In the present study, the researcher used a cross-sectional study design to collect samples from the trauma centres of Dr. ND Desai Hospital in Nadiad, Civil Hospital in Nadiad, and Anand Orthopaedic Hospital in Anand, from April to May 2024. The Institutional Ethical Committee granted permission for the conduction of the study (CHA/IEC/ADM23/08/995.03).

Inclusion criteria: All participants experienced RTAs within 30-40 days prior to data collection and were conscious and oriented. Participants aged between 18 to 45 years who were able to read or write in Gujarati or English were included in the study.

Exclusion criteria: RTA victims who were critically ill and required basic life support beyond oxygen support, or who had a known history of psychiatric illness and were receiving any psychological therapies or medications, were excluded from the study. Additionally, road traffic victims who lost a body part due to traumatic injury were also excluded from the study.

Sample estimation: According to the PTSD prevalence rate in a previous study [18], the sample size requirement for the present study was calculated using the following formula:

n=n=(Z1-α/2)²×(p)(q)/(d)²

The calculated size of sample was 345 in number, with the inclusion of 10% drop out rate, 380 was the final sample size.

Data collection procedure: The consecutive sampling technique was used, and all individuals involved in RTAs were identified through their visits to trauma centres or by contacting them via phone to inquire about their willingness to participate in the study. Participant selection was conducted by checking the inclusion and exclusion criteria. Consent was obtained from the participants, and the prevalence was assessed 30 to 40 days after the accidents. An interviewer-administered questionnaire was used to collect the data, which consisted of two main sections.

In Section I, a self-made demographic and clinical questionnaire based on previous studies [19,20] was utilised. In Section II, the PTSD Checklist (PCL-5), developed by the Veterans Affairs (VA) National Centre for PTSD [21], was used to assess PTSD symptoms.

The demographic and clinical questionnaires measured the following parameters- age (in years), gender, education, occupation, monthly income (in rupees), health insurance status, Medicolegal cases (MLC) case status, history of previous RTAs, history of hospitalisation due to RTAs, type of vehicle involved in the accident, receipt of first aid at the accident site, co-morbidity of physical illness, any surgeries following the accident, substance consumption before or during the accident, and areas of injury. The tool was translated into the local language (Gujarati) and validated by experts from various departments like including psychiatric nursing, psychology, psychiatry, language, and statistics, to check its relevance and appropriateness before starting the data collection procedure.

PTSD symptoms were assessed using the PTSD Checklist (PCL-5). This tool consists of 20 items, each scored from 0 to 4 and categorised as follows: ‘not at all (0), a little bit (1), moderately (2), quite a bit (3), and extremely (4).’ The total score ranges from 0 to 80. According to the Department of Veterans Affairs National Centre for PTSD, a score of 33 or higher [18] on this checklist indicates that a person has PTSD symptoms. Permission to use this checklist was obtained from the VA National Centre for PTSD [21]. The internal consistency of the translated tools was pretested and assessed for reliability using Cronbach’s alpha, which yielded a reliability score of 0.754.

Data analysis was performed using SPSS version 23.0. Frequency distributions were used to assess the socio-demographic and clinical characteristics. PTSD scores were calculated using descriptive statistics like including the mean±Standard Deviation (SD). The association was tested using the Chi-square test, and a 95% CI was calculated to determine the level of significance at p-value <0.05.

Most victims were aged 36-45 years, with 158 (41.6%) and male 289 (76.1%). Educationally, the largest group had secondary education 119 (31.3%). The majority were involved in business or other professions 231 (60.8%), with a significant portion earning a monthly family income of 5,000-10,000 rupees, 154 (40.5%). Only 19 participants (5.0%) had health insurance, and 216 (56.8%) had a medico-legal case, with 151 cases (39.7%) settled and 65 cases (17.1%) ongoing.

Regarding clinical characteristics, most participants had no prior accident history 349 (91.8%) or hospitalisations 366 (96.3%). Two-wheeler accidents were the most common 278 (73.2%). First aid was administered to 68 victims (17.9%). A minority 20 (5.3%) had pre-existing illnesses, and 112 participants (29.5%) underwent surgery postaccident, with leg plating being the most frequent surgical procedure 64 (16.8%). None of the participants had consumed substances before or during the accident. Internal injuries were found in 267 victims (70.3%), particularly in the lower extremities 92 (24.2%) and head/face 57 (15.0%). External injuries were present in 231 participants (60.8%), mainly bruises or abrasions on multiple body parts 82 (21.6%). Demographic variables and the prevalence of PTSD symptoms are depicted in [Table/Fig-1].

