The Impact of Depression on Driver Performance

An investigation into the role of driver characteristics in driving behaviours and subsequent clustering of Indian bus drivers

OBJECTIVES

Aberrant driving behaviours among bus drivers cause serious concerns to safety on the road. The present study aimed to measure the effects of driver characteristics on aberrant and positive driving behaviours among bus drivers and to group drivers accordingly. The study was carried out among bus drivers of the government-owned road transport corporation in Kerala, India.

METHODS

A total of 1120 drivers took part in the survey, out of which 617 drivers returned the forms with all questions answered (response rate = 55.1%). SPSS version 27.0 was used for analysis.

RESULTS

Structural equation modelling proved the predictive nature of driver characteristics on driving behaviours. K-means cluster analysis revealed clusters such as violating and angry drivers (cluster 1), knowledgeable drivers with positive driving behaviours (cluster 2), healthy and stress-free drivers (cluster 3), erroneous and stressed drivers (cluster 4) and calm drivers with positive driving behaviours (cluster 5).

CONCLUSION

Positive relationships of anger and stress on aberrant driving behaviours and higher number of drivers in clusters 1 and 4 reveal concerns of safety. The study points towards the necessity of organizational commitment for improving driver characteristics for better driver behaviours and safer roads.

Major Depressive Disorder and Driving Behavior Among Older Adults

Importance

Depression and antidepressant use are independently associated with crash risk among older drivers. However, it is unclear what factors impact daily driving that increase safety risk for drivers with depression.

Objective

To examine differences in naturalistic driving behavior and safety between older adults with and without major depressive disorder (MDD).

Design, Setting, and Participants

A prospective longitudinal cohort study was conducted among older adults (≥65 years) from the Driving Real-World In-Vehicle Evaluation System Project collected from July 1, 2021, to December 30, 2023. The sample included 85 participants with MDD and 310 participants without. Neurological, clinical, mood, and neuropsychological tests were collected annually. Daily driving behavior was recorded using a commercial data logger. Statistical analysis was performed from January 31 to June 24, 2024.

Exposure

MDD and antidepressant usage.

Main outcomes and measures

Linear mixed models with propensity score weighting compared slopes of driving behaviors over time (trips taken at night, speeding, hard braking, entropy, and radius of gyration) between groups.

Results

In a sample of 395 participants, 85 were classified as individuals with MDD (mean [SD] age, 69.6 [6.1] years; 60 [70.6%] female; 8 [9.4%] non-Hispanic Black and 77 [90.6%] non-Hispanic White) and 310 as individuals in the control group without depression (mean [SD] age, 70.1 [5.1] years; 153 [49.4%] female; 40 [12.9%] non-Hispanic Black and 270 [87.1%] non-Hispanic White). Adults with MDD had greater depressive symptoms (mean [SD], 8.35 [5.35] vs 2.33 [2.72]; difference, 6.02; 95% CI for difference, 5.17 to 6.85; P < .001), comorbidities (mean [SD], 4.08 [2.07] vs 2.79 [1.67]; difference, 1.29; 95% CI for difference, 0.87 to 1.70; P < .001), used more antidepressants (mean [SD], 0.94 [0.81] vs 0.27 [0.54]; χ21 = 65.8; P < .001), and had a higher number of medications (mean [SD], 3.80 [3.27] vs 1.98 [2.21]; χ21 = 21.0; P < .001) compared with controls at baseline. Longitudinal analysis demonstrated an association between adults with MDD and hard braking (mean [SE], 3.17 × 10-4 [7.30 × 10-5] vs 6.70 × 10-5 [4.00 × 10-5]; difference, 2.50 × 10-4; 95% CI for difference, 1.74 × 10-4 to 4.61 × 10-4; P < .001) and hard cornering events per trip (mean [SE], 0.80 [0.64] vs 0.57 [0.25]; difference, 0.23; 95% CI for difference, 0.08 to 1.06; P = .04), greater distances driven from home (mean [SE], 31.19 [7.35] vs 7.76 [3.80] km; difference, 23.43; 95% CI for difference, 0.28 to 15.2; P < .001), more unique destinations visited (mean [SE], 0.34 [0.10] vs -0.27 [0.03]; difference, 0.61; 95% CI for difference, 0.14 to 0.54; P < .001), and higher random entropy (mean [SE], 0.01 [0.01] vs -0.02 [0.00]; difference, 0.03; 95% CI for difference, -0.03 to -0.01; P < .001) over time.

Conclusions and relevance

In this longitudinal cohort study of older drivers, adults with MDD demonstrated distinct and riskier driving behaviors than those in the control group without depression, with higher rates of hard braking, cornering, and unpredictability in driving patterns over time. Routine depression screening and tailored interventions are essential for enhancing driving safety and maintaining independence among older adults with MDD. Comprehensive care approaches addressing both mental and physical health are crucial for this vulnerable population.

Distribution and association of road traffic accident with depression among Indian population aged 45 years and above: nested multilevel modelling analysis of nationally representative cross-sectional survey

INTRODUCTION

The prevalence of important public health problems like road traffic accidents (RTA) and depression are surging. This study was aimed to estimate distribution and determine the association between RTA and depression among Indian population aged 45 years and above: overall and stratified into age group, gender and across states/union territories as aspirants, achievers, and front runners.

METHODS

Using Longitudinal Aging Study in India (LASI) dataset (April 2017-December 2018), we have conducted this study among middle aged (45-59 years) and older adults and elderly (≥ 60 years) Indians. Bivariate analysis was conducted to estimate the prevalence of RTA and depression nationally and across aspirants, achievers, and front runner states. States and union territories were categorised as low, medium, and high as per RTA and depression prevalence, which were further cross tabulated. Spatial distribution maps were created using Microsoft Excel. We have documented the association of RTA with depression. To reduce the confounding effects of demographic and socioeconomic; health related and behavioural covariates; propensity score matching (PSM) was conducted. Nested multilevel regression modelling was analysed using STATA version 17.

