Injury (1991) 22, (S), 365-368
Printedin Great Britain
365
The effects of road traffic accidents on driving behaviour R. Mayou’, S. Simkinl and J. ThrelfallZ ‘University
Department
of Psychiatry,
Wameford
Hospital, Oxford, UK and 20xford
Questionnairesabout fk effects of accidentson subsequent driving behaviourwere sent to 869 people admittedconsecutivelyto a general hospitalas a result of involvementin road frajic accidents4-6 years previously. 7%ere were 418 (48 per cent) q&es, 67 per cenf of delivered questionnaires.One-fifth of fhe moforcyclisfs had stopped using a motorcycle.Nearly one-halffk motorcyclistsand vehicledriversreported that they now drove more slowly and that they were more caufiaus.A considerableproportionof repliesdesm’bedemotionaldistress,avoic&ce and limitationof activities.Lack of conjiaknce in driving was common immediately after tk accident.After 4-6 years, one-thirdof respondents reported that they still suj$red spefjic anxiety about the pk~ce$of fk accidentand about situationssimilarto fk accident. Many people were anriow about being passengers.The findingshave implications for road safety, for fk recognitionand managementof a common, and often disabling,clinicalproblem,andfor tk assessmentof disabilities in medical reportsfor compensationproceedings.
Introduction Road traffic accident victims often tell their friends and their doctors that they have become anxious about driving or being a passenger, and such problems are often mentioned in medical reports for compensation proceedings. A Canadian survey reported that 18.5 per cent of 524 hospitalized road accident victims suffered ‘phobias’ 3-4 years after accidents and that 3 I per cent reported they now drove more ‘defensively’ (Interministerial Task Force, 1981). Post-traumatic stress disorder as described after major disasters is an occasional complication (Malt, 1988; Burstein, 1989). There has been no systematic account of the occurrence and nature of changes in driving and of changes in confidence following accidents. This paper reports a 4-6 year follow-up of consecutive admissions of road traffic accident survivors to the ]:ohn Radcliffe Hospital, Oxford. The Oxford Road Accident Group have collected systematic data on all such admissions (Tunbridge et al., 1988).
Methods In 1989 a questionnaire
(aged
17-65
years)
was sent to all surviving subjects who had been vehicle drivers or
0 1991 Butterworth-Heinemann OOZO-1383/91/050365-04
Ltd
Road Accident
Group, Oxford, UK
passengers or motorcycle (or moped) riders, admitted during a 2-year period between 1983 and 1985. Subjects with incomplete addresses and highly mobile groups such as students or members of the armed forces were excluded. Enquiries were made about perceived effects of the accident on driving. The questions being based on clinical experience and the preliminary findings of a current prospective study of psychosocial aspects of major road accidents. A total of 869 questionnaires were sent out and 418 (49 per cent) completed questionnaires returned. There were 248 envelopes returned undelivered, often marked as ‘gone away’ or ‘not known’. Replies were received for 67 per cent of delivered questionnaires. The reasons for lack of response include false addresses and considerable geographical mobility, especially among younger accident victims. Nonrespondents were younger but did not differ in other characteristics. One-half of the replies provided extra details and comments (often extensive). We use ‘motorcyclists’ as a general term for the 118 motorcycle, 23 moped and 2 scooter drivers; and ‘car drivers’ for the 143 car, 10 goods vehicles and 3 unspecified drivers. We obtained Oxford Road Accident Group data about the nature of the accident, age, length of admission, duration of unconsciousness and Injury Severity Score (ES). The first 400 questionnaires returned were analysed using the Statistical Package for Social Sciences (Nie et al., 1975) for x2 and f tests, as appropriate.
