi-square analysis (OR >2) for significant associations with demographic, pre-MVA and post-MVA variables. Factors with significant associations were entered into a logistic regression model to determine significant statistical predictors of post-MVA sequelae contributing to non-recovery. RESULTS: The claimants were aged 17 to 80 years (mean age 42 years), and approximately half (53%, n=159) were female. The time from MVA to interview averaged 2.5 years. Widespread pain was present in 18% (n=54), and widespread somatosensory signs implying central sensitisation (OR=9.85, p<.001) was the most significant multivariate association. Long-term opiate use post-MVA (32%) was predicted by pre-MVA sleep disturbance (OR=5.08, p=.001), post-MVA major depressive disorder (MDD) (OR=3.02, p=.003) and long-term unemployment (OR=2.22. p=.007). Approximately half (47%, n=142) required post-MVA support from a psychologist or psychiatrist. Post-traumatic stress disorder (PTSD) was diagnosed by a psychiatrist or psychologist in 20% (n=59), yet early identification of risk of PTSD was rare. Pre-MVA, 89.4% (n=268) were studying or employed. Permanent unemployability post-MVA occurred in 35% (n=104) and was predicted by MDD (OR=3.59, p=.001) and antidepressant use (OR=2.17, p=.005). Major social change post-MVA (70%) was predicted by older age (OR=.966, p=.003), depressive symptoms (OR=3.71, p<.001) and opiate use (OR=2.00, p=.039). CONCLUSIONS: Biomedical factors, including older age, impaired sleep and indicators of widespread central sensitisation, and psychological factors, including stress, anxiety and depression, were the most prominent multivariate associations as statistical predictors of major adverse sequelae contributing to non-recovery for claimants with chronic pain post-MVA.

Psychological Distress, Pain and Insurance Claims Negatively Affect Long-Term Health-Related Quality of Life After Road Traffic Injuries.

OBJECTIVE: A prospective cohort study to investigate how injury and early post-injury psychosocial factors influence health outcomes 12 months after road traffic injury. METHODS: Residents of New South Wales, Australia, with road traffic injury in the period 2013-16 were recruited. Explanatory factors were evaluated for outcomes over 12 months using 12-Item Short Form Survey (SF-12) Physical and Mental Component Scores (PCS and MCS). Path models and mediation analysis were used to examine the effect of injury severity and explanatory factors. RESULTS: SF-12 PCS and MCS outcomes were poorer among participants with baseline psychological distress, for all injury severities (ß coefficients -3.3 to -9.3, p < 0.0001). Baseline pain and psychological distress, and baseline PCS and MCS were each involved in indirect effects of injury severity on 12-month PCS and MCS. Injury severity, baseline PCS and MCS, and baseline psychological distress were also associated with the likelihood of a compulsory third-party insurance claim, and claiming was negatively associated with 12-month PCS and MCS outcomes (beta coefficients -0.22 and -0.14, respectively, for both, p < 0.01). CONCLUSION: Baseline factors, including pain, psychological distress and lodging a compulsory third-party insurance claim, negatively impact long-term physical and mental health status following road traffic injury, emphasizing the importance of early screening and intervention. TRIAL REGISTRATION: Australia New Zealand Clinical trial registry identification number: AC- TRN12613000889752.