ObjectivesTo determine the pattern of emergence of post‐traumatic stress disorder (PTSD) among motor vehicle accident victims and to examine the influence of PTSD on subsequent levels of disability.
DesignA longitudinal study of motor vehicle accident victims one month and 18 months after the accident.
SubjectsTwenty‐four motor vehicle accident victims admitted by the trauma team at the Royal Adelaide Hospital. A 52% response rate was achieved.
Main outcome measuresPosttraumatic stress disorder as diagnosed by the Diagnostic Interview Schedule and disability as measured with the Sickness Impact Profile.
ResultsEighteen months after their accidents, six of the 24 subjects had clinically significant PTSD and one was considered borderline. None had been previously diagnosed or treated. The group with PTSD had higher scores on all measures of psychological distress one month after the accident and were more likely to use immature psychological defences. There was no association between physical outcome (measured with the modified Glasgow Outcome Scale) at six months and subsequent diagnosis of PTSD. However, the group with PTSD had higher levels of disability on assessment with the Sickness Impact Profile, particularly in the domain of social functioning. The results suggest PTSD was associated with work‐related dysfunction equal to that associated with severe physical handicap.
ConclusionThe data from this pilot study suggest that PTSD after motor vehicle accidents is an important cause of disability, which may also become the focus for damages in litigation. Thus, there is a need for further investigation of the early patterns of distress and to design preventive programs for victims of road accidents. (Med J Aust 1993; 159: 529‐534)
Attitudes of people with HIV disease towards HIV have seldom been measured. However, a well-established scale to measure attitudes toward cancer in those with the disease, the 38-item Mental Adjustment to Cancer (MAC) scale was modified to assess adjustment to HIV disease. We administered the scale to 107 Australian men with HIV infection, of whom 36 had an AIDS-defining condition, who were patients at an ambulatory care facility and in a research study. The data were factor analyzed using a method identical to that used in the development of the MAC scale to determine the latent dimensions of attitudes toward HIV/AIDS. The Mental Adjustment to HIV scale (MAH) factor analysis revealed five factors: Helplessness-Hopelessness, Fighting Spirit, and Denial-Avoidance as in the original MAC scale, plus a Fatalism subscale which also measured Preoccupation, and a new subscale, which measured Belief in Influencing the Course of the Disease. Together, these five factors accounted for half of the variance. These data suggest that while there are similarities between mental attitude to cancer and mental attitude to HIV in the latent dimensions of the questionnaire items, there are also some differences. Most significant is the belief in people with HIV disease in being able to personally influence the course of the illness, and the combination of Preoccupation with Fatalism. The five subscales of the MAH scale had Cronbach's alpha reliabilities between 0.80 and 0.55. The MAH appears to be a useful way to measure total attitudes and subscale scores of people with HIV infection, including AIDS, to their disease.
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