Results The characteristics of the respondents are summarized in TableI. Over one-half were still suffering physical consequences of the accident, problems that were blamed for the loss of jobs and businesses, and for deterioration of family life. Caution and awareness. Many people felt they had become safer, better drivers as a result of their accident, driving more slowly, carefully and considerately (Tub,%I). One-quarter commented that they were more alert to safety, road conditions, weather, the behaviour of other drivers and took more care about judging distances and junctions. For some, increased awareness meant a change from reckless to more sensible driving. Others had become
Injury: the British Joumal of Accident Surgery (1991) Vol. tHNo.5
366
Table I. Characteristics of the respondents and general consequences. Motorcycle/ moped driver (N= 946) Sex
Male Female
Mean age (years) ISS Score
l-5 6-10 11+
Physical consequences:
Nil Mild Considerable
Further accidents: Caution as a driver:
Table II. Consequences
Pillion passenger (N=9)
124 I?:; 22 28 (SD 13.4) 54 I:;; 59 33 (23)
3
(33) (67)
216.2 (SD 3.2) 1 (11) 4 I::; 4
63 67 16
(43) (46) (11)
4 3 1
Nil
131
(90)
8
2+ 1
132
(1) (9)
No change Bit slower
77 56
(55) (40)
Lot slower
6
(4)
for motorcycle/moped
Number (%)
15:;
Avoid place of accident
43 49 32.6 (SD 50 23 19
(47) (53) 15.2) (54) (25) (21)
280 120 31.4 (SD 163 128 109
(70) (30) 14.2) (41) (32) (27)
(13)
(49) (45) (7)
41 41 70
(45) (45) (11)
181 178 37
(48) (45) (9)
(100)
137
(90)
86
(94)
362
(91)
123
1:;
5 1
(1) (5)
306
I;;
75 61
(52) (43)
35 33
(49) (47)
192 153
(53) (42)
7
(5)
3
(4)
16
(4)
(63) (38)
riders. Number (%) Pillion passengers (N=9)
Drivers (N = 942) Change in motorcycle riding Increase No change Decrease Stopped Lack of confidence in motorcycling (now)’ General impairment Nervous in similar situations Nervous at place of accident
110 (72) 43 (28) 34.5 (SD 14.6) 58 (38) 42 (28) 53 (35)
Total (N=400)
73 67 10
5 3
Car passenger (N=9.2)
Car driver (N= 953)
Total
10 27 76 29
(7) (19) (54) (20)
2 1 4 2
(22) (11) (44) (22)
12 28 80 31
(8) (19) (53) (21)
18 35 20
(17) (34) (19)
2 5 4
(29) (71) (57)
20 40 24
(17) (36) (21)
(5)
1
(14)
6
5
(5)
*Percentages for those still riding motorcycle.
cautious, sometimes to an extent which made it difficult for them to drive other than at very quiet times or in quiet areas. Many of those who felt they had been innocent victims said they became very aware of the unpredictable behaviour of other drivers. In contrast, several drivers said that as the accident had not been their fault, there were no changes they could make. excessively
Motorcycle riders Motorcyclists were young, and mainly male (Table I). Most reported a decrease in motorcycling after their accident, giving as reasons: the belief that cars are safer (37 per cent); lack of confidence in motorcycling (30 per cent); physical disability (15 per cent) and changes in work (14 per cent). One-fifth, including nearly one-half of the women riders, had stopped motorcycling altogether, several because their families had persuaded them to give up. Those with persistent physical disability were especially likely to have given up and to have become more cautious. Nearly one-quarter of those still motorcycling reported that they had suffered some general, but usually temporary, lack of confidence. Specific worries were more persistent (Table U), concern varying from mild minor distress to marked anxiety. Lack of confidence was most frequent in those who had suffered serious injuries as assessed by the
Injury Severity Score (P
Printedin Great Britain
365
The effects of road traffic accidents on driving behaviour R. Mayou’, S. Simkinl and J. ThrelfallZ ‘University
Department
of Psychiatry,
Wameford
Hospital, Oxford, UK and 20xford
Questionnairesabout fk effects of accidentson subsequent driving behaviourwere sent to 869 people admittedconsecutivelyto a general hospitalas a result of involvementin road frajic accidents4-6 years previously. 7%ere were 418 (48 per cent) q&es, 67 per cenf of delivered questionnaires.One-fifth of fhe moforcyclisfs had stopped using a motorcycle.Nearly one-halffk motorcyclistsand vehicledriversreported that they now drove more slowly and that they were more caufiaus.A considerableproportionof repliesdesm’bedemotionaldistress,avoic&ce and limitationof activities.Lack of conjiaknce in driving was common immediately after tk accident.After 4-6 years, one-thirdof respondents reported that they still suj$red spefjic anxiety about the pk~ce$of fk accidentand about situationssimilarto fk accident. Many people were anriow about being passengers.The findingshave implications for road safety, for fk recognitionand managementof a common, and often disabling,clinicalproblem,andfor tk assessmentof disabilities in medical reportsfor compensationproceedings.
Introduction Road traffic accident victims often tell their friends and their doctors that they have become anxious about driving or being a passenger, and such problems are often mentioned in medical reports for compensation proceedings. A Canadian survey reported that 18.5 per cent of 524 hospitalized road accident victims suffered ‘phobias’ 3-4 years after accidents and that 3 I per cent reported they now drove more ‘defensively’ (Interministerial Task Force, 1981). Post-traumatic stress disorder as described after major disasters is an occasional complication (Malt, 1988; Burstein, 1989). There has been no systematic account of the occurrence and nature of changes in driving and of changes in confidence following accidents. This paper reports a 4-6 year follow-up of consecutive admissions of road traffic accident survivors to the ]:ohn Radcliffe Hospital, Oxford. The Oxford Road Accident Group have collected systematic data on all such admissions (Tunbridge et al., 1988).
