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Δημήτριος Δικαίος, Καθηγητής, Ιατρική, ΕΚΠΑ
Θωμάς Παπαρρηγόπουλος, Καθηγητής, Ιατρική, ΕΚΠΑ
Κωνσταντίνος Ψάρρος, Αναπληρωτής Καθηγητής, Ιατρική, ΕΚΠΑ
Summary:
Introduction: Mental disorders and the effects of treatment often affect sleep and vigilance and may have an impact on driving behavior. Depression is the fourth cause of illness and mortality after cardiovascular problems, cancer and road accidents. The global prevalence of depression is 4.7% in the general population and is characterized by mental, emotional and executive dysfunction. Sleep disorders are often observed in depression, either insomnia or hypersomnia. Symptoms of depression or adverse drug reactions, such as lethargy and sleep disorders are expected to affect both the functional level and daily routine of the individual. Driving is almost a daily activity for a large part of the world's population; the focus of the researches is on exploring the factors that lead to road accidents. Most of them have focused on human factors contributing to road accidents, such as socio-demographic characteristics and general personality traits but also driving ability, behavior and attitude.
Purpose: The purpose of this research was to study driving behavior and performance in patients suffering from depression in association with sleep disorders. The specific goals included; (a) exploring the symptoms of depression and their role, (b) correlating sleep disorders in depressed patients, and (c) investigating the type of antidepressant treatment in association with driving behavior.
Methods: The current analysis entailed between-group comparisons of driving performance of depressed patients who are under treatment or untreated and a group of healthy controls. The sample of the current study was patients suffering from depression and monitored in a regular basis in the Psychiatric Clinic of the University Hospital of Heraklion, Crete and in collaborating centers. The study involved 13 patients with depression (one patient was not receiving medication) and 18 controls. Participants were asked to drive in a driving simulator. The simulator is in the Laboratory of Health Behavior and Road Safety Studies of the Department of Social Work, ATEI of Heraklion, Crete. During the driving activity of depressed patients and control group, were measured Standard Deviation of Lateral Position (SDLP) , the ability to maintain the distance from the in front vehicle, the change of steering position, and the response to stimuli.
Results: It was found that the intensity of depression is positively related to the number of road accidents (p = 0.001). There was positive correlation between the number of road accidents, body mass index and functional level and somnolence on the next day (p = 0.003 and p = 0.002 respectively). Aggressive driving was found to be positively related to fatigue and sleep disturbances (p = 0.002 and p = 0.035, respectively). The reduced ability to maintain constant vehicle velocity was found to be positively correlated with the body mass index and the overall AIS score in insomnia (p = 0.013 and p = 0.021, respectively). A statistically significant positive correlation exists between the distance from the leading vehicle and the taking of drugs with potential hypnotic effects (p = 0.007). Participants who were under medication were maintaining longer distance from the infront vehicle, probably due to the effects of the drugs (p=0,007). The reduced ability to maintain steady route in the traffic lane is positively correlated to the intensity of depression (p=0,026) and drowsiness/reduced functional level (p=0,041), and negatively correlated to the intensity of stress (p=0,017). It turns out that the severity of the disease and the intensity of the symptoms contribute to steer more right and left in the lane and not have a steady route. In addition, depressed patients tend to drive more to the right lane, possibly as a result of fear and / or medication, in order not to be near the cars that pass faster at the fast lane (left lane). Perhaps this shows that patients suffering from depression tend to lead more defensively than controls.
Conclusion: In this study in Greek population, we examined the driving performance and behavior in correlation to depression and sleep disorders. Measurements were performed in patients suffering from depression and in controls. As we found; (a) from the experimental study and (b) from the questionnaire observation study, there are significant differences between the group of depressed patients and those of the controls. In particular, it has been found that driving performance and behavior are influenced by both physical characteristics and mental factors associated with depression and sleep disorders.
Keywords:
Depression, Sleep disorders, Drugs, Driving, Driving simulator
