ORIGINAL ARTICLE

Prevalence and determinants of posttraumatic stress disorderand

depression among survivors of motor vehicle accidents from a hilly Indian
state
Deeksha Arora, C Xavier Belsiyal, Vikram Singh Rawat 1
College of Nursing, AIIMS, 1Department of Psychiatry, AIIMS, Rishikesh, Uttarakhand, India

ABSTRACT

Background: Motor vehicle accidents (MVAs) are the leading cause of death and have also been proven
debilitating for their survivors. In India, with poor road infrastructure and low maintenance, MVAs are quite
apparent. With a significant focus of treatment on physical health, psychological consequences linked to these
traumas are often neglected.
Aim: The aim of this study was to estimate the prevalence of posttraumatic stress disorder and depression, as well
as the determinants of these disorders among survivors of MVAs.
Materials and Methods: An institution-based, cross-sectional descriptive study was conducted among 250
survivors of MVA visiting a tertiary care center in Uttarakhand (India) during December 2019, recruited using total
enumerative sampling. Data were collected with standardized and validated tools that consisted of
sociodemographic information, Posttraumatic Stress Disorder Checklist 5, and Zung Self-Rating Depression Scale.
Data were analyzed using SPSS version 23, including descriptive (frequency, percentage, mean, and mean
percentage) and inferential statistics (Mann–Whitney, Kruskal–Wallis, and binary logistic regression).
Results: The prevalence of posttraumatic stress disorder (PTSD) was found to be 32.4%, and mild and moderate
depressions were present among 14.4% and 6.4% of the study population, respectively. Witnessing death (odds ratio
[OR] = 5.52; 95% confidence interval [CI] = 0.92–3.06), loss of valuables (OR = 2.62; 95% CI = 0.78–9.04),
self-blame (OR = 6.06; 95% CI = 1.15–31.91), and perceived death threat (OR = 9.98; 95% CI = 5.89–46.85) acted
as determinants in the occurrence of PTSD and depression.
Conclusion: A considerably large proportion of the population suffered from psychiatric disorders following the
trauma. These must be addressed with an urgent development of multidisciplinary teams incorporating mental
health services across all hospitals’ trauma units.

Key words: Collisions, depression, posttraumatic stress disorder, survivor, traffic accidents

Address for correspondence: Dr. C Xavier Belsiyal,
Assistant Professor, College of Nursing, AIIMS, Rishikesh,
Uttarakhand, India.
E-mail: jinbelsi@gmail.com
Submitted: 10-Sep-2020, Revised: 24-Oct-2020,
Accepted: 30-May-2021, Published: 17-Jun-2021
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Access this article online
Website:
www.indianjpsychiatry.org
DOI:
10.4103/psychiatry.IndianJPsychiatry_1059_20
INTRODUCTION
“Every year, the lives of approximately 1.35 million people
are cut short due to a road traffic crash worldwide.
Motor vehicle accidents (MVAs) are now the primary
cause of death,
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How to cite this article: Arora D, Belsiyal CX, Rawat
VS. Prevalence and determinants of posttraumatic stress
disorder and depression among survivors of motor
vehicle accidents from a Hilly Indian state. Indian J
 Arora, et al.: Prevalence and determinants of PTSD and depression among survivors of motor vehicle

mainly among people aged 15–29 years. Furthermore,

between 20 and 50 million more people suffer nonfatal Studies of adult RTAs have shown similar results with
injuries, with many incurring a disability as a result of higher psychological disturbances and distress among
their injury.”[1] In India, the morbidity, disability, and those who survived a severe trauma such as a RTA, among
mortality are high, with estimated road traffic death rate which PTSD
substantially increasing from 16.6% in 2013 to 22.6%
in 2016.[2] The rapidity of occurrence has reached one
vehicular accident every 3 min and one death every 10
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min.[3] The consequences and costs of these losses are

BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4

significant.