RESULTS

Prevalence of RTA was 1.84% (1.74-1.94) nationally, highest among achiever states [2.04% (1.82-2.30)]. Prevalence of depression was 6.08% (5.90-6.26) nationally, highest among aspirant states [7.02% (6.74-7.30)]. The adjusted odds of having RTA was significantly among depressed [aOR (95% CI) 1.76 (1.45-2.15)] than non-depressed participants; which was much higher among females [aOR (95% CI) 1.93 (1.43-2.62)] than in males [aOR (95%CI) 1.67 (1.29-2.16)] and much higher among middle aged [aOR (95%CI) 2.08 (1.63-2.65)]. Odds of RTA was highest across front runners [aOR (95%CI) 1.86 (1.26-2.72)] followed by aspirant states [aOR (95%CI) 1.79 (1.37-2.33)].

CONCLUSION

This study established the positive association between depression and road traffic accidents among middle aged, older adults and elderly. Therefore, efforts must be taken to address mental health issues in them with proper policy implication more focused on females and middle aged. Front runner's states should get the limelight followed by aspirant states.

Ecological validity of executive function tests in predicting driving performance

Almost all of our everyday activities depend on executive function (EF) skills. In line with the increasing attention to the ecological validation of neuropsychological assessment and intervention methods, this study aimed to explore the ecological validity of a relevant set of widely used EF tests, mostly from well-known paradigms of EF assessment, in predicting driving ability. Ninety-six healthy novice drivers (Mage = 26.2 years, SD = 8.4; 48 female) completed four stages of our data collection including psychological, EF, and driving assessments. For the psychological assessment, validated measures of sensation-seeking, risk-taking, personality traits, ADHD symptoms, depression, anxiety, and stress were administered. For the EF assessment, selected tests from the Delis-Kaplan Executive Function System (D-KEFS: Trail Making, Design Fluency, and Tower) and the Behavioral Assessment of the Dysexecutive Syndrome (BADS: Key Search, Zoo Map, and Modified Six Elements) along with a computerized Stroop test were administered. For the driving assessment, we used a simulated driving test comprising of 14 key dimensions of driving skills. Several correlations and multiple regression analyses were conducted. Significant correlations were found between all the EF measures and driving performance. Moreover, the EF measures predicted the driving ability over and above the effects of previous driving experience and the psychological variables. These results provide supporting evidence for the ecological validity of the EF tests in predicting driving performance. The incorporation of assessment and intervention targeting multiple domains of EF into driving rehabilitation and education programs could be a focus of future research.

Driver's Licensure and Driving Outcomes Among Youths With Mood Disorders

Importance

Mood disorders are prevalent among adolescents and young adults, and their onset often coincides with driving eligibility. The understanding of how mood disorders are associated with youth driving outcomes is limited.

Objective

To examine the association between the presence of a mood disorder and rates of licensing, crashes, violations, and suspensions among adolescents and young adults.

Design, Setting, and Participants

This cohort study was conducted among New Jersey residents who were born 1987 to 2000, age eligible to acquire a driver's license from 2004 to 2017, and patients of the Children's Hospital of Philadelphia network within 2 years of licensure eligibility at age 17 years. The presence of a current (ie, ≤2 years of driving eligibility) mood disorder was identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. Rates of licensure and driving outcomes among youths who were licensed were compared among 1879 youths with and 84 294 youths without a current mood disorder from 2004 to 2017. Data were analyzed from June 2022 to July 2023.

Main Outcomes and Measures

Acquisition of a driver's license and first involvement as a driver in a police-reported crash and rates of other adverse driving outcomes were assessed. Survival analysis was used to estimate adjusted hazard ratios (aHRs) for licensing and driving outcomes. Adjusted rate ratios (aRRs) were estimated for driving outcomes 12 and 48 months after licensure.

Results

Among 86 173 youths (median [IQR] age at the end of the study, 22.8 [19.7-26.5] years; 42 894 female [49.8%]), there were 1879 youths with and 84 294 youths without a mood disorder. A greater proportion of youths with mood disorders were female (1226 female [65.2%]) compared with those without mood disorders (41 668 female [49.4%]). At 48 months after licensure eligibility, 75.5% (95% CI, 73.3%-77.7%) and 83.8% (95% CI, 83.5%-84.1%) of youths with and without mood disorders, respectively, had acquired a license. Youths with mood disorders were 30% less likely to acquire a license than those without a mood disorder (aHR, 0.70 [95% CI, 0.66-0.74]). Licensed youths with mood disorders had higher overall crash rates than those without mood disorders over the first 48 months of driving (137.8 vs 104.8 crashes per 10 000 driver-months; aRR, 1.19 [95% CI, 1.08-1.31]); licensed youths with mood disorders also had higher rates of moving violations (aRR, 1.25 [95% CI, 1.13-1.38]) and license suspensions (aRR, 1.95 [95% CI, 1.53-2.49]).

Conclusions and Relevance

This study found that youths with mood disorders were less likely to be licensed and had higher rates of adverse driving outcomes than youths without mood disorders. These findings suggest that opportunities may exist to enhance driving mobility in this population and elucidate the mechanisms by which mood disorders are associated with crash risk.

Cause-specific mortality and comorbid neurodevelopmental disorder in 167,515 patients with bipolar disorder: An entire population longitudinal study

OBJECTIVE

Studies addressing premature mortality in bipolar disorder (BD) patients are limited by small sample sizes. Herein, we used almost 99 % of the population of Taiwan to address this issue, and its association with comorbid neurodevelopmental disorders and severe BD.

METHODS

Between 2003 and 2017, we enrolled 167,515 individuals with BD and controls matched 1:4 for sex and birth year from the National Health Insurance Database linked to the Database of National Death Registry in Taiwan. Time-dependent Cox regression models were used to examine cause-specific mortality (all-cause, natural, and unnatural causes [accidents or suicide]).

RESULTS

With adjustments of sex, age, income, urbanization, and physical conditions, suicide was associated with the highest risk of mortality (reported as hazard ratio with 95 % confidence interval: 9.15; 8.53-9.81) among BD patients, followed by unnatural (4.94; 4.72-5.17), accidental (2.15; 1.99-2.32), and natural causes (1.02; 1.00-1.05). Comorbid attention-deficiency hyperactivity disorder did not contribute to the increased risk of cause-specific mortality; however, comorbid autism spectrum disorder (ASD) increased such risks, particularly for natural (3.00; 1.85-4.88) and accidental causes (7.47; 1.80-31.1). Cause-specific mortality revealed a linear trend with the frequency of psychiatric hospitalization (all, p for trend <0.001), and BD patients hospitalized twice or more each year had 34.63-fold increased risk of suicide mortality (26.03-46.07).