The overall prevalence rate of PTSD symptoms was found to be 46.3% (n=176). The mean PTSD symptom score was 29.41, representing a mean percentage of 36.8%, with a standard deviation of 10.68. The prevalence of PTSD symptoms among RTA victims according to various demographic categories showed that younger victims (ages 18-25) had the highest PTSD rate, at 52.4% (n=55). Females showed a slightly higher prevalence 43 (47.3%) than males 133 (46.0%). Primary education was correlated with the highest PTSD rate 38 (67.9%). PTSD was more prevalent among those with a monthly income below 5,000 rupees 42 (60.9) and among individuals with business or other professions 114 (49.4%). Health insurance showed minimal impact, with 168 (46.5%) of uninsured victims experiencing PTSD. MLC were associated with a lower PTSD prevalence 94 (43.5%) compared to non MLC cases 82 (50%).

The prevalence of PTSD symptoms among RTA victims based on clinical variables indicated that victims with previous accidents 17 (54.8%) and those who had been previously hospitalised 7 (50.0%) exhibited higher PTSD rates. Victims of two-wheeler accidents 136 (48.9%) and three-wheeler accidents 24 (54.5%) had higher PTSD prevalence compared to those involved in four-wheeler accidents 5 (20.8%). First aid did not significantly impact PTSD rates. Those with physical comorbidities had a lower PTSD rate 6 (30%) than those without 170 (47.2%). The PTSD prevalence was similar for those who had surgery after the accident 52 (46.4%) and those who did not 124 (46.3%). No substance use was reported. Internal injuries showed a PTSD rate of 124 (46.4%), with specific injuries such as hip injuries 5 (71.4%) and back injuries 1 (100%) having higher rates. External injuries exhibited a PTSD prevalence of 106 (45.9%), with bruises or abrasion on upper extremity showing the highest rate (56.8%, n=21). Clinical variables and the prevalence of PTSD symptoms were depicted in [Table/Fig-2].

Among the socio-demographic variables of the subjects, education (p-value=0.027) and monthly family income (p-value=0.011) were significantly associated with PTSD symptoms. Among clinical variables, the type of vehicle involved in the accident (p-value=0.012) also showed a statistically significant association with PTSD symptoms, as depicted in [Table/Fig-2].

Several studies have consistently reported high prevalence rates of PTSD symptoms among RTA survivors, supporting the current finding of 46.3%. Soori H et al., found that 40.06% of RTA survivors exhibited PTSD symptoms, emphasising the psychological impact of traffic accidents [22]. Similarly, another study by Fekadu W et al., reported that 46.5% of survivors developed PTSD [23], closely aligning with these results and highlighting the significant mental health burden faced by this population.

However, the prevalence of PTSD in the present study was higher than that in studies conducted in West Africa (26.43%), Raipur, India (22.6%), and Ethiopia (15.4%) [19,24,25]. This variation in PTSD prevalence could be attributed to differences in the timing of PTSD assessments, the instruments used, and factors such as country, race, gender, and education level.

Younger victims (18-25 years) showed the highest PTSD prevalence. However, these findings differ from a previous study by Arora D et al., in which participants older than 45 years had an increased chance of developing PTSD [18]. A possible reason could be the preponderance of younger individuals in the current study, as well as their developmental stage in coping strategies and limited life experiences.

Females exhibited a slightly higher occurrence of PTSD compared to males, consistent with previous research by Yimer GM et al., which found that women have a higher likelihood of developing PTSD after trauma [20]. Biological, psychological, and social factors may contribute to this gender disparity. Regarding education and income, primary education was correlated with the highest PTSD rate. Lower educational attainment may be associated with reduced access to coping resources and support systems. Similarly, victims with a monthly income below 5,000 rupees showed a higher prevalence of PTSD. Financial strain can exacerbate stress and limit access to mental health services, compounding the impact of trauma. These findings are supported by the study of Daddah D et al., indicating that lower socio-economic status is a risk factor for PTSD [24].