Road traffic accidents (RTAs) are a rapidly growing

burden, especially in developing countries, posing a high
economic burden on low- and middle-income
countries.[4] Despite the burden, MVAs remain a largely
overlooked public health problem, especially in such
countries.[5] Often, the treatment of MVAs addresses only
physical concerns, while the psychological aspects are
ignored. A meta-analysis found that 1489 out of 6804
RTA survivors had posttraumatic stress disorder
(PTSD).[6]

PTSD is characterized by re-experiencing the

traumatic event in the form of vivid dreams, disturbing
memories, flashbacks, or nightmares, which are
accompanied by strong or overwhelming emotions,
particularly fear or horror, and intense physical
sensations. Such persistent heightened current threat
causes significant impairment in personal, family, social,
educational, occupational, or other important areas of
functioning as per the International Classification of
Diseases 11th version.[7]

About 8 million people have PTSD in a given year, and

out of the total population who experience traumatic
events, 20% of people will develop PTSD.[8] While
considering the Indian perspective, the prevalence
varies from a lesser percentage to as high as 70%,
which can be due to methodological differences,
methods of sampling, or case detection. [9] A common
psychiatric illness comorbid with PTSD is depression.[10] A
high percentage of the PTSD group who recently faced a
MVA also met the criteria of major depressive disorder.
[11]
A prior history of depression is a significant risk
factor of developing PTSD as there are more chances,
approximately 3–5 times more, to have depression
among people with PTSD than their counterparts. In
the recent past, depression has become a common
mental disorder, with statistics reaching an alarming
rate of 1 in 10 people suffering from depressive disorder
every year.[8] People with depression commonly present
with complaints of persistent sad mood, loss of interest
in previously pleasurable activities, decreased energy,
guilt or low self-esteem, disturbed biological
functioning, and poor concentration. According to the
WHO, globally, more than 300 million people of all ages
suffer from depression.[12]

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 Arora, et al.: Prevalence and determinants of PTSD and depression among survivors of motor vehicle
and depressive disorders of moderate severity are accident, presence of other significant medical/surgical
most frequent.[13] The lifetime prevalence of comorbidities (factors which may increase the level of
depression in the general population is about 10%– stress among survivors of MVA), and those under
20%; likewise, depression is one of the most prevalent substance
disorders reported in persons involved in a MVA.[10]
Depression does not occur in isolation; instead, it is
accompanied by PTSD in 48.99% of posttrauma
patients.[14]

About 85% of people who met with a traumatic event

during their lifetime did not undergo any intervention
to overcome the emotional stress caused by the
trauma.[15] However, many people face immense
difficulty adapting to circumstances that include
psychological, social, physical, legal, and financial
challenges.[16] Increasing vehicular mobility in
developing countries, like India, necessitates further
research to assess MVAs’ psychological effects. In this
context, the current study assessed the prevalence of
and factors affecting PTSD and depression among
survivors of MVAs visiting a tertiary care center.

MATERIALS AND METHODS

A cross-sectional descriptive study was conducted at

All India Institute of Medical Sciences, Rishikesh,
India, during December 2019 to estimate the
prevalence of PTSD and depression, their correlation,
and association with sociodemographic variables of the
study population. Permission was obtained from the
Institutional Ethics Committee (IEC) to carry out the
study with Registration No. ECR/736/Inst/UK/2015/RR-
18. Anonymity and confidentiality of information were
maintained, and informed consent was obtained.
Patients who had symptoms and fulfilled the diagnostic
criteria for PTSD/depression were referred for
consultation.

Sample size and sampling

As per the prevalence rate from previous studies, [17]
the required sample size was estimated using the
following formula n = Z2P (1 − P)/d2. The sample size
was calculated, which came out to be 245 in number.
Considering the attrition rate, 250 patients were
recruited from different clinical departments of the
selected tertiary care center, using a total enumerative
sampling technique. After obtaining consent, patients
who fulfilled the inclusion and exclusion criteria were
included in the study.

Sampling criteria
Patients visiting various departments of the tertiary
care center, aged between 19 and 65 years, literate
(who can read and write with understanding in
Hindi/English), and who survived MVA at least 1
month to 12 months before data collection were
included in the study. Patients with a history of
psychiatric illness, presence of head injury during an
2 Indian Journal of Psychiatry Volume 63, Issue 3, May-June
 Arora, et al.: Prevalence and determinants of PTSD and depression among survivors of motor vehicle

intoxication at the time of the interview were excluded Whitney U and Kruskal–Wallis) were used. Binary
from the study. logistic regression analysis was conducted to

Questionnaire
Data were collected via an interviewer-administered
questionnaire, which contained three main sections.
These were the sociodemographic details
(sociodemographic profile, accident profile, and clinical
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profile), the prevalence of PTSD, and depression among

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the study population.