CONCLUSIONS

BD patients with a higher frequency of psychiatric hospitalization have the highest risk of suicide mortality, and comorbid ASD was associated with an increased risk of natural and accidental causes of mortality.

Effects of insomnia on risky driving behavior among bus drivers: The mediating effect of mental health

Crashes caused by problems with bus drivers' physical and mental health have increased in frequency in recent years. Insomnia, a common type of sleep problem, has significant positive relationships with both crash risk and mental health problems, especially anxiety and depression, which are themselves associated with driving behavior. However, few studies have conducted analysis on sleep-related problems and mental health exclusively on bus drivers, nor on how these problems influence driving performance. Thus, this study explored the effect of insomnia and mental health on bus drivers' risky driving behavior and evaluated the interaction of four variables: insomnia, anxiety, depression, and risky driving behavior. The survey-based investigation was conducted in a bus company in Suzhou, China, with 1,295 bus drivers participating. Insomnia, anxiety, and depression were self-reported based on professional mental health scales and risky driving behaviors were measured by the Driver Behavior Questionnaire. Two mediation models and a chain mediation model were developed to examine relationships among the bus drivers' insomnia, anxiety, depression, and risky driving behavior. Results revealed that (a) bus drivers less than 31 years old, drivers with more than 11 years' experience driving buses, and those with crash and violation involvement within three years demonstrated more severe degrees of insomnia, anxiety, depression, and risky driving behavior; (b) there were significant positive correlations and interactions among the four variables. Results specifically related to the interaction among variables include findings that (a) anxiety mediated between insomnia and risky driving behavior; (b) depression mediated between insomnia and risky driving behavior; and (c) anxiety affected bus drivers' risky driving behavior primarily though depression. The findings in this study indicate the importance of regular physical and mental health examination of bus drivers and suggest that interventions focused on insomnia and mental health problems may be helpful to reduce risky driving behaviors of bus drivers both directly and indirectly.

Dissecting the mediating and moderating effects of depression on the associations between traits and coronary artery disease: A two-step Mendelian randomization and phenome-wide interaction study

Background

Depression is often present concurrently with coronary artery disease (CAD), a disease with which it shares many risk factors. However, the manner in which depression mediates and moderates the association between traits (including biomarkers, anthropometric indicators, lifestyle behaviors, etc.) and CAD is largely unknown.

Methods

In our causal mediation analyses using two-step Mendelian randomization (MR), univariable MR was first used to investigate the causal effects of 108 traits on liability to depression and CAD. The traits with significant causal effects on both depression and CAD, but not causally modulated by depression, were selected for the second-step analyses. Multivariable MR was used to estimate the direct effects (independent of liability to depression) of these traits on CAD, and the indirect effects (mediated via liability to depression) were calculated. To investigate the moderating effect of depression on the association between 364 traits and CAD, a cross-sectional phenome-wide interaction study (PheWIS) was conducted in a study population from UK Biobank (UKBB) (N=275,257). Additionally, if the relationship between traits and CAD was moderated by both phenotypic and genetically predicted depression at a suggestive level of significance (Pinteraction≤0.05) in the PheWIS, the results were further verified by a cohort study using Cox proportional hazards regression.

Results

Univariable MR indicated that 10 of 108 traits under investigation were significantly associated with both depression and CAD, which showed a similar direct effect compared to the total effect for most traits. However, the traits "drive faster than speed limit" and "past tobacco smoking" were both exceptions, with the proportions mediated by depression at 24.6% and 7.2%, respectively. In the moderation analyses, suggestive evidence of several traits was found for moderating effects of phenotypic depression or susceptibility to depression, as estimated by polygenic risk score, including chest pain when hurrying, reason of smoking quitting and weight change. Consistent results were observed in survival analyses and Cox regression.

Conclusion

The independent role of traits in CAD pathogenesis regardless of depression was highlighted in our mediation analyses, and the moderating effects of depression observed in our study may be helpful for CAD risk stratification and optimized allocation of scarce medical resources.

Driving Behaviour in Depression Based on Subjective Evaluation and Data from a Driving Simulator

Road traffic collisions are a major issue for public health. Depression is characterized by mental, emotional and executive dysfunction, which may have an impact on driving behaviour. Patients with depression (N = 39) and healthy controls (N = 30) were asked to complete questionnaires and to drive on a driving simulator in different scenarios. Driving simulator data included speed, safety distance from the preceding vehicle and lateral position. Demographic and medical information, insomnia (Athens Insomnia Scale, AIS), sleepiness (Epworth Sleepiness Scale, ESS), fatigue (Fatigue Severity Scale, FSS), symptoms of sleep apnoea (StopBang Questionnaire) and driving (Driver Stress Inventory, DSI and Driver Behaviour Questionnaire, DBQ) were assessed. Gender and age influenced almost all variables. The group of patients with depression did not differ from controls regarding driving behaviour as assessed through questionnaires; on the driving simulator, patients kept a longer safety distance. Subjective fatigue was positively associated with aggression, dislike of driving, hazard monitoring and violations as assessed by questionnaires. ESS and AIS scores were positively associated with keeping a longer safety distance and with Lateral Position Standard Deviation (LPSD), denoting lower ability to keep a stable position. It seems that, although certain symptoms of depression (insomnia, fatigue and somnolence) may affect driving performance, patients drive more carefully eliminating, thus, their impact.

Crash harm before and during the COVID-19 pandemic: Evidence for spatial heterogeneity in Tennessee

Major concerns have been raised about road safety during the COVID-19 pandemic in the US, as the crash fatalities have increased, despite the substantial reduction in traffic. However, a comprehensive analysis of safety-critical events on roadways based on a broader set of traffic safety metrics and their correlates is needed. In addition to fatalities, this study uses changes in total crashes and total monetary harm as additional measures of safety. A comprehensive and unique time-series database of crashes and socio-economic variables is created at the county level in Tennessee. Statistics show that while fatal crashes increase by 8.2%, total crashes decrease by 15.3%, and the total harm cost is lower by about $1.76 billion during COVID-19 (2020) compared with pre-COVID-19 conditions (2019). Several models, including generalized least squares linear, Poisson, and geographically weighted regression models using the differences between 2020 and 2019 values, are estimated to rigorously quantify the correlates of fatalities, crashes, and crash harm. The results indicate that compared to the pre-pandemic periods, fatal crashes that occurred during the pandemic are associated with more speeding & reckless behaviors and varied across jurisdictions. Fatal crashes are more likely to happen on interstates and dark-not-lighted roads and involve commercial trucks. These same factors largely contribute to crash harm. In addition, a greater number of long trips per person not staying home during COVID-19 is found to be associated with more crashes and crash harm. These results can inform policymaking to strengthen traffic law enforcement through appropriate countermeasures, such as the placement of warning signs and the reduction of the speed limit in hotspots.

