Resumen:

En México los accidentes son un grave problema de salud pública. Estos eventos de tipo traumático tienen una probabilidad potencial de ocurrir de forma fortuita en cualquier momento de la vida de los individuos. Actualmente ocupan la tercera causa de mortalidad general y la primera en adultos jóvenes. Los accidentes producidos por vehículos de motor ocupan el primer puesto dentro del rango de los accidentes en general, esto de acuerdo a las tasas de mortalidad en adultos jóvenes que publican la OMS, la OPS y la SSA en México.

Una de las consecuencias de los accidentes de tránsito por vehículo de motor es la secuela psicológica que dejan en los individuos en edad productiva. Estas secuelas se conocen como Trastorno por Estrés Postraumático (TEPT) y a pesar de que en nuestro país existen cifras alarmantes de ausentismo laboral y baja en la productividad como consecuencia de ello, no ha sido estudiado a profundidad.

El Estrés Postraumático es un trastorno de ansiedad causante de disfunción psicosocial y aparece en condiciones de exposición a un estresor traumático. La etiología del TEPT es multifactorial y en ella intervienen factores genéticos, psicológicos, educativos y ambientales.

El propósito del presente estudio fue determinar la frecuencia del TEPT en pacientes que hubiesen tenido lesiones físicas por accidentes de tránsito (accidentes automovilísticos producidos por vehículos de motor) y que fueron atendidos en el Servicio de Ortopedia y Trauma, del Hospital Regional "Lic. Adolfo López Mateos" del ISSSTE. Para ello se diseño un estudio transversal descriptivo con muestreo no probabilístico seleccionando una muestra mediante los criterios de inclusión siguientes: ser mayor de 18 años, haber sufrido accidente por vehículo de motor, haber sido atendido al menos por un mes en el Servicio de Trauma y Ortopedia de ese centro hospitalario, y encontrarse en condiciones físicas y mentales para contestar un cuestionario. El instrumento fue un formato autoaplicable conformado por la Escala de Mississippi para el TEPT para tamizaje, selección de casos y medición de la severidad de los síntomas. También se incluyó la Cédula de Evaluación Clínica en Neuropsiquiatría de la OMS (Schedules for Clinical Assessment in Neuropsychiatry-SCAN), un instrumento que establece el perfil de afecto (PANAS), y por último una cédula de identificación para datos sociodemográficos.

En el estudio participaron 37 sujetos que cumplieron con los criterios de inclusión. De éstos, 57% fueron hombres y 43% mujeres, con un promedio de edad de 35 años (DE=12.44); 40.5% eran solteros, 51.4% casados; 43.2% de los sujetos tenía nivel de educación básica y 56.8% media superior y superior. Para la calificación de TEPT, se determinó como casos a los sujetos que puntuaron por arriba de 5 en la Escala de Mississippi y posteriormente eran confirmados con la cédula SCAN. La mayoría de los sujetos que sufrieron accidentes fueron hombres (57%), los eventos ocurrieron en día sábado, cuando éstos se dirigían a su casa, en su automóvil y sin compañía. La mayoría de los sujetos estuvieron involucrados en choques vehiculares. De todos los casos, 62.2% cumplieron con los criterios para ser corroborados con TEPT, lo cual representa un porcentaje mayor al reportado en población mexicana. Se encontraron diferencias estadísticamente significativas en la proporción de sujetos que reportaron TEPT y el tipo de vehículo en que se encontraban al ocurrir el accidente (X²=9.868, p=.007), así como en el tiempo que había trascurrido desde el momento del mismo (X²=8.651, p=.013). De las pruebas de asociación con el perfil de afecto, el afecto negativo durante la última semana anterior al estudio tuvo una correlación positiva y significativa con el TEPT, es decir que a mayor afecto negativo hay más síntomas de estrés.

Palabras clave: Accidentes de tránsito; trastorno por estrés postraumático; pacientes

Summary:

We have carried out this research because accidents are a serious public health problem in Mexico. They are the third overall mortality cause and the first among young adults. In addition, in our country, the study of posttraumatic stress disorder (PTSD) has not been focused sufficiently on accidents, not to speak of motor vehicles accidents.

Among the different types of accidents, traffic accidents are placed at the top of the list. Aside from causing injuries and the loss of man hours at work, these accidents bring about emotional distress to affected individuals.

Stress is a factor that triggers short-and medium-term consequences which are in turn reflected in the quality of life of the patient and his/her family.

PTSD is an anxiety disorder that causes psychosocial disfunctioning and appears due to the exposure to a stressor or traumatic event. It may come about in two ways: when the subject is a victim of a serious threat to his/her life or integrity and when the subject witnesses an event seriously affecting a third party.

The main stressors may be natural phenomena, such as hurricanes and earthquakes, intentional attacks, such as rape or any form of criminal violence, and, as is the case here, from traumatic events caused by motor vehicles.

The etiology of PTSD is multi-factorial and involves genetic, psychological, educational, and environmental aspects. It has three forms: severe, where the disorder appears immediately after the occurrence of the event or until a month later; chronic, lasting between one and three months; and delayed, where symptoms appear six months after the event.

Our objective was to establish PTSD frequency in patients with physical injuries caused by motor vehicles accidents who were attended at the Regional Orthopaedics and Trauma Hospital "Adolfo López Mateos". Together with the application of the scales, we were interested in making a description of the socio-demographical side of accidents, comparing the affect profile, and somehow defining the wide range of factors involved in the occurrence of this problem.

For this, we devised a transversal and descriptive study with a non-probabilistic sampling. The sample was chosen using the following inclusion criteria:

a) Being older than 18 years.

b) Having suffered a motor vehicle accident.

c) Having received attention for a month at least at the Orthopaedics and Trauma Hospital "Adolfo López Mateos".

d) Having the physical and mental conditions to answer a self-report questionnaire or at least to be interviewed instead.

The instrument used was a self-report questionnaire consisting of different scales: 1. The Mississippi PTSD Scale for screening, case selection and symptoms severity measurement. This scale has been translated and validated in Mexico. 2. The WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN). 3. An instrument to establish the affect profile (PANAS). 4. A socio-demographical data identification schedule.

Results from this study show some interesting characteristics from subjects involved in traffic accidents such as the fact that victims are mostly men driving alone at weekends. As has been pointed out, this supports the importance of putting into practice actions to educate drivers involved in such circumstances more often. In addition, policies which allow for the modification of traffic environments as to their adequateness to social contexts should be established.

Likewise, data from this work agree with those from other studies as to the existence of an association between the presence of PTSD and the involvement in car accidents.

Although the prevalence of the sample of this study is much higher than previous Mexican reports, it shows some interesting figures regarding the fact that most subjects who reported PTSD were women who had an elementary education level and a partner by the time of the accident. Falls from vehicles, people run over by cars and individuals driving alone at the time of accidents were other relevant high-impact findings.

While it is true, on the one hand, that the aforementioned results are non-significant, they do give an idea of some aspects which would be useful to bear in mind in providing clinical attention to affected individuals. On the other hand, aspects which did have a statistical significance on the data from this sample should be taken into account. One of these was the fact that the higher rate of PTSD was reported in individuals who suffered an accident while being inside a vehicle, in individuals involved in an accident which had occurred between one and three months before and who in addition tended to present a negative affect profile. These are important findings because they give us the opportunity to consider more specific aspects at the time of developing attention strategies which could alleviate the temporal impact and scale of the problem.

Key words: Road traffic accidents; post-traumatic stress disorder; patients