Characteristics of real-world driving behavior in people with schizophrenia: a naturalistic study utilizing drive recorders

Okada, Hiroki; Komagata, Saki; Takagi, Mayu; Kamata, Yuichi; Matsumoto, Junichi; Maeyama, Takaya; Takashio, Yukiko; Matoba, Masaki · 2025 · Crossref

DOI: 10.1038/s41537-025-00613-1

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Summary

This study addresses the lack of real-world data regarding driving behaviors in people with schizophrenia (PWS), a gap left by previous research that relied primarily on laboratory-based simulators. While simulator studies have yielded conflicting results regarding the driving safety of PWS, real-world observations are necessary to accurately assess driving styles and risk factors. The researchers aimed to compare the driving behaviors of PWS with healthy controls (HC) and examine the relationships between driving violations, cognitive impairments, and clinical symptoms. The study utilized a naturalistic design involving 20 PWS and 20 HC participants, all aged 20–60 with at least five years of driving experience. Data were collected over 10 weeks using in-vehicle drive recorders equipped with GPS and accelerometers, capturing 500 km of routine driving for each participant. The PWS group, all in remission and treated with antipsychotics, underwent neuropsychological testing to assess processing speed, attention, memory, and planning, as well as clinical evaluations using the Positive and Negative Syndrome Scale (PANSS) and the Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS). The analysis focused on traffic violations, dangerous maneuvers (such as sudden braking and steering), and average speeds, employing factor analysis and correlation tests to identify underlying behavioral patterns. The results indicated that PWS exhibited significantly lower average and maximum driving speeds compared to HC. Notably, PWS showed no instances of speeding and significantly fewer violations related to inhibition, such as distracted driving via smartphone use. Factor analysis categorized violations into speed, inattention, and inhibition types. Inattention violations among PWS were significantly associated with deficits in sustained attention and useful field of view (UFOV). Additionally, sudden braking events in PWS were linked to extrapyramidal symptoms rather than aggressive driving styles. In contrast, HC participants engaged in more speeding and distracted driving behaviors. These findings challenge the assumption that PWS are inherently high-risk drivers, suggesting they are less likely to engage in reckless or intentional risky behaviors than healthy individuals. Instead, driving errors in PWS appear to stem from cognitive deficits, particularly in attention and visual processing, rather than deliberate violations. The study concludes that driver assistance systems and safety assessments for PWS should prioritize addressing cognitive impairments rather than focusing solely on behavioral compliance. This evidence supports a more nuanced approach to driving privileges for individuals with schizophrenia, emphasizing cognitive support over blanket restrictions.

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Topics

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• mci dementia driving
• anxiety depression driving
• cognitive capacity variation
• sex gender
• prescription meds
• medical conditions

Information type

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• Empirical Findings: observational prevalence, behavioral performance data
• Methodological Resource: dataset resource