Motor vehicle accidents

Motor vehicle accidents and adolescents: An empirical study
on their emotional and behavioral profiles, defense strategies
and parental support
Luca Cerniglia a,⇑
, Silvia Cimino b
, Giulia Ballarotto b
, Elisa Casini b
, Anna Ferrari b
,
Paola Carbone b
, Mariangela Cersosimo a
a
International Telematic University Uninettuno, Italy
b
Sapienza, University of Rome, Italy
a r t i c l e i n f o
Article history:
Received 11 October 2014
Received in revised form 16 September
2015
Accepted 16 September 2015
Keywords:
Adolescence
Motorbikes collisions
Emotional–behavioral functioning
a b s t r a c t
Background: Research has limitedly focused on adolescents’ emotional–behavioral func-
tioning preceding road collisions and on the role of family support. Objective: To verify
whether the rates of motorbikes collisions among adolescents are associated with their
emotional–behavioral functioning, their use of specific defense strategies and family sup-
port. Method: N = 150 adolescents who visited an emergency department for road accidents
were selected and completed self-report questionnaires assessing emotional–behavioral
functioning, difficulty in identifying and describing emotions, use of defense strategies
and perceived family support. Results: Higher rates of motorbike collisions are associated
with more maladaptive emotional–behavioral functioning. Higher perceived family sup-
port is associated with lower rates of collisions. Conclusions: Recidivism of motor vehicle
collision among adolescents can be considered as a form of acting-out caused by their psy-
chological difficulties.
Ó 2015 Elsevier Ltd. All rights reserved.
1. Introduction
Unintentional injuries are reported as the largest cause of death among adolescents (aged 15–19) and more than sixty
percent of these injuries are consequences of motor vehicle collisions (MVCs). Nonfatal road crashes involve more than
1.5 million adolescents every year only in the US, who are treated in emergency departments and this trend has been stable
for decades (Sarma, Carey, Kervick, & Bimpeh, 2013). Adolescents are involved in a high number of collisions and they have a
three-times risk of crashes if compared to older drivers (Insurance Institute for Highway Safety, 2012). In Italy, road traffic
accidents are the first cause of death for people aged under 30% and 67% of these collisions involve adolescents driving
motorbikes, composing the second largest proportion in Europe after Greece (Marengo, Settanni, Vidotto, & Ciairano, 2012).
Most collisions are usually attributed to human errors, inexperience or other factors (such as alcohol or drug use, fatigue
or distraction). Drivers’ errors can be defined as unintended omission of actions, due to limited skill connected to fatigue and/
or to the use of mobile phones or other in-vehicle information systems (IVIS – especially during night hours) or deliberate
violations of safe practices and road rules, frequently associated to alcohol or drug use (Reason, Manstead, Stradling, Baxter,
& Campbell, 1990). Clarke, Ward, and Truman (2005) suggested that most adolescents willingly violate rules, by driving
http://dx.doi.org/10.1016/j.trf.2015.09.002
1369-8478/Ó 2015 Elsevier Ltd. All rights reserved.
⇑ Corresponding author at: Corso Vittorio Emanuele II, 39, 00100 Rome, Italy
E-mail address: l.cerniglia@uninettunouniversity.net (L. Cerniglia).
Transportation Research Part F 35 (2015) 28–36
Contents lists available at ScienceDirect
Transportation Research Part F
journal homepage: www.elsevier.com/locate/trf

through red traffic lights, intentionally missing stops and so forth. But recent research in this field has suggested that MVCs
are events with a much more complex etiology including personal characteristics and psychological functioning (Hole,
2008). It has been underlined that subjects with a borderline personality disorder frequently show reckless and impulsive
driving (First, Frances, & Pincus, 2002) and that antisocial personality disorders, ADHD, impulse control and obsessive–com-
pulsive disorders seem to be related to motor vehicles collisions. Moreover, other psychiatric conditions such as psychotic
disorders, mood disorders and sleep disorders have been connected to MVCs (Galovsky, Malta, & Blanchard, 2006). Adoles-
cents’ personality has been proposed as one of the main issues affecting driving style and likelihood of collisions. Rimmo and
Aberg (1999) demonstrated that sensation seeking is connected with an increased risk of crashes, as it is primarily associated
with a high rate of violations. It has also been proposed that anger and aggressiveness are common personality character-
istics of young drivers (Chliaoutakis et al., 2002) often resulting in an aggressive driving (AD) style, while Ulleberg (2001)
suggested that riskiness should be considered as related to a wider constellation of personality measures including low altru-
ism, normlessness, hostility, high anger, low empathy, neuroticism, poor parent-offspring attachment quality (Tambelli,
Cimino, Cerniglia, & Ballarotto, 2015) and anxiety (see also Lucidi et al., 2010). Impulsivity has also been related to collision
involvement especially in mid-adolescence (Steinberg, 2008) and some authors have suggested the use by these subjects of
non-cognitive (i.e. affective) signals to make decisions while driving (Dahlen, Edwards, Tubrè, Zyphur, & Warren, 2012). It
has been found that externality is related to anxiety (Paciello, Fida, Cerniglia, Tramontano, & Collie, 2012; Paciello, Fida,
Tramontano, Collie, & Cerniglia, 2012), which in turn increases the likelihood of road accidents (Lajunen & Summala,
1995) but other studies showed that internality and depressive symptoms are associated with dissociative driving styles
and errors, resulting in collisions (Holland, Geraghty, & Shah, 2010).
