Long-term outcome of trauma in children: the psychological consequences of a bus accident.

The psychological consequences of trauma on 28 Swedish children were examined 1 year and 3 years after a bus accident in western Norway in 1988. Symptoms were assessed by the Impact of Event Scale (IES), semi-structured interviews, and a questionnaire developed for this study. At the 1-year follow-up, large proportions of the sample had symptoms of Intrusion and Avoidance (IES) and symptoms of general psychological distress, but no clinically significant symptoms were observed at the 3-year follow-up. Girls and children who experienced loss in the accident were characterised by high levels of Intrusion, whereas passenger trauma and age were unrelated to the outcome. A bidirectional relationship was observed between the mothers' and the children's symptoms over time, whereas the fathers' symptoms were unrelated to the children's symptoms. The clinical implications of the study are that symptoms in all children of traumatised families deserve attention during the first year post-trauma, and that objective risk indicators (age, sex, and types of trauma) do not provide sufficient information to identify children at risk.