Psychological distress following a motor vehicle crash: A systematic review of preventative interventions

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Injury, Int. J. Care Injured xxx (2016) xxx–xxx

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Psychological distress following a motor vehicle crash: A systematic review of preventative interventions Rebecca Guest* , Yvonne Tran, Bamini Gopinath, Ian D. Cameron, Ashley Craig John Walsh Centre for Rehabilitation Research, Kolling Institute for Medical Research, Sydney Medical School-Northern, The University of Sydney, Australia

A R T I C L E I N F O

A B S T R A C T

Article history: Received 2 September 2016 Accepted 5 September 2016

Introduction: Psychological distress following a motor vehicle crash (MVC) is prevalent, especially when the person sustains an associated physical injury. Psychological distress can exhibit as elevated anxiety and depressive mood, as well as presenting as mental disorders such as Post Traumatic Stress Disorder (PTSD) or Major Depressive Disorder (MDD). If unmanaged, psychological distress can contribute to, or exacerbate negative outcomes such as social disengagement (e.g., loss of employment) and poor healthrelated quality of life, as well as contribute to higher costs to insurers. This systematic review summarises current research concerning early psychological intervention strategies aimed at preventing elevated psychological distress occurring following a MVC. Method: A systematic review of psychological preventative intervention studies was performed. Searches of Medline, Embase, PsychINFO, Web of Science and Cochrane Library were used to locate relevant studies published between 1985 and September 2015. Included studies were those investigating MVC survivors who had received an early psychological intervention aimed at preventing psychological distress, and which had employed pre- and post- measures of constructs such as depression, anxiety and disorders such as PTSD. Results: Searches resulted in 2608 records. Only six studies investigated a psychological preventative intervention post-MVC. Interventions such as injury health education, physical activity and health promotion, and therapist-assisted problem solving did not result in significant treatment effects. Another six studies investigated psychological interventions given to MVC survivors who were assessed as subclinically psychologically distressed prior to their randomisation. Efficacy was varied, however three studies employing cognitive behaviour therapy (CBT) found significant reductions in psychological distress compared to wait-list controls. Conclusion: Psychological interventions aimed at preventing psychological distress post-MVC are limited, often involving small samples, with subsequent poor statistical power and subsequent high risk of bias. These factors make it difficult to draw conclusions, however CBT appears encouraging and therefore worthy of consideration as a preventative intervention. ã 2016 Elsevier Ltd. All rights reserved.

Keywords: Psychological treatment Prevention MVC Motor vehicle crash Psychological distress

Introduction Motor vehicle crashes (MVCs) constitute a leading cause of death and serious physical injury worldwide [1–3]. Extensive economic burden is associated with emergency services, vehicle damage, legal and administrative costs, as well as the medical treatments associated with both physical and psychological short and long-term rehabilitations [3]. Efforts to ameliorate the

* Corresponding author at: John Walsh Centre for Rehabilitation Research, Kolling Institute for Medical Research, Sydney Medical School-Northern, The University of Sydney, Corner Reserve Road and First Avenue, Royal North Shore Hospital, St Leonards, NSW 2065, Australia. E-mail address: [email protected] (R. Guest).

associated economic burden have attracted significant research activity predominantly focussed on preventing MVCs. A broad range of preventative strategies by governments have included strategies such as the development and management of road infrastructure, law enforcement targeting speed and alcohol consumption, and the provision of safer vehicles [4]. Despite these initiatives, death and injury rates from MVCs continue to rise, especially in developing countries [1,5]. While a declining trend exists in more developed countries, it is nevertheless concerning that costs associated with MVCs are significant [4]. For example, in Australia the cost of MVCs is approximately $17b or 2.3% of Gross Domestic Product [6]. Just as concerning is the knowledge that costs are significantly greater when psychological distress is experienced after a MVC. For example, costs have been found to

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double when a person is involved in compensation and also suffers psychological distress related to their MVC [7]. In response, considerable effort has been invested in studying MVC impacts, as well as psychological interventions employing, for instance, cognitive behaviour therapy (CBT), for those diagnosed with psychological disorders [2,4,8,9]. Typically, these psychological interventions are conducted months or years after the MVC [2] and conceivably, such a delay in treatment results in increased risk of psychological distress developing into psychological disorders like post-traumatic stress disorder (PTSD). Less emphasis however, has been placed on conducting psychological interventions delivered soon after the MVC, with the goal of preventing the development of psychological distress and disorder. The prevalence of psychological distress following a MVC is high [8,10,11] and appears to be independent of physical injury severity [8,12,13]. Common psychological impacts include clinically elevated anxiety and depressive mood, as well as mental disorders such as PTSD, major depressive disorder (MDD), acute stress disorder (ASD) and adjustment disorder (AD) [8,14]. Left untreated, sub-clinically elevated psychological distress is associated with increased risk of psychological disorder requiring lengthy and expensive treatment interventions [8,14,15]. This suggests there is a need for early interventions aimed at preventing the worsening of psychological symptoms following a MVC. Psychological distress is even more common for MVC survivors who are also involved in compensation [14,16–20]. The compensation system itself appears to generate additional stress for those involved as they navigate their way through an often stressful medico-legal process [17,21–23]. For example, large differences in perceived fairness have been found between fault-based versus no-fault compensation systems, with lower perceived fairness experienced by those in the at-fault system, and further, perceived fairness was shown to be positively correlated with better health outcomes after adjusting for demographic and injury variables [24]. This strengthens earlier research that found claimants who were not at fault, or attributed fault to others, were found to experience poorer recovery outcomes than those who were at fault [25]. Procedural justice is another compensation-related systemic factor with potential influence on health outcomes, with one study finding claimants’ interactions with insurance companies were perceived as less fair than their interactions with lawyers [26]. Furthermore, significantly greater costs are incurred when a claim involves a psychological disorder in addition to the claimant’s physical injury [27,28]. A psychological disorder can have extensive consequences for the MVC survivor and their family, including severe emotional dysregulation, poor coping strategies, delayed return to work, and financial strain, in addition to elevated costs for insurance companies [14,28,29]. Arguably, an effective intervention program delivered soon after the MVC aimed at preventing the development of psychological distress would be beneficial for addressing these consequences. For example, such an intervention could improve the MVC survivor’s capacity for coping with the potentially stressful processes they experience post-MVC, resulting in reduced risk of psychological disorder and its negative impacts. Evidence suggests that psychological distress is somewhat independent of physical injury severity. For example, elevated psychological distress has been shown to be associated with both catastrophic MVC-related injuries such as spinal cord injury (SCI) [14,30,31], and non-catastrophic physical injuries such as whiplash injury [8,14,32]. A systematic review investigating psychological distress following a MVC found 21% to 67% of MVC survivors suffered depressive mood states, while anxiety and driving phobia was experienced by up to 47%, and over 40% suffered symptoms consistent with PTSD [33]. Similar rates of psychological distress have also been found by other researchers [8,11,12,15,34]. These