Other authors underlined the importance of considering environmental factors and family functioning in general and in
studying risky behaviors and driving (Cerniglia, Cimino, & Ballarotto, 2014; Cimino, Cerniglia, & Paciello, 2014; Lucarelli,
Cimino, D’Olimpio, & Ammaniti, 2013). Taubman-Ben-Ari and Katz-Ben-Ami (2012) proposed that parents have an impor-
tant role in their offspring’s driving behavior by conveying their priorities, values, perceptions and practices about safety
and noted that the lack of an open and direct communication between parents and adolescents could be associated with
a higher prevalence of risky driving among youths. Beck, Shattuck, and Raleigh (2001) suggested that the family can consti-
tute a protection against the involvement of adolescent in risky behaviors. A developmental view suggests that adolescents
involve in risky behaviors because of their need of perceiving themselves as skilled and independent or to gain popularity
with their peers (Allen & Brown, 2008). The latter hypothesis seems confirmed by the fact that a higher presence of a pas-
senger (of the same age) on the vehicle is associated to a higher rate of collisions, when the drivers are 14–18 years old
(Simons-Morton, Lerner, & Singer, 2005).
Most of the scientific literature addressing emotional-adaptive psychological functioning connected to motor vehicle col-
lisions in adolescence (as well as in adulthood) has focused on the outcomes after the accident in terms of possible acute or
chronic psychological consequences, leaving the assessment of adolescents’ emotional functioning before the accident lim-
itedly explored (Day, Brasher, & Bridger, 2012). Carbone (2009, 2010), instead, proposed that adolescents’ maladaptive psy-
chological functioning preceding the MVC could increase the likelihood of a collision, which in turn could be considered an
acting-out determined by a psychological sufferance, and in particular by adolescents’ difficulties in identifying and coping
with their own emotions [alexithymic traits and massive use of defense strategies such as denial, displacement and omnipo-
tence are suggested to be associated with risk-taking in adolescence (Dahl, 2008; Paivio & McCulloch, 2004)]. In this perspec-
tive, the emergency department visits are to be interpreted by clinicians as adolescents’ unconscious attempts to receive
psychological help. The same author showed that motor vehicle collisions in adolescents’ life are not isolated events occur-
ring once in many years, but they can repeat several times in a relatively limited amount of time and suggested that ado-
lescents with no other physical or mental illness can visit emergency departments up to four or five times in one year,
due to the injuries reported in a MVC (mostly in accidents occurred while driving motorbikes).
While research have clearly demonstrated that adults may suffer from depression and post-traumatic stress disorder after
a MVC, literature on negative psychological consequences in adolescents who were involved in motor collisions is scarce and
often rely on case reports. Research has given very limited attention to psychological functioning of adolescents after road
collisions except for those studies that addressed samples with PTSD disorders or symptoms and this resulted in a lack of
studies addressing groups of adolescents who did not developed PTSD symptoms after a MVC (Le Brocque, Hendrikz, &
Kenardy, 2010).
In the aim of deepening the understanding the etiology of motor collisions and planning effective preventive programs,
Iversen and Rundmo (2002) have underlined that it is crucial gathering information about the facts and experienced feelings
preceding and subsequent to the accident. In fact, their studies have shown that 30% of MVC are forgotten very rapidly, if
their physical and psychological consequences are not severe. Coherently, it can be useful to assess the psychological impact
of the accident and the mental conditions that have preceded it, both in the immediate preceding period and in the months
before. This can be done, in Di Gallo, Barton, and Parry-Jones’s (1997) view, in the emergency departments that adolescents
visit after the collision, giving them also the opportunity of expressing feelings and limiting the avoidance which seem cor-
related for example to subsequent PTSD symptoms.
