|Year : 2019 | Volume
| Issue : 3 | Page : 143-148
Substance abuse and depression among auto-rickshaw drivers: A study from the national capital region of Delhi, India
Shaurya Kaul1, Anish Kumar Gupta2, Taposh Sarkar2, Syed Khursheed Ahsan1, Narinder Pal Singh2
1 Department of Psychology, Jamia Millia Islamia, New Delhi, India
2 Department of Medicine, Max Super Speciality Hospital, Ghaziabad, Uttar Pradesh, India
|Date of Submission||13-Jun-2019|
|Date of Acceptance||14-Jun-2019|
|Date of Web Publication||19-Aug-2019|
Dr. Narinder Pal Singh
Department of Medicine, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: Auto-rickshaw driver is exposed to many kinds of risks owing to his profession, such as stressful occupational conditions, environmental pollution, and drug abuse such as smoking, tobacco, and alcohol use. The present study is an attempt to estimate the prevalence of substance abuse and depression among auto-rickshaw drivers and compare these with nonauto-rickshaw drivers. Subjects and Methods: A total of 120 participants were enrolled randomly in the study, i.e., 60 each from auto-rickshaw drivers and nonauto-rickshaw population. To fulfill the objective, methodology based on the test application of the Beck's Depression Inventory, Hamilton Anxiety Rating Scale, and alcohol, smoking, and substance involvement screening test was used. A predesigned questionnaire was used that included information such as general health status, habits, addictions, and work experience. To establish statistical relationships between two or more random variables, the Pearson correlation coefficient was also calculated. Results: In the present study, significant high prevalence of tobacco and alcohol use was seen among auto drivers, 83.3% and 63.3% as compared to nonauto-rickshaw drivers (tobacco and alcohol, 46.6% and 46.1%, respectively). The prevalence of depression in auto-rickshaw drivers was 90% (mild-to-severe range) which was significantly high compared to nonauto-rickshaw drivers (60%). On the Hamilton Anxiety Rating Scale, more than half of the auto-rickshaw drivers, i.e., 60%, had mild-to-moderate anxiety which was higher than nonauto-rickshaw (5%). Driving experience, age, and substance abuse (alcohol and tobacco use) showed a significant association with depression. Conclusion: This study demonstrated a high prevalence of depression, anxiety, and substance abuse in auto-rickshaw drivers. There was a positive correlation of depression with substance abuse (alcohol and tobacco), age, and work experience. This study will assist the psychologist to understand and treat the mental health issues among professional drivers.
Keywords: Anxiety, auto-rickshaw driver, depression, substance abuse
|How to cite this article:|
Kaul S, Gupta AK, Sarkar T, Ahsan SK, Singh NP. Substance abuse and depression among auto-rickshaw drivers: A study from the national capital region of Delhi, India. Indian J Med Spec 2019;10:143-8
|How to cite this URL:|
Kaul S, Gupta AK, Sarkar T, Ahsan SK, Singh NP. Substance abuse and depression among auto-rickshaw drivers: A study from the national capital region of Delhi, India. Indian J Med Spec [serial online] 2019 [cited 2020 Jan 22];10:143-8. Available from: http://www.ijms.in/text.asp?2019/10/3/143/264526
| Introduction|| |
Neuropsychiatric conditions including mood, anxiety, and drug use disorders are known contributors to the global burden of disease. According to the latest prevalence estimates of mental disorders in India, the point prevalence of any psychiatric disorders was estimated in 23.5%, 14.6% for any anxiety disorder, and 6.7% for depressive disorders. Auto-rickshaws are the main modes of public transport, and professional drivers are the backbone of the nation. A large number of auto-rickshaw drivers are involved in abusive habits day by day. They are facing health problems too. Many of the rickshaw drivers are not aware of the deleterious effects of smoking and drug abuse. Their mental and physical health is also important aspect for the growth of a nation. In India, very few studies have been conducted related to the mental health issues of professional drivers. The level of depression is also associated with education status, age, socioeconomic status, substance abuse, and personality. In view of this, the present study was conducted to find the prevalence of substance abuse and to evaluate depression and anxiety among the auto-rickshaw drivers and to establish the correlation of depression among the participants with various risk factors such as substance abuse and socioeconomic status. It is expected that the findings of the present study will assist the mental health worker working in an area to understand and treat the mental health issues among professional drivers.