high rates of psychological distress suggests preventative measures are required soon after the MVC to improve resilience and reduce the risk of elevated distress developing into severe psychological disorders such as MDD, ASD and PTSD [14,35]. Greater resilience experienced by people with physical disabilities appears to equip them with greater capacity for coping with their physical disability, compared to those with lower resilience, suggesting resilience is an appropriate target of change [35]. There is a growing body of evidence aimed at identifying the predictors of poor recovery post-MVC [36–39]. Research suggests that involvement in compensation is one such predictor [16,17]. Therefore a potential target for change is to identify factors that reduce stress in the compensation process [17]. Accordingly, based on their findings, Murgatroyd, Cameron and Harris (2011) suggest policy review and legislative change may positively influence the experience of the claims process, thereby reducing the risk of poor recovery for claimants. An alternative strategy for reducing risk of psychological distress developing post-MVC would involve psychological interventions delivered soon after the MVC, designed to equip survivors with skills and strategies needed for successfully dealing with the many stressors faced in relation to their MVC. Stressors could include impairment following physical injury, chronic pain, disrupted sleep, financial and familial strain, and reduced social and physical activity participation. Consequently, the inclusion of lifestyle skills, directed at improving sleep, diet, and exercise incorporated into early psychological interventions also has potential. As mentioned, there is extensive research focussed on treating psychological distress associated with MVCs when a person has been diagnosed with psychological disorder [2,9,40–43], and to a much lesser degree when involved in compensation [27,44]. Very little attention however, has been given to investigating the prevention of psychological distress for MVC survivors. Therefore, the aim of this study was to identify studies that investigated psychological interventions delivered soon after the MVC and determine their efficacy in preventing the development of psychological distress. Method Search strategy To conduct a thorough systematic review on studies that investigated interventions aimed at preventing psychological distress following a MVC using pre- and post-intervention psychometrics for such conditions as anxiety, depression and PTSD. A high yield search strategy was employed. We searched Ovid Medline, Cochrane Library, PsychINFO, Web of Science and Embase databases for studies published from 1985 to September 2015, accessed via OvidSP interface using subject terms such as motor vehicle accidents, motor vehicle crash, MVC, prevention and psychological injury or distress, as well as specific psychological terms such as anxiety, depression, PTSD and driving phobia. It was decided to contain the searching to only peer-reviewed papers and not databases focussed on methodology or protocol as these would only report preliminary results. Search terms were mapped to Medical Subject Heading (MeSH) terms and synonyms were grouped together using Boolean operators. Guidelines of the Cochrane Collaboration, together with the assistance of a librarian, were used to develop a search strategy that would identify all studies relevant to the research. With the assistance of Librarian database experts, minor modifications to the search strategy were necessary to take into consideration the different search and index terms used by the different databases. Additional searching was employed using Google Scholar for prominent authors in the field. Reference lists of

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all relevant articles were screened for additional publications, and recent systematic reviews and meta-analyses were also screened for relevant articles. Results of the database searches were downloaded into Endnote X7 and duplicate papers were excluded. One author (RG) initially screened all titles and abstracts for relevant titles and/ or abstracts. Relevant full text articles, and articles considered potentially relevant were screened by two authors (RG and AC) and a decision made as to which articles should remain. No relevance disagreements were encountered.

departing from the preventative criterion, we argue here that if sub-clinical levels of psychological distress did not elevate postintervention, then this could be considered as a preventative intervention and therefore worthy of review and analysis. Studies were excluded if i) they reported psychological interventions administered to under 18 year olds post-MVC, ii) they incorporated other trauma-related events in addition to a MVC resulting in difficulty separating treatment effects, and iii) studies that did not utilise measures that had been reported in the professionally peer reviewed journals as being valid and reliable.

Inclusion and exclusion criteria

Selection of studies

This review was limited to studies published in English and available as full text. Articles were selected for inclusion according to the following criteria: i) studies that involved participants who had experienced a MVC, and randomized to either a psychological intervention or a control group, ii) studies that employed psychometrically sound pre- and post-measures of psychological constructs, iii) studies that involved a preventative psychological intervention that recruited MVC survivors prior to any determination of psychological disorder. This third criterion was relaxed if the study involved participants who had initially been assessed for current psychological distress, and were found to have minimal, or sub-clinical psychological morbidity only. Whilst recognised as

Fig. 1 summarises the selection procedure based on PRISMA guidelines [45]. Employing the previously mentioned inclusion and exclusion criteria, the search identified 2563 records. An additional 48 records were included after internet searching of prominent authors in the field. Adjustment for duplicate records (n = 943) reduced the number of records to 1668, and after title and abstract screening, a further 1577 were excluded (e.g. not specific to MVC, physical injury focus rather than psychological distress). This left 91 full text articles that were read in full and analysed. However a further 79 were excluded due to reasons such as paediatric studies, no specific testing of an intervention, no psychometric measurement utilised, or the intervention was a

Records idenfied through database searching (n = 2563)

Addional records idenfied through other sources (n = 48)

Total n = 2611 Duplicates Removed (n = 943)

Records Screened (n = 1668)

Records Excluded: (n = 1577) Reasons include: 1.Child-specific treatments or those administered to u/18 year olds 2.Not specific to MVC 3.Physical injury only

Full-text arcles assessed for eligibility (n = 91)

Records Excluded: (n=79) Reasons include: 1.Studied treatment rather than preventave intervenon. 2.Discussed prevenon, with no specific prevenon intervenon tested. 3. Child-specific intervenons.

