The effect of major railway accidents on the psychological health of train drivers--I. Acute psychological responses to accident.

The acute psychological reactions of 101 train drivers to on-the-track accidents were studied by means of clinical interviews and questionnaires (Impact of Event Scale, GHQ-20 and a questionnaire addressing stress symptoms, pre-accident expectancies and worries). More than half of the train drivers reported moderate to high intrusive distress (mean 11.3) within hours to days after the accident but only 1/3 reported symptoms of acute psychophysiological arousal. Intrusive symptoms related to visual impressions were most frequently reported. Avoidance was less prevalent (mean 8.8). Clinical interviews, relationship between pre-accident worries and severity of the acute responses and positive correlation between GHQ-scores relating to the fortnight preceding the accident and IES-intrusion scores, suggest that premorbid variables may influence the stress response. Involvement in more than two previous accidents invoked a feeling of vulnerability and produced stronger acute responses. Post-accident experiences involving various personal contacts did not correlate with the stress responses in this study and only a few drivers experienced such events in a negative way. Denial of the possibility of being involved in accidents was not associated with increased risk of strong acute responses, indicating that denial does not predict poor outcome in healthy persons exposed to situations where possibility of avoiding the event is outside the control of the person.

The effect of major railway accidents on the psychological health of train drivers--II. A longitudinal study of the one-year outcome after the accident.

The psychological impact on 101 train drivers of accidents causing major injuries or death to persons was studied by means of clinical interviews and questionnaires (Impact of Event Scale, General Health Questionnaire and a questionnaire addressing stress symptoms plus past and pre accident expectancies of being involved in accidents). The drivers were examined within hours to a few days after the accident and later at 1 month and 1 year. One month after the accident the symptoms of distress were significantly reduced and most so among the drivers with no preaccident risk experience according to self reports during the acute phase. A minor further reduction of distress was found at 1 year. Drivers with two or more previous accident experiences and those who had worried about being involved in accidents showed highest symptoms of distress at follow-up. Eleven out of 101 drivers reported sick leave more of than 1 week after the accident and this was related to higher intrusion scores. The few drivers who report longterm psychological distress are best predicted by a combination of acute high IES scores, experience of previous accidents and risk expectancy prior to the current accident. The study suggests that premorbid and non-accident related variables are more important for the 1 year psychological outcome of healthy drivers after on-the-track accidents than the stress event itself.