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Accident proneness as an expression of self-destructiveness

(2007) Visser, Ellen

This thesis examines the association between accident proneness and (un)conscious self-destructiveness in a sample of injury repeaters attend-ing a Dutch emergency department. Accident proneness is the concept used to explain the observation that accidents tend to cluster within indi-viduals. It refers to the tendency of an individual to experience more ac-cidents than otherwise identical individuals (in terms of basic personal characteristics like age, gender and place of residence), due to stable per-sonality characteristics. Accident-prone individuals suffer from their inju-ries and they use a disproportionate part of medical services due to their injuries. This makes these individuals an important target in injury pre-vention.

Accident proneness
The concept of accident proneness has been and still is the subject of much debate. Therefore, this thesis starts with the investigation of the mere existence of the concept. Chapter 2 presents a review of definitions and operationalisations used in various studies concerning accident proneness. Definitions, operationalisations, and subject characteristics varied highly among these studies. Therefore, this chapter provides no overall estimate of the prevalence of accident proneness. However, by meta-analysis of empirical data of eight studies of the general population, the number of observed accident repeaters is higher than the number ex-pected by chance. Thus, an accident-prone group indeed exists. Next, the question emerges how these accident-prone individuals can be identified, since the majority of accident repeaters experience accidents due to mere bad luck.

Injury circumstances
This second methodological issue is investigated in Chapter 3. The group of accident repeaters is probably a heterogeneous one. Not all accident repeaters can be marked as accident-prone, because some of them may experience accidents solely due to bad luck or behaviours of others. This suggests that examining accident or injury circumstances may help to identify repeaters with accidents that occur mainly because of their own behaviours. Therefore, we compare a sample of injury repeaters and sin-gly injured patients attending an emergency department on injury cir-cumstances. Injury circumstances include injury environments such as home and traffic and include the influence of patients’ own behaviours on injury causation. In injury repeaters, patients own high-risk behaviours such as aggressiveness, alcohol, and medication use, are more often in-volved in injury occurrence than in singly injured patients. This differ-ence is especially present in environments in which these behaviours most frequently occur, namely in nightlife and at home.

Mood and anxiety disorders
These findings indicate that high-risk behaviours may play a role in acci-dent proneness. This raises the question whether accidents are the result of unconscious self-destructive tendencies, as illustrated by the everyday expression ‘accidentally on purpose’. Since self-destructive tendencies or intentional injuries are associated with mental illnesses, we compare a sample of the general population with injury repeaters on the prevalence of mood and anxiety disorders in Chapter 4. In high-risk behaviour injury repeaters, the prevalence of mood and anxiety disorders is higher than in a sample of the general population. This association is independent of the presence of alcohol dependence.

Self-destructiveness
Thus, accident proneness shares correlates with intentional injury occur-rence. Accident proneness as an expression of self-destructiveness implies that accident proneness is associated with conscious self-destructive ten-dencies such as deliberate self-harm and suicide attempts. Less evident self-destructive tendencies such as an unhealthy lifestyle may also be as-sociated with accident proneness. The position of accident proneness on a continuum of self-destructiveness is investigated in Chapter 5. We com-pare the prevalence of suicidal ideation and unhealthy lifestyles in injury repeaters and self-harmers with a sample of the general population. The results of this study reveal that injury repeaters can be placed between individuals of the population and individuals with intentional injuries on a continuum of self-destructive tendencies. Accident proneness may thus be regarded as an expression of self-destructiveness.

Implications of this study
In this study, we find accident proneness to be associated with high-risk behaviours, mood and anxiety disorders, and (un)conscious self-destructive tendencies. However, in the future, longitudinal research is needed to investigate the causality between these potential risk factors and accident proneness. Based on the results of those studies, prospective intervention studies can be developed targeting underlying risk factors which may prevent other health problems as well.

	Title and contents
	Chapter 1
	Chapter 2
	Chapter 3
	Chapter 4
	Chapter 5
	Chapter 6
	References
	Summary
	Samenvatting
	Dankwoord
	Curriculum vitae
	Publicaties
	Complete thesis