Studies included: (n = 12)

Fig. 1. Consort diagram for retrieval of studies for this systematic review.

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three levels of risk. These are low risk of bias (+), unclear risk of bias (?) or high risk of bias ( ) across all seven domains [46]. Overall level of risk was then determined within each trial: low risk (low risk of bias for all key domains), unclear risk (low or unclear risk of bias for all key domains) or high risk (high risk of bias for one or more key domains). See Fig. 2 for a breakdown of the quality assessment and risk of bias for the 12 studies. Two authors (AC and RG) independently assessed the quality of bias in each study and discrepancies were resolved by discussion based on further inspection with potential disagreements to be resolved via subsequent discussion. Fig. 2 shows that all 12 studies contained limitations resulting in bias of sufficient degree to influence study outcomes and conclusions. A numerical score is also provided for each study, ranging from three to six, with seven the highest quality score possible. Results of the quality assessment were taken into account when drawing conclusions about efficacy of the interventions conducted in the 12 studies and implications for future research in this area.

treatment for existing psychopathology rather than prevention. This resulted in 12 studies that met all criteria and were included in the systematic review after independent examination by another member of the research team (AC). Quality assessment The quality assessment of the risk of bias for the included studies was determined using the Cochrane Collaboration’s tool for assessing risk of bias in randomised trials [46]. This tool assesses six sources of bias (or seven domains, in that selection bias is comprised of two sources of bias), including: 1) Selection bias, assessed from two sources a) random sequence generation, that is, the method used to generate the random allocation sequence is described in sufficient detail, and b) allocation concealment, that is, the method used to conceal allocation is described in sufficient detail to determine whether allocation could have been foreseen. 2) Performance bias, involving blinding of participants and personnel, that is, measures to blind trial participants and investigators to the allocation of groups are sufficiently described. 3) Detection bias, involving blinding of outcome assessment, that is, whether measures were taken and described to blind investigators conducting the analysis from knowing which intervention participants received. 4) Attrition bias coming from incomplete outcome data. This involves assessing whether main outcome variable data is complete, including description of attrition and exclusions from analysis. 5) Reporting bias, involving whether selective outcome reporting occurred, and 6) other bias, including any other type of obvious bias or concerns [46]. Based on the above assessment of bias sources, the overall quality assessment for each study was determined by assigning one of

+ + + + + + + + + + + +

? + + + + + + + + + + +

Key + ?

2 5 3 4 4 5 5 3 5 6 6 3

High High High High High High High High High High High High Level of Risk

+ + + + + + + + + + +

Risk Rating (total = 7)

? ? + ? + + + -

Incomplete Outcome Data (Attrition Bias) Selective Reporting (Reporting Bias) Other Bias

+ + + + + + -

Table 1 displays the 12 systematic review studies with outcome measures and findings. Only six of the 12 studies were classified as preventative interventions for psychological distress following a MVC, with two of these six focussed on a preventative intervention for claimants involved in compulsory third party compensation schemes following a MVC. The remaining six involved a psychological intervention for people assessed as having subclinical symptoms of psychological distress in accordance with the third inclusion criteria.

Blinding of Outcome Assessment (Detection Bias)

-

Blinding of Participants and Personnel (Performance Bias)

+ + + + + + + -

Allocation to Concealment (Selection Bias)

2014 2013 2001 1996 1999 2000 2014 2011 2011 2006 2003 1993

Random Sequence Generation (Selection Bias)

Littleton Elbers Gidron Hobbs Conlon Mayou Wu Mouthaan Zoellner Maercker Ehlers Brom

Results

Low risk of bias High risk of bias Unclear risk of bias

Fig. 2. Risk of bias for each study using the Cochrane Collaboration’s tool for assessing risk of bias in randomised controlled trials.

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Table 1 Studies reviewed with sample numbers, intervention, outcome measures and key findings with effect sizes for prevention intervention (inclusion irrespective of psychological status) versus combined treatment/prevention intervention (sub-clinical psychological symptoms recorded prior to intervention). * Effect sizes calculated by author using reported SD/M or F statistics. Author Year

N

Intervention (n) Population

Psychological Injury Prevention Studies: 1 Littleton 157 Standard care (82) vs. Explanations of pain and selfet al. 2014 management (75) Australia—Hospital setting 2 Elbers et al. 176 Website information/Therapist Assistance (88) vs Existing 2013 Websites (88) Holland—3 claims settlement offices 3 Gidron Memory Structuring(8) Supportive listening (9) Israel— 17 et al.2001 Hospital setting 4 Hobbs 106 Psychological debriefing/information (54) vs control (52) et al.1996 U.K.—hospital setting 5 Conlon et al. 40 Psychological Debriefing (18) 1998 vs control (22) Ireland—trauma clinic 6 Mayou et al. 61 Psychological debriefing and information (30) vs control (31 U. 2000 K.—Hospital setting Sub-Clinical Psychological Injury Treatment/Prevention Studies: 7 Wu. et al. 53 Writing, Reading/In-Vivo Exposure (25) vs 2014 SHB (28) Hong Kong—hospital setting 8 Mouthaan et al. 2011

10

9 Zoellner et al. 2011

40

10 Maercker et al. 2006

42

11 Ehlers et al. 2003

85

12 Brom et al. 1993

151

Internet delivered Video/Audio (5) vs control (5) Netherlands—hospital setting CBT Manualised (20) vs wait-list (20) Germany—self-referred MVC survivors CBT Manualised (21) vs wait-list (21) Germany—University setting CBT (28) vs SHB (28) vs Repeated Assessment (29) England—discharged hospital patients Psychological help (68) vs Monitoring (83) Netherlands—police reports with follow-up letter

Outcomes Measures

Significant Differences between Groups Effect Sizes (ES)

Dep, Anx HADS Dep, Anx SCL-90

No significant difference

PTSD PT DS PTSD IES

Significant Difference between groups MS significantly less total PTSD symptoms ES No significant group differences

PTSD IES, CAPS

No significant group differences

PTSD IES

3 year follow up of Hobbs et al. (1996) No significant group differences

Dep, Anx HADS

Significant differences between groups Lower dep (Cohen’s d = 0.71) and anx (Cohen’s d 0.77) symptoms*

