Alexandra Fort
email: alexandra.fort@univ-eiffel.fr

Boris Collette

Myriam Evennou

Christophe Jallais

Barbara Charbotel

A N Stephens

Antonio R Hidalgo-Munoz

Avoidance and personal and occupational quality of life in French people with driving anxiety

Keywords: driving anxiety, avoidance, automobile, cognition, well-being

niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.

Avoidance and personal and occupational quality of life in French people with driving anxiety

Introduction

Driving anxiety is a phenomenon that can manifest in a variety of ways. This ranges from apprehension of specific driving situations, or of general driving, to a phobia of driving either as a driver or as a passenger. Driving anxiety was first examined from a clinical perspective, understanding the longer term consequences of motor vehicle crash involvement (for example, [START_REF] Hickling | Post-traumatic stress disorder and motor vehicle accidents[END_REF][START_REF] Taylor | Measuring anxiety-related avoidance with the Driving and Riding Avoidance Scale (DRAS)[END_REF]. In these studies, posttraumatic stress disorder was examined and driving phobia was assessed through the Diagnostic and Statistical Manual criteria of mental disorders for specific phobia (DSM4, APA, 1994). This research has considerably improved the understanding of the psychological consequences of road crashes. However, researchers have now shown that it is not necessary to have been involved in a crash to develop a level of driving anxiety that can impact daily life [START_REF] Taylor | Comparison and characteristics of motor vehicle accident (MVA) and non-MVA driving fears[END_REF]. Some individuals experiencing driving anxiety report a panic attack as the source of their anxiety. For others, it can be the fear of being judged and some have no memory of a specific event triggering this anxiety [START_REF] Ehlers | The Driving Cognitions Questionnaire: Development and preliminary psychometric properties[END_REF]. Thus, people who have never been involved in a motor vehicle crash, neither as a driver nor a passenger, may report levels of driving anxiety such that they avoid driving in specific situations or completely avoid driving or riding in a car [START_REF] Taylor | Comparison and characteristics of motor vehicle accident (MVA) and non-MVA driving fears[END_REF].

Driving anxiety can vary in its intensity. In a population study conducted in New-Zealand, [START_REF] Taylor | The extent and characteristics of driving anxiety[END_REF] asked people to estimate the intensity of their driving anxiety on a scale from 0 to 10. Half of the population reported experiencing mild driving anxiety (scoring between 2 and 4) and a sixth reported moderate to severe anxiety (scoring between 5 and 10).

However, people who tend to higher levels of driving anxiety also tend to have lower levels of mental health and quality of life [START_REF] Hempel | Scared behind the wheel: What impact does driving anxiety have on the health and well-being of young older adults?[END_REF].

The diversity of sources from which anxiety can originate and the different intensity levels one can experience suggest that the consequences of driving anxiety could vary across individuals.

In addition, specific driving concerns also differ across individuals and their anxiety levels. Three main types of concerns have been identified for anxious drivers: panic related concerns, crash related concerns and social concerns [START_REF] Ehlers | Clinical characteristics of driving phobia[END_REF]. Drivers with higher anxiety levels tend to have a higher frequency of these concerns [START_REF] Stephens | The impacts of anxiety over driving on self-reported driving avoidance, work performance and quality of life[END_REF][START_REF] Taylor | The extent and characteristics of driving anxiety[END_REF].

Therefore, it is important to investigate how these concerns differ from one person to another, to understand how to address them. For instance, a recent Australian study suggested that individuals with extreme driving anxiety are more concerned by the potential for crash involvement when compared to individuals with mild or moderate anxiety [START_REF] Stephens | The impacts of anxiety over driving on self-reported driving avoidance, work performance and quality of life[END_REF]. Thus, targeting crash-related worries may be more effective for more anxious drivers compared to those with only mild anxiety.

Another key consequence of driving anxiety is avoidance [START_REF] Stewart | Driving and riding avoidance following motor vehicle crashes in a non-clinical sample: Psychometric properties of a new measure[END_REF].

