Journal Mobile Options
Table of Contents
Vol. 77, No. 2, 2008
Issue release date: January 2008
Psychother Psychosom 2008;77:111–118

Posttraumatic Stress Disorder following Accidental Injury: Rule or Exception in Switzerland?

Schnyder U. · Wittmann L. · Friedrich-Perez J. · Hepp U. · Moergeli H.
Department of Psychiatry, University Hospital, Zurich, Switzerland

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Background: There is still marked variability in the findings concerning psychiatric disorders associated with traumatic injury. The aim of this study was to determine the incidence of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) following accidental injuries, and to predict the PTSD symptom level at 6 months, taking into particular consideration the role of pre-existing psychiatric morbidity and insufficient command of the local language. Method: A total of 255 accident survivors who were hospitalized for at least 2 consecutive nights at a Swiss university hospital for treatment of recently acquired physical injuries were interviewed within 2 weeks of the trauma and 6 months after the accident. Patients who did not have a good command of German but were fluent in Italian, Spanish, Portuguese, Serbo-Croatian or Albanian were assessed using interpreters. The main outcome measure was the Clinician-Administered PTSD Scale. Results: Ten patients (3.9%) were diagnosed as having ASD. At 6 months, 8 patients (3.1%) had PTSD. A regression model using 12 potential predictor variables explained 40% of the variance of PTSD symptoms; mild traumatic brain injury (p < 0.001), pain (p < 0.05), ASD symptom level (p < 0.001) and emotional coping (p = 0.001) predicted higher PTSD symptom levels, while high Sense of Coherence (p < 0.05) and perceived responsibility for the accident (p < 0.01) were associated with lower PTSD symptom levels at follow-up. Conclusions: ASD and PTSD seem to occur less frequently following accidental injuries than previously reported in the literature. Pre-existing psychiatric morbidity and lack of proficiency in the locally spoken language do not appear to play an important role in the development of PTSD.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Breslau N, Davis GC, Andreski B, Peterson E: Traumatic events and posttraumatic stress disorder in an urban population of young adults. Arch Gen Psychiatry 1991;48:216–222.
  2. Breslau N, Kessler RC, Chilcoat HD, Schultz LR, Davis GC, Andreski P: Trauma and posttraumatic stress disorder in the community – The 1996 Detroit Area Survey of Trauma. Arch Gen Psychiatry 1998;55:626–632.
  3. Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB: Posttraumatic stress disorder in the national comorbidity study. Arch Gen Psychiatry 1995;52:1048–1060.
  4. Creamer M, Burgess P, McFarlane AC: Post-traumatic stress disorder: findings from the Australian National Survey of Mental Health and Well-Being. Psychol Med 2001;31:1237–1247.
  5. O’Donnell ML, Creamer M, Bryant RA, Schnyder U, Shalev A: Posttraumatic disorders following injury: an empirical and methodological review. Clin Psychol Rev 2003;23:587–603.
  6. Creamer M, Manning C: Acute stress disorder following an industrial accident. Aust Psychol 1998;33:125–129.

    External Resources

  7. Harvey AG, Bryant RA: Predictors of acute stress following motor vehicle accidents. J Trauma Stress 1999;12:519–525.
  8. Blanchard EB, Hickling EJ, Taylor AE, Loos WR: Psychiatric morbidity associated with motor vehicle accidents. J Nervo Ment Dis 1995;183:495–504.
  9. O’Donnell ML, Creamer M, Pattison P: Posttraumatic stress disorder and depression following trauma: understanding comorbidity. Am J Psychiatry 2004;161:1390–1396.
  10. Koren D, Arnon I, Klein E: Acute stress response and posttraumatic stress disorder in traffic accident victims: a one-year prospective, follow-up study. Am J Psychiatry 1999;156:367–373.
  11. Ursano RJ, Fullerton CS, Epstein RS, Crowley B, Kao TC, Vance K, Craig KJ, Dougall AL, Baum A: Acute and chronic posttraumatic stress disorder in motor vehicle accident victims. Am J Psychiatry 1999;156:589–595.
  12. Schnyder U, Moergeli H, Klaghofer R, Buddeberg C: Incidence and prediction of posttraumatic stress disorder symptoms in severely injured accident victims. Am J Psychiatry 2001;158:594–599.
  13. Brewin CR, Andrews B, Valentine JD: Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol 2000;68:748–766.
  14. Ozer EJ, Best SR, Lipsey TL, Weiss DS: Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychol Bull 2003;129:52–73.
  15. Baker SP, O’Neill B, Haddon W: The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974;14:187–196.
  16. Teasdale G, Jennett B: Assessment of coma and impaired consciousness: a practical scale. Lancet 1974;2:81–84.
  17. Scott J, Huskisson EC: Graphic representation of pain. Pain 1974;2:175–184.

