Psychological Distress and Utilization of Psychological Treatment Following Motor Vehicle Accidents

Psychological Distress and Utilization of Psychological Treatment Following Motor Vehicle Accidents | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 14 November 2025 V1 Latest version Share on Psychological Distress and Utilization of Psychological Treatment Following Motor Vehicle Accidents Authors : Franziska Epe-Jungeblodt 0000-0002-9931-1532 [email protected] , Katja Bertsch , and Marta Andreatta Authors Info & Affiliations https://doi.org/10.22541/au.176311996.69181838/v1 172 views 103 downloads Contents Abstract Introduction Materials and Method Procedure Measures Data analysis Results Potential barriers to treatment utilization Continuities in treatment utilization Trajectories of psychological distress Discussion Data availability Funding information Conflict of interest disclosure Ethics approval and participant consent Supplementary Material References Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Objective: Motor vehicle accidents (MVAs) increase the risk for mental disorders, yet many affected individuals do not receive adequate treatment. This study examined distress trajectories, help seeking behavior, and perceived barriers among MVA-exposed and unexposed individuals over 12 months. Methods: Individuals with ( n = 63) and without MVA exposure ( n = 108) completed two online surveys 12 months apart. Psychological distress was assessed using the Brief Symptom Checklist and the Posttraumatic Stress Disorder Checklist for DSM-5. Utilization of psychological treatment and perceived barriers were also measured. Analyses compared distress between groups, tested whether baseline distress mediated the effect of MVA exposure on treatment utilization, examined distress changes related to treatment, and compared barriers across groups. Results: MVA-exposed individuals reported higher distress than unexposed individuals ( d = 0.54, CI [0.24,0.87]) and exposure indirectly predicted treatment utilization through elevated distress ( b = 0 . 23, CI 0 . 04, 0 . 43 ). However, the total effect ( b = - 0 . 01, CI - 0 . 63, 0 . 60 ) of MVA exposure on treatment utilization was not significant. No group differences emerged in perceived barriers. Over time, psychological treatment predicted greater distress reduction specifically among MVA-exposed individuals ( b = -0.73, CI - 1 . 35, - 0 . 11 ). Conclusion: Despite elevated distress, MVA-exposed individuals did not receive psychological treatment more often than controls. Among those exposed, treatment was associated with greater distress reduction over time. Identifying MVA-specific barriers to treatment is essential to improve targeted outreach and prevent chronic courses of post-MVA psychological distress. Introduction Motor vehicle accidents (MVAs) are among the most common traumatic events worldwide (Benjet et al., 2016). In the European Union, 20,380 deaths due to road traffic accidents were recorded in 2023, the majority of which included motor vehicles (European Commission, 2025; Eurostat, 2025). MVAs can result in severe and persistent psychological distress. Epidemiological studies estimate that approximately 26% of MVA-exposed individuals develop posttraumatic stress disorder (PTSD, Bhateja et al., 2025), with major depression and anxiety disorders also frequently observed (Kovacevic et al., 2020). Nearly half of those affected still meet criteria for at least one mental disorder two years after the MVA (Kenardy et al., 2018), underscoring the high risk of chronicity. These findings emphasize the urgent need for timely and effective interventions to mitigate psychological distress following MVAs. Psychological treatment, particularly cognitive-behavioral therapy, is an effective treatment for MVA-related PTSD (Maercker et al., 2006) as well as depression (Cuijpers et al., 2021), and anxiety disorders in general (Carpenter et al., 2018). However, mental disorders remain widely undertreated (Brandstetter et al., 2017) and individuals suffering from MVA-related mental disorders may have difficulties to receive psychological treatment (Auerbach & Surges, 2019). Understanding why treatment rates remain low is essential for reducing barriers, improving access, and preventing chronic distress following MVAs. Yet, to date, no study has systematically compared utilization of psychological treatment and barriers between MVA-exposed and unexposed individuals. A range of psychological and structural