This may be partial avoidance, when only specific driving situations are avoided, like dense traffic or highways, or total avoidance when driving is completely avoided. Higher levels of driving anxiety are associated with greater avoidance [START_REF] Ehlers | The Driving Cognitions Questionnaire: Development and preliminary psychometric properties[END_REF][START_REF] Stephens | The impacts of anxiety over driving on self-reported driving avoidance, work performance and quality of life[END_REF][START_REF] Taylor | The extent and characteristics of driving anxiety[END_REF]. Even if some alternatives to driving may exist (public transport, home service, cycling, etc.), avoidance can be very detrimental in particular in areas with poor or no public transport services [START_REF] Marottoli | Consequences of driving cessation decreased out-of-home activity levels[END_REF]. This restriction on mobility can have a significant impact extending beyond mobility. This impact not only makes it more difficult for social interactions, or potential caring responsibilities, but, at the professional level, it also makes it difficult to carry out certain work-related activities [START_REF] Costa | Demographics, clinical characteristics and quality of life of Brazilian women with driving phobia[END_REF]. While previous research has investigated the impacts on quality of life for those experiencing driving anxiety, the potential impacts on work, and perceived quality of work life, have scarcely been studied.

However, there is evidence to suggest these relationships exist. For example, Taylor, Alpass, Stephens & Towers (2011) reported that within a population of "young older" drivers (55-72 years old), 2.4% claimed that their usual activities or work had been affected due to driving anxiety for, at least, one day in the previous month.

Thus, while driving anxiety may affect mobility, and in-turn influence one's decisions regarding occupation, there are only limited data about the link between driving anxiety and work. In addition, it is known that anxiety traits can affect all areas of life: decision making [START_REF] Hartley | Anxiety and decision-making[END_REF], procrastination [START_REF] Zhang | The overlapping region in right hippocampus accounting for the link between trait anxiety and procrastination[END_REF], work [START_REF] Nordahl | In or out of work: A preliminary investigation of mental health, trait anxiety and metacognitive beliefs as predictors of work status[END_REF]. Likewise, driving anxiety may have repercussions outside the driving activity itself, in daily life, and potentially in occupational life as well.

These potential outcomes of driving anxiety are under-researched in France. In addition, and as mentioned above, limited data are available concerning the potential repercussions of driving anxiety in the occupational domain. To address these gaps, we designed an online survey to determine the manifestations of driving anxiety in terms of concerns, avoidance and some aspect of personal and occupational life, in a French population. The survey focussed on individuals experiencing driving anxiety across varying intensities, from mild to extreme anxiety. Information was sought regarding driving history and the perceived consequences of driving anxiety on personal and occupational life. Two questionnaires were also used: a French translation of the Driving Cognitions Questionnaire, to collect information about what drivers feel and think while driving; and a French translation of the Driving and Riding Avoidance Scale designed to understand avoidance behaviours related to driving anxiety.

Method

Participants

A large advertising campaign was conducted to recruit participants experiencing driving anxiety through social networks and associations dealing with driving education or with driving anxiety. Potential participants were approached through the following advertisement: "Are you anxious when you drive a car? Are you worried about finding yourself in certain driving situations? You do not drive or almost not drive because of this anxiety? Although there are relatively few data available on this discomfort while driving, which can range from simple discomfort to a real phobia (sometimes referred to as amaxophobia), it seems to be quite common and affects a large number of people. We are interested in your opinion, even if you do not have a driver's license or you never drive."

Participants were eligible to take part in the study if they were 18 years or older, currently resided in France and experienced driving anxiety.

Procedure

Ethical approval was obtained from IFSTTAR Ethics committee. The online survey was hosted using Limesurvey online platform (www.limesurvey.org). The first three questions asked for age, country of residence and consent to participate to the survey. If all three inclusion criteria were met, then the survey could start. The survey took approximately 30 minutes to complete.

Measures

Demographic information.

Questions about demographic information included year of birth, gender, French residence district, driver's licence status, annual mileage and whether participants lived in an urban area or rural area. Participants also provided information regarding their occupation, distance living from work and method of commuting to and from work.

Driving Cognitions Questionnaire (DCQ).

