Long-term stress experienced by trauma patients was assessed for a sample of 137 patients treated at a large urban trauma center after suffering traumatic injuries resulting from motor vehicle/motorcycle accidents, falls, pedestrian accidents, and stabbing and gunshot wounds. Levels of psychological distress reported 3 to 39 months after the accident were considerable, but a measure of injury severity commonly used in critical care settings was not a good predictor of psychosocial outcome. The subjective impact of the accident and injury-related financial and employment problems were more important in predicting outcome than medical variables or time since injury. Family environment ratings were significantly worse for subjects with elevated levels of psychiatric symptoms. The results suggest that psychosocial interventions may benefit many of these individuals. Aspects to be considered in planning the intervention include projected functional disability, likely employment and financial problems, subjective perceptions of the accident and its implications, and family and social support.