Indian Journal of Social Psychiatry

ORIGINAL ARTICLE
Year
: 2022  |  Volume : 38  |  Issue : 2  |  Page : 161--167

Assessing the quality of life among nonfatal road traffic accident victims by using WHO-QOL-BREF


Suchismita Mishra1, Bontha V Babu2, Palaniappan Marimuthu1,  
1 Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
2 Division of Socio-Behavioural and Health Systems Research, Indian Council of Medical Research, New Delhi, India

Correspondence Address:
Prof. Palaniappan Marimuthu
Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru - 560 029, Karnataka
India

Abstract

Background/Objectives: Road traffic accident affects people more in terms of disability with prolonged treatment than premature death. More people suffer from nonfatal injuries, with many incurring a disability as a result of their injury. The study aims to report the quality of life among nonfatal road traffic accident victims of Karnataka state, India. Methodology: Consecutive data of 6 years (2013–2018) on road traffic injuries of the state of Karnataka were collected from the States Crimes Records Bureau of Karnataka. The contact details of victims categorized as nonfatal were traced out. Finally, 286 nonfatal cases were selected as respondents. Data were collected using WHO-QOL-BREF questionnaire to measure the quality of life. Results: The better quality of life in all the four domains, that is, physical health, psychological health, social relationships, and environmental health, was found among the less injured category of victims. There was a statistically significant difference (P < 0.05) among the different categories of accidents as well as the types of postaccident occupation of the respondents for all the four domains. A significant variation was found across different age groups for the physical health domain. Respondents of below 18 years were found with the better mean score for all the domains. Similar differences are observed for education for all the domains, except the social relation domain. The Mann–Whitney U-test revealed a significant difference between those who received the compensation and those who did not receive the compensation for the psychological domain. Conclusions: The study warrants policy-related measures with ease of compensation procedures by simplifying the insurance processes and counseling. Indeed, rehabilitation measures need to be taken seriously by the government as the support system is vital for the improvement for quality of life among road traffic accident victims.



How to cite this article:
Mishra S, Babu BV, Marimuthu P. Assessing the quality of life among nonfatal road traffic accident victims by using WHO-QOL-BREF.Indian J Soc Psychiatry 2022;38:161-167


How to cite this URL:
Mishra S, Babu BV, Marimuthu P. Assessing the quality of life among nonfatal road traffic accident victims by using WHO-QOL-BREF. Indian J Soc Psychiatry [serial online] 2022 [cited 2022 Sep 30 ];38:161-167
Available from: https://www.indjsp.org/text.asp?2022/38/2/161/349352


Full Text



 Introduction



Road traffic accident is one of the most critical public health problems, especially in developed and developing countries. Globally, it was estimated that road traffic accident is the eighth leading cause of death[1] and projected to be the third leading cause of disability-adjusted life years by 2020.[2] The World Health Organization also emphasized that more people suffer from nonfatal injuries with many incurring disabilities due to road traffic accidents.[3] India, as a developing country, is not exempted from this situation.

The victims, as well as their family, have to undergo many changes due to road traffic accident such as physical impairment, socioeconomic complications, and mental health issues. Quality of life is an important component to assess the health condition of an individual. The WHO defines the quality of life as individuals' perception of their position in life in the context of the culture and value systems in which they live and concerning their goals, expectations, standards, and concerns. Conceptually, it is a broad concept, which affects in a complex way by the individuals' physical health, psychological state, level of independence, social relationships, personal beliefs, and their relationship to salient features of their environment. WHO QOL-100 was the first instrument developed by the WHO to measure the quality of life of individuals. Later, the instrument was revised to WHO QOL-BREF instrument.[4]

