Dear Editor,
Nowadays, health policymakers have shown significant interest in the topic of traffic health, indicating its growing importance to public health worldwide. Currently, road traffic injuries rank as the eighth leading cause of death globally across all age groups, and projections indicate they will rise to become the seventh leading cause of death by 2030. The situation of traffic health in Iran is a matter of great concern, with road-related fatalities ranking as the third most significant cause of death in the country (1).
According to reports, the primary reasons behind traffic accidents in Iran include driver faults, environmental factors, road-related factors, road-user factors, and vehicle-related factors (2). Common driver errors that cause traffic accidents include distracted driving, exceeding speed limits, and making incorrect assumptions about other drivers. Driving under the influence of drugs or alcohol, falling asleep while driving, and inadequate control over the vehicle are also significant driver errors contributing to accidents. Mental health problems such as depression, anxiety, ADHD, and bipolar disorder significantly increase the risk of road traffic accidents. These conditions can hinder cognitive function, impact concentration, decision-making, and reaction times, thus laying the groundwork for accidents (3). In this regard, a systematic review revealed that psychiatric disorders are associated with an elevated risk of motor vehicle crashes, as indicated by fifteen studies (4). Studies in Iran discovered that ADHD and anxiety disorders raised the likelihood of accidents among motorcycle, car, bus, and truck drivers (5, 6). Furthermore, a study demonstrated that psychological disorders and substance use were significant factors among women engaging in risky driving behaviors. The presence of psychological disorders amplified the likelihood of such behavior by around nine times, while drug use increased it by approximately three times. Additionally, the study discovered that psychological disorders were among the most influential factors contributing to risky driving behaviors among men, increasing the likelihood of such behaviors by 8.2 times (7).
Moreover, survivors of car accidents may encounter mental health problems, including persistent anxiety, nightmares, excessive worry, post-traumatic stress disorder, and phobias. These conditions can substantially impact their capacity to drive safely. Another important aspect to consider is adolescence, a crucial stage in life, where teens are more likely to engage in risky behaviors, particularly risky driving behaviors, leading to a fatal crash rate almost three times higher than that of older drivers (8). Factors influencing adolescent risky driving include developmental changes, peer pressure, and mental health issues. Adolescents' ongoing socio-emotional development and high prevalence of mental health conditions among them (14%) make them more prone to risky driving (9). Moreover, underage drinking, drug use, and lack of valid driver licenses contribute to the risks associated with teen drivers in fatal crashes.
To mitigate the rate of traffic accidents and their consequences, restrictions on driving privileges are considered in many parts of the world. Several approaches exist to restrict driving privileges, including reciprocal privileges, hardship or restricted licenses, suspended or restricted driver's licenses, and licenses with specific conditions that dictate when and/or where the individual is permitted to drive (10).
In Iran, acquiring a driver's license involves fulfilling various prerequisites, including meeting the minimum age requirement, providing a national identity card, birth certificate, fingerprint information, blood group documentation, biometric photograph, payment of driver's license fees, presenting a health report, and obtaining a criminal record certificate. Driver's licenses in Iran are categorized into five types: Motorcycle permit, third-grade driver's license, second-grade driver's license, first-grade driver's license, and specific driver's license. Furthermore, there are certain instances where the issuance and renewal of driver's licenses are strictly prohibited. These cases include severe visual problems, auditory deficiencies, and motor system disorders. Additionally, specific mental health problems such as acute psychosis, individuals in the acute phase of bipolar disorder, and those with confirmed epilepsy are also conditions that prohibit obtaining a driver's license. Moreover, the health deputy of the Law Enforcement Command of the Islamic Republic of Iran (NAJA) stated that individuals exempted from military service due to mental disorders are directed to the NAJA Psychiatry Commission to obtain a driver's license. However, it is reported that 50% of these individuals are unable to acquire the license.
Authors’ Recommendation
Despite the presence of several restrictive laws for obtaining a driver's license in Iran, the scope of these laws pertaining to mental health is too limited and primarily focuses on acute issues. Meanwhile, many people struggle with chronic mental problems that can substantially impact their driving abilities, potentially compromising road safety. Hence, there is a need to place greater emphasis on assessing the mental health status of individuals who are seeking to obtain or renew a driver's license. This can be achieved through thorough evaluations of their mental health screening records in the national integrated health system (SIB website) and examining their history of psychiatric consultations and medication usage via the electronic prescribing system.
Additionally, schools can play a crucial role in educating teenagers about risky driving behaviors, even though teenagers are not yet eligible to obtain a driver's license. School counselors have the potential to decrease the likelihood of teenagers developing a propensity for high-risk driving in the future by screening adolescent students for psychological well-being and offering them personalized counseling services to address unmet mental health needs. Taking into account the mental well-being of these individuals and implementing periodic restrictions on their driving licenses may contribute to enhancing overall traffic safety within society.