| Subjects and Methods|| |
A total of 120 samples were enrolled in the study, i.e., 60 each from auto-rickshaw drivers and nonauto-rickshaw users. The participants were randomly selected based on the following criteria: registered male auto-rickshaw drivers with 1 year of driving experience. Participants were enrolled through random sampling technique. Selection of auto-rickshaw drivers was done by approaching at various three-wheel parks and by approach to auto-rickshaw association in Central Delhi area (Delhi Gate). Nonauto-rickshaw users were enrolled randomly. The study protocol was explained to all the participants before the start of the study. Informed written consent was obtained from each study participant before starting the interview (15–20 min). Since the objective of the research was to correlate depression and anxiety among auto-rickshaw drivers with various risk factors such as substance abuse and financial insecurity and compare the findings with the matched general population, methodology based on the test application of the Beck's Depression Inventory (BDI), Hamilton Anxiety Scale, and alcohol, smoking, and substance involvement (ASSI) test was used. A predesigned questionnaire was used for the participants to fill up before taking the test. This included information such as general health status, current medical problems, personal habits, addictions, hours spent on job, and history of road traffic accidents. Confidentiality of the study participants was assured and maintained throughout the study.
Beck's Depression Inventory
The BDI is a series of questions developed to measure the intensity, severity, and depth of depression in patients with psychiatric diagnoses. It is composed of 21 questions, each with four possible responses on a score rating from 0 to 3, indicating the severity of the symptom. Each question was designed to assess a specific symptom common among people with depression.,, The BDI test has good internal consistency and reliability.
Hamilton Anxiety Rating Scale
The scale consists of 14 items, each defined by a series of symptoms, and measures both psychic anxiety (mental agitation and psychological distress) and somatic anxiety (physical complaints related to anxiety). Each item is scored on a scale of 0 (not present) to 4 (severe), with a total score range of 0–56, whereas <17 indicates mild severity, 18–24 mild-to-moderate severity, and 25–30 moderate-to-severe severity. Its main advantage is that it shows a satisfactory degree of consistency.
The alcohol, smoking, and substance involvement screening test developed by the WHO
The ASSI screening test (ASSIST) is an 8-item questionnaire designed to determine a risk score for each substance which is used to start a discussion (brief intervention) with clients about their substance use. The score obtained for each substance falls into a “lower,” “moderate,” or “high” risk category which determines the most appropriate intervention for that level of use (“no treatment,” “brief intervention” or “referral to specialist assessment, and treatment” respectively).
Collected data were tabulated, and quantitative parameters were expressed as mean and standard deviation, whereas qualitative variables were presented as frequency and percentages. Two-tailed independent unpaired t-test and Chi-square test were used to establish association. To establish statistical relationships between two variables, the Pearson correlation coefficient is also calculated.
| Results|| |
The purpose of the present study was to evaluate the prevalence of substance abuse and to find depression and anxiety among the auto-rickshaw drivers. Further data were analyzed to correlate depression among auto-rickshaw drivers with various risk factors such as substance abuse and financial insecurity.
A total of 120 patients were enrolled in the study, i.e., 60 each from auto-rickshaw drivers and nonauto-rickshaw population. Detailed demographic profiles are mentioned in [Table 1]. In both the groups (auto-rickshaw drivers and nonauto-rickshaw drivers), majority belonged to the age group of 20–39 years with the mean age of 37.52 ± 7.07 and 35.18 ± 7.43 years, respectively. All of them were males and married. 55% belonged to lower-middle class (Class III) in the former group as against 66.6% in the latter group. More than half of the auto-rickshaw drivers (53.3%) were driving for <10 h/day, as against 73.3% of the nonauto-rickshaw drivers, who were working for <10 h/day, and 73.3% versus 63.3% had been in their respective occupations for more than 10 years in the respective groups.