Prevention and intervention programs on adolescents who were involved in MVCs are usually conducted in schools and
mostly focus information provision and psycho-education, mainly aiming at strengthening copying skills, in a cognitive–
behavioral framework, to encourage and support safe driving and reduce risk of collisions (Cox, Kenardy, & Hendrikz,
2008). The results of these prevention programs worldwide have been mixed. Some of them produced good outcomes in
L. Cerniglia et al. / Transportation Research Part F 35 (2015) 28–36 29

terms of reduced rates of collisions and risky driving behaviors but a majority of them did not give positive effects (see Lund
& Aarø, 2004 for a review).
On the basis of the above literature, this paper intends to constitute a first step toward the filling of the gap in literature,
which mostly studied clinical populations with psychiatric diagnosis and/or PTSD symptoms and the maladaptive psycho-
logical consequences of MVC among adolescents, limiting the possibility of planning efficient prevention programs.
We hypothesize that adolescents’ more maladaptive psychological profiles are associated to higher rates of collisions and,
more specifically, we aim to verify that adolescents who recurrently visited emergency departments due to a motorbike
collision:
1. Show a maladaptive emotional–behavioral functioning;
2. show difficulties in identifying and describing their own emotions;
3. massively use defense strategies.
Rooting on previous research (Beck et al., 2001) we also hypothesize that:
4. A low family support contributes to adolescents’ more maladaptive emotional–behavioral functioning, to their impaired
capacity of identifying and describing their emotions and their massive use of defense strategies.
2. Method
2.1. Procedure and participants
From the total number of subjects (N = 1213) who visited an Italian emergency department for motor vehicle collisions
over a period of one year (from June 2013 to June 2014) we selected N = 346 adolescents (age range: 14–17 years) who were
involved in motorbike accidents and did not show any psychiatric diagnosis, including PTSD symptoms or acute stress when
assessed through the SCID I (Non-Patient Edition; First, Spitzer, Gibbon, & Williams, 2002). Through an anamnestic self-
report questionnaire administered after the medical visit, for the aims of this study we excluded from the sample: adoles-
cents who were not driving the motorbike at the moment of the accident (N = 23 passengers were excluded); adolescents
who were reported serious injuries (N = 17); adolescents who refused to participate in the study (N = 9); adolescents whose
parents denied consent for their son or daughter to participate in the research (N = 11); adolescents who reported a psychi-
atric diagnosis or were following a pharmacological or psychological treatment (N = 11). The medical visit also measured
alcohol concentrations and a drug test was performed. Twenty-five (N = 25) adolescents who were positive to alcohol or drug
use were excluded from the present study.
The sample fitting the inclusion criteria (N = 250) was balanced for gender resulting in N = 202 adolescents. The mean age
of the subjects was 15.57 (s.d = 0.7). Most of the adolescents’ families recruited for the study (86%) had a middle socio-
economic status (Hollingshead, 1975), and a majority (72%) were intact family groups. 61% of the adolescent were firstborn.
The families were 92% Caucasian and 73% relied on more than one income. From the sample of 202 adolescents, N = 52 ado-
lescents were excluded due to incomplete data in their questionnaires. Three groups (Ntot = 150; 76 boys and 74 girls) were
created based on the number of their visits to an emergency department from June 2012 to June 2013 (for motorbike col-
lisions): Group 1: adolescents that have experienced four or more accidents (N = 51; 25 boys and 26 girls); Group 2: adoles-
cents that have experienced three accidents (N = 49; 25 boys and 24 girls); Group 3: adolescents that have experienced one
or two accidents (N = 50; 26 boys and 24 girls). The sample was organized in three groups with the above criteria on the basis
of Marcelli’s studies (Marcelli, Ingrand, Ingrand, & Delamour, 2011) on motor vehicle collisions recidivism in adolescence.