Electroconvulsive Therapy and Risk of Road Traffic Accidents: A Danish Register-Based Cohort Study

OBJECTIVE

The aim of the study is to examine whether electroconvulsive therapy (ECT) was associated with the subsequent risk of being involved in a road traffic accident.

METHODS

A cohort of all 375,435 patients older than 18 years with their first psychiatric hospital contact between 2003 and 2017 in the Danish National Patient Registry was followed for road traffic accidents until December 2018. Associations between ECT and road traffic accidents were examined using Cox regression analyses with multiple adjustments and using propensity score matching on sociodemographic and clinical variables.

RESULTS

A total of 8486 patients (0.2%) were treated with ECT. During the median follow-up of 5.9 years, 778 of these patients (12.5%) were involved in a road traffic accident and the unadjusted incidence of road traffic accidents was lower among these patients (incidence rate, 15.5 per 1000 patient-years; 95% confidence interval [CI], 14.5-16.7) compared with patients not treated with ECT (incidence rate, 20.0 per 1000 patient-years; 95% CI, 20.0-20.3). Electroconvulsive therapy was not associated with road traffic accidents in the Cox regression models after adjustment for all covariables (hazard ratio, 1.00; 95% CI, 0.92-1.08) or in the propensity score-matched sample (hazard ratio, 0.91; 95% CI, 0.83-1.08). The HRs did not vary materially with follow-up time or when analyses were stratified on sex, age, or type of hospital contact.

CONCLUSIONS

The analysis of Danish National registry data indicates that ECT is not associated with the risk of being involved in major road traffic accidents.

The Management of Obstructive Sleep Apnea Patients during the COVID-19 Pandemic as a Public Health Problem-Interactions with Sleep Efficacy and Mental Health

With the onset of the COVID-19 outbreak, it was stipulated that patients with obstructive sleep apnea (OSA) may have a greater risk of morbidity and mortality and may even experience changes in their mental health. The aim of the current study is to evaluate how patients managed their disease (sleep apnea) during the COVID-19 pandemic, to determine if continuous positive airway pressure (CPAP) usage changed after the beginning of the pandemic, to compare the stress level with the baseline, and to observe if any modifications are related to their individual characteristics. The present studies highlight the level of anxiety, which was high among patients with OSA during the COVID-19 pandemic (p < 0.05), with its influence on weight control (62.5% of patients with high levels of stress gained weight) and sleep schedule (82.6% reported a change in sleep schedule). Patients with severe OSA and high levels of stress increased their CPAP usage (354.5 min/night vs. 399.5 min/night during the pandemic, p < 0.05). To conclude, in OSA patients, the presence of the pandemic led to a greater level of anxiety, changes in sleep schedule and weight gain because of job loss, isolation, and emotional changes, influencing mental health. A possible solution, telemedicine, could become a cornerstone in the management of these patients.

The Assessment of Driving Fitness Using an On-Road Evaluation in Patients With Cirrhosis

INTRODUCTION

The association between cirrhosis and driving performance is of particular clinical relevance because of the life-threatening safety issues both for the driver with cirrhosis and the general public. Study aims were to assess (i) driving competency through the use of an in-office computerized battery and on-road driving assessment (DriveABLE) and (ii) the association between minimal hepatic encephalopathy (MHE), in-office paper-pencil tools, and additional measures (e.g., frailty, depression, cognitive testing) with unsafe driving.

METHODS

Patients were prospectively recruited from 2 tertiary care liver clinics. In-office tests and in-office and on-road assessments of driving competence were completed. The χ 2 test and 1-way analysis of variance were used to analyze differences among those with and without MHE. Logistic regression was used to evaluate predictors of an indeterminate/fail result on the in-office computerized driving assessment battery (DriveABLE Cognitive Assessment Tool [DCAT]).

RESULTS

Eighty patients participated with a mean age of 57 years, 70% male, 75% Child-Pugh B/C, and 36% with a history of overt hepatic encephalopathy. Thirty percent met MHE criteria on both the psychometric hepatic encephalopathy score and the Stroop app tests. Only 2 patients (3%) were categorized as "unfit to drive" in the on-road driving test, one with MHE and the other without. Fifty-eight percent of the patients were scored as indeterminate/fail on the DCAT. This corresponded to a higher mean number of on-road driving errors (5.3 [SD 2.1] vs 4.2 [SD 1.6] in those who passed the DCAT, P = 0.01). Older age (odds ratio 1.3; confidence interval 1.1, 1.5; P = 0.001) and MHE by Stroop/psychometric hepatic encephalopathy score (odds ratio 11.0; confidence interval 2.3, 51.8; P = 0.002) were independently predictive of worse performance on the DCAT.

DISCUSSION

Worse performance in in-office testing was associated with worse scores on a computerized driving assessment battery and more on-road driving errors, but in-office tools were insufficient to predict on-road driving failures. A diagnosis of MHE should not be used alone to restrict driving in patients with cirrhosis. At-risk patients require on-road driving tests under the supervision of driving regulatory agencies. Future studies should continue to refine and evaluate in-office or at-home testing to predict driving performance.

Mental health conditions and unsafe driving behaviors: A naturalistic driving study on ADHD and depression

INTRODUCTION

Road injuries remain a persistent public health concern across the world. The task of driving is complicated by mental health conditions, which may affect drivers' executive functioning and cognitive resource allocation. This study examines whether attention-deficit/hyperactivity disorder (ADHD) and depression are associated with unsafe driving behaviors.

METHOD

Generalized linear mixed models were employed to estimate the association of self-reported ADHD and depression with 18 unsafe driving behavior types found prior to at-fault crashes and near-crashes using a large-scale naturalistic driving dataset. Driver demographics, cognitive traits, environmental factors, and driver random effects were included to reduce confounding and biases.

