The impact of psychological distress on recovery from injuries sustained in a traffic crash. (The IMPRINT Study).

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Rationale: The biological mechanisms leading to psychological disorders and morbidity after MVC remain unclear. There is now solid evidence that aberrant heartbeats are a sign of poor adaptability to stressful events, and this relates to an unbalanced state of the autonomic nervous system (ANS). However, the significance of heart activity to identify who is more likely to develop a psychological distress and to fail to recover from traumatic injury is not yet well understood. The proposed study will address this important gap in research by using heart activity as a promising biomarker in early recognition of psychological sequelae and stress-related morbidity after a MVC. The use of a biopsychosocial model will shed light on possible links to autonomic responses and risks factors identified in the literature as key contributors to recovery following a MVC. Aims: (1) To determine whether heart activity predicts vulnerability to psychopathological conditions (e.g. depression, PTSD, etc) and associated morbidity (eg pain, fatigue, etc) following a MVC. (2) To compare psychophysiological status and morbidity to a group of non-MVC controls. (3) To determine the strength of relationship between ANS activation (heart activity) and key risk factors implicated in recovery after MVC, with an emphasis on emotional and cognitive responses to the crash. Method: The study will utilise a prospective, case-control cohort design. Participants will be adults, who have experienced a minor to moderate injury after a MVC and subsequently admitted to an ED of major hospitals in NSW. Proposed recruitment is approximately 70 to 100 MVC survivors. Comparisons to a healthy control group (who have not experienced a MVC in the past 5 years), age-sex matched to MVC survivors, will also occur. The design will involve longitudinal assessment, with follow-up measures at 3, 6 and 12 months post-injury, after the baseline (within 6 weeks of the MVC). MVC survivors and controls will be similarly assessed. (a) Autonomic assessment: The assessment of ANS will consist of collection of early post-crash vital signs (at the scene and Emergency Department admission), as well as prospective ECG-based HRV recordings, performed at baseline and 3 months post-injury. (b) Biopsychosocial assessment: The autonomic response to the MVC will be investigated over time in relation to personal and environmental factors, known as influencing health outcome and recovery after an injury. This data, together with health and social outcomes, will be collected using online interviewing assessment at baseline, 3, 6 and 12 months post-injury. Significance: Key outcomes are psychological distress, stress-related physical conditions and recovery indicators over a 12 month period after a MVC. Findings will clarify whether biomarkers of psychological distress exist and can aid in identifying the most vulnerable people, avoiding delay in recovery and return to work, decreasing costs, and preventing chronicity.