The adolescents who filled out the anamnestic questionnaire (which was appositely prepared for the study by the
research group) and accepted to participate in the study were administered the following self-reporting instruments (the
order of administration of the questionnaires was randomly decided):
3. Measures
3.1. Emotional and behavioral assessment
Youth self-report (YSR) (Achenbach, 1991; Italian version – Frigerio et al., 2001) is a self-report questionnaire that covers
behavioral and emotional problems in the past 6 months. It contains 112 problem items, which are scored on a 3-point scale
(0 = not true, 1 = somewhat or sometimes true, 2 = very or often true). The YSR total problem scale can be divided into nine
syndrome subscales: Withdrawn, Somatic complaints, Anxious/depressed, Social problems, Thought problems, Attention
problems, Delinquent behavior, Aggressive behavior, Self destruct Identity. Withdrawn, Somatic complaints and Anxious/
Depressed together comprise a broad ‘‘Internalizing” dimension (31 items), whereas Delinquent and Aggressive behaviors
together constitute an ‘‘Externalizing” dimension (32 items; Achenbach, 1991). Higher scores on these scales indicate more
maladaptive functioning. Some YSR items are included in the ‘‘Other problems” subscale (32 items). Achenbach and Rescorla
(2001) found that the internal consistency for the empirically based problem scales was supported by Cronbach’s alphas ran-
ged from .71 to .95.
30 L. Cerniglia et al. / Transportation Research Part F 35 (2015) 28–36

3.2. Assessment of the ability to describe and identify emotions
The Toronto Alexithymia Scale (TAS-20) is a self-report scale comprised of 20 items (Bagby, Parker, & Taylor, 1994; Bagby,
Taylor, & Parker, 1994; Italian version – La Ferlita, Bonadies, Solano, De Gennaro, & Gonini, 2007). Each item is rated on a five-
point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree); five items are negatively keyed. The three-factor
structure of the scale was found to be theoretically congruent with the alexithymia construct. The first factor consists of
items assessing the ability to identify feelings and to distinguish them from the somatic sensations that accompany emotional
arousal. Factor 2 consists of five items assessing the ability to describe feelings to other. Factor 3 consists of eight items assess-
ing externally oriented thinking. Higher scores on these scales indicate more maladaptive functioning. The tool demonstrates
good internal consistency and test–retest reliability (Total score’s internal reliability coefficient is .86) In addition, it has been
found to be stable and replicable across clinical and nonclinical populations (Parker, Taylor, & Bagby, 2003).
3.3. Assessment of defense strategies
The Response Evaluation Measure for Youth (REM-71; Steiner, Araujo, & Koopman, 2001) is a 71-item self-report ques-
tionnaire allowing the evaluation of 21 defenses (Acting out, Splitting, Displacement, Dissociation, Fantasy, Passive aggres-
sion, Projection, Repression, Omnipotence, Undoing, Conversion, Somatization, Withdrawal, Suppression, Denial, Humor,
Intellectualization, Reaction Formation, Idealization, Altruism, Sublimation) assessed by 3 or 4 items each and rated on a
9-point scale from ‘‘strongly disagree” (scored as 1) to ‘‘strongly agree” (scored as 9). Higher scores on this questionnaire
indicate a more massive and frequent use of the defense strategies. The scale has favorable psychometric properties, as
described in the original validation study including satisfactory internal coherence. The current Italian version was obtained
through back-translation and demonstrated a good internal consistency and test–retest reliability (reliability coefficient .84)
(Prunas et al., 2009).
3.4. Perceived filial self-efficacy
The questionnaire assesses filial perception of their parents’ accessibility, sensitivity and support in day-to-day situations
and in hypothetical critical moment in adolescents’ life. Higher scores at this questionnaire indicate higher perceived support
from parents (Bandura, Caprara, Barbaranelli, Regalia, & Scabini, 2011). Adolescents’ perceived filial self-efficacy (PFSE) was
measured by 16 items rated on a 7-point scale from ‘‘strongly disagree” (scored as 1) to ‘‘strongly agree” (scored as 7) assess-
ing belief in their capabilities to discuss with their parents personal problems even under difficult circumstances; cultivate
positive affective ties and manage negative emotional reactions toward them; get parents to see their side on contentious
issues; manage stress arising from parents’ marital conflicts; and to influence constructively parental attitudes and social
practices. ‘‘I can get my parents to understand my point of view when it differs from theirs” is an item measuring a sense
of efficacy to manage potentially contentious issues. The construction of the scale was guided by knowledge concerning pro-
totypic situations adolescents have to manage with their parents (Italian version – Scabini, 1995; Smetana, 1996). It had a
reliability coefficient of .87 (Bandura et al., 2011).