barriers to mental health care have been identified. Low mental health literacy, i.e. the limited knowledge about mental disorders, their symptoms, and treatments, predicts reduced help-seeking in both trauma-exposed and general populations (Kantor et al., 2017). Stigma, including fears of negative consequences if one’s mental health problems become known, is another frequently reported barrier (Schomerus et al., 2019). Some individuals turn to maladaptive coping strategies, such as self-medication (Hawn et al., 2020), which may inhibit functional coping strategies, such as help-seeking, although findings are inconsistent (Sheerin et al., 2016). Trauma-specific barriers, such as fear of discussing the accident in therapy, may also deter treatment, though their relative importance remains unclear (Kantor et al., 2017). Structural and organizational factors can further impede access. These include anticipated costs, time demands, travel distance, and limited treatment availability (Kantor et al., 2017). In Germany, long waiting times, averaging 20 weeks, pose a significant obstacle (Singer et al., 2022). Facilitators of help-seeking behavior include positive prior experiences with health care providers, encouragement from social networks, and previous psychological treatments, whereas negative experiences or discouragement may inhibit it (Schreiber et al., 2009). Socio-demographic and cultural factors are also relevant: Conformity with traditional male gender roles, older age, low socioeconomic status, and migration history have each been associated with lower mental health care utilization in the general population (Kamali et al., 2023; Loef et al., 2021; Seidler et al., 2016; Wuthrich & Frei, 2015). However, these factors have not been systematically investigated in MVA-exposed samples, which encompass more men than women (Statistisches Bundesamt (Destatis), 2022). In summary, MVA exposure is associated with elevated risk for persistent psychological distress, yet treatment utilization remains low. Numerous psychological, structural, and socio-demographic factors may help explain this treatment gap, but evidence on MVA-specific barriers is lacking. The current longitudinal study compared psychological distress, utilization of psychological treatment, and perceived barriers between MVA-exposed and unexposed individuals at two time points 12 months apart. Based on prior research, we expected higher initial distress in MVA-exposed individuals. We further hypothesized that higher initial distress would predict a greater probability of treatment utilization over the following 12 months and tested whether distress mediated the link between MVA exposure and treatment utilization. We explored whether MVA exposure was associated with distinct perceived barriers to psychological treatment. Finally, we hypothesized that previous psychological treatment would predict continued utilization and that individuals engaging in psychological treatment during the study period would show greater reductions in psychological distress than those who did not. Materials and Method Participants Data were drawn from a larger project on MVA-related psychological distress and driving performance (Tomzig et al., 2024), which included a baseline online survey, a face-to-face interview, and a driving performance test (the latter not considered here). The baseline survey and interview together formed the first measurement time point (T0). All participants were invited to complete a follow-up online survey (T1) one year after baseline. The study was approved by the local ethics committee of the Department of Psychology. Inclusion criteria were: (1) age 17–70 years, (2) possession of a valid car driver’s license, (3) self-identification as an active driver, and (4) either experience of a severe MVA as driver or passenger within the past 3–30 months or no lifetime MVA experience. An MVA was defined as severe if it involved at least one injury or required vehicle towing. The target sample size for the original project was based on feasibility, aiming for \(\geq\) 40 MVA-exposed participants and\(\geq\) 40 matched unexposed controls (matched on gender, age, driving experience, and familiarity with the local road network). Participants were recruited via online advertisements and a participant panel. Recruitment for the baseline survey was closed once 41 MVA-exposed participants and their matched controls had completed the interview. A sensitivity analysis was conducted to determine the minimum