Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Psychiatry
Published in: BMC Psychiatry 1/2017

Open Access 01-12-2017 | Research article

A systematic review of evidence for fitness-to-drive among people with the mental health conditions of schizophrenia, stress/anxiety disorder, depression, personality disorder and obsessive compulsive disorder

Authors: Carolyn A. Unsworth, Anne M. Baker, Man H. So, Priscilla Harries, Desmond O’Neill

Published in: BMC Psychiatry | Issue 1/2017

Login to get access

Abstract

Background

Limited evidence exists regarding fitness-to-drive for people with the mental health conditions of schizophrenia, stress/anxiety disorder, depression, personality disorder and obsessive compulsive disorder (herein simply referred to as ‘mental health conditions’). The aim of this paper was to systematically search and classify all published studies regarding driving for this population, and then critically appraise papers addressing assessment of fitness-to-drive where the focus was not on the impact of medication on driving.

Methods

A systematic search of three databases (CINAHL, PSYCHINFO, EMBASE) was completed from inception to May 2016 to identify all articles on driving and mental health conditions. Papers meeting the eligibility criteria of including data relating to assessment of fitness-to-drive were critically appraised using the American Academy of Neurology and Centre for Evidence-Based Medicine protocols.

Results

A total of 58 articles met the inclusion criteria of driving among people with mental health conditions studied, and of these, 16 contained data and an explicit focus on assessment of fitness-to-drive. Assessment of fitness-to-drive was reported in three ways: 1) factors impacting on the ability to drive safely among people with mental health conditions, 2) capability and perception of health professionals assessing fitness-to-drive of people with mental health conditions, and 3) crash rates. The level of evidence of the published studies was low due to the absence of controls, and the inability to pool data from different diagnostic groups. Evidence supporting fitness-to-drive is conflicting.