4. Statistical analyses
A preliminary screening of the data showed few data missing for each instrument (3% for each instrument). Missing data
were corrected using multiple imputation in SPSS software (Version 18.0). To examine the emotional and behavioral profiles
and the use of defense strategies in the three groups, we carried out multivariate analyses of variances (MANOVAs) consid-
ering the effects of age and gender. In all MANOVAs, univariate analyses were then conducted on significant effects, and the
Scheffè’s test was used for contrasts. We then conducted three linear regressions to verify [rooting on literature in the field
which suggested such an impact (Beck et al., 2001)] the possible contribution of perceived family support and group belong-
ing on all subscales of YSR, TAS-20 and REM-71. In all the analyses we conducted, the adolescents’ age and sex showed no
significant effect on the variables. All analyses were performed with SPSS software (Version 18.0).
5. Results
5.1. Adolescents’ emotional–behavioral profiles
To verify whether adolescents who recurrently visited emergency departments due to a motorbike collision show a mal-
adaptive emotional–behavioral functioning, a MANOVA conducted on the three groups’ scores [distinguished consistently
with Marcelli’s studies (2011). Group 1: adolescents that have experienced four or more accidents (N = 51); Group 2: ado-
lescents that have experienced three accidents (N = 49); Group 3: adolescents that have experienced one or two accidents
(N = 50)] on all subscales of YSR, showed a Group effect (k = 0.12; F(26,228) = 70.122; p < 0.001). Table 1 shows mean scores,
standard deviations, F and p values. Adolescents’ scores on all YSR scales except on Attention Problems and Delinquent
Behavior, were significantly higher in Group 1, compared to Group 2 and Group 3 (Scheffè post-hoc test; p < 0.001). On Self

Destructive Identity subscale Group 1 and Group 2 showed no significant difference, whereas Group 3 showed significant
differences.
5.2. Adolescents’ ability to describe and identify emotions
To verify whether adolescents who recurrently visited emergency departments due to a motorbike collision show diffi-
culties in identifying and describing their own emotions, a MANOVA conducted on the three groups’ scores on all subscales
of TAS-20, showed a Group effect (k = .117; F(6,248) = 79.431; p < 0.001). Table 2 shows mean scores, standard deviations, F
and p values. Adolescents’ scores on Factor 1, 2 and 3 were significantly higher in Group 1, compared to Group 2 and Group 3
(Scheffè post hoc test; p < 0.001).
5.3. Adolescents’ defense strategies use
To verify whether adolescents who recurrently visited emergency departments due to a motorbike collision massively
use defense strategies, a MANOVA conducted on the three groups’ scores on all subscales of REM-71, showed a Group effect
(k = 0.097; F(46,208) = 10.021; p < 0.001). Table 3 shows mean scores, standard deviations, F and p values. Adolescents’
scores on all REM-71 were significantly higher in Group 1, compared to Group 2 and Group 3 (Scheffè post hoc test;
p < 0.001).
5.4. Contribution of family support and group belonging on all subscales of YSR, TAS-20 and REM-71
To verify whether a low family support contributes to adolescents’ more maladaptive emotional–behavioral functioning,
to their impaired capacity of identifying and describing their emotions and their massive use of defense strategies, three lin-
ear regressions were performed to investigate whether an association existed between adolescents’ group belonging, PFSE
and YSR, REM-71 and TAS-20 scores. Group belonging and perceived familiar support were used as predictors, whereas ques-
tionnaires scores were used as regressors. Group belonging showed no significant effect on any of the questionnaires scores.
With regards to adolescents’ emotional–behavioral profiles, higher scores at PFSE predict lower scores at all subscales of YSR.
With regards to adolescents’ ability to describe and identify emotions, higher scores at PFSE predict lower scores at Factor 1,
2 and 3. With regards to adolescents’ defense strategies, higher scores at PFSE predict lower scores at all subscales of REM-71
(Tables 4–6 shows R2
, b, t and p values for YSR, TAS-20 and REM-71 questionnaires).
6. Discussion
The present study aimed to verify that problematic psychological functioning, difficulty in identifying and describing
their emotions, the use of specific defense strategies, were associated with higher rates of motor vehicle accidents (MVCs)
in adolescents without a psychiatric diagnosis. Further, the study intended to verify that a low family support perceived by
adolescents contributes to their maladaptive psychological functioning. This aim has been pursued by assessing three groups
of subjects: Group 1 included adolescents who experienced four or more collisions in the last year; Group 2 included ado-
lescents who experienced three collisions in the last year; Group 3 included adolescents who experienced one or two colli-
sions in the last year.
Table 1
Adolescents’ emotional–behavioral profiles: mean scores, standard deviations, F and p values.
