Els van Meijel

59 Results of a 2–4-year follow-up study | Chapter 4 Introduction Accidents such as traffic accidents, sports accidents and falls are a major cause of pediatric unintentional injury (Brosbe et al., 2011; Kassam-Adams et al., 2013; van Meijel et al., 2015). Besides physical injuries, children can suffer from posttraumatic stress symptoms following accidents. The majority of the children recover within a few weeks, but if the symptoms persist for more than 1 month and cause significant impairment in one or more areas of functioning, posttraumatic stress disorder (PTSD) can be diagnosed. PTSD is a debilitating psychiatric disorder. If left untreated, PTSD negatively affects children’s functioning and physical recovery from injury (Kahana et al., 2006; Kassam-Adams et al., 2013). Evidence-based psychological treatments for PTSD are available and have proven to be effective in children with multiple types of trauma (Cohen et al., 2010; Morina, Koerssen, & Pollet, 2016; Smith et al., 2018). However, it is likely that PTSD in many children and adolescents remains undiagnosed and that not everyone with a PTSD diagnosis receives adequate trauma-focused therapy (Mehta & Ameratunga, 2012; NICE, 2005; Smith et al., 2018). Without treatment, symptoms can be prolonged or worsen significantly over time. Moreover, they are often associated with other severe, long-term effects such as psychosocial problems and learning difficulties (NICE, 2005). Although the long-term impact of traumatic events can be substantial, research on the long-term psychological consequences of accidental injury is scarce. Regarding long-term prevalence of posttraumatic stress reactions, we found only one recent study that assessed posttraumatic stress reactions following accidents beyond two years (Arnberg, Rydelius, & Lundin, 2011). This study examined seven survivors of a bus crash—all 12 year-old schoolchildren—with multiple injuries. This group still reported posttraumatic stress symptoms, such as sadness, feelings of guilt, intrusions and avoidance, 20 years after the accident. They reported significantly more symptoms than a group of 33 indirectly affected persons. The findings of this study suggest that traumatic accidents are associated with long-term posttraumatic stress reactions, but the limitations of the small sample and lack of representativeness on age preclude further conclusions. Other studies had a follow-up period of 2 years or less after an accident (Alisic et al., 2014; Brosbe et al., 2011; Gillies et al., 2003; Hiller et al., 2016; Olofsson et al., 2009).