Posttraumatic Stress Disorder Checklist (PCL-5) was

used to assess PTSD (Weathers, Litz, et al., 2013). It is
a 20-item self-report measure that corresponds to the
DSM-5 diagnostic criteria for PTSD. Each item score
ranges from 0 to 4 as not at all (0), a little bit (1),
moderately (2), quite a bit (3), and extremely (4). The
total score of the tool is 80 and obtained by summing
the scores of the 20 items. A cutoff score of ≥33 was
used for the provisional diagnosis of PTSD.

Zung Self-Rating Depression Scale (ZSRDS) (Zung, 1965)

includes a total of 20 items that rate the four common
characteristics of depression: the pervasive effect, the
physiological equivalents, other disturbances, and
psychomotor activities. Out of 20 items, 10 are
positively worded, and 10 are negatively worded
questions. Each item is scored on a scale of 1–4 (a little
of the time, some of the time, a good part of the time).
The score ranges from 20 to 80, and as per the score
attained, the patients were categorized into normal (25–
49), mildly depressed (50–59), moderately depressed
(60–69), and severely depressed (70 and above).

The tools used for the present study were translated

into the local language (Hindi) and were validated by
the experts from the field of psychiatry, psychiatric social
work, psychologists, and psychiatry nursing for its
relevance and appropriateness. Content validity index for
Hindi translated tool was calculated with a score of
0.80 and 0.84 for PCL-5 and ZSRDS, respectively. The
translated tools were pretested and assessed for
reliability using the split-half method. Tools have
presented excellent psychometric properties with
impressive validity and reliability scores. PCL-5
represented a reliability score of 0.75, whereas ZSRDS
showed a score of 0.70.

Data analysis
Data were analyzed using Statistical Package for
Social Sciences (SPSS 23.0) developed by International
Businesses Machines Corporation (IBM), New York, USA.
Sociodemographic, accident, and clinical characteristics were
assessed using frequency distributions. PTSD and
depression scores of the study population were
nonnormally distributed, indicating a skewed
distribution. Thus, nonparametric tests (Mann–

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 Arora, et al.: Prevalence and determinants of PTSD and depression among survivors of motor vehicle
determine the association between PTSD, depression the accident (P = 0.001), and perceived death threat
scores, and sociodemographic characteristics. An from the accident (P = 0.05) were found to be
adjusted odds ratio (OR) was calculated with a 95% significantly associated with PTSD. Similarly, the
confidence interval (CI) to determine the level of participants’ use of the substance and perceived death
significance at P < 0.05. threat contributed to the prevalence of depression
[Tables 1 and 2].
RESULTS

Data were collected from a total of 250 study

participants visiting the various departments of the
tertiary care center. Almost half (42.4%) of the study
population comprised those in the age range of 31–45
years. There was a clear preponderance (77.2%) of
males among the study population. Most of them were
married (78.8%) and belonged to upper lower
socioeconomic status (58.4%). Accident characteristics,
clinical characteristics, and their association with PTSD
and depression severity scores are depicted in Tables 1
and 2.

Prevalence of posttraumatic stress disorder and

depression among survivors of motor vehicle
accidents PTSD was found to be prevalent among 32.4% of
the survivors of a MVA, and depression was found to be
prevalent among 20.8% of them; 14.4% were mildly
depressive, and 6.4% were moderately depressive after
the trauma.

Correlation between the prevalence of

posttraumatic stress disorder and depression
A strong positive correlation was found between PTSD
and depression score (r = 0.80; P = 0.00) [Table 3].

Association between posttraumatic stress

disorder, depression, and sociodemographic
characteristics Sociodemographic, accident, and
clinical profile with posttraumatic stress disorder
and depression
Among sociodemographic characteristics,
participants aged >45 years (P = 0.002) and who
were just literate (P = 0.001) were found to be
significantly associated with PTSD, whereas depression
was more common among participants who lived in
urban areas (P = 0.01). Considering the accident
profile, those who drove the vehicle at a faster speed
(P = 0.001), witnessed death (P = 0.03), and lost
valuables (P = 0.02) were associated with PTSD. A
different trend was observed with depression and its
variables, where pillion rider and whose vehicle
collided with stationary objects were associated with
depression.