detectable effect size. For the present analyses, all individuals who completed the T0 online survey were included. The sample at baseline comprised N = 171 participants (Figure 1), of whom 82 (48.0%) completed the interview. At T1, 90 participants (52.6%) completed the follow-up online survey, and 53 (31.0%) completed all three components. Figure 1. Flow chart for the sample size through the baseline online survey (T0 online survey), face-to-face interview (T0 interview), and follow-up online survey (T1 online survey), indicating the number of participants in each study component along with the number of participants who dropped out between the study components. Sociodemographic characteristics are presented in Table 1. Among interview participants, 18 (22.0%) met diagnostic criteria for an affective disorder, anxiety disorder, or PTSD. Table 1 Sample characteristics at baseline Age ( SD ) 33.70 (15.27) 34.78 (14.44) Gender male 34 (54.0%) 39 (36.1%) female 29 (46.0%) 69 (63.9%) Months since MVA 16.94 (12.20) (missing) 1 108 Years of education less than 9 years 2 (5.4%) 0 (0.0%) 9 years 1 (2.7%) 2 (3.0%) 10 years 9 (24.3%) 20 (29.9%) 12 to 13 years 25 (67.6%) 45 (67.2%) (missing) 26 41 SES Index low 0 (0.0%) 2 (4.4%) medium 20 (76.9%) 28 (62.2%) high 6 (23.1%) 15 (33.3%) (missing) 37 63 Hometown size (inhabitants) 1 7 (20.0%) 11 (18.0%) 2 10 (28.6%) 24 (39.3%) 3 3 (8.6%) 4 (6.6%) 4 15 (42.9%) 22 (36.1%) (missing) 28 47 Migration history no migration 27 (93.1%) 49 (96.1%) first generation 0 (0.0%) 1 (2.0%) second generation 2 (6.9%) 1 (2.0%) (missing) 34 57 Lifetime number of therapies 0 34 (82.9%) 37 (90.2%) 1 3 (7.3%) 3 (7.3%) 2 4 (9.8%) 1 (2.4%) (missing) 22 67 Note. MVA: Motor vehicle accident, months since MVA: months between MVA and T0 online survey (reported for MVA group only), SES Index: socioeconomic index classification, lifetime number of therapies: lifetime number of reported therapies before the MVA (MVA group) or more than 30 months prior to T0 (no MVA group). M ( SD ) for metric variables, n (%) for categorical variables. Procedure Eligibility and matching criteria were verified at survey entry. The T0 survey assessed MVA characteristics (for exposed participants), current psychological distress, and current and lifetime help-seeking behavior. Participants, who had experienced an MVA within the past 3–30 months, along with matched controls, were invited to a face-to-face interview with a clinical psychologist on average, 6.70 ( SD = 8.67) weeks after the T0 online survey. The interview included a structured clinical assessment for DSM-5 disorders, a detailed mental health treatment history, and questionnaires on self-medication and perceived barriers to psychological treatment. MVA-exposed participants additionally completed a structured interview on accident characteristics. Participants received $100 for completing the interview and driving performance test. All T0 survey participants were re-contacted 12 months later to complete a follow-up online survey (T1). This follow-up survey assessed socioeconomic status and migration history and re-assessed current psychological distress, past-year and current help-seeking behavior, self-medication, and perceived barriers to psychological treatment. Participants received $10 for completing the T1 online survey. Measures Help-seeking behavior, barriers towards psychological treatment, and self-medication were assessed via self-generated materials. These are available on OSF ([anonymized]). Psychological distress. Distress was assessed at T0 and T1 with the Brief Symptom Checklist , German version (BSCL, Franke, 2017) and the Posttraumatic Stress Disorder Checklist for DSM-5 , German version (PCL-5, Krüger-Gottschalk et al., 2017). The BSCL is a 53-item self-report measure rated on a 5-point Likert scale (0 “not at all” to 4 = “very strongly”), yielding a Global Severity Index with excellent internal consistency in the present sample (\(\alpha_{\text{sample}}\) = .97). The PCL-5 assesses current PTSD symptoms with 20 items rated on a 5-point scale (0 “not at all” to 4 = “very strongly”), producing a total score with excellent internal consistency (\(\alpha_{\text{sample}}\) = .95). Mental disorder diagnosis. Current mental disorders were assessed at T0 with the Mini-DIPS Open Access (Margraf & Cwik, 2017), a structured clinical interview for DSM-5 disorders. We focused on PTSD, anxiety disorders, and mood disorders, consistent with prior research linking these conditions to MVA exposure. Help seeking