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2007, Number 6

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Salud Mental 2007; 30 (6)

Trastorno por estrés postraumático en pacientes con lesiones no intencionales producidas en accidentes de tránsito

Pérez-Rincón ME, González-Forteza C, Ramos LL, Jiménez TJA

Language: Spanish
References: 58
Page: 43-48
PDF size: 52.84 Kb.


ABSTRACT

We have carried out this research because accidents are a serious public health problem in Mexico. They are the third overall mortality cause and the first among young adults. In addition, in our country, the study of posttraumatic stress disorder (PTSD) has not been focused sufficiently on accidents, not to speak of motor vehicles accidents.
Among the different types of accidents, traffic accidents are placed at the top of the list. Aside from causing injuries and the loss of man hours at work, these accidents bring about emotional distress to affected individuals.
Stress is a factor that triggers short-and medium-term consequences which are in turn reflected in the quality of life of the patient and his/her family.
PTSD is an anxiety disorder that causes psychosocial disfunctioning and appears due to the exposure to a stressor or traumatic event. It may come about in two ways: when the subject is a victim of a serious threat to his/her life or integrity and when the subject witnesses an event seriously affecting a third party. The main stressors may be natural phenomena, such as hurricanes and earthquakes, intentional attacks, such as rape or any form of criminal violence, and, as is the case here, from traumatic events caused by motor vehicles.
The etiology of PTSD is multi-factorial and involves genetic, psychological, educational, and environmental aspects. It has three forms: severe, where the disorder appears immediately after the occurrence of the event or until a month later; chronic, lasting between one and three months; and delayed, where symptoms appear six months after the event.
Our objective was to establish PTSD frequency in patients with physical injuries caused by motor vehicles accidents who were attended at the Regional Orthopaedics and Trauma Hospital “Adolfo López Mateos”. Together with the application of the scales, we were interested in making a description of the sociodemographical side of accidents, comparing the affect profile, and somehow defining the wide range of factors involved in the occurrence of this problem.
For this, we devised a transversal and descriptive study with a non-probabilistic sampling. The sample was chosen using the following inclusion criteria:
a)Being older than 18 years.
b)Having suffered a motor vehicle accident.
c)Having received attention for a month at least at the Orthopaedics and Trauma Hospital “Adolfo López Mateos”.
d)Having the physical and mental conditions to answer a selfreport questionnaire or at least to be interviewed instead.
The instrument used was a self-report questionnaire consisting of different scales: 1. The Mississippi PTSD Scale for screening, case selection and symptoms severity measurement. This scale has been translated and validated in Mexico. 2. The WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN). 3. An instrument to establish the affect profile (PANAS). 4. A socio-demographical data identification schedule.
Results from this study show some interesting characteristics from subjects involved in traffic accidents such as the fact that victims are mostly men driving alone at weekends. As has been pointed out, this supports the importance of putting into practice actions to educate drivers involved in such circumstances more often. In addition, policies which allow for the modification of traffic environments as to their adequateness to social contexts should be established.
Likewise, data from this work agree with those from other studies as to the existence of an association between the presence of PTSD and the involvement in car accidents.
Although the prevalence of the sample of this study is much higher than previous Mexican reports, it shows some interesting figures regarding the fact that most subjects who reported PTSD were women who had an elementary education level and a partner by the time of the accident. Falls from vehicles, people run over by cars and individuals driving alone at the time of accidents were other relevant high-impact findings.
While it is true, on the one hand, that the aforementioned results are non-significant, they do give an idea of some aspects which would be useful to bear in mind in providing clinical attention to affected individuals. On the other hand, aspects which did have a statistical significance on the data from this sample should be taken into account. One of these was the fact that the higher rate of PTSD was reported in individuals who suffered an accident while being inside a vehicle, in individuals involved in an accident which had occurred between one and three months before and who in addition tended to present a negative affect profile. These are important findings because they give us the opportunity to consider more specific aspects at the time of developing attention strategies which could alleviate the temporal impact and scale of the problem.


REFERENCES

  1. ALMANZA M, PAEZ A, HERNANDEZ M, BARAJAS G, NICOLINI H: Traducción, confiabilidad y validez concurrente de dos escalas de estrés postraumático. Salud Mental, 19(suplemento 3):2-4, 1996.

