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Meta-Analysis
. 2016 Sep 8;6(9):e011993.
doi: 10.1136/bmjopen-2016-011993.

Psychological impact of injuries sustained in motor vehicle crashes: systematic review and meta-analysis

Ashley Craig  1 , Yvonne Tran  1 , Rebecca Guest  1 , Bamini Gopinath  1 , Jagnoor Jagnoor  1 , Richard A Bryant  2 , Alex Collie  3 , Robyn Tate  1 , Justin Kenardy  4 , James W Middleton  1 , Ian Cameron  1
Affiliations
Meta-Analysis

Psychological impact of injuries sustained in motor vehicle crashes: systematic review and meta-analysis

Ashley Craig et al. BMJ Open. .

Abstract

Objective: The aim of this meta-analysis was to determine the psychological impact associated with motor vehicle crash (MVC)-related physical injuries.

Design: Systematic review and meta-analysis.

Data sources: Multiple search engines included MEDLINE (via OVID), PsycINFO and Embase, and studies were sourced from scientific journals, conference papers and doctoral theses.

Study selection: A high-yield search strategy was employed. Terms like 'psychological distress', 'depression', 'PTSD' and 'motor vehicle accident' were employed. These key words were run primarily and secondary searches were then conducted in association with the major injury types. Studies needed to compare psychological distress in people injured in an MVC with uninjured controls who had not recently experienced an MVC.

Data extraction: Searches resulted in the identification of 2537 articles, and after eliminating duplicates and studies not meeting inclusion criteria, 24 studies were selected involving 4502 injured participants. These studies were entered into separate meta-analyses for mild to moderate traumatic brain injury (mTBI), whiplash-associated disorder (WAD) and spinal cord injury (SCI).

Results: Elevated psychological distress was associated with MVC-related injuries with a large summary effect size in WAD (0.90), medium to large effect size in SCI (0.69) and small to medium effect size in mTBI (0.23). No studies meeting inclusion criteria were found for burns, fractures and low back injury. Increased psychological distress remains elevated in SCI, mTBI and WAD for at least 3 years post-MVC.

Conclusions: Rehabilitation strategies are needed to minimise distress subsequent to MVC-related physical injuries and the scientific robustness of studies requires improvement.

Keywords: motor vehicle accident; musculoskeletal injury; psychological distress; spinal cord injury; traumatic brain injury.

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Figures

Figure 1
Figure 1
Flow diagram showing PRISMA selection process of the studies eligible for inclusion.
Figure 2
Figure 2
Meta-analysis and forest plot results for the eight mTBI studies, including Hedges’ g effect sizes, 95% CIs and the overall effect size for all eight studies. Effect sizes to the right indicate that the mTBI samples have higher levels of psychological distress. mTBI, moderate traumatic brain injury.
Figure 3
Figure 3
Meta-analysis and forest plot results for the five SCI studies, including Hedges’ g effect sizes, 95% CIs and the overall effect size for all five studies. Effect sizes to the right indicate that the SCI samples have higher levels of psychological distress. SCI, spinal cord injury.
Figure 4
Figure 4
Meta-analysis and forest plot results for the 11 WAD studies, including Hedges’ g effect sizes, 95% CIs and the overall effect size for all 11 studies. Effect sizes to the right indicate that the WAD samples have higher levels of psychological distress. WAD, whiplash-associated disorder.
Figure 5
Figure 5
Regression of effect sizes for psychological distress following an MVC for the three MVC-related injury types. MVC, motor vehicle crash.
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