Motor vehicle driving in high incidence psychiatric disability: Comparison of drivers with ADHD, depression, and no known psychopathology

https://doi.org/10.1016/j.jpsychires.2015.03.009Get rights and content

Highlights

  • First nationwide study of driving outcomes for multiple psychiatric disabilities.

  • ADHD but not Depression portended increased risk for multiple collisions/violations.

  • ADHD but not Depression portended increased risk for collision fault.

  • Depression but not ADHD predicted an increased risk for self-reported injury following a collision.

Abstract

Although not often discussed in clinical settings, motor vehicle driving is a complex multitasking endeavor during which a momentary attention lapse can have devastating consequences. Previous research suggests that drivers with high incidence psychiatric disabilities such as ADHD contribute disproportionately to collision rates, which in turn portend myriad adverse social, financial, health, mortality, and legal outcomes. However, self-referral bias and the lack of psychiatric comparison groups constrain the generalizability of these findings. The current study addressed these limitations and examined the unique associations among ADHD, Depression, and adverse driving outcomes, independent of self-selection, driving exposure, and referral bias. The Strategic Highway Research Program (SHRP-2) Naturalistic Driving Study comprises U.S. drivers from six sites selected via probability-based sampling. Groups were defined by Barkley ADHD and psychiatric diagnosis questionnaires, and included ADHD (n = 275), Depression (n = 251), and Healthy Control (n = 1828). Primary outcomes included self-reported traffic collisions, moving violations, collision-related injuries, and collision fault (last 3 years). Accounting for demographic differences, ADHD but not Depression portended increased risk for multiple violations (OR = 2.3) and multiple collisions (OR = 2.2). ADHD but not Depression portended increased risk for collision fault (OR = 2.1). Depression but not ADHD predicted increased risk for self-reported injury following collisions (OR = 2.4). ADHD appears uniquely associated with multiple collisions, multiple violations, and collision fault, whereas Depression is uniquely associated with self-reported injury following a collision. Identification of the specific mechanisms underlying this risk will be critical to designing effective interventions to improve long-term functioning for drivers with high incidence psychiatric disability.

Section snippets

Design and overview

The SHRP-2 Naturalistic Driving Study consists of 3,600 drivers from six U.S. sites (New York, Washington, Pennsylvania, Indiana, Florida, and North Carolina). A detailed description of study recruitment, participants, and methodology is provided in Antin et al. (2011). Briefly, participants were selected through a probability-based sampling approach and consented to have their vehicles outfitted with a sophisticated data acquisition system to capture day-to-day driving data continuously for

Preliminary analyses

Data were available for over 99% of the 3,259 cases for all dependent and independent variables (range = 99.1%–99.8%; N = 7 to 31 missing cases) with the exception of self-reported income (16.2% missing; N = 2,731 respondents).2 Chi-square tests supported a Missing At Random (MAR) assumption; the probability of missing data did not vary significantly as a

Discussion

The current study used a large, nationwide sample to examine the relative risk of motor vehicle violations, collisions, collision-related injuries, and collision fault associated with ADHD and Depression relative to drivers with no known psychopathology. To our knowledge, this is the first study to compare drivers with multiple forms of high incidence psychopathology while also accounting for known risk factors of increased violation and collision rates. Using the nationally representative

Role of funding source

Preparation of this manuscript was funded in part by a UVa Curry School of Education Foundation grant (PI: Kofler) from the Galant Family. The sponsor had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. Aduen and Kofler had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Contributors

All authors contributed substantially to the conceptualization and development of the study.

Conflict of interest

The authors have no conflicts of interest to report.

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