RESULTS

Controlling for other covariates, people with self-reported ADHD were more likely to have performed improper braking or stopping (OR = 4.89, 95% CI 1.82-13.17) prior to an at-fault crash or near-crash, while those with self-reported depression did not have a significant association with any unsafe driving behavior.

CONCLUSIONS

After accounting for demographic, cognitive, and environmental covariates, individuals with ADHD and depression were not prone to purposefully aggressive or reckless driving. Instead, drivers with self-reported ADHD may unintentionally execute unsafe driving behaviors in particular driving scenarios that require a high level of cognitive judgment.

PRACTICAL APPLICATIONS

These findings can inform the curriculum design of driver's education programs that help learners with mental health conditions gain practice in certain road scenarios, for example, more practice on preemptively reducing speed instead of making sudden brakes and smooth turning on curved roads for students with ADHD. Furthermore, specific advanced driver assistance systems may prove particularly helpful for drivers with ADHD, such as detection of leading objects and curve speed warning.

Assessing the Possible Effect of Depression on Driving Behavior: A Cross-sectional Study

Background: Driving as a complex behavior pattern is influenced by a set of conscious and unconscious factors. One of the most important causes of traffic accidents in Iran is human factors, which include the driver's mental status, personality traits, mental illnesses, or psychiatric disorders. Depression is one of the most common psychiatric disorders affecting driving behavior. Objectives: The aim of this study was to examine whether depression may affect driving performance. Methods: This cross-sectional study was done on 100 participants who were divided into two groups, patients with major depressive disorder (MDD) and the healthy control group. Driving behavior was assessed by the Manchester Driving Behavior Questionnaire (MDBQ), and three computerized tests [Tower of London Test, Wisconsin Card Sorting Test (WCST), and reaction time] were used to evaluate the participants’ neuropsychiatric characteristics. The results were compared between the two groups using SPSS version 19. Results: There were 51 cases in the MDD group (male = 59%, female = 41%) and 50 patients in the non-depressed group (male = 22%, female = 78%). The mean age of the group with MDD and the control group was 38 ± 8 and 36 ± 9 years, respectively, with no significant differences (P = 0.23). The results showed that the highest mean reaction time (875 ± 198, P = 0.018) was related to the depressed non-risky drivers, and the depressed risky drivers showed the worse function in all domains of WCST (trials to complete first category: 28 ± 23, P = 0.002, total error: 33 ± 9, P = 0.001, and perseveration error: 15 ± 9, P = 0.009) in comparison with another group. Considering the mean score of the tower of London test, the non-depressed non-risky drivers showed the shortest time (219 ± 172, P = 0.001) spent on doing the task, while the depressed non-risky drivers showed the longest mean latency time (213 ± 96, P = 0.001). Conclusions: The findings of the present study showed that depression is associated with deficits in multiple cognitive domains, such as executive function, which may lead to a significant decline in different aspects of driving behavior.

How did the COVID-19 pandemic affect road crashes and crash outcomes in Alabama?

With the rising number of cases and deaths from the COVID-19 pandemic, nations and local governments, including many across the U.S., imposed travel restrictions on their citizens. This travel restriction order led to a significant reduction in traffic volumes and a generally lower exposure to crashes. However, recent preliminary statistics in the US suggest an increase in fatal crashes over the period of lockdown in comparison to the same period in previous years. This study sought to investigate how the pandemic affected road crashes and crash outcomes in Alabama. Daily vehicle miles traveled and crashes were obtained and explored. To understand the factors associated with crash outcomes, four crash-severity models were developed: (1) Single-vehicle (SV) crashes prior to lockdown order (Normal times SV); (2) multi-vehicle (MV) crashes prior to lockdown order (Normal times MV); (3) Single-vehicle crashes after lockdown order (COVID times SV); and (4) Multi-vehicle crashes after lockdown order (COVID times MV). The models were developed using the first 28 weeks of crashes recorded in 2020. The findings of the study reveal that although traffic volumes and vehicle miles traveled had significantly dropped during the lockdown, there was an increase in the total number of crashes and major injury crashes compared to the period prior to the lockdown order, with speeding, DUI, and weekends accounting for a significant proportion of these crashes. These observations provide useful lessons for road safety improvements during extreme events that may require statewide lockdown, as has been done with the COVID-19 pandemic. Traffic management around shopping areas and other areas that may experience increased traffic volumes provide opportunities for road safety stakeholders to reduce the occurrence of crashes in the weeks leading to an announcement of any future statewide or local lockdowns. Additionally, increased law enforcement efforts can help to reduce risky driving activities as traffic volumes decrease.

Road safety status during COVID-19 pandemic: exploring public and road safety expert's opinions

The main objective of this study is to investigate the status of traffic safety and the public perception of traffic safety during the during COVID-19 pandemic. Three different data sets are used in this study: road crash and traffic violation data from Qatar, and two separate questionnaire surveys (from general public and road safety experts). Results showed that during COVID-19 period, the total number of crashes in Qatar significantly reduced during the pandemic compared with the previous 5 years. However, the rates of serious and fatal injuries significantly increased. Regarding the general public perceptions, more than 80% reported that roads became safer while driving behaviours improved during the pandemic. On the other hand, more than 50% of the experts disagreed that roads became safer, 55% disagreed that driving behaviours improved and 70% agreed that less attention from governments was directed toward road safety during the pandemic. The findings from this study could help policy makers to understand the road safety status during the pandemic to make appropriate adjustments in the traffic laws and regulations on a temporary basis. This could help in reducing crash-related injuries and as a result reduce pressure on health and other emergency services.

The Impact of Cognition and Gender on Speeding Behaviour in Older Drivers with and without Suspected Mild Cognitive Impairment

Purpose

Mild cognitive impairment and gender can impact different aspects of driving performance and behaviour in older drivers. However, there is little evidence on how these may affect naturalistic speeding behaviour. Therefore, the aim of this study was to examine the relationship between speeding events and cognitive status for older male and female drivers.

Participants and Methods

A naturalistic driving study collected objective driving information over a two-week period using an in-vehicle monitoring device from 36 older drivers with suspected mild cognitive impairment and 35 older drivers without cognitive impairment. The outcome of interest examined was the number of speeding events, defined as travelling 5+ km/h over the posted speed limit for at least a minute.