behavior. Current and past help-seeking from six formal sources (telephone counseling, face-to-face counseling, non-medical practitioner, general practitioner, psychiatrist, clinical psychologist) and three informal sources (partner, family, friends) were assessed at T0 and T1 with nine dichotomous self-generated items (“Have you sought help from any of the following persons because of psychological difficulties?”). During T0 interviews, participants reported all episodes of mental health service utilization, including duration, primary problem domain, and providers consulted. Barriers towards psychological treatment. Perceived barriers were assessed at T0 and T1 with 14 self-generated items (e.g., “There are not enough clinical psychologists in my area.”) rated on a 5-point Likert scale (0 “totally disagree” to 4 “totally agree”). Self-medication. Substance use for coping was assessed at T0 and T1 with six self-generated items (e.g., “I drink alcohol.”) rated from 1 (“never”) to 5 (“daily”). Socioeconomic status. Education, occupation, and income were assessed at T1 and combined into a composite index (range: 3–21) reflecting low, medium, or high socioeconomic status (Lampert et al., 2018). MVA characteristics. Accident characteristics, injury-related disability, and accident-related fear and avoidance were assessed at T0 with the Accident Fear Questionnaire Accident Fear Questionnaire (AFQ, Kuch et al., 1995). The avoidance subscale (10 items, 9-point Likert scale from 0 “Would not avoid it” to 8 “Always avoid it”) demonstrating good internal consistency (\(\alpha_{\text{sample}}\) = .89). Additional details were obtained during the T0 interview with the Motor Vehicle Accident Interview (Blanchard & Hickling, 2004), a 47-item structured interview with open-ended, categorical, and Likert-format responses. Data analysis Analyses were conducted in R (Version 4.4.2; R Core Team, 2023) and the R-packages lavaan (Version 0.6.19; Rosseel, 2012), lme4 (Version 1.1.36; Bates et al., 2015), papaja (Version 0.1.3; Aust & Barth, 2023), and performance (Version 0.13.0; Lüdecke et al., 2021). Mean scores of the scales were calculated if \(\geq\) 50% of items were completed, with missing items imputed by the individual’s scale mean (Newman, 2014). Dichotomous variables for time point, MVA exposure, and help-seeking behavior were dummy-coded. Analyses were conducted with available data (listwise deletion per analysis). Missingness ranged from 0.0% to 52.6% and was mainly due to non-participation in interviews or follow-up surveys (Supplemental Table 14). Significance was set at \(\alpha\) = .05, and p -values and confidence intervals were Bonferroni corrected. First, psychological distress at T0 was compared between MVA-exposed and unexposed individuals using independent-samples t -tests. Logistic regression was then applied to examine whether T0 distress predicted psychological treatment utilization during the following 12 months. A mediation analysis with diagonally weighted least squares estimation was conducted to test whether the effect of MVA exposure on subsequent psychological treatment utilization was mediated by baseline distress. Perceived barriers to psychological treatment and self-medication at T0 were compared between MVA-exposed and unexposed participants using t -tests and Wilcoxon tests. Logistic regression was further used to test whether psychological treatment prior to T0 predicted utilization in the 12 months following T0 when controlling for distress at T0. Finally, linear mixed-effects models with fixed slopes and random intercepts for participants were applied to examine changes in psychological distress between T0 and T1. These models first compared individuals with and without psychological treatment in that period, and subsequently added MVA exposure and the interaction between psychological treatment and MVA exposure to test for differential effects. Results Elevated psychological distress following MVA experience We first tested whether individuals with MVA experience reported greater psychological distress at T0 than unexposed controls. As expected, MVA-exposed participants reported significantly higher symptom severity than unexposed individuals on both the BSCL, \(t\)(87.09) = 3.21,\(p_{\text{Bonf}.}\) = .004, \(d\) = 0.54, and the PCL-5,\(t\)(96.41) = 4.07, \(p_{\text{Bonf}.}\) < .001, \(d\) = 0.68. Psychological distress as a predictor of treatment utilization In line with our hypothesis, higher psychological distress at T0 predicted a greater probability of psychological treatment utilization during follow-up (BSCL: \(b\) = 0.93, 98% CI\(\left[0.32,1.68\right]\), \(z\) = 3.14,\(p_{\text{Bonf}.