The DCQ measures the frequency of anxiety related thoughts that drivers may experience while driving [START_REF] Ehlers | Clinical characteristics of driving phobia[END_REF][START_REF] Ehlers | The Driving Cognitions Questionnaire: Development and preliminary psychometric properties[END_REF]. The original DCQ includes 20-items that can be classified in three categories: panicrelated items (e.g. I will not be able to think clearly), crash related items (e.g. I will be injured), thoughts and social concerns items (e.g. People I care about will criticise me), with internal consistencies assessed through Cronbach's coefficient α of .93, .92 and .89, respectively [START_REF] Ehlers | The Driving Cognitions Questionnaire: Development and preliminary psychometric properties[END_REF]. Participants respond to each item on a 5-point Likert scale from 0 (Never) to 4 (Always) indicating the frequency of each thought while driving. Scores for each item are averaged across each factor. Higher scores indicate a higher frequency of concern. To our knowledge, this was the first time this questionnaire was used in a French study. Therefore, we translated the questionnaire into French. We also conducted a Principal Component Analysis (PCA) in order to test for the replicability of the three-factor structure.

Driving and Riding Avoidance Scale (DRAS).

The DRAS [START_REF] Stewart | Driving and riding avoidance following motor vehicle crashes in a non-clinical sample: Psychometric properties of a new measure[END_REF]) is a questionnaire used to measure avoidance behaviours for driving or riding in a vehicle. It contains 20-items describing various driving and riding situations. Participants indicate how often they have avoided each situation due to anxiety over the past seven days [START_REF] Sullman | Social desirability and self-reported driving behaviours: Should we be worried?[END_REF]. Participants respond using a four-point Likert scale from 0 (avoid rarely or none of the time) to 3 (most or all of the time). [START_REF] Stewart | Driving and riding avoidance following motor vehicle crashes in a non-clinical sample: Psychometric properties of a new measure[END_REF] identified four factors in this questionnaire: general avoidance, traffic avoidance, weather avoidance and riding avoidance, with internal consistencies (Cronbach's coefficient α) of.82, .85, .86, .82, respectively. Scores are summed for each factor. Higher scores indicate higher avoidance level. The DRAS was translated into French2 and a PCA was used in order to test the fourfactor structure.

Anxiety level and relationship with quality of life and work.

Participants rated their level of driving anxiety on an 11-point scale (from 0 = none to 10 = extreme) as done in previous studies (Taylor et al., 2011;[START_REF] Taylor | The extent and characteristics of driving anxiety[END_REF]. Participants also reported on an 11-point scale (from 0 = not at all to 10 = very much) the extent to which their driving anxiety has: 1) determined the choice of their place of residence; 2) affected their daily activities and 3) affected their quality of life in the last month. Quality of life was defined as "your sense of physical and psychological well-being, your autonomy, your social relationships and your relationships at work and with your family and friends". To determine the importance of the social part of driving anxiety, participants also reported how ashamed they are of their driving anxiety on an 11-point scale (0 = not at all; 10 = very strongly).

Regarding their occupation, participants reported 1) how much their career choice was determined by driving anxiety (from 0 = not at all to 10 = very much); 2) whether driver anxiety has been a barrier to getting a job (Yes/No); 3), if they had ever considered leaving a position due to this anxiety (Yes/No); and 4) if they had ever been late to work, or absent from work due to driving anxiety (Yes/No; number if any).

Data analysis

The self-reported intensity of driving anxiety was categorised across three levels: mild (1-5), moderate (6)(7)(8) and extreme (9-10) [START_REF] Collette | Caractérisation par questionnaire de la population française touchée par l'anxiété de la conduite, identification de la gêne et de ses répercussions socioprofessionnelles[END_REF]. This segmentation into three levels was chosen to bring precision to the analysis conducted about the perceived impact of driving anxiety according to its intensity. Indeed, apart from its statistical relevance in terms of group size, this categorisation allowed separating the extremely anxious people (9-10) from the moderately anxious ones (6)(7)(8) which previously have been grouped together (for instance Taylor et al., 2011;[START_REF] Taylor | The extent and characteristics of driving anxiety[END_REF] but see also [START_REF] Collette | Caractérisation par questionnaire de la population française touchée par l'anxiété de la conduite, identification de la gêne et de ses répercussions socioprofessionnelles[END_REF][START_REF] Stephens | The impacts of anxiety over driving on self-reported driving avoidance, work performance and quality of life[END_REF] for same classification). This classification is expected to highlight the likely differences between the two higher levels of anxiety on driving avoidance and performance. Cases with 0 on this scale were removed from the analysis (37 cases). Age was categorised into six groups: 18-24; 25-34; 35-44; 45-54; 55-64; 65+. Data analyses were conducted with SPSS v.26 for Windows. Relationships for categorical data were examined using Chi-Square independence tests. In cases where there were 20% of the cells with an expected count less than five (e.g. gender) Fisher's Exact Test p value was reported. Effect sizes were interpreted using Cramer's V (φc) with values up to 0.10, 0.30 and 0.50 indicating small, medium and large effects respectively [START_REF] Cohen | Statistical Power Analysis for the Behavioral Sciences (Second)[END_REF].