Results

The majority of participants (n=58, 81.69%) did not have a speeding event during the two-week monitoring period. Twenty-three speeding events were recorded among seven drivers with suspected mild cognitive impairment and six drivers without cognitive impairment. The majority of speeding events (82.61%) were by older male drivers and occurred in 60km/h and 70km/h speed zones. The results of the two negative binomial regression models found that in older male drivers, suspected mild cognitive impairment (IRR=7.45, 95% CI=1.53–36.15, p=0.01) was associated with a significantly higher rate of speeding events, while increasing age was associated with a lower rate of speeding events (IRR=0.80, 95% CI=0.64–1.00, p=0.04). For older female drivers, there were no factors significantly associated with the rate of speeding events.

Conclusion

While the overall number of speeding events were infrequent, suspected mild cognitive impairment was associated with a significant increase in the rate of speeding events for older male drivers, but not for older female drivers. Speeding interventions and injury prevention policy strategies may need to be targeted differently for male and female drivers with mild cognitive impairment.

The Impact of Two MMPI-2-Based Models of Personality in Predicting Driving Behavior. Can Demographic Variables Be Disregarded?

The driver’s personality is a key human factor for the assessment of the fitness to drive (FTD), affecting driving decisions and behavior, with consequences on driving safety. No previous study has investigated the effectiveness of Minnesota Multiphasic Personality Inventory (MMPI)-2 scales for predicting the FTD. The present study aimed to compare two MMPI-2-based models of normal and pathological personality traits (i.e., Inventory of Driving-related Personality Traits (IVPE)-MMPI vs. Personality Psychopathology Five (PSY-5) scale) in predicting the cognitive FTD. One hundred young and eighty-seven adult active drivers completed the MMPI-2 questionnaire as a measure of personality and a computerized driving task measuring for resilience of attention (Determination Test (DT)), reaction speed (Reaction Test (RS)), motor speed (MS), and perceptual speed (Adaptive Tachistoscopic Traffic Perception Test (ATAVT)). The effects of age, gender, and education were also controlled. Results showed that the models controlled for demographics overperformed those neglecting them for each driving outcome. A negative effect of age was found on each driving task; the effect of gender, favoring males, was found in both the RS and the MS, and the effect of education was found on the DT and the ATAVT. Concerning personality traits, significant effects were found of sensation seeking (IVPE-MMPI) on each outcome; of anxiety (as a measure of emotional instability; IVPE-MMPI) and introversion (PSY-5) on the measures of MS; and of psychopathic deviation (as a measure of self-control; IVPEMMPI) on the DT. The study confirmed the key role of demographic factors in influencing the FTD, further suggesting the usefulness of some MMPI2-based personality scales in the assessment of driving-related personality determinants.

Age-Related Diseases and Driving Safety

Due to demographic changes, the number of older drivers is steadily increasing. Mobility is highly relevant for leading an independent life in the elderly. It largely depends on car driving, which is a complex task requiring a multitude of cognitive and motor skills vulnerable to age- related functional deterioration. The almost inevitable effects of senescence may be potentiated by age-related diseases, such as stroke or diabetes mellitus. Respective pharmacological treatment may cause side effects, additionally affecting driving safety. The present article reviews the impact of age-related diseases and drug treatment of these conditions on driving fitness in elderly drivers. In essence, we focus on diseases of the visual and auditory systems, diseases of the central nervous system (i.e., stroke, depression, dementia and mild cognitive disorder, and Parkinson's disease), sleep disorders, as well as cardiovascular diseases, diabetes mellitus, musculoskeletal disorders, and frailty. We will outline the role of functional tests and the assessment of driving behavior (by a driving simulator or in real traffic), as well as the clinical interview including questions about frequency of (near) accidents, etc. in the evaluation of driving fitness of the elderly. We also address the impact of polypharmacy on driving fitness and end up with recommendations for physicians caring for older patients.

Mindfulness, sleep, and post-traumatic stress in long-haul truck drivers

BACKGROUND

The high stress culture and demands associated with long-haul truck driving place truckers at risk for mental health and sleep disorders, and thereby, increased risk for accidents, injuries, and fatality. Hours-of-service regulations have proven insufficient as a stand-alone intervention to protect the welfare of long-haul truckers, impacting those working in the industry and those sharing our nation's roads. Interventions to increase mindfulness have been used across occupational and personal domains to improve sleep quality, mental health, awareness of the environment, and reaction time.

OBJECTIVE

The purpose of this study was to examine the relationships between sleep, mental health, health care utilization, and mindfulness in long-haul truck drivers in the United States.

METHODS

Participants (N = 140) were recruited to complete a web-based survey. Descriptive statistics, bivariate analysis, and regression analysis were used to examine variables of interest.

RESULTS

Post-traumatic Stress Disorder (PTSD) symptomology and daytime sleepiness predicted mental health care utilization in the past year. Mindfulness was inversely correlated with PTSD symptomology, however in the full regression model, mindfulness failed to predict mental health care utilization.

CONCLUSIONS

Occupational health professionals should utilize mindfulness screenings as an adjunctive component to traditional mental health screenings and refer drivers for advanced care as appropriate.

Coronavirus disease 2019: What could be the effects on Road safety?

In March 2020, the World Health Organization declared COVID-19 a world-wide pandemic. Countries introduced public health measures to contain and reduce its spread. These measures included closures of educational institutions, non-essential businesses, events and activities, as well as working from and staying at home requirements. These measures have led to an economic downturn of unprecedented proportions. Generally, as economic activity declines, travel decreases and drivers are exposed to a lower risk of collisions. However, research on previous economic downturns suggests economic downturns differentially affect driver behaviours and situations. COVID-19 pandemic effects on road safety are currently unknown. However, preliminary information on factors such as the increased stress and anxiety brought about by the COVID-19 pandemic, more "free" (idle) time, increased consumption of alcohol and drugs, and greater opportunities for speeding and stunt driving, might well have the opposite effect on road safety. Using an interactionist model we identify research questions for researchers to consider on potential person and situation factors associated with COVID-19 that could affect road safety during and after the pandemic. Collaborative efforts by researchers, and public and private sectors will be needed to gather data and develop road safety strategies in relation to the new reality of COVID-19.