PTSD STAI

No significant group difference

PTG PTGI

Total PTG—No significant group difference

No significant differences

Cohen’s d = 1.3*

PTSD CAPS Significant differences between groups over time Greater reductions in PTSD symptoms for CBT (Cohen’s d = 1.55) PTSD PTDS Significant differences between CBT and others Greater PTSD improvements for CBT group (Cohen’s d = 0.49.* PTSD IES

No significant group differences

Abbreviations;: Dep: Depression; Anx: Anxiety; HADS: Hospital Anxiety and Depression Scale; SCL-90: Symptom Checklist; PTSD: Post Traumatic Stress Disorder; PTDS: Post Traumatic Diagnostic Scale; CT: Cognitive Therapy; IES: Impact of Events Scale; CAPS: Clinically Administered PTSD Scale for DSM-5; CBT: Cognitive Behaviour Therapy; SHB: Self Help Book; STAI: State Trail Anxiety Inventory; PTG- Post Traumatic Growth; PTGI- Post Traumatic Growth Inventory. * Effect sizes calculated by author using reported SD/M or F statistics.

Interventions employed in these 12 studies consisted of psychological interventions delivered soon after a MVC. The only exception was the Elbers et al. study [27] where MVC survivors were offered preventive intervention 12 months post-MVC. This study however was retained in the review because it involved a prevention intervention. Table 2 provides detailed descriptions of the interventions used in each study. All interventions utilised psychological interventions, with components of CBT designed to change behaviour, thoughts, cognitions and emotions employing strategies like education, self-monitoring, goal-setting, relaxation, problem solving and thought restructuring [2,15,44,47–49]. Control groups typically received self-help booklets [2,49], referral to websites for information [27] and regular monitoring [42] through to standard care practices [27,44] or were wait-list controls [43,47]. Measures of depression, anxiety and PTSD were the main outcome measures, with one study investigating posttraumatic growth as an outcome measure. Post-traumatic growth as an outcome measure was relevant to the aims of the systematic review given it refers to how a person copes and responds to psychological distress following a MVC [43]. In accordance with the inclusion criteria, only studies using measures that have been peer reviewed in professional journals as valid and reliable were included in the review. Depression and anxiety were measured using the Hospital and Anxiety and Depression Scale [50] and the SCL-90 Symptom Checklist [51].

PTSD was measured with the Post Traumatic Diagnostic Scale [52], Impact of Events Scale [53], State Trait Anxiety Inventory [54] and the Clinically Administered PTSD scale for DSM-5 [55]. Post Traumatic Growth was measured using the Post Traumatic Growth Inventory [56]. In the first six prevention studies, the only significant difference between groups was found by Gidron et al. [40] who found reduced PTSD symptoms as a result of memory restructuring treatment (see Table 2 for detailed explanation of this treatment). This study found a large effect size of 1.3 in comparison to the control condition of supportive listening [40]. The remaining five prevention studies reported non-significant differences between the psychological interventions and control conditions [15,27,44,57,58]. No differences in psychological distress were found for interventions involving education programs, promotion of self-management skills, or encouragement of increased activity soon after the MVC, when compared to a control [44]. Similarly, no significant differences were found when comparing online education plus therapist-assisted problem solving to a control condition [27]. Furthermore, psychological debriefing was not found to be efficacious [57–59]. However, reference to Fig. 2 demonstrates that the significant findings of Gidron et al. [40] are challenged by the low quality of the study design, where a high risk of bias was found, and a low numerical score of 3/7, and the small sample size (see Table 1). Two prevention studies found no

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Table 2 Descriptions of interventions including timing post-MVC and dosage for each study included in the systematic review. Intervention Author, Year

Intervention Types with Timing and Dosage

Intervention delivered early, but unclear how soon after MVC. Evaluation by musculoskeletal physician who provided explanations of participant’s injuries, psychological assistance for pain management, promotion of self-management and encouragement for early return to activity levels using a presentation and an individualised exercise plan. Booklets and brochures related to healing and area-specific exercises for soft tissue injuries post-MVC. Control—usual care provided to MVC survivors. Website Information with Therapist Intervention delivered 12 months after MVC. 3 modules 1) information about compensation process (49 pages); 2) five lessons Assistance of problem-solving therapy including step-by-step plan, communicating effectively and coping with unsolvable problems, with homework assignments and feedback; and 3) 10 frequently asked questions with answers (1 page). Control—Links provided to Elbers et al., 2013 existing information and support websites (8 pages). Memory Structuring Intervention delivered within 1 month after MVC. Two telephone delivered CBT sessions in the form of memory structuring. Gidron et al., 2001 Therapist listened to the participants’ trauma account, then the therapist repeated the trauma narrative back in an organised and logical manner. Participants practiced the structured narrative to the therapist and others. Control—2 supportive listening sessions. Participants were telephoned twice and invited to describe the event to the counsellor. The counsellor provided supportive listening and informed the participants about treatment for PTSD available in the hospital unit. Psychological Debriefing & Information Intervention delivered within 48 h after MVC. 1 h of debriefing. Combination of review of the traumatic experience, Hobbs et al., 1996 encouragement of emotional expression and promotion of cognitive processing. Advice regarding common emotional reactions, value of talking about the experience and early graded return to driving activity plus an information leaflet consolidating advice for the treatment group. Control—assessments. Psychological Debriefing Intervention delivered within 1 month after MVC. 1 counselling session of 30 min of psychological debriefing following initial Conlon et al., 1998 assessment. Encouragement of emotional and cognitive expression about the MVC with education on PTSD and coping, advice and seeking help, with brochure and follow up phone number. Control—monitoring following assessment. Intervention delivered within 1–3 months after MVC. 1 h of psychological debriefing promoting emotional and cognitive Psychological Debriefing and Information processes with the goal of leading to resolution of the trauma with information on common reactions to trauma and Mayou et al., 2000 encouragement to seek support from family and general practitioner. Control—monitoring following assessment. Writing, Reading, In-vivo Exposure Intervention delivered 1–3 months after MVC. 4 separate weekly sessions of 1.5 h based on CBT strategies. Writing and reading Wu et al., 2012 about trauma with in-vivo exposure. Education on stress responses, identification of cognitive distortions and homework tasks. Control—64-page self-help booklet based on CBT strategies including education on PTSD responses and rationale for exposurebased exercises for habituation and realistic appraisals. Internet Video/Audio information Intervention timing after MVC is unclear. Trauma-related information delivered via a 30 min internet program including Moutthaan et al., 2011 psycho-education, modelling, in-vivo exposure and social support delivered via video in addition to 2 separate 7 min audio presentations relating to stress management. Control—matched and assessed. CBT Manualised Intervention timing after MVC is unclear. 8–12 weekly CBT sessions. Reading and writing about trauma, imaginal and in-vivo Maercker et al., 2006 exposure with cognitive restructuring and relaxation skills. Structured and organised treatment modules in a professionally Zoellner et al., 2011 disseminated treatment manual aimed at normalise reactivity, cognitive restructuring and attention to existential issues. Control—wait-list. CT vs CBT Self-Help Booklet vs Repeated Intervention delivered 1 month after MVC. 3 week self-monitoring phase. Those who did not recover were randomly assigned Assessments to 1 of 3 groups: 1) cognitive therapy (CT) which included CBT strategies (employing behavioural and cognitive strategies) of up Ehlers et al., 2003 to 12 sessions during 3 months and up to 3 booster sessions. 90 min for the initial sessions and 60 min thereafter based on Ehlers and Clark model such as modification of negative appraisals, correction of problematic autobiographical memory, dysfunctional behavioural and cognitive responses; 2) CBT Self-Help—64 page book (approx. 18000 words) Understanding Your Reactions To Trauma based on CBT principles for treatment of PTSD; or 3) repeated assessment—20 min session that followed a standardized protocol, the clinician explained symptoms may reduce without intervention, some people would require specialist intervention, and that for those who did need intervention, it was unknown whether immediately or delayed treatment was more effective. Psychological Help Intervention delivered 1 month after MVC. 3 sessions of psychological help including support, education, reality testing, and Brom et al., 1993 referral to psychotherapeutic treatment. Letters were sent to accident survivors from police records and invited into the program. Control—assessment and monitoring. Explanations/Self-management Littleton et al., 2014 Psychological help (68)