  2. BELLOMO A, DE-GIORGI A, PETITO A, CAMMEO C, LEPORE A, BORRELLI A, NARDINI M: Post-traumatic stress disorder as a consequence of severe road traffic accidents. Minerva-Psichiatrica, 47(2):155-163, 2006.

  3. BLANCHARD E, HICKLING E: After the Crash: Psychological Assessment and Treatment of Survivors of Motor Vehicle Accidents. Segunda edición. APA Books. Washington, 2003.

  4. BLANCO C: Trastorno por estrés postraumático: estudio en accidentes de tráfico. MAPFRE Medicina, 14(1):30-35, 2003.

  5. CARBONELL C, CARVAJAL C: El trastorno por estrés postraumático: una consecuencia de los asaltos. Revista Médica Chile, 132:839-844, 2004.

  6. CHAN A, AIR T, MCFARLANE A: Posttraumatic stress disorder and its impact on the economic and health costs of motor vehicle accidents in South Australia. J Clinical Psychiatry, 64(2):175-181, 2003.

  7. CRUZ J: Victimización por violencia urbana: niveles y factores asociados en América Latina y España. Revista Panamenricana de Salud Pública, 5(4/5):259-267, 1999.

  8. GREEN B: Psychological research in traumatic stress: an update. J Traumatic Stress, 7(3):341-362, 1994.

  9. GREEN J: “Accident” should not be purged. BMJ USA, 1 (julio/agosto):373-374, 2001.

  10. HIDALGO R, DAVIDSON J: Posttraumatic stress disorder: Epidemiology and health related considerations. J Clinical Psychiatry, 61(suplemento 7):5-13, 2000.

  11. HIDALGO-SOLORZANO E, HIJAR M, BLANCOMUÑOZ J, KAGEYAMA-ESCOBAR M: Factores asociados con la gravedad de lesiones ocurridas en la vía pública en Cuernavaca, Morelos, México. Salud Pública México, 47(1):30-38, 2005.

  12. HIJAR M: Utilidad del análisis geográfico en el estudio de las muertes por atropellamiento. Salud Pública México, 42(3):188-193, 1999.

  13. INSTITUTO NACIONAL DE SALUD PUBLICA/ SECRETARIA DE SALUD. Encuesta Nacional de Salud 2000, 2003. Descargado de http://www.insp.mx/ensa/, en mayo de 2007.

  14. KESSLER R, SONNEGA A, BROMET E, HUGHES M, NELSON C: Posttraumatic stress disorder in the National Comorbidity Survey. Archives General Psychiatry, 52(12):1048- 1060, 1995.

  15. LANDOLT M, VOLLRATH M, TIMM K, GNEHM H, SENNHAUSER F. Predicting posttraumatic stress symptoms in children after road traffic accidents. J American Academy Child Adolescent Psychiatry, 44(12):1276-1283, 2005.

  16. MARTIN DEL CAMPO A, CORTES J, HERRERA K, DE LA PEÑA F: Construcción de la Escala de Perfil Afectivo. Salud Mental, 19(supl 3):36-58, 1996.

  17. MC FARLANE A, SCHRADER G, BOOKLESS C,BROWNE D: Prevalence of victimization, posttraumatic stress disorder and violent behaviour in the seriously mentally ill. Australian New Zealand J Psychiatry, 40(11-12):1010–1015, 2006.

  18. MEDINA-MORA ME, BORGES-GUIMARAES G, LARA C y cols: Prevalencia de trastornos mentales y uso de servicios: resultados de la Encuesta Nacional de Epidemiología Psiquiátrica en México. Salud Mental, 26(4):1-16, 2003.

  19. MEDINA-MORA ME, BORGES-GUIMARAES G, LARA C, RAMOS-LIRA L, ZAMBRANO J, FLEIZ-BAUTISTA C. Prevalencia de sucesos violentos y de trastorno por estrés postraumático en la población mexicana. Salud Pública México, 47(1):8-22, 2005.

  20. O’DONNELL M, CREAMER M, ELLIOTT P, ATKIN C: Health costs following motor vehicle accidents: The role of Posttraumatic Stress Disorder. J Traumatic Stress, 18(5): 557- 561, 2005.

