Underreported: Drivers not seeking help for mental health issues

Underreported: Drivers not seeking help for mental health issues

Many truck drivers suffer from mental health issues but are reluctant to seek help, often because they fear losing their jobs.

"Men don’t seek care, especially mental health care, as readily as women. This is amplified by an industry that’s primarily men and a hyper-masculine industry at that.  You have DOT regulations that make it difficult, if not impossible, for medications that could really help,” says Mona Shattell, Professor & Chairperson, Community Systems and Mental Health Nursing at Rush University's College of Nursing.

The ability to drive with mental health problems, such as anxiety or depression - with or without medications – is a judgment call by the medical examiner. Drivers are reluctant to admit to these health issues to physicians or their managers and get the help they need because they risk losing their medical certification.

"Managers need to be aware that it’s a problem, be aware that people aren’t going to necessarily say 'I’m having some issues. I’m depressed, I don’t want to eat, I don’t have any enjoyment in life. I’m working, but I’m barely making it through. I have a really short fuse, I have a bad temper and I’m getting into fights or I’m drinking too much, I'm using drugs.' Drivers in general are not open about these issues."

Mental health challenges come with the job, and, as every driver knows, many are related to the everyday stresses of the job. "Certainly the work environment is stressful; they have to deliver on time, have to meet the HOS rules. Sometimes there’s double bookkeeping. Drivers have to decide which rule they are going to break," says Shattell, who recently has written general articles on drivers and mental health for the New York Times and The Atlantic. She and colleagues also published in Issues in Mental Health Nursing, a peer-reviewed article titled Occupational Stressors and the Mental Health of Truckers in 2010.

In this article she notes: "Findings from the current study show that truckers face many occupational stressors including constant time pressures, social isolation, disrespectful treatment from others, driving hazards such as weather changes, traffic, and road conditions, and violence or fear of violence. Facing such stressors may be a factor in the prevalence of risky behaviors including drug use and paying for sex. Therefore, mental health promotion and treatment for truckers is an important area of concern and must be examined within the broader context of the transportation environment." 

Unfortunately, few scientists are studying drivers' mental health. There is little funding for the issue, it's difficult to get drivers to participate and, sadly, most in the mental health community are simply not interested. Physical health, yes, but not mental health, says Shattell.

You can see this lack of interest in a global search for journal articles in PubMed, a comprehensive database of peer-reviewed journal articles, a service of the U.S. National Library of Medicine. In essence, if PubMed doesn't have it, it doesn’t exist. A query for articles about "truck drivers and mental health" turned up five articles, two of which were about North American truckers, including Shattell's article, and one each from Brazil, Australia and Japan. Articles on drivers' physical health issues were in the hundreds.

Another reason why physical health is a more fertile subject is because it can be measured clinically, things like blood pressure and weight. Mental health studies require self-reporting which is always subjective. In addition, more people are willing to share physical health issues but not mental health problem due to an unwarrented stigma still attached to them. For example, in Shattell's 2010 study, more than 75 percent of drivers reported multiple physical health problems such as pain, hypertension and diabetes. Only 19 percent of truckers acknowledged mental health issues including stress and anxiety. Shattell notes that acknowledging mental health issues is not confined to the driver community. "All of us want to believe that we're mentally healthy, we don't want to believe that we're not."

Still, drivers' unique work environment amplifies any problems. For instance, while drivers often put on a tough exterior, Shattell reported that many drivers are sensitive to the negative perception and treatment that they receive from the general public and those they come in contact with in the course of their job such as receiving clerks and warehouse personnel. She also noted that drivers expressed sadness and helplessness at not being home for traumatic family events such as a death. Another issue that cropped up during interviews was truckers exposure to potential violence at truckstops, forcing them to carry weapons, and at witnessing fatal crashes on the road. Some drivers exhibit symptoms of PTSD because of these occurrences. "I got an email from a psychiatrist just a couple of weeks ago. He had a client who stopped driving because of a fear of bridges, and that’s not unheard of. The PTSD that we’re going to see more of is really about witnessing violence, being part of violence, witnessing traumatic events on the road. PTSD episodes can be triggered by more time on the road. We hear PTSD and we think war and veterans coming back from conflicts, and that's a problem. But veterans have a solid network of medical care providers, more so than the everyday truck driver," says Shattell.

 Is there hope for drivers' mental health issues? Even if drivers want to ask for treatment, it's difficult because of their tight schedules and scant access to mental health professionals. Shattell sees an answer in telehealth, accessing health professionals through the internet. In addition, she thinks reframing the issue of mental health might spur more drivers to seek help. "Drivers should frame it as support, as help, dealing with the stressors of the job – as a way of handling your job better. I think more drivers would be open to that."

Shattell would like to conduct a new driver survey if she can amass the self-funding. "The focus will be on sleep, emotional health, mental health and some physical health questions, because it’s related. We want to look at sexual violence and PTSD." The survey will also include women drivers, a group not represented in the 2010 survey.

Shattell concludes: "We're doing it because we’re interested, because we know the population is underserved and undervalued, and we want to help."

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