Risky driving behaviour in Abu Dhabi, United Arab Emirates: a cross-sectional, survey-based study

Background

Traffic collision fatality rates per mile travelled have declined in Abu Dhabi similar to many developed countries. Nevertheless, the rate is still significantly higher than the average of countries with similar GDP and socio-demographic indicators. The literature on the subject in the UAE is limited especially in the area of studying drivers behaviour. This study aims to find determinants of risky driving behaviours that precipitate having a road traffic collision (RTC) in the United Arab Emirates (UAE).

Methods

A cross-sectional, survey-based study was employed. Participants were 327 active drivers who were attending Abu Dhabi Ambulatory Health Care Services clinics. They were provided with a questionnaire consisting of demography, lifestyle history, medical history, driving history, and an RTC history. They were also given a driving behaviour questionnaire, a distracted driving survey, depression screening and anxiety screening.

Results

Novice drivers (less than 25 years old) were 42% of the sample and 79% were less than 35 years. Those who reported a history of an RTC constituted 39.8% of the sample; nearly half (47.1%) did not wear a seatbelt during the collision. High scores in the driving behaviour questionnaire and high distraction scores were evident in the sample. Most distraction-prone individuals were young (90.5% were less than 36 years old). High scores in the driving behaviour questionnaire were also associated with high distraction scores (p < 0.001). Respondents with high depression risk were more likely to be involved in the RTC. With each one-point increase in the driver’s distraction score, the likelihood of a car crash being reported increased by 4.9%.

Conclusion

Drivers in the UAE engage in risky behaviours and they are highly distracted. Some behaviours that contribute to severe and even fatal injuries in RTCs include failing to wear a seatbelt and being distracted. Younger people were more likely distracted, while older drivers were more likely to have higher depression scores. Depression is suggested as a determinant factor in risky driving. These findings are informative to other countries of similar socioeconomic status to the UAE and to researchers in this field in general.

The Drives for Driving Simulation: A Scientometric Analysis and a Selective Review of Reviews on Simulated Driving Research

Driving behaviors and fitness to drive have been assessed over time using different tools: standardized neuropsychological, on-road and driving simulation testing. Nowadays, the great variability of topics related to driving simulation has elicited a high number of reviews. The present work aims to perform a scientometric analysis on driving simulation reviews and to propose a selective review of reviews focusing on relevant aspects related to validity and fidelity. A scientometric analysis of driving simulation reviews published from 1988 to 2019 was conducted. Bibliographic data from 298 reviews were extracted from Scopus and WoS. Performance analysis was conducted to investigate most prolific Countries, Journals, Institutes and Authors. A cluster analysis on authors' keywords was performed to identify relevant associations between different research topics. Based on the reviews extracted from cluster analysis, a selective review of reviews was conducted to answer questions regarding validity, fidelity and critical issues. United States and Germany are the first two Countries for number of driving simulation reviews. United States is the leading Country with 5 Institutes in the top-ten. Top Authors wrote from 3 to 7 reviews each and belong to Institutes located in North America and Europe. Cluster analysis identified three clusters and eight keywords. The selective review of reviews showed a substantial agreement for supporting validity of driving simulation with respect to neuropsychological and on-road testing, while for fidelity with respect to real-world driving experience a blurred representation emerged. The most relevant critical issues were the a) lack of a common set of standards, b) phenomenon of simulation sickness, c) need for psychometric properties, lack of studies investigating d) predictive validity with respect to collision rates and e) ecological validity. Driving simulation represents a cross-cutting topic in scientific literature on driving, and there are several evidences for considering it as a valid alternative to neuropsychological and on-road testing. Further research efforts could be aimed at establishing a consensus statement for protocols assessing fitness to drive, in order to (a) use standardized systems, (b) compare systematically driving simulators with regard to their validity and fidelity, and (c) employ shared criteria for conducting studies in a given sub-topic.

The Teen Driver

For many teenagers, obtaining a driver's license is a rite of passage, conferring the ability to independently travel to school, work, or social events. However, immaturity, inexperience, and risky behavior put newly licensed teen drivers at risk. Motor vehicle crashes are the most common cause of mortality and injury for adolescents and young adults in developed countries. Teen drivers (15-19 years of age) have the highest rate of motor vehicle crashes among all age groups in the United States and contribute disproportionately to traffic fatalities. In addition to the deaths of teen drivers, more than half of 8- to 17-year-old children who die in car crashes are killed as passengers of drivers younger than 20 years of age. This policy statement, in which we update the previous 2006 iteration of this policy statement, is used to reflect new research on the risks faced by teen drivers and offer advice for pediatricians counseling teen drivers and their families.

Depression and Alzheimer's Disease Biomarkers Predict Driving Decline

BACKGROUND

Symptomatic Alzheimer's disease (AD) and depression independently increase crash risk. Additionally, depression is both a risk factor for and a consequence of AD.

OBJECTIVE

To examine whether a depression diagnosis, antidepressant use, and preclinical AD are associated with driving decline among cognitively normal older adults.

METHODS

Cognitively normal participants, age ≥65, were enrolled. Cox proportional hazards models evaluated whether a depression diagnosis, depressive symptoms (Geriatric Depression Scale), antidepressant use, cerebrospinal fluid (amyloid-β42 [Aβ42], tau, phosphorylated tau181 [ptau181]), and amyloid imaging biomarkers (Pittsburgh Compound B and Florbetapir) were associated with time to receiving a rating of marginal/fail on a road test. Age was adjusted for in all models.

RESULTS

Data were available from 131 participants with age ranging from 65.4 to 88.2 years and mean follow up of 2.4 years (SD = 1.0). A depression diagnosis was associated with a faster time to receiving a marginal/fail rating on a road test and antidepressant use (p = 0.024, HR = 2.62). Depression diagnosis and CSF and amyloid PET imaging biomarkers were associated with driving performance on the road test (p≤0.05, HR = 2.51-3.15). In the CSF ptau181 model, depression diagnosis (p = 0.031, HR = 2.51) and antidepressant use (p = 0.037, HR = 2.50) were statistically significant predictors. There were no interaction effects between depression diagnosis, antidepressant use, and biomarker groups. Depressive symptomology was not a statistically significant predictor of driving performance.

CONCLUSIONS

While, as previously shown, preclinical AD alone predicts a faster time to receiving a marginal/fail rating, these results suggest that also having a diagnosis of depression accelerates the onset of driving problems in cognitively normal older adults.

Young females at risk while driving with a small child

INTRODUCTION

Previous research suggests that young mothers with little driving experience are at risk when driving with a small child passenger. In this study we examined the prevalence, characteristics and risk of fatal motor vehicle crashes involving an infant passenger under the age of one among female drivers of different ages.

