Driving and depression: exploring the current knowledge, attitudes, and practices of health professionals in Ireland

Depression is a common mental illness characterized by low mood, loss of interest and enjoyment, and reduced energy leading to diminished activity. An estimated 322 million people worldwide or 4.4% of the world’s population experience depression at any given time. The figures for Ireland suggest that 212,555 people in Ireland are currently experiencing depression. Driving is important for many individuals with depression as it contributes to health and quality of life by maintaining independence, fostering a sense of self, facilitating social participation and access to health/medical services and the community and as such can be classified as an occupation enabler. However, the evidence would suggest the individuals with a psychiatric diagnosis have an almost double risk of being involved in a motor vehicle accident. This could be attributed to the impact of the depression itself with deficits in cognition and psychomotor retardation commonly reported or the side-effects of psychotropic medication. Currently, in Ireland there is no national consensus on the process of determining fitness to drive (FtD) for individuals with depression reflecting what is occurring internationally because of limited scientific evidence about what constitutes an adequate FtD assessment with this population As Consultant psychiatrists, General practitioners and occupational therapists in Ireland are the most likely health care professionals to be involved in FtD decision making with individuals with depression, this thesis has two components which aim to explore: o What are the current attitudes of health professionals in Ireland to driving and depression? o Are Irish health professionals aware of and adhering to the Sláinte agus Tiomáint guidelines in the assessment of fitness to drive of individuals with depression? o What are the current practices of health professionals (Consultant Psychiatrists, General Practitioners, and Occupational Therapists) in Ireland in the assessment of fitness to drive of individuals with depression? o What is the confidence and competence of health professionals in Ireland in the assessment of fitness to drive with individuals with depression? The aims achieved through three research articles are presented in this thesis. The first article is a discussion piece for occupational therapists on the introduction of the Sláinte agus Tiomáint FtD guidelines in Ireland. The article discusses the relevance of the guidelines to occupational therapy; particularly therapists working in mental health and primary care settings where the issue is often overlooked. Finally, the paper explores how occupational therapists can include the assessment of fitness to drive within their clinical practice as it is internationally recognized as within the scope of occupational therapy. The second article is an empirical study of the attitudes, knowledge, and practices of three professional groups. The article presents a quantitative survey of health professionals (n=228) (Consultant Psychiatrists, General Practitioners, and Occupational Therapists) in Ireland exploring their current knowledge, attitudes and practices related to the assessment of FtD and depression and the Sláinte agus Tiomáint FtD guidelines in Ireland. The article also contains insights from health professions via qualitative comments. The third article presents findings from a survey of occupational therapists (n=98) where open-ended questions were used to explore their knowledge, attitudes, and practices to the assessment of FtD and depression. The data collected from the study in the second article was reanalysed to focus on the roles and practices of occupational therapists working in Primary Care and Mental Health in Ireland. Summary of main results from Article 2 and Article 3: • Assessment of FtD was deemed important by the majority (75%) of respondents. • Routine discussion of driving with clients with depression was only reported by a minority of respondents (39.5%). • The majority of respondents relied on an informal discussion or assessment • Clinical reasoning was vital in making FtD decisions • Important factors that influence their FtD decision making include: impaired cognition, decreased concentration, medication side-effects, suicidal ideation/intent and decreased reaction time. • Varying levels of confidence and competence were self-reported by all professions, with the occupational therapy respondents tending to have the lowest levels of self-reported confidence and competence in the assessment of fitness to drive. • All respondents across the three professions reported the need for additional training in the area of assessment of FtD. Key recommendations from this research include: • There is a need for specific training and skill development in the assessment of FtD with individuals with depression for health professionals. Future research should focus on the requirements needed by each health profession to address driving with individuals with depression. • Occupational therapists need to include driving into their clinical practice rather than overlooking it or referring to other disciplines or professions. • Qualitative research with service users is needed to understand better the lived experience of driving with depression and to inform how the issue is addressed with individuals with depression.