Schäfer Ingo, Barkmann Claus, Riedesser Peter, Schulte-Markwort Michael
Department of Psychiatry and Psychotherapy, University of Hamburg, Hamburg, Germany.
Psychopathology. 2006;39(4):159-64. doi: 10.1159/000092676. Epub 2006 Apr 11.
The impact of road traffic accidents (RTAs) on the physical health of children is well recognized, but their psychological consequences have only recently become a topic of research. While other traumatic experiences in childhood are well studied, this kind of trauma has been poorly investigated to date.
A prospective cohort study was conducted of 8- to 18-year-old children and adolescents who were involved in RTAs in a large urban area during a 6-month period. The children and adolescents were interviewed within 1 week after the accident and, again, 3 months later. In total, 72 children and adolescents took part in the study. Symptoms of posttraumatic stress, depression and anxiety were assessed by a structured clinical interview and standardized questionnaires.
One week after the accident, 11% of the children met the diagnostic criteria for posttraumatic stress disorder (PTSD) according to ICD-10 and a further 13% met the criteria for 'subsyndromal PTSD'. Complex syndromes consisting of subsyndromal posttraumatic stress, (separation) anxiety and depression were common among those children. Isolated cases of anxiety and depression symptoms were also observed but rarely reached an impairing level. Three months after the accident, 25% of the children reported persistence of the PTSD symptoms (measured by the Impact of Event Scale - Revised). The strongest predictor of the extent of posttraumatic stress after 3 months was proven to be the initial level of PTSD symptoms. This predictor alone accounted for 38% of its variance.
Our results provide evidence that even after 'everyday' RTAs, psychological consequences are common. Special attention should be paid to the common occurrence of subsyndromal psychological disturbances and more complex syndromes. The results further indicate the limitations of the PTSD concept in the assessment of posttraumatic disturbances in childhood and adolescence.
道路交通事故（RTAs）对儿童身体健康的影响已得到充分认识，但其心理后果直到最近才成为研究课题。虽然童年时期的其他创伤经历已得到充分研究，但迄今为止，这类创伤的研究还很不足。
对一个大城市地区在6个月内遭遇道路交通事故的8至18岁儿童和青少年进行了一项前瞻性队列研究。这些儿童和青少年在事故发生后1周内接受了访谈，并在3个月后再次接受访谈。共有72名儿童和青少年参与了该研究。通过结构化临床访谈和标准化问卷评估创伤后应激、抑郁和焦虑症状。
事故发生1周后，根据国际疾病分类第10版（ICD - 10），11%的儿童符合创伤后应激障碍（PTSD）的诊断标准，另有13%符合“亚综合征性PTSD”标准。由亚综合征性创伤后应激、（分离）焦虑和抑郁组成的复杂综合征在这些儿童中很常见。也观察到了孤立的焦虑和抑郁症状病例，但很少达到损害程度。事故发生3个月后，25%的儿童报告创伤后应激障碍症状持续存在（通过事件影响量表修订版测量）。事实证明，3个月后创伤后应激程度的最强预测因素是创伤后应激障碍症状的初始水平。仅这一预测因素就占其方差的38%。
我们的结果表明，即使是“日常”的道路交通事故后，心理后果也很常见。应特别关注亚综合征性心理障碍和更复杂综合征的普遍发生。结果还表明了创伤后应激障碍概念在评估儿童和青少年创伤后障碍方面的局限性。