}\) = .003, PCL-5: \(b\) = 1.54, 98% CI\(\left[0.62,2.66\right]\), \(z\) = 3.45,\(p_{\text{Bonf}.}\) = .001). Mediation analyses indicated that MVA exposure indirectly increased treatment utilization through higher BSCL scores at T0, \(b=0.23\), 95% CI\(\left[0.04,0.43\right]\), \(z=2.38\), \(p=.017\). Neither the direct, \(b=-0.25\), 95% CI\(\left[-0.83,0.34\right]\), \(z=0.83\), \(p=.405\), nor the total effect, \(b=-0.01\), 95% CI\(\left[-0.63,0.60\right]\), \(z=0.05\), \(p=.963\), were significant (Figure 2). Comparable results were obtained with the PCL-5 (Supplemental Figure 5). Fit indices are not reported because the mediation models were saturated. Figure 2. Mediation between MVA exposure and psychological treatment utilization during follow-up via psychological distress (measured by the Brief Symptom Checklist, BSCL) at T0. Numbers indicate standardized linear regression coefficients. The direct effect of psychological distress at T0 on treatment utilization during follow-up is given in brackets after the total effect. *** p < .001, ** p < .01, * p < .05. Exploratory analyses of sociodemographic predictors are provided in the Supplemental Material. Potential barriers to treatment utilization Next, we compared perceived barriers between MVA-exposed and unexposed individuals at T0 (Figure 3). The most frequently endorsed barrier was “could not find a therapist” in both groups, followed by “fear of therapist rejection”, “fear of insurance-related disadvantages”, and “knowledge-related barriers”. Figure 3. Perceived barriers to psychological treatment for MVA-exposed and unexposed individuals at T0. Fear of carrier disadv.: fear of carrier disadvantages, fear of insur. disadv.: fear of insurance-related disadvantages. Higher values indicate stronger perception of the barrier. Grey points represent individual participant’s responses, colored points indicate means, error bars indicate 95% confidence intervals. Barriers with minimal endorsement (“distance to therapist’s office,” “dissuaded by a family member,” “dissuaded by a health care professional”, Supplemental Table 2) were excluded from further analyses. At T0, no significant group differences were observed in perceived barriers (all \(p_{\text{Bonf}.}\) \(\geq\) .364, Supplemental Table 3) or in self-medication frequencies (all \(p_{\text{Bonf}.}\)\(\geq\) .648, Supplemental Table 4). Among MVA-exposed participants, higher AFQ disability scores at T0 predicted greater treatment utilization during follow-up, \(b=0.85\), 95% CI \(\left[0.36,1.66\right]\), \(z=2.75\),\(p=.006\), and the effect remained significant when controlling for baseline distress (Supplemental Table 7). Continuities in treatment utilization As hypothesized, psychological treatment prior to T0 strongly predicted utilization during follow-up, \(b=2.68\), 95% CI\(\left[1.51,3.99\right]\), \(z=4.30\), \(p<.001\), and this effect remained robust after controlling for T0 distress,\(b=2.56\), 95% CI \(\left[1.19,4.11\right]\),\(z=3.51\), \(p<.001\) (Supplemental Table 8). Exploratory analyses further showed that contact with other mental health providers prior to T0 also predicted subsequent psychological treatment (Supplemental Table 9), and that individuals with psychological treatment prior to T0 reported fewer knowledge-related barriers at T0 (Supplemental Table 10). Trajectories of psychological distress Finally, we examined whether psychological treatment during follow-up was associated with a stronger reduction in psychological distress between T0 and T1. Contrary to expectations, linear mixed-effects models showed no stronger decrease in distress among participants with psychological treatment compared to those without (BSCL: \(b\) = 0.11, 98% CI \(\left[-0.08,0.29\right]\), \(t\)(90.37) = 1.29,\(p_{\text{Bonf}.}\) = .397, PCL-5: \(b\) = 0.14, 98% CI\(\left[-0.17,0.44\right]\), \(t\)(92.83) = 1.01,\(p_{\text{Bonf}.}\) = .635; Supplemental Table 11). In an exploratory model including MVA exposure, however, a significant three-way interaction between time, treatment utilization, and MVA exposure emerged for the PCL-5, \(b\) = -0.73, 98% CI\(\left[-1.35,-0.11\right]\), \(t\)(86.92) = -2.69,\(p_{\text{Bonf}.