Moreover, clinical profile illustrated that participants

who sustained fracture posttrauma (P = 0.05), used
substance while driving (P = 0.001), blamed self for

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 Arora, et al.: Prevalence and determinants of PTSD and depression among survivors of motor vehicle

Table 1: Association between accident profile and severity of scores of posttraumatic stress disorder and depression
Characteristics Frequency (%) PTSD severity score (PCL-5) Depression severity score (ZSRDS)
Median IQR P Median IQR P
Accident group
Vehicle driver 141 (56.4) 20.00 23 0.50 26.00 26 0.04*
Pillion rider 69 (27.6) 20.00 21 20.00 16
Passenger 25 (10) 20.00 26 23.00 23
Pedestrian 15 (6) 20.00 17 28.00 17
Nature of accident
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Collided with another vehicle 149 (59.6) 20.00 27 0.19 20.00 23 0.001*
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Collided with a stationary object 42 (16.8) 20.00 18 20.00 14

Collided with a pedestrian 25 (10) 20.00 17 36.00 17
Fallen from height 25 (10) 32.00 26 36.00 22
Others 9 (4.2) 41.00 22 52.00 20
Number of vehicles involved
1 72 (28.8) 20.00 13 0.35 20.00 18 0.56
2 174 (69.6) 44.00 17 23.00 24
3 2 (0.8) 22.00 0 20.00 0
≥4 2 (0.8) 20.00 0 20.00 0
Type of vehicle involved
Two-wheeler 192 (76.8) 20.00 12 0.45 20.00 21 0.24
Three-wheeler 11 (4.4) 23.00 10 24.00 11
Four-wheeler 16 (6.4) 20.00 5 20.00 17
More than four-wheeler 31 (12.4) 20.00 26 20.00 30
Speed of the vehicle (km/h)
≤30 57 (22.9) 23.00 9 0.59 23.00 19 0.59
31-59 136 (54.4) 20.00 20 20.00 22
≥60 57 (22.8) 23.00 25 23.00 25
Use of seat belt/helmet by driver and pillion rider†
Yes 101 (40.4) 20.00 11 0.48 20.00 16 0.48
No 109 (43.6) 28.00 31 28.00 29
Witnessed death
Yes 23 (9.2) 48.00 24 0.55 48.00 32 0.55
No 227 (90.8) 20.00 12 20.00 18
Loss of valuables
Yes 43 (17.2) 44.00 24 0.94 26.68 35 0.94
No 207 (82.8) 20.00 17 26.39 17
Current litigation/compensation
Yes 17 (6.8) 48.00 30 0.14 48.00 35 0.14
No 233 (93.2) 20.00 18 20.00 20
*P value significant at≤0.05; †Total number of participants is 210. IQR Interquartile range; ZSRDS Zung Self-Rating Depression Scale; PCL-5 Posttraumatic Stress
Disorder Checklist; PTSD Posttraumatic stress disorder

Binary logistic regression analysis of study variables

To explore how individual factors influence the prevalence
of PTSD and depression, while controlling for the
effects of other factors, binary logistic regression
analysis was performed. Loss of valuables (OR = 2.62; 95%
CI = 0.78–9.04), witnessing death (OR = 5.52; 95% CI =
0.92–3.06), and death threat (OR = 8.23; 95% CI =
4.93–48.40) were the significant predictors of PTSD
[Table 3]. In context of depression [Table 4], accident
group (OR = 0.48; 95% CI = 0.24–0.95), nature of
accident (OR = 1.45; 95% CI = 1.09–1.92), self-blame
(OR = 6.06; 95% CI = 1.15–31.91),
and death threat (OR = 9.98; 95% CI = 5.89–46.85)
were found to be the significant predictors of level of
depression [Tables 4 and 5].
DISCUSSION
With the increased incidence of MVAs and advanced
trauma services focusing on precise management of
Indian Journal of Psychiatry Volume 63, Issue 3, May-June
physical aspects, often psychological consequences
remain untouched. These psychological traumas emerge
out later with possibly even worse prognosis.
Findings related to the prevalence of posttraumatic
stress disorder
PTSD is a common psychological disorder among MVA
victims. The present study reported a high prevalence
of PTSD (32.4%) among survivors of MVA visiting
various departments of the tertiary care center. The
possible reason for it could be inapt psychological care,
lack of awareness about the importance of psychological
health, and severity of the trauma. Prevalence of PTSD
was consistent with the study conducted in Israel[18] (32%)
and Iran[19] (30.49%).
However, the prevalence was lower compared to previous
studies conducted in southern Nigeria, [10] 41.3%; Ethiopia,[20]
46.5%; and Portugal,[21] 58.9%. This difference could be
attributed, partially, to the exclusion of survivors with
2
 Arora, et al.: Prevalence and determinants of PTSD and depression among survivors of motor vehicle

