Self-Harm and Crash Risk

Could some crashes be an act of self harm?

In Australia up to 4,700 young people are hospitalised per year following a crash.  There are 24,087 young people hospitalised per year following self harm.  But is there a link?
Young people are particularly at risk for mental health problems.  These problems may lead to self-harm and suicide.  Deliberate motor vehicle crashes may be caused by young drivers as a means of self-harm or suicide.  Other factors that are associated with self-harm also might increase the risk of crashing, e.g. alcohol, disturbed sleep, and poor impulse control.
To date, most studies have looked at young people who have died in crashes.  The mental health status of those drivers was determined after their deaths. However, a new Australian study has examined the mental health status of young drivers before they crash, and looked at associations between this and their risk of crashes not causing death.  In this study, newly licensed NSW drivers aged 17-24 were asked about their self-harm behaviour.  Of 20,822 surveyed, 871 (4%) of young drivers engaged in self-harm behaviours (such as cutting, burning, self-battering, poisoning and self-harm with lethal intent).  Self-harm was most commonly reported by:

  • The youngest drivers (17 year olds)
  • Females
  • Those born in Australia
  • Rural and regional drivers
  • Those who had driven more
  • Those reporting more risk taking behaviour
  • Those with a history of drug or alcohol abuse
  • Those with less hours of sleep per night.

This Australian study found that young drivers, who had previously reported self-harm behaviours, were at a 42% higher risk of crash than those who didn’t report the behaviours.  This increased risk remained (37% higher risk) even after accounting for other factors  such as age, sex, average driving hours per week, previous crashes, psychological distress, and amount of sleep.  Of the 871 young drivers who reported self-harm, 88 (10%) had at least one crash and 84% of those who had a crash were involved in multiple-vehicle incidents affecting other road users.
Reducing the risk of crash in young drivers is important.  The results of this study highlight a need for programs managing road behaviour in young people with poor mental health.  There is some evidence that programs designed to improve the general resilience of young people can also reduce the risk of road-related risky behaviours.  Further research on this topic will be essential.  In the interim, general practitioners, teachers, parents and youth groups need to identify self-harming behaviour so that they can help self-harmers seek appropriate treatment.

Factbase Recomendations

Young drivers who engage in self-harm are at increased risk of crash.  Effective interventions to address self-harm should be expanded to include potential vehicle-related risk.  These interventions should be assessed to determine if they decrease the risk of crash in this group of young drivers.

References

Australian Institute of Health and Welfare (AIHW). Young Australians: their health and well-being 2007. Available: http://www.aihw.gov.au/publications/index.cfm/title/10451  (accessed 11 Nov 2009).

Blows S, Ivers RQ, Connor J, Ameratunga S, Woodward M & Norton R. Marijuana use and car crash injury. Addiction 2005;100:605-11.

Connor J, Norton R, Ameratunga S & Jackson R.  The contribution of alcohol to serious car crash injuries. Epidemiology 2004;15:337-44.

Connor J, Norton R, Ameratunga S, Robinson E, Civil I, Dunn R, Bailey J & Jackson R. Driver sleepiness and risk of serious injury to car occupants: population based case control study. British Medical Journal, 2002;324:1125.

Dahl RE. Biological, developmental and neurobehavioral factors relevant to adolescent driving risks. American Journal of Preventive Medicince, 2008;35:S278-84.

Evans J, Platts H, Liebenau A.  Impulsiveness and deliberate self-harm: a comparison of “first timers” and “repeaters”. Acta Psychiatrica Scandinavica, 1996;93:378-80.

Griffin KW, Botvin GJ, Nichols TR.  Long-term follow-up effects of a school-based drug abuse prevention program on adolescent risky driving. Prevention Science 2004;5:207-12.

Herman H, Saxena S, Moodie R, editors. Promoting mental health: concepts, emerging evidence, practice. Report of the World Health Organization Department of Mental Health and Substance Abuse in collaboration with the Victorian Health Promotion Foundation and the University of Melbourne. 2005. Available: http://www.who.int/mental_health/evidence/en/ (accessed 2008 Nov 11).

Hilakivi I, Veilahti J, Asplund P, Sinivuo J, Laitinen L & Koskenvuo K.  A sixteen-factor personality test for predicting automobile driving accidents of young drivers. Accident Analysis and Prevention, 1989;21:413-8.

Ivers RQ, Blows SR, Stevenson MR, Norton RN, Williamson A, Eisenbruch M, Woodward M, Lam L, Palamara P & Wang J. A cohort study of 20 822 young drivers: the DRIVE study methods and population. Injury Prevention, 2006;12:385-9.

Martiniuk ALC, Ivers RQ, Glozier N, Patton GC, Lam LT, Boufous S, Senserrick T, Williamson A, Stevenson M & Norton R. Self-harm and risk of motor vehicle crashes in youth: the DRIVE prospective cohort study. Canadian Medical Association Journal( accepted 25 June 2009 in press).

Ohberg A, Penttila A, Lonnqvist J. Driver suicides. British Journal of Psychiatry 1997;171:468-72.
Skegg K. Self-harm. Lancet 2005;366:1471-83.

Self-Harm and Crash Risk