One-way ANOVAs were conducted to assess relationships between anxiety group and continuous variables. Bonferroni post hoc tests were used to determine significant differences between each group while adjusting for multiple comparisons. As mentioned, two Principal Component Analyses (PCA) were conducted on the scores of DCQ and DRAS respectively and Varimax rotations were used. For each PCA adequacy of the factorial solution was given by the Kaiser-Meyer-Olkin index (Results are given in supplementary materials). In addition, the mean scores for each item were examined for the entire sample and then, separately for each anxiety group.

Results

Final dataset

A total of 2,879 persons visited the survey website. Participants were included in the dataset if they met the following criteria: i) three inclusion criteria; ii) level of anxiety superior or equal to 1; and iii) all items of the questionnaire completed. Eventually, responses from 304 participants were included in the final dataset for analysis (see Table 1, first column). The majority of participants were women (79.9%; males = 20.1%). They ranged in age from 18 to 77 years (M = 36.96; ± 13.56). Most of them held a driver's licence (92%).

Among those not holding a licence, 37.5% indicated they were currently learning to drive.

The mean anxiety intensity score was 6.45 (±2.63) on the 11-point scale.

Sample characteristics according to three levels of driving anxiety

The sample distribution according to three levels of anxiety (mild from 1 to 5, moderate from 6 to 8, and extreme from 9 to 10) is shown in Table 1: 32.2% of the sample were classified as mildly anxious, 44.7% were moderately anxious and 23% were extremely anxious.

A significant difference in the levels of driving anxiety was observed according to gender (χ 2 (2) = 10.90, p = .0043, φc =.189), due to an over-representation of males among the mildly anxious, and an under-representation among extremely anxious drivers. A significant difference was also found across age group (χ 2 (8) = 37.38, p < .0001, φc = .248), due to an over-representation of the 18-24 years old and an under-representation of the 35-44 years old among the mildly anxious group as well as an under-representation of the 18-24 years old and an over-representation of the 35-44 years old among the extremely anxious.

Holding a driver's licence or not was significantly related to anxiety level (χ 2 (2) = 9.82, p < .007, φc = .180): those without a licence were under-represented in the mildly anxious group and over-represented in both other groups. Finally, there was a significant relationship between place of residence (urban or rural) and level of anxiety (χ 2 (2) = 8.01, p = .0182, φc = .162). People living in rural areas were over-represented within the mildly anxious group and under-represented within the extremely anxious group. represents the ones, which make the largest contribution to the overall chi-square statistic.

Driving Cognitions Questionnaire results: Negative thoughts while driving

The main negative thoughts linked to driving were assessed through the Driving Cognitions Questionnaire. This questionnaire was only administered to the participants who reporting driving (n = 250), excluding people without their drivers licence and those who did not drive anymore.

The PCA conducted on DCQ scores resulted in four factors (eigenvalues greater than 1) and a cumulative explained variance percentage of 71.8% (see supplementary material for further details). Two of these factors corresponded to the panic-related and to the social concern items identified by [START_REF] Ehlers | Clinical characteristics of driving phobia[END_REF][START_REF] Ehlers | The Driving Cognitions Questionnaire: Development and preliminary psychometric properties[END_REF]. The two last factors corresponded to the crash related items but split into two categories depending on whether it is a fear for oneself (e.g. I will be injured) or for others (e.g. I will injure someone). The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.911, indicating suitability of the data for this analysis. In addition, the questionnaire demonstrated good internal consistency (α = 0.94) for the total score and for each of these four factors (See Table 2 for Cronbach alphas). analysis revealed that for each factor, scores of the extremely anxious group were significantly higher than those of the moderately and mildly anxious groups (p < .001), and scores of the moderately anxious group were significantly higher than those of the mildly anxious group (p < .001).