Group 1 (SD) Group 2 (SD) Group 3 (SD) F (2,147) p values
Withdrawn 9.24 (1.904)a
5.53 (1.697)b
3.7 (2.401)c
98.214*
<0.001
Somatic complaints 9.41 (1.486)a
7.76 (1.234)b
4.58 (2.483)c
91.916*
<0.001
Anxious/depressed 19.94 (5.057)a
7.96 (3.323)b
4.5 (2.41)c
233.171*
<0.001
Social problems 7.88 (1.366)a
5.31 (2.229)b
4 (1.807)c
58.996*
<0.001
Thought problems 5.31 (1.556)a
4.67 (1.36)b
3.88 (1.365)c
12.71*
<0.001
Attention problems 3.33 (1.657)a
3.51 (0.916)a
3.72 (0.927)a
1.265 0.285
Delinquent behavior 2.69 (1.010)a
3.67 (1.068)a
3.92 (0.853)a
22.4*
<0.001
Aggressive behavior 22.78 (3.651)a
14.67 (5.456)b
7.08 (2.117)c
197.805*
<0.001
Self destruct. Identity 14.94 (2.204)a
14.73 (2.506)a
7.46 (2.589)b
152.975*
<0.001
Other problems 14.82 (4.321)a
11.08 (3.599)b
7 (2.176)c
63.581*
<0.001
Int. dimension 34.12 (3.871)a
16.39 (4.368)b
9.28 (1.906)c
660.009*
<0.001
Ext. dimension 34.27 (4.446)a
12.61 (1.913)b
7.72 (1.654)c
1143.731*
<0.001
Total problems scale**
82.24 (8.883)a
28.94 (4.033)b
12.58 (2.666)c
1943.55*
<0.001
Means in rows not sharing a common letter differ significantly (p < 0.05).
*
Significant at p < 0.001.
**
N = 50 adolescents in Group 1 exceed the clinical cut off at YSR’s total problems scale scores. No subject in Group 2 and in Group 3 exceed the clinical
cut-off for YSR’s total problems scale scores.

Our first hypothesis was that adolescents who recurrently visited emergency departments due to motorbike collisions
show a maladaptive emotional–behavioral functioning. Our results confirm this hypothesis except for the Attention Prob-
lems and Delinquent Behavior subscales at YSR that are not associated with higher rates of MVCs in our sample. This par-
ticular result is not coherent with previous research that instead indicated distraction and lack of attention as two of the
main factors associated with road accidents in adolescence (Carbone, 2010; Lund & Aarø, 2004). Moreover, in line with recent
Table 2
Adolescents’ ability to describe and identify emotions: mean scores, standard deviations, F and p values.
Group 1 (SD) Group 2 (SD) Group 3 (SD) F(2,126) p values
Factor 1 26.92 (3.09)a
16.27 (4.82)b
10 (1.95)c
212.598*
<0.001
Factor 2 12.63 (2.29)a
11.06 (2.8)b
9.5 (2.44)c
7.172**
<0.01
Factor 3 28.96 (3.64)a
25.31 (3.29)b
12.58 (3.76)c
195.375*
<0.001
TAS-20 total score***
64.51 (5.56)a
52.63 (6.31)b
33.08 (4.57)c
286.875*
<0.001
Means in rows not sharing a common letter differ significantly (p < 0.05).
*
**
***
N = 41 subjects in Group 1, N = 6 subjects in Group 2 and none in Group 3 exceed the clinical cut-off at TAS-20’s total scores.
Table 3
Adolescents’ defense strategies use mean scores, standard deviations, F and p values.
