Depression, anxiety, bipolar disorder and stress impact on fitness to drive: findings from a systematic integrative review

Having anxiety, depression, or bipolar disorder can significantly impact one’s ability to drive. However, the specific effects of these conditions on drivers’ psychophysical capacities and the likelihood of accidents are not always well documented in the scientific literature. The aim of this study is to examine the relationship between mood disorders, specifically depression, anxiety, and bipolar disorder, and driving. A systematic review on this topic was conducted and registered with PROSPERO (CRD420251023655). A systematic search was carried out in 2025 across seven scientific databases following PRISMA guidelines. Two groups of keywords were used, one for psychopathological disorders (in the title) and another for driving-related terms (in title, abstract, and keywords), adapting them to each database’s search syntax. Filters limited results to peer-reviewed reviews published in English between 2015 and 2025. On-road studies indicate that major depression, more than mild symptoms, is associated with impairments in executive functions critical for driving, while ongoing pharmacological treatment can mitigate some negative effects. Simulator studies suggest that drivers with partially remitted depression can perform comparably to healthy drivers, underscoring the importance of maintaining psychosocial functionality. Anxiety undermines self-efficacy and attentional control, particularly affecting performance in older drivers. Bipolar disorder shows persistent deficits in sustained attention and information processing, even during remission phases. In professional drivers, multiple studies show how work-related stress, fatigue, road rage, and lack of organizational support directly influence risky behaviors. Personality traits like neuroticism and impulsivity, along with mental health disorders, significantly increase the risk of driving errors and traffic violations.