The perils of long-haul trucking

Earlier this year in the private Facebook group Truckers for Truckers, a driver posted a short but grim message. Using an ironically serene background of a blue sky with clouds, he lamented how he was "lonely," "empty," and "always on the road." He ended the missive with: "I miss my mom and I hate my life. I don't want to live no longer." In the comments section, fellow drivers offered words of support and implored him to seek professional help and find someone—anyone—to talk with. In a post on another trucker Facebook group, a member shared a link to a newspaper story of a driver who admitted he had fallen asleep behind the wheel several times before a crash that killed a Georgia state trooper. The author wrote: "Another tragic fatigue-related truck accident ... I just hope this driver doesn't turn out to have undiagnosed, untreated sleep apnea on top of everything else."

Posts like these are not uncommon, nor are the pages that host them. There are currently at least a dozen social media pages dedicated to the long-haul trucking profession. For a population often on the road, these sites serve as a remote support group where they can share stories with people who can relate.

Image caption: Mona Shattell

Image credit: Courtesy of Mona Shattell

The posts "are very colloquial, real, and raw," says Mona Shattell, the newly appointed associate dean for faculty development at the School of Nursing, who has studied the mental, physical, and sexual health of truckers for the past decade. "Some [drivers] are depressed, feeling suicidal. It's a safe place for them to go."

And safety can be in short supply. Long-haul trucking is undoubtedly one of the most dangerous professions in America. Nearly a third of the 3.5 million truck drivers in the United States will be involved in a serious road accident at some point during their careers, according to statistics from the Federal Motor Carrier Safety Administration. Long-haul truckers—interstate drivers who are typically gone for days at a time—also have some of the highest rates of injuries and illnesses of all occupations. They frequently suffer from neck, back, hip, knee, ankle, and a host of musculoskeletal injuries owing to the repeated stress on joints from driving more than 10 hours consecutively for days on end. Falls are a not-uncommon occurrence, too, particularly after a long drive during which a body has vibrated violently for hours, with a person's feet and legs absorbing most of the impact. "You start to lose feeling in these limbs," Shattell says. "Then when you step out of the cab onto this little step, you miss it or stumble, and then fall or maybe hurt yourself bracing for one."

Truckers also suffer from obesity, hypertension, diabetes, and sleep disorders at rates that are higher than the national average. Anecdotal evidence suggests high rates of substance abuse and depression, which often go undiagnosed and untreated. The on-the-job fatality rate for drivers is 11 times the national average, according to a 2016 study.

"They have more health problems than the standard population, and less access to health care, which is a dangerous mix," says Shattell, who has become a champion for this underserved population.

She has authored op-eds on trucker health in The New York Times and The Atlantic, and hosted a podcast called Health on the Highway. Last year, Shattell partnered with University of Alabama at Birmingham School of Nursing researcher Karen Heaton on a pilot study of the health of 140 truck drivers from across the country. In the study, and in conversations with truck drivers, Shattell found they are not just involved in accidents; they witness them at an alarming rate. Repeated exposure to accidents, including massive injuries and deaths to adults and children, takes its toll. Being involved in an accident can leave lasting mental scars, Shattell says, and even seeing one can cause enough stress and anxiety to become a diagnosable mental illness like acute stress disorder or post-traumatic stress disorder.

"Drivers have seen cars careen off bridges into water. Just terrible things," she says. "You cannot unsee something like that. Now it's in their brains and they're carrying this, but they have to keep trucking. Keep driving."

In talking with this population, Shattell has found that truckers will often either ignore mental health issues or refuse to seek care for fear that they'll lose valuable time on the road. Even when truckers are willing to seek mental health care, Shattell says, the demands of the job can make it difficult to follow through. Long-haul truckers are seldom at home, and they have little autonomy over their working hours—often being told what route to take, where to buy gas, and when and where to sleep. So scheduling regular appointments is tricky. In surveys and interviews, many drivers said they will seek out anything to find relief from their emotional and physical issues, including sleeping pills, painkillers, alcohol, drugs, and sex workers. "Sometimes the relief they seek is from boredom and isolation," she says. "In earlier studies when we talked to drivers, they told us they solicited sex workers for the time and companionship. It wasn't for the sex. They just wanted to talk to someone."

Shattell advocates for more nurse practitioners and primary care clinics at truck stops, as well as driver access to telehealth services. "We need to provide support where the truckers are, and that's on the road," she says. Trucking companies, she says, should offer more wellness programs. Federal guidelines on the maximum number of driving hours could be decreased from 11 to 9, in line with European standards. Engineering has a role to play, too. Some cabs, she says, now feature seats that produce less vibration. Shattell says we need more advances like this.

Shattell next plans to begin a study focused on the mental health of women truckers, currently only 6% of the workforce, in addition to conducting a larger study on the general population of drivers. Ultimately, Shattell hopes research like hers will inform changes in policy that lead to a safer workplace environment for truckers. "It's all about having these workers treated well. Right now they seek solace and assistance from one another on social media," she says. "We need to do a better job of offering them professional help when they need it the most."