CMAJ • November 24, 2009; 181 (11). First published November 16, 2009; doi:10.1503/cmaj.090459
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Research

Self-harm and risk of motor vehicle crashes among young drivers: findings from the DRIVE Study

Alexandra L.C. Martiniuk, MSc PhD, Rebecca Q. Ivers, MPH PhD, Nick Glozier, MBBS PhD, George C. Patton, MBBS PhD, Lawrence T. Lam, PhD, Soufiane Boufous, PhD, Teresa Senserrick, PhD, Ann Williamson, PhD, Mark Stevenson, PhD and Robyn Norton, PhD

From the George Institute for International Health (Martiniuk, Ivers, Glozier, Boufous, Senserrick, Stevenson, Norton), Sydney, Australia; the Murdoch Children’s Research Institute, Royal Children’s Hospital (Patton), Parkville, Australia; the Children’s Hospital at Westmead (Lam), Westmead, Australia; and the Injury Risk Management Research Centre, University of New South Wales (Williamson), Sydney, Australia

Correspondence to: Dr. Alexandra L.C. Martiniuk, George Institute for International Health, PO Box M201, Camperdown NSW 2050, Australia; fax 61 2 9657 0301; amartiniuk{at}george.org.au

Background: Some motor vehicle crashes, particularly single-vehicle crashes, may result from intentional self-harm. We conducted a prospective cohort study to assess the risk that intentional self-harm poses for motor vehicle crashes among young drivers.

Methods: We prospectively linked survey data from newly licensed drivers aged 17–24 years to data on licensing attempts and police-reported motor vehicle crashes during the follow-up period. We investigated the role of recent engagement in self-harm on the risk of a crash. We took into account potential confounders, including number of hours of driving per week, psychological symptoms and substance abuse.

Results: We included 18 871 drivers who participated in the DRIVE Study for whom data on self-harm and motor vehicle crashes were available. The mean follow-up was 2 years. Overall, 1495 drivers had 1 or more crashes during the follow-up period. A total of 871 drivers (4.6%) reported that they had engaged in self-harm in the year before the survey. These drivers were at significantly increased risk of a motor vehicle crash compared with drivers who reported no self-harm (relative risk [RR] 1.42, 95% confidence interval [CI] 1.15–1.76). The risk remained significant, even after adjustment for age, sex, average hours of driving per week, previous crash, psychological distress, duration of sleep, risky driving behaviour, substance use, remoteness of residence and socio-economic status (RR 1.37, 95% CI 1.09–1.72). Most of the drivers who reported self-harm and had a subsequent crash were involved in a multiple-vehicle crash (84.1% [74/88]).

Interpretation: Engagement in self-harm behaviour was an independent risk factor for subsequent motor vehicle crash among young drivers, with most crashes involving multiple vehicles.


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Highlights
Can. Med. Assoc. J. 2009 181: 769. [Full Text] [PDF]