The influence of depression and antidepressants on driving performance: a systematic literature review and meta-analysis.

Abstract

Abstract Background The public health impact of depression is large, as depression affects social and work functioning as well as physical health outcomes. A less explored topic is to what extent depression affects public health by impacting on road safety. To determine whether depression and antidepressant use have impact on driving safety and thereby public health, we systematically reviewed literature that examines their association with objectively assessed driving performance outcomes. Methods Two systematic literature reviews were performed, one for depression – driving performance (DEP-DP) and one for antidepressants – driving performance (AD-DP). Three online databases (PubMed, PsychINFO, Embase) were searched from Jan 1st 1997 through December 31st 2022. Estimates of effect sizes, Hedges’ g, were reported for standard deviation of lateral position (SDLP), speed, speed deviation, reaction time, visual perception, stress tolerance and reactivity, vigilance, sustained attention and selective attention. Meta-analyses were performed by calculating pooled estimates when at least three studies reported on the same outcome. Results For DEP-DP, only two studies could be included, both indicating poorer driving performance in depressed persons, but pooled estimates could not be calculated as not enough studies tested similar driving performance outcomes. For AD-DP, seven studies were included and pooled estimates could be calculated for four outcomes: reaction time, vigilance, selective attention and SDLP. AD users were less vigilant compared to healthy controls (3 studies, n=104, g=-.49, 95% CI -.85; -.13). No significant difference could be demonstrated for reaction time (3 studies, n = 93, g=.52, 95% CI -1.97; 3.00), selective attention (3 studies, n=104, g=-.45, -1.10; 0.19) or SDLP (3 studies, n=74, g=.06, 95% CI -1.15; 1.26). Conclusions Although various studies reported poorer driving performance in depressed persons as well as antidepressant users, a consistent picture is limited by the small number of studies and diverse driving performance outcomes used. Only a significant impact of antidepressant use on vigilance could be indicated, but as no comparison was made with depressed non-users, it is difficult to interpret such findings. More research is needed into the separate effects of depression and antidepressants on objectively assessed driving performance.