Self-Reported Driving Difficulty in Veterans With Traumatic Brain Injury: Its Central Role in Psychological Well-Being

Abstract

Background: The ability to drive is a core function supporting independent living. Traumatic brain injury (TBI) may impair driving capacity in numerous ways. Previous research has documented that individuals with TBI have more driving-related problems than other people and has identified predictors of driving status or capacity, mostly among civilians; however, no research has examined the implications of driving limitations for the well-being of individuals with TBI.

Objective: To examine the association between self-reported difficulty in driving with important domains of psychological well-being in veterans with TBI, with adjustment for posttraumatic stress disorder (PTSD) and years since most recent TBI.

Design: Cross-sectional.

Setting: Veterans' homes.

Participants: A total of 61 veterans of the Global Wars on Terrorism diagnosed with TBI, all outpatients at a Veterans Affairs medical center rehabilitation service.

Methods: Home interviews as a baseline assessment for a larger randomized controlled trial.

Main outcome measures: Community reintegration (extent of social participation), depressive symptomatology, and role limitations due to physical health problems and those due to emotional problems. Self-rated competence in driving was the predictor, and sociodemographic characteristics, diagnosis of PTSD, severity of TBI, and time since most recent TBI were covariates.

Results: Self-rated driving difficulty was associated with decreased community reintegration (β = .280, P =.028), greater depressive symptomatology (β = -.402, P < .001), and greater role limitations due to physical problems (β = -.312, P =.011) and to emotional problems (β = -.324, P = .006), after we adjusted for PTSD and other variables.

Discussion: The self-reported ability to drive seems to be central to psychological well-being in veterans with TBI, showing clear associations with depression, community reintegration, and health-related role limitations. These associations cannot be attributed to comorbid PTSD.

Conclusion: Rehabilitation specialists should view driving difficulty as a risk factor for poor psychosocial outcomes in veterans with TBI and seek ways to compensate for the veteran's loss of driving if it is no longer advisable.

Level of evidence: II.