Conclusions

There is a relatively small literature in the area of driving with mental health conditions, and the overall quality of studies examining fitness-to-drive is low. Large-scale longitudinal studies with age-matched controls are urgently needed in order to determine the effects of different conditions on fitness-to-drive.
Appendix
Available only for authorised users
Literature
1.
Golisz K. Occupational therapy interventions to improve driving performance in older adults: a systematic review. Am J Occup Ther. 2014;68:662–9.CrossRefPubMed
2.
Justiss MD. Occupational therapy interventions to promote driving and community mobility for older adults with low vision: a systematic review. Am J Occup Ther. 2013;67:296–302.CrossRefPubMed
3.
4.
Anstey KJ, Wood J, Lord S, Walker JG. Cognitive, sensory and physical factors enabling driving safety in older adults. Clin Psychol Rev. 2005;25:45–65.CrossRefPubMed
5.
Hammar A, Lund A, Hugdahl K. Selective impairment in effortful information processing in major depression. J Int Neuropsychol Soc. 2003;65(2):234–47.
6.
Heinrichs RW, Zakzanis KK. Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. Neuropsychology. 1998;12:426–45.CrossRefPubMed
7.
Purcell R, Maruff P, Kyrio M, Pantelis C. Neuropsychological function in young patients with unipolar major depression. Psychol Med. 1997;27(6):1277–85.CrossRefPubMed
8.
Bulmash EL, Moller HJ, Kayumov L, Shen J, Wang X, Shapiro CM. Psychomotor disturbance in depression: assessment using a driving simulator paradigm. J Affect Disord. 2006;93(1–3):213–8.CrossRefPubMed
9.
Wingen M, Ramaekers JG, Schmitt JA. Driving impairment in depressed patients receiving long-term antidepressant treatment. Psychopharmacology. 2006;188(1):84–91.CrossRefPubMed
10.
Austroads. Assessing fitness to drive: for commercial and private vehicle drivers. Australia: Sydney; 2016.
11.
Oxley J, Whelan M. It cannot be all about safety: the benefits of prolonged mobility. Traffic Injury Prevention. 2008;9(4):367–78.CrossRefPubMed
12.
Chihuri S, Mielenz TJ, Dimaggio CJ, Betz ME, DiGuiseppi C, Jones VC, Li G. Driving cessation and health outcomes in older adults. J Am Geriatr Soc. 2016;64(2):332–41.CrossRefPubMedPubMedCentral
13.
Rowse J (2010). Changing knowledge and practice: mental health service delivery and consumer fitness to drive. PhD thesis. La Trobe University, Australia.
14.
Lam LT, Norton R, Connor J, Ameratunga S. Suicidal ideation, antidepressive medication and car crash injury. Accid Anal Prev. 2005;37(2):335–9.CrossRefPubMed
15.
Sheridan MP. Assessing fitness to drive in dementia and other psychiatric conditions: a higher training learning opportunity at a driver assessment centre. Psychiatrist. 2012;36:113–6.CrossRef
16.
Waller JA. Chronic medical conditions and traffic safety: a review of the California experience. N Engl J Med. 1965;273:1413–20.CrossRefPubMed
17.
De Las Cuevas C, Ramallo Y, Sanz EJ. Psychomotor performance and fitness to drive: the influence of psychiatric disease and its pharmacological treatment. Psychiatry Res. 2010;176(2–3):236–41.CrossRef
18.
Dun C, Baker K, Swan J, Vlachou V, Fossey E. 'Drive safe' initiatives: an analysis of improvements in mental health practices (2005-2013) to support safe driving. The British Journal of Occupational Therapy. 2015;78(6):364–8.CrossRef
19.
Unsworth CA. Issues surrounding driving and driver assessment for people with mental health problems. Mental Health Occupational Therapy. 2010;15(2):41–4.
20.
Unsworth CA, Baker A, Taitz M, Chan SP, Pallant JP, Russell K, Odell M. Development of a standardised Occupational Therapy - Driver Off-Road Assessment Battery to assess older and/or functionally impaired drivers. Australian Occupational Therapy Journal. 2012;59(1):23-36.
21.
22.
23.
24.
25.
CCMTA. (2013). Determining driving fitness in Canada: Part 1: A model for the administration of driving fitness programs and Part 2: CCMTA Medical Standards for Drivers. Canadian Council of Motor Transport Administrators. Retrieved 21/12/16 from: https://​www.​transportation.​alberta.​ca/​content/​docType45/​Production/​CCMTADriverMedic​alStandardsAugus​t2013.​pdf
26.
Jerome L, Segal A, Habinski L. What we know about ADHD and driving risk: a literature review, meta-analysis and critique. Journal of the Canadian Academy of Child & Adolescent Psychiatry. 2006;15(3):105–25.
27.
Bruce C, Unsworth CA, Tay R. A systematic review of the effectiveness of behavioral interventions for improving driving outcomes in novice drivers with attention deficit hyperactivity disorder. Br J Occup Ther. 2014;77(7):348–57.CrossRef
28.
Gobbo MA, Louza MR. Influence of stimulant and non-stimulant drug treatment on driving performance in patients with attention deficit hyperactivity disorder: a systematic review. Eur Neuropsychopharmacol. 2014;24(9):1425–43.CrossRefPubMed
29.
Classen S, Monahan M. Evidence-based review on interventions and determinants of driving performance in teens with attention deficit hyperactivity disorder or autism spectrum disorder. Traffic Injury Prevention. 2013;14(2):188–93.CrossRefPubMed
30.