Table 2: Association between clinical profile and severity of scores of posttraumatic stress disorder and
depression
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Characteristics Frequency (%) PTSD severity score (PCL-5) Depression severity score (ZSRDS)
Median IQR P Median IQR P
Nature of injury
Bruise 15 (6) 20.00 0 0.05* 20.00 0 0.18
Laceration 7 (2.8) 20.00 18 21.00 19
Fracture 175 (70) 21.00 27 25.00 25
Soft-tissue injury 50 (20) 21.00 18 27.00 27
Polytrauma 3 (1.2) 38.00 0 20.00 0
Substance use by the driver
Yes 29 (11.6) 50.00 41 0.001* 35.00 31 0.001*
No 112 (44.8) 20.00 11 23.00 22
Type of treatment
Medical 86 (34.4) 34.61 7 0.26 20.00 7 0.16
Surgical 10 (4) 50.30 26 45.00 12
Both medical and surgical 123 (49.2) 49.00 35 31.00 26
Others 31 (12.4) 39.80 24 25.00 21
Ability to recall the accident
Clear 181 (72.4) 20.00 9 0.40 20.00 11 0.62
Patchy 56 (22.4) 38.00 32 38.00 32
None 13 (5.2) 41.00 41 51.00 25
Blames self for accident
Yes 17 (6.8) 67.83 35 0.001* 26.00 31 0.02*
Partly 29 (11.6) 43.50 5 45.00 32
No 204 (81.6) 36.39 6 20.00 17
Death threat from the accident
Yes 76 (30.4) 41.54 18 0.05* 50.00 21 0.13
No 174 (69.6) 37.55 2 20.00 8
History of accident
Yes 14 (5.6) 26.00 30 0.54 33.00 28 0.72
No 236 (94.4) 20.00 21 20.00 22
Past history of disability
Yes 7 (2.8) 27.00 27 0.26 20.00 8 0.61
No 243 (97.2) 20.00 20 23.00 24
*P value significant at≤0.05. IQR Interquartile range; ZSRDS Zung Self-Rating Depression Scale; PTSD Posttraumatic stress disorder; PCL-5 Posttraumatic Stress
Disorder Checklist

than studies conducted in Ethiopia,[17] 22.8%;

Table 3: Correlation between the prevalence of
southeastern Nigeria,[22] 26.7%; Australia,[23] 19.3%; southern
posttraumatic stress disorder and depression
Ethiopia,[24] 15.4%; and Zurich,[25] 4.7%. This varied
Variables r P
prevalence of PTSD could be explained by different
PTSD 0.80* 0.001 time points of PTSD assessment, different sample sizes,
Depression
*r Pearson’s correlation significant at the 0.01 level (two-tailed). PTSD
and cultural and socioeconomic status among the study
Posttraumatic stress disorder population. A systematic review also confirmed the
diverse prevalence extending from 6% to 45%, with
significant medical or surgical comorbidity in our probable cultural and socioeconomic factors
study. Patients with severe injuries tend to negatively influencing the PTSD following
appraise the situation, which could have increased the
prevalence of PTSD.

