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Effect of mental health on long-term disability after a road traffic crash: results from the UQ SuPPORT study
Justin Kenardy1, Michelle Heron-Delaney2, Jacelle Warren1
1Centre of National Research on Disability and Rehabilitation Medicine, Faculty of Health and Behavioural Sciences, The University of Queensland, Queensland, Australia.
Objective:
To investigate the relation between mental health and disability after a road traffic crash (RTC) up to 24 months for claimants with predominantly minor injuries in an Australian sample.
Design:
Longitudinal cohort study with survey and telephone interview data collected at approximately 6, 12, and 24 months post-RTC.
Setting:
Not applicable.
Participants:
Claimants (N=382) within a common-law, fault-based compulsory third-party motor accident insurance scheme in Queensland, Australia, consented to participate when invited and were approached at each wave. Retention was high (65%) at 2-year follow-up. Disability scores from at least 1 wave were known for 363 participants, with the mean age of participants being 48.4 years and 62% being women.
Interventions:
Not applicable.
Main Outcome Measure:
Self-reported disability (via the World Health Organization Disability Assessment Schedule 2).
Results:
Participants reported higher disability (mean, 10.9±9.3) compared with the Australian norms (mean, 3.1±5.3). A multilevel regression analysis found that predictors of disability included present diagnosis of posttraumatic stress disorder (PTSD), anxiety, or depression, mental health history, perceived threat to life, and pain. PTSD moderated the relation between age and disability such that older age predicted higher disability in the PTSD group only, whereas anxiety moderated the relation between expectation to return to work and disability such that those with low expectations and anxiety reported significantly higher disability.
Conclusions:
Claimants with predominantly minor physical injuries report high disability, particularly when comorbid psychiatric disorders are present, pain is high, and expectations regarding return to work are low. Developing tools for detecting those at risk of poor recovery after an RTC is necessary for informing policy and practice in injury management and postinjury rehabilitation.