    External Resources

  18. Spitzer RL, Williams JBW, Kroenke K, Linzer M, Verloin deGruy III F, Hahn SR, Brody D, Johnson JG: Utility of a new procedure for diagnosing mental disorders in primary care – the PRIME-MD 1000 study. J Am Med Assoc 1994;272:1749–1756.
  19. Marmar CR, Weiss DS, Metzler TJ: The Peritraumatic Dissociative Experiences Questionnaire; in Wilson JP, Keane TM (eds): Assessing Psychological Trauma and PTSD. New York, Guilford Press, 1997, pp 412–428.
  20. Schnyder U, Moergeli H: German version of Clinician-Administered PTSD Scale. J Trauma Stress 2002;15:487–492.
  21. Blake DD, Weathers FW, Nagy LM, Kaloupek DG, Charney DS, Keane TM: Clinician-Administered PTSD Scale for DSM-IV, Revised July 98. Boston, National Center for Posttraumatic Stress Disorder, 1998.
  22. Fuglsang AK, Moergeli H, Hepp-Beg S, Schnyder U: Who develops acute stress disorder after accidental injuries? Psychother Psychosom 2002;71:214–222.
  23. Antonovsky A: Unraveling the Mystery of Health. How People Manage Stress and Stay Well. San Francisco, Jossey Bass, 1987.
  24. Endler NS, Parker JDA: Coping with Health Injuries and Problems (CHIP) – Manual. Toronto, Multi-Health Systems Inc., 2000.
  25. Tabachnick BG, Fidell LS: Using Multivariate Statistics, ed 3. New York, Harper Collins, 1996.
  26. Bryant RA, Harvey AG: Relationship between acute stress disorder and posttraumatic stress disorder following mild traumatic brain injury. Am J Psychiatry 1998;155:625–629.
  27. Maier T: Post-traumatic stress disorder revisited: deconstructing the A-criterion. Med Hypotheses 2006;66:103–106.
  28. Delahanty DL, Herberman HB, Craig KJ, Hayward MC, Fullerton CS, Ursano RJ, Baum A: Acute and chronic distress and posttraumatic stress disorder as a function of responsibility for serious motor vehicle accidents. J Consult Clin Psychology 1997;65:560–567.
  29. Moore AD, Bombardier CH, Brown PB, Patterson DR: Coping and emotional attributions following spinal cord injury. Int J Rehabil Res 1994;17:39–48.
  30. Hepp U, Moergeli H, Buchi S, Wittmann L, Schnyder U: Coping with serious accidental injury: a one-year follow-up study. Psychother Psychosom 2005;74:379–386.
  31. Hepp U, Gamma A, Milos G, Eich D, Ajdacic-Gross V, Roessler W, Angst J, Schnyder U: Prevalence of exposure to potentially traumatic events and PTSD: the Zurich Cohort Study. Eur Arch Psychiatry Clin Neurosci 2006;256:151–158.
  32. Sommer I, Ehlert U: Adjustment to trauma exposure: prevalence and predictors of posttraumatic stress disorder symptoms in mountain guides. J Psychosom Res 2004;57:329–335.
  33. Perkonigg A, Kessler RC, Storz S, Wittchen H-U: Traumatic events and post-traumatic stress disorder in the community: prevalence, risk factors and comorbidity. Acta Psychiatr Scand 2000;101:46–59.
  34. Schnyder U, Büchi S, Mörgeli HP, Sensky T, Klaghofer R: Sense of Coherence – a mediator between disability and handicap? Psychother Psychosom 1999;68:102–110.
  35. Schnyder U, Büchi S, Sensky T, Klaghofer R: Antonovsky’s Sense of Coherence: trait or state? Psychother Psychosom 2000;69:296–302.
  36. Antonovsky A: The structure and properties of the sense of coherence scale. Soc Sci Med 1993;36:725–733.
  37. Mayou R, Bryant B, Duthie R: Psychiatric consequences of road traffic accidents. Br Med J 1993;307:647–651.
  38. Harvey AG, Bryant RA: Two-year prospective evaluation of the relationship between acute stress disorder and posttraumatic stress disorder following mild traumatic brain injury. Am J Psychiatry 2000;157:626–628.
  39. Bryant RA, Marosszeky JE, Crooks J, Gurka JA: Posttraumatic stress disorder after severe traumatic brain injury. Am J Psychiatry 2000;157:629–631.
  40. Harvey AG, Bryant RA: Reconstructing trauma memories: a prospective study of ‘amnesic’ trauma survivors. J Trauma Stress 2001;14:277–282.
  41. Fedoroff IC, Taylor S, Asmundson GJG, Koch WJ: Cognitive factors in traumatic stress reactions: predicting PTSD symptoms from anxiety sensitivity and beliefs about harmful events. Behav Cogn Psychother 2000;28:5–15.
  42. Harvey AG, Bryant RA: The relationship between acute stress disorder and posttraumatic stress disorder: a prospective evaluation of motor vehicle accident survivors. J Consult Clin Psychol 1998;66:507–512.
  43. Ursano RJ, Fullerton CS, Epstein RS, Crowley B, Vance K, Kao T-C, Baum A: Peritraumatic dissociation and posttraumatic stress disorder following motor vehicle accidents. Am J Psychiatry 1999;156:1808–1810.
  44. Wittmann L, Moergeli H, Schnyder U: Low predictive power of peritraumatic dissociation for PTSD symptoms in accident survivors. J Trauma Stress 2006;19:639–651.
  45. Hickling EJ, Blanchard EB, Buckley TC, Taylor AE: Effects of attribution of responsibility for motor vehicle accidents on severity of PTSD symptoms, ways of coping, and recovery over six months. J Trauma Stress 1999;12:345–353.
  46. Malt UF: Coping with accidental injury. Psychiatr Med 1992;10:135–147.
  47. Sijbrandij M, Olff M, Reitsma JB, Carlier IVE, Gersons BPR: Emotional or educational debriefing after psychological trauma: randomised controlled trial. Br J Psychiatry 2006;189:150–155.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50