Guest Rebecca, Tran Yvonne, Gopinath Bamini, Cameron Ian D, Craig Ashley
John Walsh Centre for Rehabilitation Research, Kolling Institute for Medical Research, Sydney Medical School-Northern, The University of Sydney, Australia.
John Walsh Centre for Rehabilitation Research, Kolling Institute for Medical Research, Sydney Medical School-Northern, The University of Sydney, Australia.
Injury. 2016 Nov;47(11):2415-2423. doi: 10.1016/j.injury.2016.09.006. Epub 2016 Sep 5.
Psychological distress following a motor vehicle crash (MVC) is prevalent, especially when the person sustains an associated physical injury. Psychological distress can exhibit as elevated anxiety and depressive mood, as well as presenting as mental disorders such as Post Traumatic Stress Disorder (PTSD) or Major Depressive Disorder (MDD). If unmanaged, psychological distress can contribute to, or exacerbate negative outcomes such as social disengagement (e.g., loss of employment) and poor health-related quality of life, as well as contribute to higher costs to insurers. This systematic review summarises current research concerning early psychological intervention strategies aimed at preventing elevated psychological distress occurring following a MVC.
A systematic review of psychological preventative intervention studies was performed. Searches of Medline, Embase, PsychINFO, Web of Science and Cochrane Library were used to locate relevant studies published between 1985 and September 2015. Included studies were those investigating MVC survivors who had received an early psychological intervention aimed at preventing psychological distress, and which had employed pre- and post- measures of constructs such as depression, anxiety and disorders such as PTSD.
Searches resulted in 2608 records. Only six studies investigated a psychological preventative intervention post-MVC. Interventions such as injury health education, physical activity and health promotion, and therapist-assisted problem solving did not result in significant treatment effects. Another six studies investigated psychological interventions given to MVC survivors who were assessed as sub-clinically psychologically distressed prior to their randomisation. Efficacy was varied, however three studies employing cognitive behaviour therapy (CBT) found significant reductions in psychological distress compared to wait-list controls.
Psychological interventions aimed at preventing psychological distress post-MVC are limited, often involving small samples, with subsequent poor statistical power and subsequent high risk of bias. These factors make it difficult to draw conclusions, however CBT appears encouraging and therefore worthy of consideration as a preventative intervention.
机动车碰撞事故（MVC）后出现心理困扰的情况很普遍，尤其是当伤者伴有身体损伤时。心理困扰可表现为焦虑和抑郁情绪加剧，还可表现为创伤后应激障碍（PTSD）或重度抑郁症（MDD）等精神障碍。如果不加以控制，心理困扰会导致或加剧诸如社交脱节（如失业）和健康相关生活质量低下等负面后果，还会增加保险公司的成本。本系统评价总结了当前有关早期心理干预策略的研究，这些策略旨在预防MVC后出现心理困扰加剧的情况。
对心理预防干预研究进行了系统评价。通过检索Medline、Embase、PsychINFO、科学网和考克兰图书馆，查找1985年至2015年9月期间发表的相关研究。纳入的研究是那些调查接受过旨在预防心理困扰的早期心理干预的MVC幸存者的研究，并且这些研究采用了诸如抑郁、焦虑等构念以及PTSD等障碍的前后测量方法。
检索得到2608条记录。只有六项研究调查了MVC后的心理预防干预。诸如伤害健康教育、体育活动和健康促进以及治疗师辅助解决问题等干预措施并未产生显著的治疗效果。另外六项研究调查了对在随机分组前被评估为亚临床心理困扰的MVC幸存者进行的心理干预。疗效各不相同，然而三项采用认知行为疗法（CBT）的研究发现，与等待名单对照组相比，心理困扰有显著降低。
旨在预防MVC后心理困扰的心理干预措施有限，通常样本量较小，导致统计效力差且存在较高的偏倚风险。这些因素使得难以得出结论，然而CBT似乎令人鼓舞，因此作为一种预防干预措施值得考虑。