METHODS

We used crash data from the US Fatality Analysis Reporting System for 1994-2013. The prevalence of fatal crashes involving infants was examined by age of female drivers and compared to the number of births among mothers of a similar age. The essential characteristics of the crashes were described, and the odds of being at fault were determined for young (16-24-year-olds) and older female drivers (25-39-year-olds) with an infant passenger or with no passengers.

RESULTS

The prevalence of fatal crashes involving infant passengers was higher among young female drivers in relation to the number of births among mothers of a similar age than among older females. Young female drivers with an infant passenger were more often at fault than older drivers (aOR=1.83, 95%, CI=1.52, 2.20). Their vehicles were older and smaller and they used proper safety seats for infants less often than the older drivers. In addition, young female drivers with an infant passenger but with no adult passenger in the vehicle were more often at fault than young female drivers with no passengers (aOR=1.27, 95% CI=1.06, 1.51). Both young and older female drivers' crashes involving an infant passenger typically occurred in ordinary driving conditions, but these drivers with infant passengers were more often reported as having fallen asleep or inattentive than those with no passengers. The presence of an adult passenger in addition to an infant passenger lowered female drivers' odds of being at fault, regardless of the driver's age.

CONCLUSIONS

Young females driving with an infant passenger, probably most often mothers, are at an elevated risk of a fatal crash, especially when they drive alone with an infant. The protective effect of an adult passenger suggests that another adult in the vehicle can assist the driver by taking care of the infant and enabling the driver to focus on driving.

Drivers' psychiatric disorders and fatal motor vehicle accidents in Finland

Relatively little is known about fatal motor vehicle accidents (FMVA) involving drivers with psychiatric disorders. In this study of all drivers killed in FMVAs in Finland between 1990 and 2011, we aimed to study drivers' death rate trends in FMVAs, with special focus on drivers with a history of psychiatric disorders. Prevalence of drivers' hospital treated psychiatric disorders, and characteristics of drivers with psychiatric disorders were also studied. For the purpose of this study, three national registers were accessed. Drivers' hospital treated psychiatric disorders were screened in a five-year period prior to death. Drivers with (n = 425) and without (n = 3856) psychiatric disorders were compared, female and male drivers separately. The main outcome measure was any psychiatric disorder in drivers within the five-year timescale. Socio-demographic factors, use of intoxicants and medication at the time of death, recent adverse life events, and drivers' physical and emotional states were used as covariates in the statistical analyses. During the study period, death rates increased for females with psychiatric disorders, and decreased for females without psychiatric disorders. Death rates for males with psychiatric disorders decreased between the years 1990-2000 and 2007-2011, and increased between the years 2000-2007. Death rates decreased over the whole study period in males without psychiatric disorders. Alcohol related disorders and affective disorders were the most prevalent hospital treated psychiatric disorders among drivers involved in FMVAs. Use of medications at the time of death, and committing suicide in traffic both associated with being a driver with psychiatric disorders involved in FMVAs for both genders. As FMVAs involving drivers with psychiatric disorders have increased, a more focused and detailed evaluation of the driving performance of drivers with psychiatric disorders is recommended. These evaluations should also be extended to drivers with non-psychotic disorders.

International approaches to driving under the influence of cannabis: A review of evidence on impact

BACKGROUND

There are knowledge gaps regarding the effectiveness of different approaches designed to prevent and deter driving under the influence of cannabis (DUIC). Policymakers are increasingly interested in evidence-based responses to DUIC as numerous jurisdictions worldwide have legally regulated cannabis or are debating such regulation. We contribute a comprehensive review of international literature on countermeasures that address DUIC, and identify where and how such measures have been evaluated.

METHODS

The following databases were systematically searched from 1995 to present: Medline, Embase, PsycINFO, CINAHL, Sociological Abstracts, and Criminal Justice Abstracts. Hand searching of relevant documents, internet searches for grey literature, and review of ongoing email alerts were conducted to capture any emerging literature and relevant trends.

RESULTS

Numerous international jurisdictions have introduced a variety of measures designed to deter DUIC. Much interest has been generated regarding non-zero per se laws that set fixed legal limits for tetrahydrocannabinol and/or its metabolites detected in drivers. Other approaches include behavioural impairment laws, zero-tolerance per se laws, roadside drug testing, graduated licensing system restrictions, and remedial programs. However, very few evaluations have appeared in the literature.

CONCLUSIONS

Although some promising results have been reported (e.g., roadside testing), it is premature to draw firm conclusions regarding the broader impacts of general deterrent approaches to DUIC. This review points to the need for a long-term commitment to rigorously evaluate, using multiple methods, the impact of general and specific deterrent DUIC countermeasures.

The impact of childhood symptoms of conduct disorder on driver aggression in adulthood

BACKGROUND

Despite limited empirical investigation, existing scientific literature suggests that individuals with a history or current diagnosis of conduct disorder (CD) may be more likely to demonstrate reckless and aggressive driving. Much of the limited research in this field examines the impact of childhood CD on driver behaviour and collision risk in young adults. Few if any, studies assess the impact of this disorder on driver behaviour beyond age 21 years. The current research is a population-based study of the impact of CD symptoms during childhood on the risk of engaging in driver aggression during adulthood.

METHODS

Data are based on telephone interviews with 5230 respondents who reported having driven in the past year. Data are derived from the 2011-2013 cycles of the CAMH Monitor, an ongoing cross-sectional survey of adults in Ontario, Canada aged 18 years and older. A binary logistic regression analysis of self-reported driver aggression in the previous 12 months was conducted, consisting of measures of demographic characteristics, driving exposure, problem substance use, alcohol- and drug-impaired driving, symptoms of attention deficit hyperactivity disorder, and childhood (before age 15) symptoms of CD.

RESULTS

When entered with demographic characteristics, driving exposure, and other potential confounders, childhood symptoms of CD increased the odds of reporting driver aggression more than two-fold (adjusted OR=2.12). Exploratory analyses of the interaction between childhood symptoms of CD and age was not a significant predictor of driver aggression.

CONCLUSIONS

Results suggest that symptoms of CD during childhood are associated with significantly increased odds of self-reported driver aggression during adulthood. Limitations and future directions of the research are discussed.