Some studies pointed out the association between road traffic accidents and the combined effects of the economic, physical, and psychological conditions of the victim. Globally, road traffic injuries (RTIs) resulted in economic loss up to $518 billion, which is 3% of the gross domestic product of most countries, but it is >3% for low- and middle-income countries.[2],[5] RTIs result in long-term consequences with disabilities more than premature death.[6] Serious injuries many times become the surviving likelihood while reducing the road fatalities.[7] There are relatively few studies available which have particularly examined the physical and psychological outcomes of road injury and its impact on the quality of life.[8] The functional capacity of work is majorly impacted on an individual negatively due to RTIs.[9] Psychologically, the victim of RTI may develop some disorders such as posttraumatic stress disorder and depression.[10],[11],[12]

Many studies witnessed that majority of the road traffic accident victims suffer from various types of injuries and disabilities. However, not only the victim but also the family members of the victim have to undergo some stress and obviously, it affects their quality of life. In India, there is a dearth of literature available on road traffic accident victims and their quality of life in terms of economic, physical, psychological, and environmental conditions. Hence, the present study was carried out among road traffic accident victims of Karnataka state and their quality of life using the WHO-QOL-BREF questionnaire.

 Methodology



Sample size

The sample size was calculated using the following formula: (P × [1 − P] × Z2]/ε2. By considering P = 0.5 and a = 0.04, if P is 0.5, this absolute method will give maximum sample size, calculated as 600. Six consecutive years of data (2013–2018) on road traffic accident victims were collected from the States Crime Records Bureau of Karnataka (SCRB). Altogether, there are 243,840 cases registered under SCRB, Karnataka, during the 6 years. All the available contact details of the victims were traced out with equal proportion weight given. Totally, 1174 victims' contact numbers were available. The available contact numbers were checked for confirmation and subsequently, the concerned person was contacted to find out his/her exact location. The oral consent of the concerned person was also taken while checking the contact number to make smooth the data collection process. Some of the contact numbers were not valid and another few people denied sharing the details about the accident. These respondents were dropped out of the sample selection. Hence, finally, 286 nonfatal cases were selected as respondents with the help of purposive sampling method.

Tools used for data collection

Demographic and socioeconomic data such as age, sex, economic standard, treatment provided, and expenditure were collected by using the questionnaire. A quality of life (WHO-BRIEF-QOL) tool was used (Field Trial version, 1996) after obtaining approval from the WHO (for both English and Kannada versions) to identify the road traffic accident victims' quality of life after the accident, which includes four broad domains, namely, physical health, psychological health, social relationships, and environmental health. The consent form for the sampled respondents was developed. All these survey tools, that is, questionnaire and consent form, were translated into Kannada languages (local language of the state of Karnataka). The translation work was verified by the publication department of the first author, that is, National Institute of Mental Health and Neurosciences (NIMHANS). A broad classification of concepts for impairment, disability, and handicap (as consequences of the accident) was incorporated in the questionnaire. For clarity, these concepts were noted in the questionnaire for easy understanding in the following manner. Impairment denotes any loss or abnormality of psychological, physiological, or anatomical structure or function. Disability denotes any restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being. Handicap denotes a result when an individual with an impairment cannot fulfill a normal life role. The interviews were conducted face to face by the field assistants by door-to-door visit. No screening instrument was used to rule out mental disorders of the respondents during data collection. However, dependents were asked whether they were mentally stable to answer the questions or not before starting the interview. In case the victim was found with a mental disorder, the victim was dropped out of the interview.

Data analysis

The data were translated into English from Kannada and subsequently, they were entered into MS-Excel. The analysis was done in SPSS version 22 (IBM Corp., Armonk, NY, USA). Out of 286 respondents, 282 answered the WHO-QOL questionnaire completely (<20% data were missing). The data were fixed for analysis (as per the guidelines, if >20% of data were missing from an assessment, the assessment should be discarded). For analysis, the transformed score was obtained. The transformed scores were calculated by following the first transformation method (converting the scores to range between 4 and 20).