}\) = .017 (Supplemental Tables 11 and 12). Symptoms decreased among MVA-exposed individuals who received psychological treatment but increased among unexposed individuals receiving treatment (Figure 4). A similar descriptive pattern was observed for the BSCL, although the interaction did not reach significance, \(b\) = -0.36, 98% CI \(\left[-0.73,0.01\right]\), \(t\)(88.63) = -2.20,\(p_{\text{Bonf}.}\) = .060. Figure 4. Trajectories of psychological distress during follow-up on the Brief Symptom Checklist (BSCL, Panel A) and the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5, Panel B) in n = 105 participants with non-missing data on psychological treatment with and without a motor vehicle accident (MVA) and with and without psychological treatment (labeled as “treatment” and “no treatment”) in that period. Thin lines show individual participant’s trajectories, thick lines show model-predicted trajectories. Discussion Motor vehicle accident exposure is associated with persistent psychological distress, including PTSD, anxiety, and depression, yet access to effective treatments such as psychological treatment often remains limited. This study followed MVA-exposed and unexposed individuals across one year to examine differences in psychological distress, utilization of psychological treatment, and perceived barriers to treatment. We tested whether MVA-exposed individuals reported higher distress, whether their distress predicted subsequent treatment utilization, and whether barriers differed between exposed and unexposed groups. In addition, we explored continuities in treatment utilization and distress trajectories as a function of treatment status. Consistent with prior work (Bhateja et al., 2025; Kovacevic et al., 2020), MVA-exposed individuals reported substantially higher distress and PTSD symptoms than unexposed individuals, even though accidents occurred, on average, 18 months earlier. These findings underscore the elevated vulnerability of MVA-exposed individuals over extended periods of time and the need for early intervention to prevent chronification. As hypothesized, higher distress predicted a greater likelihood of psychological treatment over the following year, confirming that symptom burden drives help-seeking (Mack et al., 2014). The mediation analysis indicated that although MVA-exposed individuals reported increased distress compared to unexposed individuals, and distress in turn was associated with greater treatment utilization, they were not more likely to receive treatment overall. This suggests that additional factors, possibly unmeasured barriers, may counteract the link between MVA exposure and treatment utilization (Hayes, 2009). Yet in this study, neither perceived barriers nor self-medication frequency differed by exposure status. Notably, MVA-related physical disability predicted higher rather than lower utilization and did not appear as a barrier. Trauma-specific avoidance, such as fear of discussing the accident in therapy (Kantor et al., 2017; Schreiber et al., 2009), received little endorsement, suggesting it may not represent a major barrier in this context. It is possible that our assessment did not capture the most relevant barriers. Difficulties in recognizing trauma-related symptoms as indicators of a treatable disorder, reflecting low mental health literacy, are common, particularly for non-combat traumas (Merritt et al., 2014; Reavley & Jorm, 2011), but were not assessed here. Structural barriers, however, were strongly endorsed across groups, with difficulty finding a therapist and fear of rejection by therapists rated as the most prominent obstacles. These findings highlight persistent systemic challenges within the German health care system. Consistent with earlier studies (Schreiber et al., 2009), treatment utilization showed strong continuity: Individuals with prior psychological treatment or other mental health service contact were more likely to engage in psychological treatment during the study period. Prior treatment experience may enhance mental health literacy and familiarity with service pathways, lowering knowledge-related barriers, which were indeed less frequently reported among those with treatment history. Contrary to expectations, psychological treatment during follow-up was not associated with overall stronger distress reduction. Exploratory analyses indicated, however, that MVA-exposed individuals who received psychological treatment showed symptom improvements, particularly for PTSD symptoms, whereas unexposed individuals in therapy did not. This pattern might reflect differences in treatment focus and prognosis: MVA-related symptoms might be more acute