Incidence and prediction of psychiatric morbidity after a motor vehicle accident in Japan: the Tachikawa Cohort of Motor Vehicle Accident Study

Crit Care Med. 2008 Jan;36(1):74-80. doi: 10.1097/01.CCM.0000291650.70816.D6.


Objectives: To assess both the incidence of new-onset psychiatric illness after involvement in a motor vehicle accident in Japan for comparison with Western data and the predictors of psychiatric morbidity and posttraumatic stress disorder (PTSD) evaluated immediately after the accident.

Design: Prospective cohort study of injured patients assessed immediately and 4-6 wks after involvement in a motor vehicle accident.

Setting: Intensive care unit in a teaching hospital in Tokyo, Japan.

Patients: Total of 100 consecutive patients with motor vehicle accident-related injuries (mean Injury Severity Score, 11.2; mean Glasgow Coma Scale, 14.5; age, 18-69 yrs) admitted to the intensive care unit. Patients with traumatic brain injury, suicidality, current psychiatric or neurologic illness, or cognitive impairment were excluded.

Measurements: An extensive clinical interview and evaluation of vital signs, sociodemographic variables, previous traumatic events, family history of psychopathology, Impact of Event Scale-Revised, Hospital Anxiety and Depression Scale, Clinician-Administered PTSD Scale, and Mini-International Neuropsychiatric Interview.

Results: A total of 31 patients showed some form of new-onset psychiatric illness at the 4- to 6-wk follow-up. The majority of illnesses consisted of depression (major depression, n = 16; minor depression, n = 7) and PTSD (full PTSD, n = 8; partial PTSD, n = 16). Other illnesses included alcohol dependence (n = 3), obsessive-compulsive disorder (n = 2), agoraphobia (n = 2), and social phobia (n = 1). Both psychiatric morbidity and PTSD were predicted by a sense of life threat (odds ratio, 4.2 and 6.2, respectively), elevated heart rate (odds ratio, 1.6 and 1.7), and higher Impact of Event Scale-Revised intrusion subscale score (odds ratio, 1.1 and 1.1).

Conclusion: This study showed that psychopathology and PTSD after a motor vehicle accident in Japan is common and that the incidence is within the range of that in Western countries. A combination of a sense of life threat, heart rate, and Impact of Event Scale-Revised intrusion subscale allowed for significant prediction of psychiatric morbidity and PTSD.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accidents, Traffic / psychology*
  • Accidents, Traffic / statistics & numerical data*
  • Adolescent
  • Adult
  • Aged
  • Causality
  • Cohort Studies
  • Depression / epidemiology
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Japan / epidemiology
  • Logistic Models
  • Male
  • Mental Disorders / epidemiology*
  • Middle Aged
  • Models, Theoretical
  • Multivariate Analysis
  • Prospective Studies
  • Risk Assessment / methods
  • Risk Factors
  • Stress Disorders, Post-Traumatic / epidemiology