Recent studies have shown that survivors of road traffic crashes experience significant psychological health difficulties. Perception of another party as being responsible for the occurrence of a crash has been associated with on-going distress and lower psychological well-being. This paper extends this research by examining the influence of perceived crash responsibility on depression severity. A total of 57 adults aged 18–58 years injured in a road traffic crash were interviewed prior to hospital discharge and at 2-months post-crash. The results indicate that perceiving oneself as being responsible for the crash is associated with higher levels of later depression compared to those where responsibility is perceived to be shared, and to a lesser extent compared to those perceiving another party as being responsible. Persistent pain and pre-crash psychological health were found to be strongly associated with later depression severity, while trends indicate that length of stay beyond 7 days in hospital is also an important predictor. These findings are discussed in the context of past research.