differences, however, their quality assessment scores were higher with Elbers et al. and Mayou et al. scoring 5/7 [27,59]. This perhaps suggests that the psychological intervention strategies used in these studies were not effective at reducing psychological distress following a MVC. The remaining three prevention studies [44,57,58] had sufficiently high risk of bias to question their findings. In the six remaining studies investigating psychological interventions designed to reduce sub-clinical symptoms of psychological distress, the findings of three studies suggest CBT may be efficacious in reducing distress levels [2,47,49]. These three studies used core CBT strategies (see Table 2) to address psychological distress. Whilst these studies received an overall judgment of high risk, their quality assessment scores were judged as either 5/7 [2] or 6/7 [47,49], resulting in increased confidence in their findings. For example, large effect sizes were found for reducing symptoms of psychological distress (Cohen’s d ranging between 0.71–1.55) [2,47,49], using CBT strategies such as thought restructuring, exploration of feelings, relaxation strategies, in-vivo exposure, and post-treatment boosters. Further, significant

reductions in psychological distress were maintained over time up to a 6-month follow up [2,47,49]. Zoellner et al. [43] extended the Maercker et al. [47] study (see Table 2) reporting posttraumatic growth changes over time in the same participants, however did not find significant reductions in that measure compared to the control group. The remaining two studies [42,60] were judged as having high risk as well as receiving a low numerical score of 3/7, therefore having sufficiently high risk of bias to question their findings. With reference to Fig. 2, the major sources of bias included selection bias involving concealment of allocation to groups, where no studies satisfied this quality criterion. Arguably, it is difficult to conceal group allocation in psychological interventions. Another major source of bias involved lack of blinding to outcome assessment, where only three studies satisfied this criterion. Encouragingly, seven studies provided their strategy for random assignment, while six studies described their strategy for blinding the allocation from participants and personnel. On a positive note, eleven studies described strategies for managing issues like attrition, and all studies satisfied the reporting bias criterion.

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Discussion The aim of this systematic review was to identify studies that had investigated interventions aimed at preventing psychological distress after a MVC, and determine their efficacy. After conducting a comprehensive search, six studies were found that investigated the effectiveness of a psychological prevention intervention. Five of the six studies found no significant reductions in psychological distress compared to controls [27,44,58,61,62]. Whilst the sixth study found a significant reduction [40], the very small sample size and result of the quality assessment judged the risk of bias to be too high, thus reducing confidence in its findings. Another major limitation of the six prevention studies was the nature of the psychological strategies used to treat psychological distress. Psychological strategies used included those involving minimal therapist and cognitive behavioural input, such as education, information on problem solving and psychological debriefing that is, encouraging discussion and expression of emotions related to the MVC. Furthermore, there is considerable research into the prevention of trauma-related PTSD and single-session debriefing, however the effectiveness of this type of intervention has been contentious, with a potential for increased risk of harm to the trauma survivor depending on the timing and modality of the debriefing delivery [63,64]. This suggests both the type of intervention and its timing are important factors in preventing psychological distress developing into a severe disorder. A further problem for the Elbers et al. (2013) study was the lack of early intervention which could contribute to the lack of significant reduction in psychological distress. The additional six studies investigating the reduction of subclinical symptoms of psychological distress provided some encouraging findings. The findings of three studies [2,47,49] suggest the use of core CBT strategies such as in-vivo exposure [2,47], relaxation [47] and cognitive restructuring [49] could be efficacious for preventing the development of psychological distress. In support of this assertion, these three studies received higher quality numerical ratings than other studies (see Fig. 2), and reductions in psychological distress were maintained up to at least 6 months [2,47,49]. In the clinical setting, positive mental health outcomes are more likely with early intervention [65], however barriers to early intervention exist, such as cost, confidentiality or perceptions of stigma, and problems associated with accessibility [65,66]. These barriers contribute to reduce help-seeking behaviours occurring long after symptoms have developed into complex conditions requiring long-term intensive and expensive therapies. Accordingly, this has resulted in treatment focussed on psychological symptoms when they have become established, resulting in problems like delayed return to work, poorer health outcomes and elevated costs to insurance companies [67]. A preventative model could arguably increase benefits in the short and long-term potentially resulting in sustained positive health benefits, shorter recovery times, improved return to work and daily activities, and reduced health and legal costs. The critical question is which prevention intervention is efficacious, and how can it be disseminated effectively and efficiently to large populations such as claimants in a compensation system? CBT is recognised as an evidenced-based treatment of choice for common mental health disorders [68] and is recommended by research and evidence-based clinical guidelines such as NICE as a first-line treatment for depression and the anxiety and trauma-related disorders [33,67]. This evidence suggests that CBT, offered as a preventative intervention has the potential to reduce the risk of developing complex and expensive psychological disorders. Depending on the type of target population, additional factors would require investigation such as cost effectiveness, ease at