Group 1 (SD) Group 2 (SD) Group 3 (SD) F(2,147) p values
Acting out 5.857(1.62)a
4.694(0.8)b
4.26(0.57)c
28.504*
p < 0.001
Splitting 9.782(15.3)a
6.076(0.9)b
5.576(0.62)c
3.335**
p = 0.038
Displacement 5.42(1.35)a
4.555(0.62)b
4.2(0.46)c
24.355*
p < 0.001
Dissociation 6.42(1.53)a
5.273(0.92)b
4.37(0.54)c
45.335*
p < 0.001
Fantasy 5.99(4.54)a
5.99(6.39)a
5.58(6.4)a
0.83 p = 0.92
Pass. aggression 6.441(1.38)a
5.431(0.75)b
5.002(0.44)c
30.658*
p < 0.001
Projection 5.671(1.48)a
4.463(1.09)b
3.286(0.48)c
59.264*
p < 0.001
Repression 6.34(1.77)a
4.773(0.87)b
4(0.41)c
52.389*
p < 0.001
Omnipotence 5.549(0.79)a
5.259(0.72)b
4.78(0.52)c
16.124*
p < 0.001
Undoing 6.973(1.33)a
6.076(0.99)b
4.946(0.38)c
53.48*
p < 0.001
Conversion 3.084(1.43)a
1.976(0.7)b
1.572(0.31)c
34.688*
p < 0.001
Somatization 5.351(1.91)a
3.84(0.81)b
3.28(0.299)c
38.881*
p < 0.001
Withdrawal 10.959(18.60)a
5.596(0.92)b
4.998(0.2)c
4.615**
p < 0.011
Suppression 5.347(1.08)a
4.308(0.74)b
3.696(0.42)c
55.421*
p < 0.001
Denial 5.333(1.23)a
4.449(0.72)b
4.014(0.39)c
31.185*
p < 0.001
Humor 6.075(1.14)a
5.153(0.78)b
4.704(0.51)c
33.838*
p < 0.001
Intellectualization 6.325(1.09)a
5.659(0.69)b
4.984(0.51)c
35.174*
p < 0.001
React. Formation 5.243(1.12)a
4.435(0.6)b
4.014(0.39)c
32.879*
p < 0.001
Idealization 6.69(1.41)a
6.086(0.87)b
5.436(0.68)c
18.54*
p < 0.001
Altruism 7.61(1.44)a
6.82(0.96)b
6.288(0.68)c
19.345*
p < 0.001
Sublimation 6.265(1.51)a
5.098(0.98)b
4.436(0.64)c
35.531*
p < 0.001
Means in rows, not sharing a common letter, differ significantly (p < 0.05).
*
**
Table 4
Significant contribution of perceived family support on all subscales of YSR: R2
, b, t and p values.
YSR PFSE
R2
b t p
Withdrawn .514 À.717 À12.509 <0.001
Somatic complaints .506 À.711 À12.3 <0.001
Anxious/depressed .664 À.815 À17.093 <0.001
Social problems .372 À.61 À9.354 <0.001
Thought problems .105 À.325 À4.175 <0.001
Attention problems .026 À.162 À1.995 <0.05
Delinquent behavior .198 À.445 À6.048 <0.001
Aggressive behavior .657 À.811 À16.841 <0.001
Self destruct. Identity .463 À.68 À11.296 <0.001
Other problems .419 À.647 À10.322 <0.001
Int. dimension .772 À.879 À22.386 <0.001
Ext. dimension .774 À.88 À22.532 <0.001
Total problems scale .814 À.902 À25.416 <0.001

international literature, our results show that male and female adolescents do not differ on any subscale assessing psycho-
logical functioning indicating that the classical prevalence of externalizing problems in boys and internalizing problems in
girls is not supported by more recent research (see White & Renk, 2012 for a review).
Our second hypothesis was that adolescents who recurrently visited emergency departments due to motorbike collisions
show difficulties in identifying and describing their own emotions. This hypothesis is supported by our results, with adoles-
cents who experienced higher rates of MVCs having more severe alexithymic traits. This finding corroborates previous
results obtained by other authors who demonstrated that adolescents with frequent accidental injuries are more likely to
show difficulties in recognizing and defining their emotions (Bujarski, Klanecky, & McChargue, 2010) and, in our opinion,
suggests a trend toward instinctive action instead of reflection and emotional insight. This could suggest the planning of pre-
vention programs based on the enhancing of emotional (namely the capacity of ‘‘listening” to and reflecting on one’s own
feelings and mood) rather than improving cognitive skills, which proved to have mixed result in reducing MVC rates among
adolescents (Hole, 2008).
The third hypothesis of the study was that adolescents with higher rates of MVCs massively used defense strategies. We
found that adolescents who experienced higher rates of motor collisions more massively use defense strategies compared to
subjects who were involved in a smaller number of accidents (in the same amount of time). This result does not apply, any-
way, to Fantasy subscale of REM-71, suggesting that it is not fantasizing and lack of attention to be associated with higher
rates of road accidents. Conversely, withdrawal defense strategy proved to be highly used by subjects with four or more col-
lisions, validating the hypothesis that a constellation of depressive symptoms might be associated with recidivism of MVCs
in adolescence, rather than sensation seeking (Henderson & Joseph, 2012). This repetition of accidents might be interpreted,
in our view, as the result of a series of acting-outs, which therefore are not classifiable as mere ‘‘unintentional injuries”, as
the vast majority of literature claims, but as adolescents’ implicit attempts to seek help from health operators. For this reason
we suggest that secondary prevention programs should be organized by groups of trained psychologists directly in the ED to
reduce recidivism of ‘‘accidental” collisions, offering adolescents a psychological assessment and an interview aimed at iden-
tifying possible emotional correlates of the crash.
