Association of posttraumatic stress disorder and traumatic brain injury with aggressive driving in Iraq and Afghanistan combat veterans

Simulated Driving Errors: Indicators of Real-World Driving Events in Returning Combat Veterans

Motor vehicle crashes is a leading cause of death for Veterans. We quantified the efficacy of an Occupational Therapy Driving Intervention (OT-DI) and a Traffic Safety Education (TSE) intervention on real-world driving in combat Veterans. Via a randomized trial, we assessed 42 Veterans' fitness-to-drive abilities using a CDS-250 driving simulator and driving records, to determine differences in simulated driving and real-world events pre- and post-interventions. The OT-DI group (vs. TSE) had fewer over-speeding errors (p < .001) and total number of driving errors (p = .002) post-intervention. At Post-Test 2, the OT-DI (vs. TSE) had a reduction in real-world speeding (p = .05). While statistically not significant, both interventions showed reductions in real-world speeding, number of violations (OT-DI: 23% and TSE: 46% decrease) and crashes (OT-DI: 25% and TSE: 50% decrease). Veterans showed early evidence of efficacy in improving their real-world fitness-to-drive abilities via an OT-DI and TSE intervention.

Associations between Post-Traumatic stress disorder symptoms and automobile driving behaviors: A review of the literature

Human factors are responsible for most motor vehicle accidents that occur on the road. Recent work suggests that symptoms of posttraumatic stress disorder (PTSD) are linked to reduced driving safety, yet none have provided a comprehensive review of this small, emerging literature. The present review identified twenty-two studies reporting associations between PTSD and driving behaviors. Among these, longitudinal designs (k = 3) and studies using objective driving performance measures (e.g., simulators) (k = 2) were rare. Most studies (k = 18) relied on brief screener measures of PTSD status/symptoms or a prior chart diagnosis, while few used a standardized structured interview measure to determine PTSD status (k = 4), and only a small number of studies assessed PTSD symptom clusters (k = 7). PTSD was most frequently associated with increased rates of hostile driving behaviors (e.g., cutting off others), unintentional driving errors (e.g., lapses in attention) and negative thoughts and emotions experienced behind the wheel. Findings regarding risk of motor vehicle accident and driving-related legal issues were variable, however relatively few studies (k = 5) explored these constructs. Future directions are discussed, including the need for work focused on concurrent PTSD symptom/driving-related changes, more comprehensive PTSD and driving assessment, and consideration of the contributions of comorbid traumatic brain injury history and other neurological and psychiatric conditions on driving outcomes.

Driver's Personality and Behavior for Boosting Automobile Security and Sensing Health Problems Through Fuzzy Signal Detection Case Study: Mexico City

Automobile security became an essential theme over the last years, and some automakers invested much money for collision avoidance systems, but personalization of their driving systems based on the user's behavior was not explored in detail. Furthermore, efficiency gains could be had with tailored systems. In Mexico, 80% of automobile accidents are caused by human beings; the remaining 20% are related to other issues such as mechanical problems. Thus, 80% represents a significant opportunity to improve safety and explore driving efficiency gains. Moreover, when driving aggressively, it could be connected with mental health as a post-traumatic stress disorder. This paper proposes a Tailored Collision Mitigation Braking System, which evaluates the driver's personality driving treats through signal detection theory to create a cognitive map that understands the driving personality of the driver. In this way, aggressive driving can be detected; the system is then trained to recognize the personality trait of the driver and select the appropriate stimuli to achieve the optimal driving output. As a result, when aggressive driving is detected continuously, an automatic alert could be sent to the health specialists regarding particular risky behavior linked with mental problems or drug consumption. Thus, the driving profile test could also be used as a detector for health problems.

Predictors of Driving Status in Service Members and Veterans at 1 Year Posttraumatic Brain Injury: A VA TBI Model Systems Study

OBJECTIVE

To identify predictors of driving status in service members and veterans 1 year following a traumatic brain injury (TBI).

SETTING

The 5 Department of Veterans Affairs (VA) Polytrauma Rehabilitation Centers (PRCs).

PARTICIPANTS

A total of 471 service members and veterans (128 with mild/complicated mild TBI and 343 with moderate/severe TBI) who received TBI-focused inpatient rehabilitation at one of the VA PRCs and who participated in a 1-year postinjury follow-up assessment.

DESIGN

Secondary analysis from the Department of Veterans Affairs Polytrauma Rehabilitation Centers Traumatic Brain Injury Model Systems (VA PRC TBIMS) national database.

MAIN MEASURES

Primary outcome was a single item that assessed driving status at 1 year postinjury. Predictor variables included demographics; sensory impairment, substance use, and employment status at time of injury; PTSD symptoms reported at study enrollment; and functional impairment rated at rehabilitation discharge.

RESULTS

In unadjusted bivariate analyses, among those with a mild/complicated mild TBI, older age and greater functional impairment were associated with lower likelihood of driving. Among those with a moderate/severe TBI, discharge to a nonprivate residence, greater functional impairment, and higher PTSD symptoms were linked to lower likelihood of driving. Adjusted multivariate analyses indicated that functional impairment was uniquely associated with driving status in both TBI severity groups. After controlling for other predictors, self-reported PTSD symptoms, particularly dysphoria symptoms, were associated with lower likelihood of driving in both severity groups.

CONCLUSION

Given the significance of clinician-rated functional impairment and self-reported PTSD symptoms to the prediction of driving status 1 year post-TBI among service members and veterans, rehabilitation efforts to improve functioning and reduce negative affect may have a positive impact on driving and community integration.

Driving Outside the Wire: Examining Factors Impacting Veterans' Postdeployment Driving

Combat Veterans (CVs) deployed to Iraq or Afghanistan experience driving difficulty, based on medical conditions and/or deployment exposures, elevating their risk of motor vehicle crash-related injury or death. To address grounded theory rigor and incorporate constructs such as the Person Environment Occupation Performance model, we revised the Hannold et al. (2013) conceptual framework. We conducted two focus groups with seven CVs. Conceptual framework revisions were based on an iterative process and thematic analysis. We elicited CVs' perspectives on deployment training, driving pre- and postdeployment, strategies, and intervention preferences. Personal, environmental, and task factors underpinned CVs' driving. Participants described triggers (e.g., stressful stimuli), use of environmental (e.g., car controls) or personal (e.g., avoiding traffic) strategies, and outcomes of appropriate or risky driving. Findings illustrated CVs' driving difficulty and informed development of a Veteran-centric driving intervention. Improving driving fitness has implications for Veterans' participation and community integration.