|Table 1: Sociodemographic characteristics among auto-rickshaw driver versus nonauto-rickshaw drivers|
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Prevalence of substance abuse
In the present study, a high prevalence of tobacco and alcohol use among auto-drivers was noted (83.3% and 63.3%, respectively), compared to nonauto-rickshaw drivers (tobacco and alcohol, 46.6% and 46.1%, respectively). Among all the tobacco users, all were consuming tobacco routinely, and bidi smoking (80%) was the most common followed by cigarette smoking (20%). Pleasure and relaxation were the major reasons for smoking. No one reportedly encountered health, social, legal, or financial problems on the use of tobacco. More than 80% of the tobacco users had tried to cut down on using tobacco but had failed. On risk stratification by the ASSIST, it was found that among all the tobacco users, majority (49 [98%]) were at moderate risk of health and other problems, required brief intervention, and subsequently 2% were at high risk of health problem. Only 2% were at low risk of health problem. Among the nonauto-rickshaw drivers, the prevalence of tobacco use was 46.6%, of which majority (78%) were in moderate risk of health problem, requiring brief intervention, whereas 22% were at lower risk of health.
More than three-fourth had strong desire to use alcohol weekly/monthly. Among all the alcohol users, 3 (7.8%) had financial problems on the use of alcohol. More than half (63%) of the alcohol users tried to cut down on using alcohol but failed. On risk stratification by the ASSIST, it was found that among all the alcohol users, majority (n = 35, 92.2%) were at moderate risk of health and other problems, requiring brief intervention. Only 7.8% had low risk of health problem. Among the nonauto-rickshaw population, the prevalence of alcohol use was 46% (n = 26), and 57.6% were at moderate risk of health and other problems. 42.4% were in lower risk of health problem.
Prevalence of mental disorders – depression and anxiety
Prevalence of depression
The prevalence of depression [Table 2] in auto-rickshaw population was 90%, of which more than half of the drivers had borderline-to-moderate depression. 13 (21.7%) had mild mood disturbance, 17 (28.3%) had borderline clinical depression, 22 (36.7%) had moderate depression, and only 2 (3.3%) had severe depression. The prevalence of depression in nonauto-rickshaw drivers was 60%, of which only 10% had borderline-to-moderate depression.
|Table 2: Prevalence of depression between auto-rickshaw drivers versus nonauto-rickshaw drivers|
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Prevalence of anxiety
[Table 3] shows that more than half of auto-rickshaw drivers (n = 36, 60%) had mild-to-moderate anxiety, followed by 14 (23.4%) had moderate-to-severe anxiety and 10 (16.6%) had mild anxiety. Among the nonauto-rickshaw population, more than 95% of the population had mild anxiety symptoms. [Table 4] highlights the symptoms of anxiety among the study group of auto-rickshaw drivers.
|Table 3: Severity of anxiety symptoms between auto-rickshaw drivers versus nonauto-rickshaw drivers|
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|Table 4: Symptoms of anxiety (psychic and somatic anxiety) among auto-rickshaw drivers|
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Group differences in mean score of depression, anxiety, and substance abuse
In auto-rickshaw drivers, when we analyzed anxiety, the average score was 21.41 ± 4.63 (range: 10–35), whereas the mean score for depression was 18.73 ± 6.46, with a range of 6–40. Similarly, the mean score for substance abuse was 17.8 ± 3.91 for tobacco use and 12.1 ± 4.81 for alcohol use. Similarly, in nonauto-rickshaw drivers, when we analyzed anxiety, the average score was 8.75 ± 5.27 (range: 0–24), whereas the mean score for depression was 11.1 ± 4.71, with a range of 3–25. The mean score for substance abuse was 13.3 ± 7.85 for tobacco use and 8.61 ± 7.35 for alcohol use. The results [Table 5] revealed that there were significantly higher mean score for depression, anxiety, and substance abuse in auto-rickshaw drivers than nonauto-rickshaw drivers.
|Table 5: Group differences in mean score of depression, anxiety, and substance abuse|
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Factors associated with depression in auto-rickshaw drivers
The factors that showed a significant association with depression were driving experience, age, and substance abuse (alcohol and tobacco use) [Table 6]. Auto-rickshaw drivers with the age group of 40–59 years had significantly more depression than younger group of auto-rickshaw drivers, and there were increasing trends of level of depression with age.
More depression was estimated in auto-rickshaw drivers who had substance abuse. Auto-rickshaw drivers who had depression and the consumption of alcohol and tobacco use were high (63% and 83.5%, respectively) compared to drivers who had no depression (consumption of alcohol and tobacco were 37% and 16%, respectively).