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which the intervention could be disseminated, and client satisfaction, and to what kind and size of population the intervention could be efficacious for. For example, the internet has provided an innovative forum for delivering CBT to large populations using online biblio-therapy with therapist contact [69]. A recent systematic review identified that CBT delivered online was cost-effective compared to face-to-face CBT based on symptom improvement, and reduction in time and resource demands on clinicians [70]. If it is shown that preventative interventions are cost-effective, savings arising from reduced insurance costs due to lower psychological morbidity post-MVC may indeed outweigh costs associated with delivering a preventative intervention as a standard protocol to all claimants, including to those who do not appear to warrant it. Here, the important question is the benefit versus harm associated with such an intervention offered to those who may not require it, however there appears little debate over the psychological benefits of CBT. Recent research in this area has focussed on studies that have investigated the prevention of psychological distress post-MVC for those MVC survivors entering the compensation process [27,44]. This compensation research has shown poorer health outcomes are experienced by claimants compared to non-claimants [18,71]. While the two compensation-related prevention studies in this systematic review found no benefit for claimants [27,44] it should be noted that only minimal psychological strategies were used and quality was low at least for one study [44]. Therefore, further research in preventing the development of psychological distress in MVC survivors entering compensation schemes is required. Strengths and limitations require discussion. A strength of this review is that it systematically reviewed studies that offered interventions designed to prevent the development of psychological distress. Whilst every effort was made to include all relevant articles, it is possible that early MVC intervention studies were missed due to limitations in the search strategy terminology, although the likelihood of having missed key studies in the area is considered to be small given the comprehensive search strategy used. Further limitations involved the small number of relevant studies identified by the systematic review, and restrictions associated with only reviewing full text, peer reviewed and English language studies. Implications for research The development of psychological distress remains a substantial problem for many people who sustain physical injury in a MVC, including those who enter a compensation scheme. Targeting only those who develop chronic psychological distress such as PTSD many months after the MVC may result in lost opportunities to develop early psychological interventions designed to prevent the development of psychological disorders. The result of this systematic review revealed that randomised controlled trials investigating the efficacy of psychological interventions have significant problems with bias, potentially questioning their conclusions, and only a minority of the trials resulted in significant reductions in psychological distress. However, we believe the findings do provide guidance for future direction in this area, with core CBT strategies worthy of further investigation as a prevention strategy. For example, this would involve providing an early CBT intervention to MVC survivors who have been assessed as at risk of psychological distress (e.g, using clinical cut off scores of validated depressive mood scales). This avoids the possibility of some participants receiving a CBT intervention who may not need it. Further, not all trauma survivors will respond optimally to a single uniform composition and treatment dosage, that is, duration and intensity of the intervention [72]. A broader CBT approach designed to improve MVC survivors’ overall coping and resilience

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when faced with the varied associated physical and psychological stressors seems warranted. Recommendations for future research Future research needs to determine whether a psychological distress prevention program could; i) be efficacious in preventing the development of psychological distress in those assessed at risk, and ii) have long-term benefits for MVC survivors demonstrated by improved resilience and coping with the stressors of both the MVC experience, and any compensatory systems they may be involved in as a result. Such research would likely involve exposing MVC survivors to a prevention intervention with a wait-list control group. It would also involve replicating an evidence-based therapeutic model such as a comprehensive CBT program, rather than utilising limited CBT components only, and delivering this intervention via an efficient modality such as online or email delivered sessions. Further, it would involve investigating longterm follow up to measure the effects. Conclusion Prior research interest has focussed on treating MVC-related psychological distress after it has developed into psychological disorders. This is despite PTSD, MDD and AD being associated with longer and more expensive treatments, and reduced quality of life. A more efficient solution would be to prevent psychological distress from becoming chronic by offering CBT based psychological interventions aimed at prevention of psychological distress soon after the MVC. Conflicts of interest statement The authors declare that there are no conflicts of interest Funding source This systematic review was financially supported by a Motor Accident Authority (NSW) Grant, Number: MAA 14/366 (now known as State Insurance Regulatory Authority). The funding source had no role in the design, collection, analysis, interpretation or writing up of the study. Acknowledgement The authors wish to thank librarians from The University of Sydney for their valuable advice on the search strategy and for assistance with Endnote. Appendix A. Supplementary data Supplementary data associated with this article can be found, in the online version, at http://dx.doi.org/10.1016/j. injury.2016.09.006. References [1] Nantulya VM, Reich MR. The neglected epidemic: road traffic injuries in developing countries. BMJ Br Med J 2002;324:1139. [2] Wu KK, Li FW, Cho VW. A randomized controlled trial of the effectiveness of brief-CBT for patients with symptoms of posttraumatic stress following a motor vehicle crash. Behav Cogn Psychothe. 2014;42:31–47. [3] Peden M, McGee K, Krug E. Injury: a Leading Cause of the Global Burden of Disease, 2000. World Health Organization; 2002. [4] Peden M. World Report on Road Traffic Injury Prevention. Geneva: World Health Organization; 2004. [5] Ameratunga S, Hijar M, Norton R. Road-traffic injuries: confronting disparities to address a global-health problem. Lancet 2006;367:1533–40.

