Drivers with psychotic disorders: the last inpatient or specialized outpatient care prior to a motor vehicle accident death

AI Summary

Drivers with psychotic disorders had markedly shorter survival after last inpatient or specialised outpatient care; adjusted hazard ratio 5.82 versus controls.
Seventy point two percent died in fatal motor vehicle accidents within six months of their last care contact, supporting consideration of bans exceeding six months.
Suicide was prominent; median survival after last contact among suicides was 29 days, urging physicians to assess fitness to drive and notify police when appropriate.

Nord J Psychiatry. 2026 Jul 14:1-9. doi: 10.1080/08039488.2026.2701368. Online ahead of print.

ABSTRACT

PURPOSE: Psychotic disorders are often associated with impaired driving. This study analyses drivers with psychotic disorders killed in fatal motor vehicle accidents (FMVAs) in comparison to controls without psychiatric disorders. The focus was on last care contact prior to FMVA, survival time from last contact to FMVA and official causes of death among deceased drivers.

MATERIAL AND METHODS: The study includes 94 drivers with psychotic disorders and their 146 matched controls without psychiatric disorders killed in FMVAs in Finland between 1990-2011. Drivers’ survival time after their last inpatient or specialized outpatient care, the diagnostic category of the care, and official cause-of-death category were extracted from nationwide registers.

RESULTS: Drivers with psychotic disorders were more likely to have a shorter survival time following their last care contact compared to their controls (adj. HR = 5.82, p-value <0.001). Of drivers with psychotic disorders, 70.2% had died in FMVA within 6 months of their last care contact. Among drivers with psychotic disorders whose deaths were classified as suicide, the median survival time after their last contact was only 29 days.

CONCLUSIONS: Deceased drivers with psychotic disorders were characterised by shorter survival time from their last healthcare contact to FMVA, and increased suicidality compared to controls without psychiatric disorders. Physicians should consider assessing fitness to drive in patients with psychotic disorders at every care contact, particularly when the visit concerns psychiatric problems. Driving bans exceeding six months and police notification should be carefully considered when evaluating fitness to drive in this high-risk group.

PMID:42446051 | DOI:10.1080/08039488.2026.2701368

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