Babulal Ganesh M, Chen Ling, Trani Jean-Francois, Brown David C, Carr David B, Ances Beau M, Lenze Eric J
Department of Neurology, Washington University in St Louis, St Louis, Missouri.
Institute of Public Health, Washington University in St Louis, St Louis, Missouri.
JAMA Netw Open. 2024 Dec 2;7(12):e2452038. doi: 10.1001/jamanetworkopen.2024.52038.
Depression and antidepressant use are independently associated with crash risk among older drivers. However, it is unclear what factors impact daily driving that increase safety risk for drivers with depression.
To examine differences in naturalistic driving behavior and safety between older adults with and without major depressive disorder (MDD).
DESIGN, SETTING, AND PARTICIPANTS: A prospective longitudinal cohort study was conducted among older adults (≥65 years) from the Driving Real-World In-Vehicle Evaluation System Project collected from July 1, 2021, to December 30, 2023. The sample included 85 participants with MDD and 310 participants without. Neurological, clinical, mood, and neuropsychological tests were collected annually. Daily driving behavior was recorded using a commercial data logger. Statistical analysis was performed from January 31 to June 24, 2024.
MDD and antidepressant usage.
Linear mixed models with propensity score weighting compared slopes of driving behaviors over time (trips taken at night, speeding, hard braking, entropy, and radius of gyration) between groups.
In a sample of 395 participants, 85 were classified as individuals with MDD (mean [SD] age, 69.6 [6.1] years; 60 [70.6%] female; 8 [9.4%] non-Hispanic Black and 77 [90.6%] non-Hispanic White) and 310 as individuals in the control group without depression (mean [SD] age, 70.1 [5.1] years; 153 [49.4%] female; 40 [12.9%] non-Hispanic Black and 270 [87.1%] non-Hispanic White). Adults with MDD had greater depressive symptoms (mean [SD], 8.35 [5.35] vs 2.33 [2.72]; difference, 6.02; 95% CI for difference, 5.17 to 6.85; P < .001), comorbidities (mean [SD], 4.08 [2.07] vs 2.79 [1.67]; difference, 1.29; 95% CI for difference, 0.87 to 1.70; P < .001), used more antidepressants (mean [SD], 0.94 [0.81] vs 0.27 [0.54]; χ21 = 65.8; P < .001), and had a higher number of medications (mean [SD], 3.80 [3.27] vs 1.98 [2.21]; χ21 = 21.0; P < .001) compared with controls at baseline. Longitudinal analysis demonstrated an association between adults with MDD and hard braking (mean [SE], 3.17 × 10-4 [7.30 × 10-5] vs 6.70 × 10-5 [4.00 × 10-5]; difference, 2.50 × 10-4; 95% CI for difference, 1.74 × 10-4 to 4.61 × 10-4; P < .001) and hard cornering events per trip (mean [SE], 0.80 [0.64] vs 0.57 [0.25]; difference, 0.23; 95% CI for difference, 0.08 to 1.06; P = .04), greater distances driven from home (mean [SE], 31.19 [7.35] vs 7.76 [3.80] km; difference, 23.43; 95% CI for difference, 0.28 to 15.2; P < .001), more unique destinations visited (mean [SE], 0.34 [0.10] vs -0.27 [0.03]; difference, 0.61; 95% CI for difference, 0.14 to 0.54; P < .001), and higher random entropy (mean [SE], 0.01 [0.01] vs -0.02 [0.00]; difference, 0.03; 95% CI for difference, -0.03 to -0.01; P < .001) over time.
In this longitudinal cohort study of older drivers, adults with MDD demonstrated distinct and riskier driving behaviors than those in the control group without depression, with higher rates of hard braking, cornering, and unpredictability in driving patterns over time. Routine depression screening and tailored interventions are essential for enhancing driving safety and maintaining independence among older adults with MDD. Comprehensive care approaches addressing both mental and physical health are crucial for this vulnerable population.
抑郁症及抗抑郁药的使用与老年驾驶员的撞车风险独立相关。然而，尚不清楚哪些因素会影响日常驾驶，从而增加抑郁症患者的安全风险。
研究患有和未患有重度抑郁症（MDD）的老年人在自然驾驶行为和安全性方面的差异。
设计、设置和参与者：对2021年7月1日至2023年12月30日从驾驶真实世界车载评估系统项目中收集的老年人（≥65岁）进行了一项前瞻性纵向队列研究。样本包括85名患有MDD的参与者和310名未患MDD的参与者。每年收集神经学、临床、情绪和神经心理学测试数据。使用商用数据记录器记录日常驾驶行为。于2024年1月31日至6月24日进行统计分析。
MDD和抗抑郁药使用情况。
采用倾向得分加权的线性混合模型比较两组随时间变化的驾驶行为斜率（夜间出行次数、超速、急刹车、熵和回转半径）。
在395名参与者的样本中，85名被归类为患有MDD的个体（平均[标准差]年龄，69.6[6.1]岁；60名[70.6%]为女性；8名[9.4%]为非西班牙裔黑人，77名[90.6%]为非西班牙裔白人），310名被归类为无抑郁症的对照组个体（平均[标准差]年龄，70.1[5.1]岁；153名[49.4%]为女性；40名[12.9%]为非西班牙裔黑人，270名[87.1%]为非西班牙裔白人）。与对照组相比，患有MDD的成年人在基线时具有更严重的抑郁症状（平均[标准差]，8.35[5.35]对2.33[2.72]；差异，6.02；差异的95%置信区间，5.17至6.85；P < .001）、更多的合并症（平均[标准差]，4.08[2.07]对2.79[1.67]；差异，1.29；差异的95%置信区间，0.87至1.70；P < .001）、更多地使用抗抑郁药（平均[标准差]，0.94[0.81]对0.27[0.54]；χ21 = 65.8；P < .001）以及更多的药物种类（平均[标准差]，3.80[3.27]对1.98[2.21]；χ21 = 21.0；P < .001）。纵向分析表明，患有MDD的成年人与急刹车（平均[标准误]，3.17×10-4[7.30×10-5]对6.70×10-5[4.00×10-5]；差异，2.50×10-4；差异 的95%置信区间，1.74×10-4至4.61×10-4；P < .001）以及每次出行的急转弯事件（平均[标准误]，0.80[0.64]对0.57[0.25]；差异，0.23；差异的95%置信区间，0.08至1.06；P = .04）、离家行驶的距离更长（平均[标准误]，31.19[7.35]对7.76[3.80]公里；差异，23.43；差异的95%置信区间，0.28至15.2；P < .001）、访问的独特目的地更多（平均[标准误]，0.34[0.10]对 -0.27[0.03]；差异，0.61；差异的95%置信区间，0.14至0.54；P < .001）以及随时间推移更高的随机熵（平均[标准误]，0.01[0.01]对 -0.02[0.00]；差异，0.03；差异的95%置信区间，-0.03至 -0.01；P < .001）之间存在关联。
在这项针对老年驾驶员的纵向队列研究中，患有MDD的成年人表现出与无抑郁症的对照组不同且更具风险的驾驶行为，随着时间推移，急刹车、转弯和驾驶模式不可预测性的发生率更高。常规的抑郁症筛查和针对性干预对于提高患有MDD的老年人的驾驶安全性和保持其独立性至关重要。针对身心健康的综合护理方法对于这一弱势群体至关重要。