 Results



[Table 1] provides the data on the relationship between the four domains and the consequences of the accident. It is evident from the table that among the four domains, the mean score of social relationship domain was found highest (>12) followed by psychological well-being (approximately 7) as compared to the rest of the three domains. Respondents of 'nothing happened much much' were found with a better quality of life for all the four domains (the mean score for physical health domain was 7.60 ± 1.15, that of psychological well-being domain was 8.17 ± 1.29, that of social relation domain was 16.46 ± 3.46, and that of environmental health domain was 5.83 ± 0.78). Whereas, the handicap category of respondents was found with least mean score for all the four domains. There was a statistically significant difference between the types of consequences of road traffic accident as demonstrated by the one-way ANOVA for all the domains, that is, physical health (P < 0.000), psychological well-being (P < 0.000), social relation (P < 0.000), and environmental health (P < 0.012). The post hoc test indicated that nothing happened category of respondents was found to be statistically significant to all the domains.{Table 1}

From [Table 2], it is evident that, among the types of houses, the katcha category of respondents had the highest mean value (7.18 ± 1.31) especially for both physical health and social relation domains. However, very less difference was found in the mean score among the types of houses for the psychological well-being and environmental health domains. The ANOVA indicated that there was no significant difference among the types of houses and the quality of life of the respondents.{Table 2}

Concerning the ownership of the house, it is found from [Table 3] that the free category of respondents had the lowest mean score and the rental category of respondents had the highest mean score for all the four domains of quality of life. There was a statistically significant difference between the ownership of the house for the psychological well-being (0.012) and social relationship domains (0.020).{Table 3}

[Table 4] reports the quality of life with regard to their caste affiliation. There was no significant difference between the various caste groups with their quality of life. However, the general caste respondents were found with a high mean score in all the domains except in social relation domain.{Table 4}

It is evident from [Table 5] that the highest mean score is found among the below 18-year-old category of respondents for all the four domains, that is, 12.30 ± 2.50, 11.40 ± 1.87, 11.94 ± 3.14, and 10.71 ± 1.83, respectively. However, the respondents belonging to 51–70 years' category were found with a low mean score if comparison was made between the different age categories among all the four domains of quality of life. There was a significant difference between the different age categories with the physical domain (0.018) and social relation domain (0.005).{Table 5}

[Table 6] provides the data on the distribution of respondents in terms of their education and quality of life. The respondents who studied up to primary level were found with a low mean score in all the four domains, whereas the higher studies respondents were found with higher mean score in all the four domains. There was a significant difference between the different educational qualification categories of respondents for the physical domain (0.004), psychological well-being (0.000), and environmental health domains (0.012).{Table 6}

It is evident from [Table 7] that the not working category of respondents had the lowest mean score for all the four domains. There was a significant difference between the different categories of occupation for all the dour domains (<0.05). It can be observed from [Table 8] that there is no significant difference between males and females with regard to the quality of life in all the four domains. It is evident from [Table 9] that the victims who received some compensation have higher mean scores in all the domains than those who have not received any compensation. The Mann–Whitney U-test revealed that these differences were statistically significant (P = 0.021) for the psychological domain.{Table 7}{Table 8}{Table 9}