Prevalence of PTSD in the present study was lower

2 Indian Journal of Psychiatry Volume 63, Issue 3, May-June
 Arora, et al.: Prevalence and determinants of PTSD and depression among survivors of motor vehicle
traumatic events.[26] Data from the National Survey of
Adolescents-Replication reported a 7.4% prevalence
of PTSD.[13] Furthermore, a PRISMA-compliant meta-
analysis identified the pooled prevalence of PTSD to be
22.25%.[6]

Twenty percent of the participants developed PTSD

following a motor vehicle crash in a study from India.
[27]
A high prevalence of psychiatric morbidity noted
among the Indian population could be due to a lack of
treatment and unavailability of mental health
services. This can be worsened by logistical issues
such as delay in reaching the health centers and
topographical issues in hilly areas of India.[3] Hence,
for the management of PTSD in the Indian
population; development of coordinated triage,
implementation of a screening the MVA survivors for
PTSD and Depression in the emergency department and
providing psychological counseling has been
proposed.[28]

Findings related to the prevalence of depression

Several psychological disorders are prevalent globally,
out of which lifetime prevalence of depressive disorders
was found to be 5.25%.[29] One study showed an alarming
prevalence of depression by up to 63% among MVA
survivors.[10] The

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 Arora, et al.: Prevalence and determinants of PTSD and depression among survivors of motor vehicle

depression has been found by Rebecca et al. (2018)[23]

Table 4: Binary logistic regression of sociodemographic
at 53.2%. A high prevalence of depression could be due
variables with level of posttraumatic stress disorder
to the use of self-report screening instruments, which
Sociodemographic variables P Exp(B) 95% CI for Exp(B)
(lower-upper) tend to overestimate the psychological problems
Education
compared to clinical interviews conducted by trained
Below higher secondary 0.85 1.04 0.66-1.63 mental health professionals. Among various mood
Higher secondary and above disorders occurring in the aftermath of trauma,
Speed of the vehicle (km/h) depression emerged out to be the commonest,
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≤40 0.50 0.75 0.32-1.74 highlighting the importance of early recognition and
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>40
Loss of valuables
treatment.
Yes 0.01* 2.62 0.78-9.04 higher magnitude of
No
Nature of injury
Fracture 0.71 1.15 0.52-2.58
Others†
Witnessed death
Yes 0.05* 5.52 0.92-33.06
No
Use of substance by the driver
Yes 0.25 1.41 0.77-2.55
No
Self-blame
Yes 0.16 1.71 0.80-3.65
No
Threat of death
Yes 0.001* 8.23 4.93-48.40
No

*P value significant at ≤0.05; †Bruise, laceration, soft-tissue injury, and

polytrauma. CI - Confidence interval

Table 5: Binary logistic regression of the

sociodemographic variables with level of depression
Sociodemographic variables P Exp(B) 95% CI for Exp(B)
(lower-upper)
Habitat
Rural 0.193 0.62 0.31-1.26
Urban
Accident group
Vehicle driver/pedestrian 0.03* 0.48 0.24-0.95
Pillion rider/passenger
Nature of accident
Fracture 0.01* 1.45 1.09-1.92
Others†
Use of substance by the driver
Yes 0.20 0.70 0.41-1.21
No
Witnessed death
Yes 0.10 1.86 0.87-3.99
No
Self-blame
Yes 0.03* 6.06 1.15-31.91
No
Threat of death
Yes 0.001* 9.98 5.89-46.85
No
*P value significant at ≤0.05; †Bruise, laceration, soft-tissue injury, and
polytrauma. CI - Confidence interval

current study reports a prevalence of 20.8% for

depression: mild depression (14.4%) and moderate
depression (6.4%). This finding is similar to a study
by Hassankiadeh et al. (2017)[19] at 19.89%. A much
2 Indian Journal of Psychiatry Volume 63, Issue 3, May-June
 Arora, et al.: Prevalence and determinants of PTSD and depression among survivors of motor vehicle
Relationship between posttraumatic stress disorder and
depression
In the present study, there is a significantly high
positive correlation between PTSD and depression (r
= 0.80). It has been commonly found that PTSD
increases the risk of developing and further worsening
depressive symptoms.[18] Similarly, while assessing the
psychosocial and mental variables associated with PTSD
in an Iranian study, depression proved to be an
important factor in PTSD.[30] Furthermore, Blanchard et
al. (1995)[11] revealed that PTSD and depression were
prevalent among 39% and 53% of the population,
respectively. People after trauma are perhaps vulnerable
to depression; probable mediators could be an extended
stay in the hospital leading to social distancing,
constant or persistent pain due to injury or surgery,
loss of loved ones involved in MVA, contributing to
survivor guilt, and a lack of financial support.