Two-wheeler accidents had a higher incidence of PTSD compared to four-wheeler accidents. Two-wheeler riders are more exposed and vulnerable to severe injuries, which increases the psychological impact of the accident. Similar to previous findings by Bedaso A et al., victims with prior accidents and those who have been previously hospitalised were more prone to PTSD, as repeated exposure to trauma can compound psychological distress [19]. Details of the previous studies are provided in [Table/Fig-3] [18-20,22-26].

Internal injuries showed a 46.4% PTSD rate, with specific injuries such as those to the hip (71.4%) and back (100.0%) exhibiting higher rates. The severity and location of injuries can significantly impact psychological outcomes. Severe or debilitating injuries can lead to prolonged physical pain, disability, and loss of independence, all of which contribute to the development of PTSD. These findings align with research indicating that injury severity is a predictor of PTSD [18].

Education and monthly family income were significantly associated with PTSD symptoms, highlighting the role of socio-economic factors in trauma recovery. Additionally, the type of vehicle involved in the accident showed a statistically significant association with PTSD symptoms, emphasising the need to address specific risk factors related to different types of RTAs. The findings were consistent with previous studies by Yimer GM et al., and Daddah D et al., which also showed significant associations with education and monthly income [20,24].

In the present study, the researchers acknowledge the presence of unmeasured variables that could potentially influence the findings. These variables might include factors such as pre-existing mental health conditions, social support systems, and witnessed death, which were not captured in this data due to logistical constraints and privacy concerns. There are plans for subsequent research phases to address these issues. The lack of data on pre-existing mental health conditions could mean that some individuals identified with PTSD post-accident might have had a predisposition to mental health issues, thus skewing the PTSD prevalence upwards. Similarly, unmeasured data regarding witnessing death or social support could either exacerbate or mask PTSD symptoms. Research that includes a comprehensive assessment of mental health history has reported lower PTSD prevalence, suggesting that unmeasured pre-existing conditions in this study might contribute to higher PTSD rates. Future studies should aim to include comprehensive baseline assessments of mental health and social support to better isolate the impact of RTAs on PTSD development.

The high prevalence of PTSD among RTA survivors underscores the need for comprehensive trauma care that includes psychological assessment and intervention. Emergency physicians and trauma surgeons should be trained to recognise PTSD symptoms and refer patients to mental health services. Additionally, policies should be implemented to provide financial and social support to low-income and less-educated survivors to mitigate the impact of trauma.

Future research could focus on long-term psychological outcomes, the efficacy of early nursing interventions or supportive therapies on mental health, and the longitudinal impact of PTSD among this population. Additionally, this study serves as a foundation for health policy reform, which could strengthen psychiatric nursing care for emergency patients. By focusing on high-risk factors and high-risk groups, there is significant potential to improve the quality of life for RTA victims through effective and timely nursing care.

This research can be essential in psychiatric nursing, aiding the development of educational curricula and training programs for nurses. Lastly, it emphasises the role of nurses in providing comprehensive trauma care for RTA victims.

This study was conducted on a small scale and used non probability sampling techniques, which limits the generalisability of study results beyond the research settings. Additionally, the study’s cross-sectional design limits the ability to establish causality between the identified factors and PTSD. Longitudinal studies are needed to track the development of PTSD over time and identify long-term predictors. Future research should also explore the effectiveness of early interventions and support systems in reducing the prevalence of PTSD among RTA survivors.

The findings indicate that 46.3% of PTSD symptoms among RTA victims are influenced by socio-demographic and clinical factors. Addressing the psychological impact of RTAs through integrated trauma care and support systems is crucial for improving the quality of life for survivors and reducing the long-term burden on healthcare systems. This study emphasises the need for nursing interventions for PTSD symptoms among RTA victims, highlighting the necessity of incorporating these practices into nursing care. The high occurrence of PTSD symptoms also identifies a lack of mental health services in trauma care, as health workers are more engaged in providing treatment for physical injuries. In light of these results, a multidisciplinary approach is suggested for psychiatric evaluation and tailored therapeutic strategies.