and responsive to therapy (Maercker et al., 2008), while unexposed participants might have sought treatment for more chronic conditions, which are harder to treat (Köhler et al., 2019). Strengths and limitations Key strengths include the longitudinal design, which allowed us to prospectively examine distress and treatment utilization over one year, and the broad assessment of barriers derived from established literature. However, several limitations must be acknowledged. First, the observational design limits causal interpretation. Especially, MVA-exposed individuals might have differed in psychological distress already prior to the MVA. Second, the time since MVA varied widely and averaged over one year, which may have obscured post-accident effects. Third, the design was limited to two time points, constraining our ability to model temporal dynamics between distress, utilization, and barriers. Fourth, barriers were assessed with single, unvalidated items, which may have contributed to zero findings. Attrition at follow-up (52.6%) may also have biased results, with dropouts more likely among younger and non-interviewed participants (Supplemental Table 13). In addition, because participants were originally recruited for a driving performance study, the sample was restricted to active drivers, excluding individuals, who completely avoid driving post-MVA, a group likely at heightened risk for severe distress. Power analyses indicated sufficient sensitivity to detect medium effects (\(d\) \(\geq\) 0.45), but smaller effects of potential clinical importance may have been missed. Conclusion MVA-exposed individuals experience persistently elevated distress compared to unexposed individuals, and higher distress predicts subsequent utilization of psychological treatment. Yet, despite their greater symptom burden, MVA-exposed participants were no more likely to receive psychological treatment than controls. While this study did not identify MVA-specific barriers, structural obstacles and potential deficits in mental health literacy remain important candidates. Clarifying these barriers with validated measures will be essential to improve timely access to psychological treatment and to prevent chronic courses of mental health conditions in MVA-exposed individuals. Data availability Materials, as far as not restricted access by the publisher, and code to support the findings will be made publicly available on OSF upon publication. For review purposes, anonymized OSF links can be provided privately if permitted. Due to the sensitive nature of the data and the risk of re-identification, the data cannot be made publicly available. Funding information The authors received funding from the first author’s University (Faculty of Human Sciences Overhead Fund Number [anonymized]) and the Bundesanstalt für Straßenwesen, BASt ([anonymized]). Conflict of interest disclosure The authors declare no conflict of interest. Ethics approval and participant consent This research was approved by the Ethics Committee of the Department of Psychology at the first author’s university ([anonymized]). All subjects gave written informed consent in accordance with the Declaration of Helsinki (2013) and minors could participate only with parental consent. Supplementary Material File (figure 1.docx) Download 28.48 KB File (figure 2.docx) Download 24.93 KB File (figure 3.docx) Download 95.67 KB File (figure 4.docx) Download 45.72 KB File (table 1.docx) Download 17.99 KB References 1. Auerbach, K., & Surges, F. (2019). 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Keywords health care access mental health stress and trauma Authors Affiliations Franziska Epe-Jungeblodt 0000-0002-9931-1532 [email protected] Julius-Maximilians-Universitat Wurzburg Institut fur Psychologie View all articles by this author Katja Bertsch Julius-Maximilians-Universitat Wurzburg Institut fur Psychologie View all articles by this author Marta Andreatta Universitatsklinikum Tubingen Universitatsklinik fur Psychiatrie und Psychotherapie View all articles by this author Metrics & Citations Metrics Article Usage 172 views 103 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Franziska Epe-Jungeblodt, Katja Bertsch, Marta Andreatta. Psychological Distress and Utilization of Psychological Treatment Following Motor Vehicle Accidents. Authorea . 14 November 2025. DOI: https://doi.org/10.22541/au.176311996.69181838/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. 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