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

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 (beta =.280, P = .028), greater depressive symptomatology (beta = -.402, P < .001), and greater role limitations due to physical problems (beta = -.312, P = .011) and to emotional problems (beta = .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.