To better understand the respondents' main concerns while driving s, the scores for each item were examined (see Table 3) for the entire sample and for each anxiety group. In the whole sample, the four most common thoughts were: 1) "I cannot control whether other cars will hit me"; 2) "I will hold up traffic / people will be angry"; 3) "I will not react fast enough" and 4) "People will think I am a bad driver". The three most common for whole sample were also the most commonly reported by the mildly and moderately anxious groups.

The fourth most common thought for the mildly anxious group was "People I care about will criticise me" and for the moderately anxious group was "I will cause an accident".

The four most common thoughts while driving differed for the extremely anxious group. For this group, the main concern was "I will lose control of myself and act stupidly or dangerously", followed by "I will hold up traffic / people will be angry" and "I will not be able to think clearly". With the same score, the fourth most frequent thought of this group was "People will think I am a bad driver" and "I will tremble and not be able to steer". In particular, this last concern was very specific to the extremely anxious group as it only emerged in the 17 th position for mildly and moderately anxious groups. Note. In each column, the values in bold correspond to the four items with the highest scores.

Avoidance of driving or riding by anxiety groups

Avoidance related to driving anxiety was explored through total avoidance and the DRAS factors representing different situations avoided. Note. α = Cronbach coefficient alpha.

3.

As illustrated in Table 4, there were some significant differences in the scores obtained for the four factors across anxiety groups: general avoidance (F(2,277) = 57.31, p < .0001, η 2 = 0.293), traffic avoidance (F(2,277) = 39.57, p < .0001, η 2 = 0.222), weather/darkness avoidance (F(2,277) = 21.94, p < .0001, η 2 = 0.137) and riding avoidance (F(2,277) = 15.93, p < .0001, η 2 = 0.103). Extremely anxious people reported higher levels of all four avoidance types, across the past seven days, which were almost twice as high as moderately anxious people (p < .001). In addition, moderately anxious people reported more general avoidance (p < .001) and traffic avoidance (p < .002) than mildly anxious people.

Table 5 shows the mean scores for each DRAS item across anxiety groups. The four main avoidance behaviours are reported for the whole sample and also for each group. The same two behaviours were rated as most frequent across all groups. These were: 1) "avoiding driving a car "and 2) "riding a bus to avoid driving in the car". The mildly anxious group reported more "rescheduling making a drive in the car to avoid traffic", and "avoiding driving the car because the weather was bad (e.g., fog, rain, or ice)"; the moderately anxious group reported more "avoiding driving on busy city streets" and "avoiding activities that required using a car"; and the extremely anxious group also reported more "rescheduling making a drive in the car to avoid traffic" and "avoided activities that required using a car".

Table 5.

DRAS mean item scores (SD) across all the licenced drivers (n = 280) and separately for each anxiety group.

DRAS Items All

(n = 280)

Mild

(n = 97) Note. In each column, the values in bold correspond to the four items with the highest scores.

Moderate

Reported impact of driving anxiety on general quality of life

To further explore the perceived impact of driving anxiety, we investigated the perceived consequences on different aspects of personal and occupational life.

Driving anxiety and personal life.

The self-reported impact of driving anxiety was assessed on four aspects of personal life and revealed significant differences on choice of residence (F(2,301) = 56.26, p < .0001), daily activities (F(2,301) = 63.97, p < .0001), overall quality of life (F(2,301) = 65.29, p < .0001) and level of associated shame (See Table 6).

(F(2,301) = 64.66, p < .0001). The more severe the driving anxiety, the more perceived impact across all four aspects. Post-hoc analysis revealed that for each aspect of daily life, the scores were significantly higher for moderately and extremely anxious drivers than for the mildly anxious group (p < .001 for both comparisons). Further, extremely anxious drivers scored significantly higher than the moderately anxious group (p < .001).

Table 6.

Mean (SD) of the self-reported impact on four aspects of personal life (10-points scale) across whole sample (N = 304) and separately for each anxiety group.

Total

(N = 304)

Mild

(n = 98)

Moderate

(n = 136)

Extreme

(n = 70)

Driving anxiety and occupational life. A significant difference in classification

among the three levels of driving anxiety according to work status was (χ 2 (10) = 26.65, p = .0029, φc = .209) (see Table 7). This corresponded to an under-representation in the mildly anxious group and an over-representation in the extremely anxious group of people reporting working in intermediate profession and employees. In addition, there was an over representation of unemployed (others than students and retired people) among the extremely anxious group. Note. Anxiety group columns sum to 100%. The values in bold correspond to the ones which make the largest contribution to the overall chi-square statistic.