Association between various sociodemographic factors

with posttraumatic stress disorder and depression
Among the sociodemographic characteristics, age had
a statistically significant association with PTSD;
specifically, participants aged >45 years had more chances
of developing PTSD. However, this finding differs from
previous studies in which younger age had a significant
association with PTSD.[31] A possible reason could be the
preponderance of middle-aged and older population in
the current study. Furthermore, education and habitat
were found to be associated with PTSD (P = 0.00) and
depression (P = 0.01), respectively, but logistic regression
did not confirm these findings. Literature reported that
there is a relationship between the level of education
and PTSD and that the participants with high school
education and who are not yet graduated develop
PTSD more often.[6,26] In contrast, the current study
depicts that participants with a postgraduate and above
degree are more prone to develop PTSD. In terms of
habitat, urban dwellers have more chances of
developing depression.[11]

Although there was no association found between

gender and occurrence of PTSD and depression,
numerous studies have shown a significant
association between both; female had a higher risk of
developing PTSD and depression, possibly due to
different ways of handling a stressor between genders
and females experiencing more fear and helplessness
in comparison to their male counterparts.[6,10,17,21,22,27]
Lack of association with gender

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 Arora, et al.: Prevalence and determinants of PTSD and depression among survivors of motor vehicle

could be due to fewer females involved in the study related injuries. The study advocates for training health
compared to their male counterparts. Considering the professionals in identifying psychological
various accident-related and clinical characteristics, the
present study found that factors such as witnessing death,
loss of valuables, self-blame, and perceived death
threats play a contributory role (2–8 fold higher risk) in
PTSD. On the other hand, survivors who blamed
themselves for MVAs were six times more likely to be
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depressed. The present study findings have well-

BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4

established supportive pieces of evidence by systematic

reviews[19,21,25,32] which display perceived death threat as
a contributory factor in the development of PTSD.

Fekadu et al. (2019)[20] reported that those who

witnessed death were more prone to develop PTSD
similar to the current study finding (OR: 5.52; CI:
0.92–33.06). Seethalakshmi et al. (2006)[27] reported
that pedestrians were more likely to develop
psychiatric complications than drivers which concurs
with our findings. Although previous researchers[19,22,32]
reported a relationship between occupation/work status
with PTSD and depression, no such findings were
observed in the present study. Loss of jobs with
financial difficulties may have led to a negative
appraisal of the situation.[19,22,32]

Limitations
The study is limited due to a smaller sample of groups
with nonprobability sampling techniques, which limits
the generalizability of the findings outside the study
settings. Other physical diseases/illness factors were not
explored in the study, which may affect the
psychopathology of MVA survivors. Recall bias can also
affect the findings of this study.

CONCLUSION

Researchers conclude that there is a high prevalence of

both PTSD and depression among survivors of MVAs;
several factors possibly modulate these disorders and
their persistence. An increasing trend in the number of
accidents will likely add to the burden of these. Among
various factors, perceived death threat, self-blame, and
witnessing the accident had a remarkable association
with these psychological disorders which raises a concern
toward the psychological health of those who met with
an accident, as it may lead to poor health outcomes.
These imply a substantial need for identifying and
managing the psychological effects of MVA trauma.

High prevalence is concerning and raises the need of

promoting multidisciplinary health services in trauma
units as well as at the community level to prevent the
development of long-term mental health disability.
Prompt identification of at-risk individuals by frontline
health workers will ultimately lead to early
interventions, facilitating quick recovery from MVA-

2 Indian Journal of Psychiatry Volume 63, Issue 3, May-June

 Arora, et al.: Prevalence and determinants of PTSD and depression among survivors of motor vehicle
issues, providing counseling services and management of follow-up study. Am J Psychiatry 1999;156:367-73.

crisis across health settings especially in trauma units.

Acknowledgment
The authors would like to thank the patients for their
participation in the study. The author would also like
to thank AIIMS, Rishikesh, for granting permission to
conduct the research.

Financial support and sponsorship

Nil.

Conflicts of interest
There are no conflicts of interest.

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