  21. ORENGO-GARCIA F, RODRIGUEZ M, LAHERA G, RAMREZ G: Prevalencia y tipos de trastorno por estrés postraumático en población general y psiquiátrica. Psiquis, 22(4):5.12, 2001.

  22. ORGANIZACION MUNDIAL DE LA SALUD: Informe Mundial sobre prevención de los traumatismos causados por el tránsito, 2004. Descargado de: http://www.who.int/worldhealth-day/2004/infomaterials/world_report/en/summary_es.pdf, en abril de 2007.

  23. ORGANIZACIÓN PANAMERICANA DE LA SALUD. Defunciones por accidentes de tránsito en países seleccionados de las Américas. Boletín Epidemiológico/OPS, 25(1):2-5, 2004.

  24. PALACIOS L, HEINZE G: Trastorno por estrés postraumático: una revisión del tema (primera parte). Salud Mental, 25(3):19-26, 2002.

  25. PUENTES E: Accidentes de tráfico: letales y en aumento. Editorial. Salud Pública México, 47(1):3-4, 2005.

  26. SAIZ-SANCHEZ C, BAUTISTA-RENTERO D, CORELLA-PIQUER D, CORTINA-BIRLNAGA S, GONZALEZ-ARRAEZ J: Análisis edad-periodo-cohorte de la mortalidad por accidentes de tráfico en España. Salud Pública México, 41(3):170-176, 1999.

  27. SCHAFER I, BARKMANN C, RIEDESSER P, SCHULTEMARKWORT M: Posttraumatic syndromes in children and adolescents after road traffic accidents: A prospective cohort study. Psychopathology, 39(4):159-164, 2006.

  28. SISTEMA NACIONAL DE INFORMACION EN SALUD (SINAIS), 2006. Descargado de: http://sinais.salud.gob.mx/ en abril de 2007.

  29. WING J, BABOR T, BRUGHA T, BRUKE J, COOPER E y cols.: Schedules for Clinical Assessment in Neuropsychiatry. Archives General Psychiatry, 47(6):589-593, 1990.

  30. ALMANZA M, PAEZ A, HERNANDEZ M, BARAJAS G, NICOLINI H: Traducción, confiabilidad y validez concurrente de dos escalas de estrés postraumático. Salud Mental, 19(suplemento 3):2-4, 1996.

  31. BELLOMO A, DE-GIORGI A, PETITO A, CAMMEO C, LEPORE A, BORRELLI A, NARDINI M: Post-traumatic stress disorder as a consequence of severe road traffic accidents. Minerva-Psichiatrica, 47(2):155-163, 2006.

  32. BLANCHARD E, HICKLING E: After the Crash: Psychological Assessment and Treatment of Survivors of Motor Vehicle Accidents. Segunda edición. APA Books. Washington, 2003.

  33. BLANCO C: Trastorno por estrés postraumático: estudio en accidentes de tráfico. MAPFRE Medicina, 14(1):30-35, 2003.

  34. CARBONELL C, CARVAJAL C: El trastorno por estrés postraumático: una consecuencia de los asaltos. Revista Médica Chile, 132:839-844, 2004.

  35. CHAN A, AIR T, MCFARLANE A: Posttraumatic stress disorder and its impact on the economic and health costs of motor vehicle accidents in South Australia. J Clinical Psychiatry, 64(2):175-181, 2003.

  36. CRUZ J: Victimización por violencia urbana: niveles y factores asociados en América Latina y España. Revista Panamenricana de Salud Pública, 5(4/5):259-267, 1999.

  37. GREEN B: Psychological research in traumatic stress: an update. J Traumatic Stress, 7(3):341-362, 1994.

  38. GREEN J: “Accident” should not be purged. BMJ USA, 1 (julio/agosto):373-374, 2001.

  39. HIDALGO R, DAVIDSON J: Posttraumatic stress disorder: Epidemiology and health related considerations. J Clinical Psychiatry, 61(suplemento 7):5-13, 2000.

  40. HIDALGO-SOLORZANO E, HIJAR M, BLANCOMUÑOZ J, KAGEYAMA-ESCOBAR M: Factores asociados con la gravedad de lesiones ocurridas en la vía pública en Cuernavaca, Morelos, México. Salud Pública México, 47(1):30-38, 2005.

