رانندگی وسیله نقلیه موتوری در بروز ناتوانی روانی: مقایسه رانندگان با اختلال، افسردگی و هیچ آسیب شناسی روانی شناخته شده

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.

The upsurge of research into adult attention-deficit/hyperactivity disorder (ADHD) reflects an improved understanding of the lifetime course of this chronic and potentially impairing neurodevelopmental disorder (Klein et al., 2012 and Barkley et al., 2002). Prospective studies reveal that most children with ADHD continue to meet full diagnostic criteria in adolescence (70%–80%) and adulthood (46%–66%) (Mannuzza et al., 1993, Barkley et al., 2002 and Biederman et al., 2010). These findings are consistent with epidemiological estimates for childhood (5%) (Polanczyk et al., 2007) relative to adult ADHD (4%) (Faraone et al., 2003), and clearly position ADHD as a high incidence disability throughout the lifespan when considered in the context of the disorder's broad impact on functioning (Wilens et al., 2004).

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 function of group membership (χ2 [2] = 1.02; p = .60). The groups differed significantly in age, gender, education, marital status, average annual miles driven (all p < .002), and income (p = .03). Bonferroni-corrected post hocs revealed that ADHD drivers were overrepresented in the youngest age groups (ages 16–25) and underrepresented in the oldest age groups (ages 51+). Drivers with ADHD were also less likely to have a high school diploma or college degree, were overrepresented in the extreme income groups (<$29K/year, > $150K/year), and were less likely to be married (all p < .05). Drivers with depression were more likely to be female and report driving more than 20,000 miles/year (both p < .05). These demographic variables were included as covariates in all subsequent analyses ( Table 1). Results are reported both before and after controlling for these factors given that most of these variables are known outcomes of ADHD ( Barkley et al., 2002 and Mannuzza et al., 1993) and Depression ( Harrington et al., 1990, Rao et al., 1999 and Fergusson and Woodward, 2002).