Table 8 shows the self-reported impact of driving anxiety on occupational factors, across anxiety intensity. This was only for the respondents who were currently employed or had been employed (n = 290) and did not include people who have never been employed. As expected, greater levels of anxiety were associated with higher negatively perceived impacts on occupation. Statistical analysis revealed significant differences on the three aspects: Post-hoc analysis also revealed significantly higher scores for moderately than for mildly anxious group (p < .01) and for extremely than for moderately anxious group at each stage (p < .001; see Table 8). Thus, individuals with higher anxiety levels tended to report greater impacts of their anxiety across all three aspects of work, with mean scores doubling between moderately and extremely anxious groups.

Table 8.

Mean scores (SD) of driving anxiety impact on career choice, quality of work life and performance for all the respondents who were currently employed or had been employed (n = 290) and separately for each anxiety group. To further understand the perceived impact of driving anxiety on work, respondents who were employed or had been employed (n = 290) reported whether their driving anxiety 1) had ever been a barrier to getting a position, 2) led them to ever consider leaving a position, 3) meant they ever missed or 4) were ever late to work (Table 9). A strong impact of driving anxiety intensity was observed with an over-representation of people reporting that their anxiety has been a barrier to getting a position in the extremely anxious group and an under-representation in the mildly anxious group. The same pattern was observed for people reporting having ever considered leaving a position because of their anxiety.

All

Table 9.

Relationships between anxiety group and work issue, for all the respondents who were currently employed or had been employed (n = 290) and separately for each anxiety group. Note. The values in bold are the ones, which make the largest contribution to the overall chisquare statistic.

All (n = 290) % Mild (n = 93) % Moderate (n = 128) % Extreme (n = 69) % χ 2 (

Discussion

The aim of this study was to examine the manifestation of driving anxiety in a French population experiencing driving anxiety (not restricted to motor vehicle crash victims), and to explore the extent of its perceived impact on daily life and work according to its intensity. To achieve this aim, an online survey was conducted in France, recruiting people who had experienced anxiety over driving. Therefore, this was not a prevalence study as 1) participants were not selected to be representative of the French population and 2) we focused only on people reporting some level of driving anxiety. However, this study provides a better understanding of the characteristics of participants experiencing driving anxiety in France, of how anxiety manifests and the perceived influence on other aspects of their life beyond mobility. Not surprisingly, the results of this survey are in agreement with those obtained in other countries: the greater the intensity of driving anxiety, the greater the perceived impact on avoidance and quality of life [START_REF] Costa | Demographics, clinical characteristics and quality of life of Brazilian women with driving phobia[END_REF][START_REF] Ehlers | Clinical characteristics of driving phobia[END_REF][START_REF] Hempel | Scared behind the wheel: What impact does driving anxiety have on the health and well-being of young older adults?[END_REF][START_REF] Stephens | The impacts of anxiety over driving on self-reported driving avoidance, work performance and quality of life[END_REF][START_REF] Taylor | The extent and characteristics of driving anxiety[END_REF]. Considering our whole sample, the mean reported level of driving anxiety was 6.45 (±2.63) on the 11-point scale. This level is similar to that reported by Taylor, Deane & Podd (2007) in their survey focusing on fearful driver women in New Zealand (6.98, ±1.94).

The study builds on previous research in the area by including a classification for extreme anxiety. For example, in previous surveys using the same 0 to 10 point scale to rate driving anxiety, only two categories have been used: scores between 2 and 4 were considered as mild anxiety and scores between 5 and 10 were considered as moderate to extreme anxiety [START_REF] Hempel | Scared behind the wheel: What impact does driving anxiety have on the health and well-being of young older adults?[END_REF][START_REF] Taylor | Diagnostic features, symptom severity, and help-seeking in a media-recruited sample of women with driving fear[END_REF]. Here, as in the study by Stephens and colleagues (2020), we discriminated three levels of driving anxiety: mild (from 1 to 5), moderate (from 6

to 8) and extreme (from 9 to 10). The distribution of anxiety was similar in both countries with respectively in the Australian survey and in the French survey: 32% and 32% of mildly anxious respondents, 55% and 45 % moderately anxious and 14% and 23 % extremely anxious. This finer categorisation has proven to be relevant insofar as we have observed strong statistical differences in the impact of driving anxiety between the moderately and extremely anxious groups, which might not be apparent using a less sensitive classification.

