106 severely injured accident patients were examined over a period of 12 months. Clinically relevant psychological symptoms were found in every third patient. However, the full picture of post-traumatic stress disorder occurred only rarely. It became evident that the development of post-traumatic psychological disorders is hardly dependent on objective injury characteristics, but primarily on the subjective experience of the accident event and its consequences. Psychosocial variables also largely determine the duration of accident-related incapacity for work. Early identification of psychosocial risk patients should be carried out by surgeons. However, consultative and liaison psychiatric services can make a significant contribution to the appropriate treatment and rehabilitation of severely injured accident patients. The work was awarded the Roemer Prize 1999 by the German K.