 Discussion



The study found that the respondents who had minor accidents were found with a higher quality of life compared to those in the other categories such as impairment, disability, and handicap. The difference between the categories of accidents was found significant for all the four domains. This is obvious as the duration of recovery from minor injuries may take less time as compared with that of the other categories of injuries. However, there is no doubt that all the accidents whether it is minor or critical have a negative effect on the victim's quality of life. A few studies also reported similar findings where they focused that critical/severe road traffic accident victims have a low quality of life.[13],[14] People who suffered from RTIs perceived that their health-related quality of life is low as their mobility is impacted negatively and their daily routines are effected.[15] Another study found that pain severity and interference with daily life were related significantly to lower health-related quality of life among road traffic accident victims.[16] A study done by Hasselberg et al.[17] concluded that minor and moderate road traffic accident victims had long-term life consequences in terms of physical, psychological, and financial issues. Among the caste category, the general caste people were found at a better position with regard to the quality of life compared to the other castes such as scheduled caste, scheduled tribe, and other backward class, who are found as socially disadvantaged groups. This could be the reason why a better coping strategy including better financial stability exists among the general caste category than the other castes. There was a significant difference between the age groups for physical health and social relationship domains. Concerning the ownership of the house, there was a significant difference between psychological and social relation domains. The respondents belonging to lower age category (below 18 years) were found in an advantageous position in their mean score of quality of life as compared with the other age category counterparts. With regard to the differences in quality of life between younger and older population, post road traffic accident, some studies have witnessed different results. Gopinath et al.[18] found a similar observation from their study. They also highlighted that poorer self-perceived health is observed in older population compared to younger population. However, some other factors such as biological and social support network play a major role in the scenario, while Andersen et al.[19] found no significant difference among the older and younger generations.

Except for social relation domain, there was a significant difference in the quality of life based on education. Respondents belonging to higher educational standard category were found with a higher quality of life and vice versa, whereas in a study done by Veeri et al.,[20] it was found that only in physical domain, there was a significant difference concerning education and the reason cited was, as higher education standard people are more concern about their health, they might have more knowledge toward the disease. Similar findings were obtained from another study done by O'Connel et al.[21] among HIV patients. Significant difference exists among different occupational groups for all the four domains of quality of life. However, not-working category of respondents had a lower mean score in all the four domains. This is probably due to the fact that the prolonged injury might have affected the ability to perform the job. Few studies have similar findings supporting RTI victims' failure to return to work.[22],[23],[24]

The study respondents received the compensation amount through vehicle insurance only. There was a significant difference with regard to psychological health. The physical aspect of quality of life has not been much influenced by the reception of compensation. This indicates that their physical health does not improve despite having compensation. This could be due to the severity of the injury. Getting compensation through insurance processes takes a long time. In this regard, the study carried out by Harris et al.[25] pointed out that numerous compensation-related procedures, such as claim duration, medical assessments, and lawyer engagement, have negative impacts on health.[26] Returning to normal life is a complex process and is difficult. The victims require a lot of support including access to required training and support from the system as well as from the family and community to return to normal life.[27] In this regard, compensation plays a major role, particularly in dealing with the economic burden. Simplifying the insurance processes, and counseling and rehabilitation measures are to be addressed by the government. Policy changes related to these issues are required to improve the quality of life of the road accident victims. Much more studies are required to explore the quality of life, particularly among nonfatal road traffic accident victims in the Indian context.

 Conclusions



The present study confirms that the quality of life of the nonfatal road traffic accident victims is not found at a satisfactory level. The quality of life of victims who had mild injuries was found better than the victims who suffer from disability, handicap, and impairment. A significant difference in postaccident occupation was observed with regard to quality of life, which indicates that they are unable to perform their job and have a significant impact on their overall physical, psychological, social, and environmental health. Though a very small proportion of victims received the compensation, they reported a better quality of life compared to the rest. This study suggests that the quality of life of the road traffic accident victims can be improved with a better compensation method by adopting a hassle-free procedure. This study warrants an immediate development of health policy focusing on counseling and rehabilitation of the road traffic injury victims.

Limitations of the study

The study includes data of 6 (2013–2018) consecutive years which were collected at a single point of time. Hence, some of the respondents had enough time to recover and others could be in the acute phase of their injury. This is one of the limitations of the study. However, majority of the victims have almost recovered and completed their treatment and some of them are in the process of adjusting with the situation.

Ethical approval

The study was approved by the Institutional Ethical Committee of the NIMHANS, Bengaluru, India.

Financial support and sponsorship

The study was funded by the Indian Council of Medical Research, New Delhi, India.

Conflicts of interest

There are no conflicts of interest.

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