抑郁与驾驶

Q3 Medicine
Psychiatrike = Psychiatriki Pub Date : 2024-06-28 Epub Date: 2023-05-12 DOI:10.22365/jpsych.2023.014
Vagioula Tsoutsi, Maria Papadakaki, Dimitris Dikeos
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引用次数: 0

摘要

我们最近在《国际环境研究与公共卫生杂志》上发表了一篇文章,介绍了我们对抑郁症患者驾驶行为的研究结果。1 这是第一项通过问卷调查和驾驶模拟器对希腊精神障碍患者的驾驶适应性进行评估的研究。在希腊,类似的研究仅针对帕金森病和轻度认知障碍等神经系统疾病患者。2,3 本报告旨在根据希腊有关驾驶执照和驾驶能力评估的法律法规,讨论我们的研究结果。我们研究的主要结果表明,抑郁症患者(39 人)与对照组(30 人)在驾驶员压力量表和驾驶员行为问卷的自我报告得分上没有差异,从而为上述讨论提供了证据。驾驶员压力量表评估驾驶时产生压力反应的倾向,包括驾驶攻击性、不喜欢驾驶、危险监测、寻求刺激和容易疲劳等分量表。DBQ 通过驾驶错误、交通违规和注意力缺失等分量表评估驾驶行为。模拟驾驶结果显示,患者和对照组在三个选定驾驶场景中的表现差异很小。患者与对照组之间的唯一差异是,前者仅在乡村道路场景中表现出较低的保持车辆稳定行驶轨迹的能力(以横向位置标准偏差衡量)。另一方面,患者与前车的安全距离高于对照组,这表明患者可能意识到自己的驾驶能力受到了一定程度的损害,因此倾向于更加谨慎地驾驶。1 这些发现为现有的相互矛盾的研究结果提供了一个合理的解释,这些研究结果并没有明确表明抑郁症与交通事故的易感性和碰撞风险的增加有关。相反,建议根据精神障碍的严重程度、洞察力、治疗的依从性、认知障碍的程度和稳定期来确定方法。7,8 希腊的法规限制性更强,以第 148/08.08.2016 号和第 5703/09.12.2021 号法律为指导,这些法律规定了在某些医疗条件下获得驾照的最低要求。内科医生在怀疑患者存在精神健康问题时,会要求对其进行精神检查,并根据精神诊断确定患者的能力水平("胜任 "或 "不胜任")。自初次检查起一年后,可根据患者的要求重新评估病情;在某些情况下,对于功能和社会适应能力良好的人,如果没有处方镇静药物,则允许在间隔三年后的清醒状态下延长驾驶执照的有效期。因此,希腊政府有必要重新考虑抑郁症患者获得驾照的最低要求和驾驶能力评估的时间间隔,因为这些都没有研究证据支持。对所有患者无条件地设定至少 1 年的时间限制似乎无助于降低风险,相反,这会降低患者的自主性和与社会的联系,增加耻辱感,并可能导致社会排斥、孤立和抑郁症的发展。9 因此,法律必须引入一种个体化的方法,根据现有的科学知识,即每种疾病对道路交通碰撞风险的影响以及评估时患者的临床状态,对每个案例的利弊进行权衡。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Depression and driving.

We have recently published an article in the International Journal of Environmental Research and Public Health presenting the results of our study on the driving behaviour of patients with depression.1 This is the first study conducted on the Greek population assessing the fitness-to-drive of patients with psychiatric disorders through the use of questionnaires and driving simulator. Similar studies in Greece have only been performed among patients with neurological conditions such as Parkinson's disease and mild cognitive impairment.2,3 The aim of the present communication is to discuss our findings in the light of the Greek law and regulations on driving licensure and on the evaluation of driving ability. The main findings of our study add evidence in this discussion by indicating that patients with depression (N=39) do not differ from controls (N=30) regarding their scores on the self-report questionnaires Driver Stress Inventory and Driver Behaviour Questionnaire. The DSI assesses the propensity to develop stress reactions while driving and consists of subscales for driving aggression, dislike of driving, hazard monitoring, thrill seeking, and proneness to fatigue. The DBQ assesses driving behaviour by the subscales of driving errors, traffic violations, and attention lapses. Driving simulator results showed very few differences between patients and controls in terms of their performance on the three selected driving scenarios. The sole difference found between patients and controls was that the former exhibited lower ability to maintain a stable track of the vehicle (measured as the standard deviation of lateral position) only in the rural road scenario. On the other hand, safety distance from the preceding vehicle was found to be higher in patients than in controls, indicating that patients, possibly aware of their somewhat impaired driving ability, tend to drive more carefully.1 These findings provide a plausible explanation for existing conflicting study results, which do not clearly show depression to be associated with susceptibility to traffic accidents and increased crash risk .4-6 International guidelines do not suggest a blanket restriction on the driving licensure of individuals with psychiatric disorders. Instead, there are recommendations for an approach based on the severity of the disorder, insight, adherence to treatment, level of cognitive impairment, and period of stability.7,8 Regulations in Greece are more restrictive, guided by laws 148/08.08.2016 and 5703/09.12.2021, which define the minimum requirements for licensure in certain medical conditions. A psychiatric examination is requested by internists, upon suspicion of a mental health issue and the psychiatric diagnosis assigns a competence level to the patient ("competent" or "non-competent"). The condition can be re-evaluated upon the patient's request after the lapse of one year from the initial examination; in certain conditions, renewal of driving licensure is permitted after a three-year interval in euthymia for individuals manifesting good functionality and social adjustment, provided that no sedative medication is prescribed. There is a need, therefore, for the Greek government to reconsider the minimum requirements for the licensure of patients with depression and the time intervals for evaluation of driving competence, which are not supported by research evidence. Setting a minimum time restriction of 1 year, unconditionally for all patients, does not seem to contribute to risk reduction, while on the contrary, it reduces patient autonomy and social connectivity, increases stigma, and may result in social exclusion, isolation, and the development of depression.9 Thus, it is important for the law to introduce an individualised approach with pros and cons being weighed per case, based on the existing scientific knowledge regarding the contribution of each disease to the risk of road traffic collisions and the clinical status of the patient at the time of the assessment.

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Psychiatrike = Psychiatriki
Psychiatrike = Psychiatriki Medicine-Medicine (all)
CiteScore
2.60
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