Long-term outcome of trauma in adults: the psychological impact of a fatal bus accident.

The psychological impact of trauma on 36 parents and spouses was examined 1 year (1989), 3 years (1991), and 5 years (1993) after a fatal school bus accident in Western Norway in 1988. The course and outcome of posttraumatic symptoms (Impact of Event Scale [IES]) and symptoms of general psychological distress (SCL-90) were examined in relation to type of trauma (loss vs. no loss) and prior exposure to trauma. A large proportion of the sample reported high levels of symptoms on SCL-90 and IES (Intrusion). No associations were observed between type of trauma and any of the symptom measures. Prior exposure to trauma did not affect the scores on IES but was associated with a sustained vulnerability for general psychological distress (SCL-90). Different trajectories of the symptoms indicate that two psychological processes may be involved in long-term adjustment to trauma.