[6] Connelly LB, Supangan R. The economic costs of road traffic crashes: Australia, states and territories. Accid Anal Prev 2006;38:1087–93. [7] Air TM, McFarlane AC, Psychother D. Posttraumatic stress disorder and its impact on the economic and health costs of motor vehicle accidents in South Australia. J Clin Psychiatry 2003;64:175–81. [8] Heron-Delaney M, Kenardy J, Charlton E, Matsuoka Y. A systematic review of predictors of posttraumatic stress disorder (PTSD) for adult road traffic crash survivors. Injury 2013;44:1413–22. [9] Taylor S, Koch WJ. Anxiety disorders due to motor vehicle accidents: nature and treatment. Clin Psychol Rev 1995;15:721–38. [10] Blanchard EB, Hickling EJ, Taylor AE, Loos W. Psychiatric morbidity associated with motor vehicle accidents. J Nerv Ment Dis. 1995;183:495–504. [11] Butler DJ, Moffic HS, Turkal NW. Post-traumatic stress reactions following motor vehicle accidents. Am Fam Physician 1999;60:524–31. [12] Bryant RA, Harvey AG. Psychological impairment following motor vehicle accidents. Aust J Public Health 1995;19:185–8. [13] Mayou RA, Ehlers A, Bryant B. Posttraumatic stress disorder after motor vehicle accidents: 3-year follow-up of a prospective longitudinal study. Behav Res Ther 2002;40:665–75. [14] Craig A, Tran Y, Guest R, Gopinath B, Jagnoor J, Bryant RA, et al. The psychological impact of injuries sustained in motor vehicle crashes: systematic review and meta-analysis. BMJ Open 2016 in press. [15] Mayou R, Bryant B. Outcome 3 years after a road traffic accident. Psychol Med 2002;32:671–5. [16] Grant GM, O’Donnell ML, Spittal MJ, Creamer M, Studdert DM. Relationship between stressfulness of claiming for injury compensation and long-term recovery: a prospective cohort study. JAMA Psychiatry 2014;71:446–53. [17] Murgatroyd D, Lockwood K, Garth B, Cameron ID. The perceptions and experiences of people injured in motor vehicle crashes in a compensation scheme setting: a qualitative study. BMC Public Health 2015;15:423. [18] Gabbe BJ, Cameron PA, Williamson OD, Edwards ER, Graves SE, Richardson MD. The relationship between compensable status and long-term patient outcomes following orthopaedic trauma. Med J Aust 2007;187:14. [19] Sterling M, Hendrikz J, Kenardy J. Compensation claim lodgement and health outcome developmental trajectories following whiplash injury: a prospective study. Pain 2010;150:22–8. [20] Littleton SM, Hughes DC, Poustie SJ, Robinson BJ, Neeman T, Smith PN, et al. The influence of fault on health in the immediate post-crash period following road traffic crashes. Injury 2012;43:1586–92. [21] Murgatroyd DF, Cameron ID, Harris IA. Understanding the effect of compensation on recovery from severe motor vehicle crash injuries: a qualitative study. Injury Prev 2011;17:222–7. [22] Cotti A, Magalhães T, Pinto da Costa D, Matos E. Road traffic accidents and secondary victimisation: the role of law professionals. Med & L 2004; 23:259. [23] O'Donnell ML, Creamer MC, McFarlane AC, Silove D, Bryant RA. Does access to compensation have an impact on recovery outcomes after injury. Med J Aust 2010;192:328–33. [24] Elbers NA, Collie A, Hogg-Johnson S, Lippel K, Lockwood K, Cameron ID. Differences in perceived fairness and health outcomes in two injury compensation systems: a comparative study. BMC Public Health 2016; 16:1. [25] Gabbe BJ, Simpson PM, Cameron PA, Ekegren CL, Edwards ER, Page R, et al. Association between perception of fault for the crash and function, return to work and health status 1 year after road traffic injury: a registry-based cohort study. BMJ Open 2015;5:e009907. [26] Elbers NA, Akkermans AJ, Cuijpers P, Bruinvels DJ. Procedural justice and quality of life in compensation processes. Injury 2013;44:1431–6. [27] Elbers NA, Akkermans AJ, Cuijpers P, Bruinvels DJ. Effectiveness of a web-based intervention for injured claimants: a randomized controlled trial. Trials 2013;14:227. [28] Chan AO, Air TM, McFarlane AC. Posttraumatic stress disorder and its impact on the economic and health costs of motor vehicle accidents in South Australia. J Clin Psychiatr 2003;64:175–81. [29] Kenardy J, Heron-Delaney M, Bellamy N, Sterling M, Connelly L. The University of Queensland study of physical and psychological outcomes for claimants with minor and moderate injuries following a road traffic crash (UQ SuPPORT): design and methods. Euro J Psychotraum 20145:. [30] Craig A, Perry KN, Guest R, Tran Y, Dezarnaulds A, Hales A, et al. Prospective study of the occurrence of psychological disorders and comorbidities after spinal cord injury. Arch Phys Med Rehabil 2015;96:1426–34. [31] Fann JR, Bombardier CH, Richards JS, Tate DG, Wilson CS, Temkin N, et al. Depression after spinal cord injury: comorbidities, mental health service use, and adequacy of treatment. Arch Phys Med Rehabil 2011;92:352–60. [32] Sterling M, Kenardy J, Jull G, Vicenzino B. The development of psychological changes following whiplash injury. Pain 2003;106:481–9. [33] Blaszczynski A, Gordon K, Silove D, Sloane D, Hillman K, Panasetis P. Psychiatric morbidity following motor vehicle accidents: a review of methodological issues. Compr Psychiatry 1998;39:111–21. [34] Mayou R, Ehlers A, Bryant B. Posttraumatic stress disorder after motor vehicle accidents: 3-year follow-up of a prospective longitudinal study. Behav Res Ther 2002;40:665–75. [35] A., Craig, Resilience in People with Physical. The Oxford handbook of Rehabilitation Psychology. (2012) 474. [36] Suissa S. Risk factors of poor prognosis after whiplash injury. Pain Res Manage 2002;8:69–75.