We finally made the hypothesis that a low family support contributes to adolescents’ more maladaptive emotional–
behavioral functioning, to their impaired capacity of identifying and describing their emotions and their massive use of
Table 5
Significant contribution of perceived family support on all Factors TAS-20: R2
TAS-20 PFSE
R2
b t p
Factor 1 .724 À.851 À19.695 <0.001
Factor 2 .085 À.292 À3.711 <0.001
Factor 3 .612 À.782 À15.285 <0.001
TAS total score .727 À.852 À19.84 <0.001
Table 6
Significant contribution of perceived family support on all subscales of REM-71: R2
REM PFSE
R2
b t p
Acting out .21 À.459 À6.28 <0.001
Splitting .043 À.207 À2.58 <0.05
Displacement .205 À.453 À6.178 <0.001
Dissociation .359 À.599 À9.1 <0.001
Fantasy .269 À.602 À8.1 <0.001
Passive aggression .263 À.512 À7.26 <0.001
Projection .46 À.678 À11.24 <0.001
Repression .412 À.642 À10.18 <0.001
Omnipotence .168 À.41 À5.47 <0.001
Undoing .344 À.587 À8.82 <0.001
Conversion .266 À.516 À7.32 <0.001
Somatization .269 À.519 À7.38 <0.001
Withdrawal .063 À.251 À3.153 <0.01
Suppression .352 À.594 À8.97 <0.001
Denial .27 À.519 À7.39 <0.001
Humor .275 À.524 À7.49 <0.001
Intellectualization .279 À.528 À7.57 <0.001
Reaction Formation .292 À.54 À7.81 <0.001
Idealization .181 À.425 À5.72 <0.001
Altruism .146 À.382 À5.02 <0.001
Sublimation .304 À.551 À8.04 <0.001

defense strategies. Our results confirmed this hypothesis and are coherent with the studies of Beck et al. (2001) and Kolaitis
et al. (2011) showing that the perceived possibility for the adolescent to rely on his/her parents’ help, understanding, support
and sensitivity reduces their propensity to risk, maladaptive psychological functioning in general (Cimino, Cerniglia, Paciello,
& Sinesi, 2013; Tambelli, Cerniglia, Cimino, & Ballarotto, 2015) and diminishes likability of alcohol and drug use (which are
associated with higher rates of MVCs).
The present paper has some limitations. First, the sample homogeneity in terms of race and geographical origin does not
enable wide generalizations of the results to the general population to be made. Second, we did not assess parents’ psycho-
logical functioning and/or psychopathological risk as suggested by previous research. Third, we did not consider the quality
of adolescents’ relationships with their peers that instead is suggested to be an important factor associated with youths’
internalizing and externalizing functioning, and propensity to involve in risky behaviors (Allen & Brown, 2008). These last
two limitations are due to the impossibility of administering a large number of tools in the particular environment (emer-
gency departments) where the study was done. Further, we used self-report questionnaires to measure adolescents’ psycho-
logical functioning and family support. On the other hand we used SCID I to assess possible psychiatric disorders and exclude
diagnosed individuals from the study.
By excluding psychiatrically diagnosed subjects from the sample, we assured not to include adolescents who showed
PTSD symptoms or disorders, which they could have developed from previous traumatic experiences (including previous
MVCs), whereas the majority of the studies on road accidents in adolescence considered post-traumatic symptoms, limitedly
focusing on general psychological functioning (Cerniglia, Cimino, Ballarotto, & Monniello, 2014; Sarma et al., 2013). To our
knowledge, moreover, no other study focused on family support and its role in predicting adolescents’ rates of motor acci-
dents, since international literature mainly considers family functioning and support as a variable related to treatment out-
comes subsequent to collisions, especially as a mediator and a protective or risk factor for the development of post-traumatic
symptoms or disorders (Zehnder, Meuli, & Landolt, 2010). We are also not aware of any other study which attempted to
empirically verifying the hypothesis that motor vehicle collisions among adolescents can be considered as acting-outs
caused by psychological difficulties in identifying and coping with their own emotions.
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