Methods In 1989 a questionnaire
(aged
17-65
years)
was sent to all surviving subjects who had been vehicle drivers or
0 1991 Butterworth-Heinemann OOZO-1383/91/050365-04
Ltd
Road Accident
Group, Oxford, UK
passengers or motorcycle (or moped) riders, admitted during a 2-year period between 1983 and 1985. Subjects with incomplete addresses and highly mobile groups such as students or members of the armed forces were excluded. Enquiries were made about perceived effects of the accident on driving. The questions being based on clinical experience and the preliminary findings of a current prospective study of psychosocial aspects of major road accidents. A total of 869 questionnaires were sent out and 418 (49 per cent) completed questionnaires returned. There were 248 envelopes returned undelivered, often marked as ‘gone away’ or ‘not known’. Replies were received for 67 per cent of delivered questionnaires. The reasons for lack of response include false addresses and considerable geographical mobility, especially among younger accident victims. Nonrespondents were younger but did not differ in other characteristics. One-half of the replies provided extra details and comments (often extensive). We use ‘motorcyclists’ as a general term for the 118 motorcycle, 23 moped and 2 scooter drivers; and ‘car drivers’ for the 143 car, 10 goods vehicles and 3 unspecified drivers. We obtained Oxford Road Accident Group data about the nature of the accident, age, length of admission, duration of unconsciousness and Injury Severity Score (ES). The first 400 questionnaires returned were analysed using the Statistical Package for Social Sciences (Nie et al., 1975) for x2 and f tests, as appropriate.
Results The characteristics of the respondents are summarized in TableI. Over one-half were still suffering physical consequences of the accident, problems that were blamed for the loss of jobs and businesses, and for deterioration of family life. Caution and awareness. Many people felt they had become safer, better drivers as a result of their accident, driving more slowly, carefully and considerately (Tub,%I). One-quarter commented that they were more alert to safety, road conditions, weather, the behaviour of other drivers and took more care about judging distances and junctions. For some, increased awareness meant a change from reckless to more sensible driving. Others had become
Injury: the British Joumal of Accident Surgery (1991) Vol. tHNo.5
366
Table I. Characteristics of the respondents and general consequences. Motorcycle/ moped driver (N= 946) Sex
Male Female
Mean age (years) ISS Score
l-5 6-10 11+
Physical consequences:
Nil Mild Considerable
Further accidents: Caution as a driver:
Table II. Consequences
Pillion passenger (N=9)
124 I?:; 22 28 (SD 13.4) 54 I:;; 59 33 (23)
3
(33) (67)
216.2 (SD 3.2) 1 (11) 4 I::; 4
63 67 16
(43) (46) (11)
4 3 1
Nil
131
(90)
8
2+ 1
132
(1) (9)
No change Bit slower
77 56
(55) (40)
Lot slower
6
(4)
for motorcycle/moped
Number (%)
15:;
Avoid place of accident
43 49 32.6 (SD 50 23 19
(47) (53) 15.2) (54) (25) (21)
280 120 31.4 (SD 163 128 109
(70) (30) 14.2) (41) (32) (27)
(13)
(49) (45) (7)
41 41 70
(45) (45) (11)
181 178 37
(48) (45) (9)
(100)
137
(90)
86
(94)
362
(91)
123
1:;
5 1
(1) (5)
306
I;;
75 61
(52) (43)
35 33
(49) (47)
192 153
(53) (42)
7
(5)
3
(4)
16
(4)
(63) (38)
riders. Number (%) Pillion passengers (N=9)
Drivers (N = 942) Change in motorcycle riding Increase No change Decrease Stopped Lack of confidence in motorcycling (now)’ General impairment Nervous in similar situations Nervous at place of accident
110 (72) 43 (28) 34.5 (SD 14.6) 58 (38) 42 (28) 53 (35)
Total (N=400)
73 67 10
5 3
Car passenger (N=9.2)
Car driver (N= 953)
Total
10 27 76 29
(7) (19) (54) (20)
2 1 4 2
(22) (11) (44) (22)
12 28 80 31
(8) (19) (53) (21)
18 35 20
(17) (34) (19)
2 5 4
(29) (71) (57)
20 40 24
(17) (36) (21)
(5)
1
(14)
6
5
(5)
*Percentages for those still riding motorcycle.
cautious, sometimes to an extent which made it difficult for them to drive other than at very quiet times or in quiet areas. Many of those who felt they had been innocent victims said they became very aware of the unpredictable behaviour of other drivers. In contrast, several drivers said that as the accident had not been their fault, there were no changes they could make. excessively
Motorcycle riders Motorcyclists were young, and mainly male (Table I). Most reported a decrease in motorcycling after their accident, giving as reasons: the belief that cars are safer (37 per cent); lack of confidence in motorcycling (30 per cent); physical disability (15 per cent) and changes in work (14 per cent). One-fifth, including nearly one-half of the women riders, had stopped motorcycling altogether, several because their families had persuaded them to give up. Those with persistent physical disability were especially likely to have given up and to have become more cautious. Nearly one-quarter of those still motorcycling reported that they had suffered some general, but usually temporary, lack of confidence. Specific worries were more persistent (Table U), concern varying from mild minor distress to marked anxiety. Lack of confidence was most frequent in those who had suffered serious injuries as assessed by the
Injury Severity Score (P