Please cite this article in press as: R. Guest, et al., Psychological distress following a motor vehicle crash: A systematic review of preventative interventions, Injury (2016), http://dx.doi.org/10.1016/j.injury.2016.09.006

G Model JINJ 6892 No. of Pages 9

R. Guest et al. / Injury, Int. J. Care Injured xxx (2016) xxx–xxx [37] Hendriks EJ, Scholten-Peeters GG, van der Windt DA. Neeleman-van der Steen CW, oostendorp RA, verhagen AP. Prognostic factors for poor recovery in acute whiplash patients. Pain 2005;114:408–16. [38] Ehlers A, Mayou RA, Bryant B. Psychological predictors of chronic posttraumatic stress disorder after motor vehicle accidents. J Abnorm Psychol 1998;107:508–19. [39] Mayou R, Bryant B, Ehlers A. Prediction of psychological outcomes one year after a motor vehicle accident. Am J Psychiatry 2014. [40] Gidron Y, Gal R, Freedman S, Twiser I, Lauden A, Snir Y, et al. Translating research findings to PTSD prevention: results of a randomized-controlled pilot study. J Trauma Stress 2001;14:773–80. [41] Hovens J, van de Weerd M. Posttraumatic stress disorder in debriefed survivors of a bus accident. Psychol Rep 1998;82:1075–81. [42] Brom D, Kleber RJ, Hofman MC. Victims of traffic accidents: incidence and prevention of post-traumatic stress disorder. J Clin Psychol 1993;49:131–40. [43] Zoellner T, Rabe S, Karl A, Maercker A. Post-traumatic growth as outcome of a cognitive-behavioural therapy trial for motor vehicle accident survivors with PTSD. Psychol Psychother: Theor Rese Pract 2011;84:201–13. [44] Littleton SM, Hughes DC, Poustie SJ, Robinson BJ, Neeman T, Smith PN, et al. An early intervention programme had no detectable influence on the health status of people with musculoskeletal injuries following road traffic crashes: comparative study. Injury 2014;45:304–11. [45] Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009;151:264–9. [46] Higgins JP, Altman DG, Gøtzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ: Br Med J 2011343:. [47] Maercker A, Zollner T, Menning H, Rabe S, Karl A. Dresden PTSD treatment study: randomized controlled trial of motor vehicle accident survivors. BMC Psychiatry 2006;6:29. [48] Gidron Y, Gal R, Givati G, Lauden A, Snir Y, Benjamin J. Interactive effects of memory structuring and gender in preventing posttraumatic stress symptoms. J Nerv Ment Dis 2007;179–82. [49] Ehlers A, Clark DM, Hackmann A, McManus F, Fennell M, Herbert C, et al. A randomized controlled trial of cognitive therapy, a self-help booklet, and repeated assessments as early interventions for posttraumatic stress disorder. Arch Gen Psychiatry 2003;1024–32. [50] Herrmann C. International experiences with the hospital anxiety and depression scale-a review of validation data and clinical results. J Psychosom Res 1997;42:17–41. [51] Vallejo MA, Jordán CM, Díaz MI, Comeche MI, Ortega J. Psychological assessment via the internet: a reliability and validity study of online (vs paperand-pencil) versions of the general health questionnaire-28 (GHQ-28) and the symptoms check-list-90-revised (SCL-90-R). J Med Internet Res 2007;9:e2. [52] Foa EB, Cashman L, Jaycox L, Perry K. The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. Psychol Assess 1997;9:445. [53] Creamer M, Bell R, Failla S. Psychometric properties of the impact of event scale—revised. Behav Res Therapy 2003;41:1489–96.

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[54] Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988;56:893. [55] Keen SM, Kutter CJ, Niles BL, Krinsley KE. Psychometric properties of PTSD Checklist in sample of male veterans. J Rehabil Res Dev 2008;45:465–74. [56] Cann A, Calhoun LG, Tedeschi RG, Taku K, Vishnevsky T, Triplett KN, et al. A short form of the posttraumatic growth inventory. Anxiety Stress Coping 2010;23:127–37. [57] Hobbs M, Mayou R, Harrison B, Worlock P. A randomised controlled trial of psychological debriefing for victims of road traffic accidents. Br Med J 1996;313:1438–9. [58] Conlon L, Fahy T, Conroy R. PTSD in ambulant RTA victims: a randomized controlled trial of debriefing. J Psychosom Res\ 1999;46:37–44. [59] Mayou RA, Ehlers A, Hobbs M. Psychological debriefing for road traffic accident victims. Three-year follow-up of a randomised controlled trial. Br J Psychiatry 2000;589–93. [60] Mouthaan J, Sijbrandij M, Reitsma JB, Luitse JSK, Carel Goslings J, Olff M. Trauma tips: an internet-based intervention to prevent posttraumatic stress disorder in injured trauma patients. J Cyber Ther Rehabil 2011;4:331–40. [61] Mayou R, Ehlers A, Hobbs M. Psychological debriefing for road traffic accident victims: three-year follow-up of a randomised controlled trial. Br J Psychiatry 2000;176:589–93. [62] Hobbs M, Mayou R, Harrison B, Worlock P. A randomised controlled trial of psychological debriefing for victims of road traffic accidents. BMJ: Br Med J 1996;313:1438–9. [63] Kaplan Z, Iancu I, Bodner E. A review of psychological debriefing after extreme stress. Psychiatr Serv 2001;52:824–7. [64] Kenardy J. Postttraumatic stress prevention: how do we move forward. Adv Mind Body Med 2001;17:183–6. [65] Kelly CM, Jorm AF, Wright A. Improving mental health literacy as a strategy to facilitate early intervention for mental disorders. Med J Aust 2007;187:S26–30. [66] Gulliver A, Griffiths KM, Christensen H. Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry 2010;10:113. [67] O'Donnell ML, Bryant RA, Creamer M, Carty J. Mental health following traumatic injury: toward a health system model of early psychological intervention. Clin Psychol Rev 2008;28:387–406. [68] King R, Schweitzer R, Giacomantonio G, Keogh T. Psychodynamic psychotherapy: the evidence is in. InPsych: Bull Aust Psychol Soc Ltd 2010;32:28–9. [69] Andersson G, Cuijpers P. Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cogn Behav Ther 2009;38:196–205. [70] Hedman E, Ljótsson B, Lindefors N. Cognitive behavior therapy via the Internet: a systematic review of applications, clinical efficacy and cost–effectiveness. Exp Rev Pharmacoecon Outcomes Res 2012;12:745–64. [71] Cassidy JD, Carroll LJ, Cote P, Lemstra M, Berglund A, Nygren A. Effect of eliminating compensation for pain and suffering on the outcome of insurance claims for whiplash injury. N Engl J Med 2000;342:1179–86. [72] Collins LM, Murphy SA, Bierman KL. A conceptual framework for adaptive preventive interventions. Prev Sci 2004;5:185–96.

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