Barkley RA, Cox D. A review of driving risks and impairments associated with attention deficit/ hyperactivity disorder and the effects of stimulant medication on driving performance. J Saf Res. 2007;38(1):113–28.CrossRef
31.
Tsuang MT, Boor M, Fleming JA. Psychiatric aspects of traffic accidents. Am J Psychiatr. 1985;142(5):538–46.CrossRefPubMed
32.
Menard I, Korner-Bitensky N. Fitness to drive in persons with psychiatric disorders and those using psychotropic medications. Occup Ther Ment Health. 2008;24(1):47–64.CrossRef
33.
34.
35.
36.
Brunnauer A, Buschert V, Segmiller F, Zwick S, Bufler J, Schmauss M, et al. Mobility behaviour and driving status of patients with mental disorders - an exploratory study. Int J Psychiatry Clin Pract. 2016;20(1):40–6.CrossRefPubMed
37.
De Las Cuevas C, Sanz EJ. Fitness to drive of psychiatric patients. J Clin Psychiatry. 2008;10(5):384–90.
38.
McNamara C, Buckley SE. The road to recovery: experiences of driving with bipolar disorder. Br J Occup Ther. 2015;78(6):356–63.CrossRef
39.
40.
Segmiller, F. M., Buschert, V., Laux, G., Nedopil, N., Palm, U., Furjanic, K., ... & Brunnauer, A. (2015). Driving skills in unmedicated first-and recurrent-episode schizophrenic patients. European Archives of Psychiatry and Clinical Neuroscience, 1–6.
41.
Zingg C, Puelschen D, Soyka M. Neuropsychological assessment of driving ability and self-evaluation: a comparison between driving offenders and a control group. Eur Arch Psychiatry Clin Neurosci. 2009;259(8):491–8.CrossRefPubMed
42.
Langan C. Psychiatric illness and driving: Irish psychiatrists' documentation practices. Ir J Psychol Med. 2009;26(1):16–9.CrossRef
43.
Menard I, Korner-Bitensky N, Dobbs B, Casacalenda N, Beck PR, Gelinas I, et al. Canadian psychiatrists' current attitudes, practices, and knowledge regarding fitness to drive in individuals with mental illness: a cross-Canada survey. The Canadian Journal of Psychiatry. 2006;51(13):836–46.CrossRefPubMed
44.
Menard I, Benoit M, Boule-Laghzali N, Hebert M-C, Parent-Taillon J, Perusse J, et al. Occupational therapists' perceptions of their role in the screening and assessment of the driving capacity of people with mental illnesses. Occup Ther Ment Health. 2012;28(1):36–50.CrossRef
45.
Rouleau S, Mazer B, Menard I, Maryse G. A survey on driving in clients with mental health disorders. Occup Ther Ment Health. 2010;26(1):85–95.CrossRef
46.
47.
Crancer A Jr, Quiring DL. The mentally ill as motor vehicle operators. Am J Psychiatr. 1969;126(6):807–13.CrossRefPubMed
48.
Eelkema RC, Brosseau J, Koshnick R, McGee C. A statistical study on the relationship between mental illness and traffic accidents - a pilot study. American Journal of Public Health Nations Health. 1970;60(3):459–69.CrossRef
49.
Kastrup M, Dupont A, Bille M. Traffic accidents involving psychiatric patients. Description of the material and general results. Acta Psychiatr Scand. 1977;55(5):355–68.CrossRefPubMed
50.
Kastrup M, Dupont A, Bille M, Lund H. Traffic accidents involving psychiatric patients: characteristics of accidents involving drivers who have been admitted to Danish psychiatric departments. Acta Psychiatr Scand. 1978;58(1):30–9.CrossRefPubMed
51.
Brunnauer A, Laux G. Driving ability under sertindole. Pharmacopsychiatry. 2012;67(11):1776–81.
52.
Hawley CA, Galbraith ND, De Souza VD. Medical education on fitness to drive: a survey of all UK medical schools. Postgrad Med J. 2008;84:635–8.CrossRefPubMed
53.
O’Neill D, Crosby T, Shaw A, Haigh R, Hendra TJ. Fitness to drive and the older patient: aware ness among hospital physicians. Lancet. 1994;344:1366–7.CrossRefPubMed
54.
55.
Kahvedžic A, Mcfadden R, Cummins G, Carr D, O'Neill D. Impact of new guidelines and educational programme on awareness of medical fitness to drive among general practitioners in Ireland. Traffic Injury Prevention. 2015;16(6):593–8.CrossRefPubMed
Metadata
Title
A systematic review of evidence for fitness-to-drive among people with the mental health conditions of schizophrenia, stress/anxiety disorder, depression, personality disorder and obsessive compulsive disorder
Authors
Carolyn A. Unsworth
Anne M. Baker
Man H. So
Priscilla Harries
Desmond O’Neill
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2017
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-017-1481-1

Other articles of this Issue 1/2017

BMC Psychiatry 1/2017 Go to the issue

Research article

Validation of the short Arabic UPPS-P Impulsive Behavior Scale

Research article

Immune suppression of IgG response against dairy proteins in major depression

Research article

The Autism–Tics, ADHD and other Comorbidities inventory (A-TAC): previous and predictive validity

Case report

Periodic catatonia with long-term treatment: a case report

Research article

Personality traits and suicide attempts with and without psychiatric disorders: analysis of impulsivity and neuroticism

Study protocol

The PULSAR Specialist Care protocol: a stepped-wedge cluster randomized control trial of a training intervention for community mental health teams in recovery-oriented practice