There was also a significant increase in the level of depression in auto-rickshaw drivers who had driving more than 10 years compared to those driving for 10 years or less. [Figure 1] indicates the average depression score noted with the number of years of driving noted in the study group.
|Figure 1: Mean depression score with driving experience in auto-rickshaw drivers|
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| Discussion|| |
An auto-rickshaw driver is exposed to many kinds of risks owing to his profession. Many of these risks such as environmental pollution (noise and air), odd duty hours, financial insecurity as well as deranged lifestyle due to irregularity of meals, bad posture while driving, stressful occupational conditions, smoking tobacco, and habituated to alcohol, predispose them to various comorbid conditions. The present study attempted to estimate the prevalence of depression and substance abuse among auto-rickshaw drivers and correlate these with the general population. A disturbing trend witnessed is that more and more auto-rickshaw drivers are being drawn into the devastating habit of substance abuse. The prevalence of consumption of smoking and alcohol use among auto-rickshaw drivers was very high compared to the general population. In the present study, significant high prevalence of tobacco and alcohol use among auto drivers was 83.3% and 63.3%, compared to nonauto-rickshaw drivers (tobacco and alcohol, 46.6% and 46.1%, respectively). Pleasure and relaxation were the major reasons for smoking and alcohol consumption. On risk stratification, it was found that more than three-fourth drivers were at moderate risk of health and other problems compared to nonauto-rickshaw drivers. In a study conducted by Kaur et al., 2014, the prevalence of consumption of smoking and drug use was very high among rickshaw drivers. More than three-fourths (76.0%) of the rickshaw drivers were smokers which were consistent with our results. Similarly, a cross-sectional study by Bhatia et al., 2014, was conducted among 400 auto-rickshaw drivers of Gwalior, India. The results demonstrated that the prevalence of tobacco use among auto drivers was 84.25%. One of the cross-sectional studies by Ruiz-Grosso et al., 2014, revealed that the overall prevalence of alcoholism was 74.3% and concluded that common mental disorders such as alcohol abuse presented higher rates in public transportation drivers than the general population.
It is important to acknowledge the prevalence of depression and/or anxiety in public transportation drivers since the development of comorbid anxiety and/or depression not only leads to increasing work disability and poor quality of life but also associates with increased use of medical services and substantially higher health-care costs. Professional drivers were also at increased risk for depression when compared to the general population. The present study demonstrated a high prevalence of depression (90%) in auto-rickshaw population than the general population which was 60%. More than half of the auto-rickshaw drivers had borderline-to-moderate depression. In the present study, the severity of anxiety level was high in more than half of auto-rickshaw drivers; 36 (60%) had mild-to-moderate anxiety than normal general population, which was 5%.
The level of depression among auto-rickshaw drivers was associated with driving experience, age, and substance abuse. Auto-rickshaw drivers with the age group of 40–59 years had significantly more depression than younger group of auto-rickshaw drivers, and there were increasing trends of level of depression age. More depression was estimated in auto-rickshaw drivers who had prevalent substance abuse. Among auto-rickshaw drivers who had depression, the consumption of alcohol and tobacco use were high compared to drivers who had no depression. The results revealed that depression may be one of the reasons for substance abuse in auto-rickshaw drivers. There was also increase in the level of depression in auto-rickshaw drivers who had been driving more than 10 years and increasing trends of depression with driving experience.
The similar findings consistent with a study by Shen et al., 2013, investigated depression status and associated factors in occupational drivers. The incidence of depression was 53.74%. The study reported that the level of depression is associated with driving experience, socioeconomic status, education, and age. In another study conducted by Sinha and Shashikala, 2015, in Bangalore city, the results revealed that 29.8% had mild stress and 2% had moderate stress, showing increasing trends with age.
There were a few limitations in the present study. The sample size was small, the study was for shorter duration of time, there was no follow-up of the study participants, and there was no intervention plan (coping strategies). Although the BDI provides reasonable screening data, identifying patients at risk for depression, it does not diagnose depression itself.
| Conclusion|| |
This study showed a high prevalence of depression, anxiety, and substance abuse in auto-rickshaw drivers than nonauto-rickshaw drivers. There was a positive correlation of depression with substance abuse, age, and duration of work experience. High prevalence of depression was estimated at 90% in auto-rickshaw population than nonauto-rickshaw drivers which was 60%.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]