  41. HIJAR M: Utilidad del análisis geográfico en el estudio de las muertes por atropellamiento. Salud Pública México, 42(3):188-193, 1999.

  42. INSTITUTO NACIONAL DE SALUD PUBLICA/ SECRETARIA DE SALUD. Encuesta Nacional de Salud 2000, 2003. Descargado de http://www.insp.mx/ensa/, en mayo de 2007.

  43. KESSLER R, SONNEGA A, BROMET E, HUGHES M, NELSON C: Posttraumatic stress disorder in the National Comorbidity Survey. Archives General Psychiatry, 52(12):1048- 1060, 1995.

  44. LANDOLT M, VOLLRATH M, TIMM K, GNEHM H, SENNHAUSER F. Predicting posttraumatic stress symptoms in children after road traffic accidents. J American Academy Child Adolescent Psychiatry, 44(12):1276-1283, 2005.

  45. MARTIN DEL CAMPO A, CORTES J, HERRERA K, DE LA PEÑA F: Construcción de la Escala de Perfil Afectivo. Salud Mental, 19(supl 3):36-58, 1996.

  46. MC FARLANE A, SCHRADER G, BOOKLESS C,BROWNE D: Prevalence of victimization, posttraumatic stress disorder and violent behaviour in the seriously mentally ill. Australian New Zealand J Psychiatry, 40(11-12):1010–1015, 2006.

  47. MEDINA-MORA ME, BORGES-GUIMARAES G, LARA C y cols: Prevalencia de trastornos mentales y uso de servicios: resultados de la Encuesta Nacional de Epidemiología Psiquiátrica en México. Salud Mental, 26(4):1-16, 2003.

  48. MEDINA-MORA ME, BORGES-GUIMARAES G, LARA C, RAMOS-LIRA L, ZAMBRANO J, FLEIZ-BAUTISTA C. Prevalencia de sucesos violentos y de trastorno por estrés postraumático en la población mexicana. Salud Pública México, 47(1):8-22, 2005.

  49. O’DONNELL M, CREAMER M, ELLIOTT P, ATKIN C: Health costs following motor vehicle accidents: The role of Posttraumatic Stress Disorder. J Traumatic Stress, 18(5): 557- 561, 2005.

  50. ORENGO-GARCIA F, RODRIGUEZ M, LAHERA G, RAMREZ G: Prevalencia y tipos de trastorno por estrés postraumático en población general y psiquiátrica. Psiquis, 22(4):5.12, 2001.

  51. ORGANIZACION MUNDIAL DE LA SALUD: Informe Mundial sobre prevención de los traumatismos causados por el tránsito, 2004. Descargado de: http://www.who.int/worldhealth-day/2004/infomaterials/world_report/en/summary_es.pdf, en abril de 2007.

  52. ORGANIZACIÓN PANAMERICANA DE LA SALUD. Defunciones por accidentes de tránsito en países seleccionados de las Américas. Boletín Epidemiológico/OPS, 25(1):2-5, 2004.

  53. PALACIOS L, HEINZE G: Trastorno por estrés postraumático: una revisión del tema (primera parte). Salud Mental, 25(3):19-26, 2002.

  54. PUENTES E: Accidentes de tráfico: letales y en aumento. Editorial. Salud Pública México, 47(1):3-4, 2005.

  55. SAIZ-SANCHEZ C, BAUTISTA-RENTERO D, CORELLA-PIQUER D, CORTINA-BIRLNAGA S, GONZALEZ-ARRAEZ J: Análisis edad-periodo-cohorte de la mortalidad por accidentes de tráfico en España. Salud Pública México, 41(3):170-176, 1999.

  56. SCHAFER I, BARKMANN C, RIEDESSER P, SCHULTEMARKWORT M: Posttraumatic syndromes in children and adolescents after road traffic accidents: A prospective cohort study. Psychopathology, 39(4):159-164, 2006.

  57. SISTEMA NACIONAL DE INFORMACION EN SALUD (SINAIS), 2006. Descargado de: http://sinais.salud.gob.mx/ en abril de 2007.

  58. WING J, BABOR T, BRUGHA T, BRUKE J, COOPER E y cols.: Schedules for Clinical Assessment in Neuropsychiatry. Archives General Psychiatry, 47(6):589-593, 1990.




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