The majority of research and clinical literature on the stressful effects of road traffic accidents concentrate on the effects on one individual ie. the victim/claimant. Litigation and treatment both emphasise this focus. However lawyers and clinicians/medico-legal experts are aware that a serious accident can result in de-stabilising of the relationship which the ‘victim’ has, for example, with their partner/husband/wife.
Previous research (Nicholls and Ayers, 2007) has considered how the experience of another type of trauma – childbirth – impacts not only on the mother concerned but also on the couple’s relationship. Several key themes and subthemes were identified which have been specifically extrapolated to the context of road traffic accidents. These include:-
- a) Accident – specific factors: Physical injuries, acute stress reaction and perceived lack of control.
- Quality of Care received: Information provision, access to GP.
- Relationship Effects: Impact on physical relationship, general communication, negative emotion, receiving and giving support, coping together as a couple.
50 consecutive claimants were interviewed as part of a regular medico legal practice. Couple-related information was extracted and this data forms the basis of the following discussion of ‘couple factors’. The implications of this for considering travel anxiety, phobia and disruption as discussed.
Accident factors most commonly mentioned as affecting the relationship were: presence of spouse in index vehicle, severity of physical injury to claimant, claimants pain coping, claimants acute stress response and partner’s lack of control.
- Presence of spouse:- Experiencing the trauma with a partner results in certain effects, some positive, some negative. Mutual understanding of a shared experience can result in greater empathy and care giving although the level of injury (physical or psychological) can act against this. Conversely, partner absence from the incident can result in lack of understanding or alternatively, greater energy and health for care giving to the claimant.
- Severity of claimant physical coping:- Both the initial prediction of claimant injury and the subsequent medical reality have a stressful effect on the partner. This, coupled with the claimant’s own pain coping style, places considerable responsibility on the partner to support, care for and generally t hold the situation’ together in the immediate (+ subsequent) aftermath of the accident.
- Claimant’s Acute Stress response:- The claimants peri-traumatic or ‘within-vehicle’ emotional response and their subsequent response over the next few days can seriously impact on the partner who inevitably is the main care-giver for non-hospitalised claimants.
- Perceived lack of control:- All the above accident factors result in the partner feeling a lack of control, not only of the accident initially but also of the injuries, both physical and psychological which his/her partner is experiencing and displaying.
Quality of Care received
Factors here were information provision, staff response and accessibility and response of GPs.
- a) Information Provision: Whether at the accident scene or subsequently at hospital, the level and quality of information provided about the claimant and professional actions (emergency services, medical services) are crucial to the partner. Lack of information or, in some cases, ‘It could have been worse’ information can have a significant and adverse effect on the partner and increase their already heightened anxiety.
- b) Staff Responsiveness:- Staff attitudes, competence and communication reinforce or exacerbate the previous area of infortngjion provision to reassure or frustrate a waiting partner. This is added to by factors relating to continuity of care and quality of hospital environment.
- c) Access to and response of GP:- Irrespective of whether the claimant requires post-hospital follow up, or the GP is the first ‘port of call’ for a post-accident consultation, the ease of access for an appointment and the responsiveness of the GP to both the physical and psychological requirements of the claimant have significant effects on the patients well-being also. The ability of the GP to mobilise a partner’s care giving can have a significant and positive effect on both partner and claimant.
Most claimants and their partners mention the effects of accidents on their relationship in terms of effects on their physical relationship, communication within the relationship, negative emotion and conflict, support given/received and general coping as a couple.
- Physical relationship: A claimant who has suffered either physical or psychological injuries, or both, is unlikely to place his/her sexual relationship at the top of their priority list. A partner’s reaction to the claimant’s understandable avoidance of intimacy will vary from sympathetic understanding to confusion to feelings of rejection. Each of these reactions will have differential effects on the claimant’s
- Communication within the relationship: When couples talk about the accident trauma, experience and associated difficulties, this helps create mutual understanding and potential problem solving. Avoidance of talking resulted in confusion and lack of care giving. Lack of partner empathy adversely affected the relationship.
- Negative Emotion and Conflict:- feelings of rejection in either claimant or partner (e.g when partner return to work; lack of intimacy) resulted in negative communication and irritability. The ‘vicious cycle’ of negative emotion and lack of empathy can significantly stress the relationship and slow or impede recovery.
- Coping as a couple:- Given the accident-related demands (coping with injuries, medical care) and everyday demands (childcare, household and work demands), it can be difficult for couples to find the time to talk to or support one another. Positive time together and comments about the relationship are crucial to coping.
Implications of ‘Couple Factors’ on Travel anxiety
Post-accident travel anxiety typically consists of one or more of the following: driver and/or passenger anxiety and avoidance, and reluctance to travel.
The effect on the partner and the response by the partner have a significant effect on the prognosis of the claimant’s anxieties.
- Lack of partner understanding including immediate response of criticism and labelling anxiety as being silly’ or icriticising my driving’ can stop anxiety naturally resolving with practice.
- Partner’s own anxiety can reinforce the claimant’s nervousness and reluctance to travel.
Difficulty either partner have in coping with the normal ‘lack of control’ being a passenger can agitate and frustrate the driver (whether they are the claimant or partner) and result in heightened anxiety and reluctance to travel.
The key implication of this systemic or ‘couple’ approach to road accident stress are that it is essential for couples (both claimant and partner) to have clear and considerate information on the psychological effects of trauma on both parties and, secondly, both partners should be involved in the resolution of claimant travel anxiety.
This paper has explored the perceived impact of a road traffic accident on couples. It is apparent that RTA-related stress affects the couple’s relationship in many ways. The main feelings of loss of control, rejection and helplessness, and conflict and blame within relationships are crucial to subsequent coping. As usual the impact of such stress on couples can vary from relationships strengthening and growth to ‘risk of separation’ One of the factors affecting severity of negative impact on the couple is the level/severity of psychological injury in a) the claimant + b) both claimant and partner (when involved in accident). This impact will be also affected by pre-existing psychological status of either partner, and quality of the marital relationship prior to the accident and the presence of other adverse life stresses.
The implication for lawyers and experts alike is that greater awareness is required of the effect on partners of trauma affecting a claimant both in assessing the social consequences of an accident (relevant to diagnosis and quantum assessment) and increasing the reliability of prognosis by maximising partner involvement.
Ref: Koch HCH + Kevan T (2005) Psycholigal Injury. XPL Press St Albans Nicholls K and Ayers (2007) Childbirth – related PTSD in couples. A qualitative study. Br. J. Health Psychology. 12, 491-509.