These results are discussed in the next sections.

Characteristics of our sample by level of anxiety

Our results revealed a significant proportion of those aged 35-44 years in the extremely anxious group whereas the 18-24 years old people were the least represented in the same group. This last result could be explained by a reduced need to use a car by younger people. As a result, they are less exposed to driving and would experience less anxiety.

However, this relationship has not been clearly demonstrated in the literature on driving anxiety (see for instance [START_REF] Stephens | The impacts of anxiety over driving on self-reported driving avoidance, work performance and quality of life[END_REF] and further studies are needed to better understand this possible relationship between age and driving anxiety.

In our sample, as in [START_REF] Stephens | The impacts of anxiety over driving on self-reported driving avoidance, work performance and quality of life[END_REF], the most anxious people were overrepresented among unlicensed drivers. Some people may choose not to learn how to drive due to their anxiety, while others may fail their driving test because of their anxiety during the driving examination [START_REF] Fairclough | Anxiety and performance in the British driving test[END_REF].

People with extreme driving anxiety were under-represented in the population living in rural areas. It would be interesting to investigate this point further. At least two hypotheses could be proposed. People with more severe anxiety may relocate to urban areas to find some alternatives to car driving, or where traffic density is lower and therefore perceived risk of crash is also lower. Another explanation is that living in rural areas may protect against anxiety in general and driving related anxiety. While, individual factors such as personality and transportation needs are important factors, it is known that city life and mental wellbeing are interconnected (Lecic-Tosevski, 2019). This issue is beyond the scope of this discussion, however, these should all be evaluated and considered when working with, and supporting, individuals with their driving anxiety.

How driving anxiety manifests can be examined using the Driving Cognitions Questionnaire. Considering the whole sample, the three reported main concerns were: "I cannot control whether other cars will hit me", "I will not react fast enough" and "I will hold up traffic / people will be angry". These are the same main concerns as those reported by [START_REF] Taylor | Diagnostic features, symptom severity, and help-seeking in a media-recruited sample of women with driving fear[END_REF] and [START_REF] Ehlers | Clinical characteristics of driving phobia[END_REF]. In addition, and as expected, the scores for the four types of concerns (panic, social and crash risks with fear for others or for oneself) were higher for extremely anxious drivers than for those with lower anxiety (both mild and moderate). As it has also been observed by [START_REF] Stephens | The impacts of anxiety over driving on self-reported driving avoidance, work performance and quality of life[END_REF], the type of main concerns strongly depended on driving anxiety intensity. If concerns were similar between mildly and moderately anxious groups, they strongly differed with those of the extremely anxious group.

The predominant concern in this group was the fear of losing control. That is, they were not confident in their own capabilities to manage the situation. In contrast, the predominant concern in the other two groups was the fear of being hit by others. This difference may be due to a weaker self-confidence and/or self-esteem of the most anxious individuals at least on their driving performances or capabilities. Literature on general anxiety shows that low selfesteem and high trait anxiety are associated [START_REF] Danielsson | Global self-esteem and the processing of positive information about the self[END_REF]. This highlights the fact that the level of self-confidence and level of trust in others should be assessed in order to understand the mechanisms of driving anxiety at an individual level.

Avoidance, quality of life and quality of work and driving anxiety

Driving anxiety often leads to avoidance, which may be partial or total. Avoidance can have a strong impact on mobility and autonomy particularly for people who do not have easy access to public transport services. To fully examine this, our sample included unlicensed drivers. This allowed consideration of the impact of driving anxiety at the early stages of driving history, e.g. prior to learning. It also allowed inclusion of people who may have once driven, but have now surrendered their licence due to anxiety, either of their own violation or through medical advice. Not surprisingly, in terms of avoidance, the more intense the anxiety, the stronger the avoidance, both total and partial.

To assess avoidance, we used a French translated version of the driving and riding avoidance scale (DRAS). Factor analyses revealed a strong consistency with data from

Steward & St Peter ( 2004) by replicating the four same dimensions: general avoidance, traffic avoidance, weather/darkness avoidance and riding avoidance. Only one item ("18-I put off a brief trip or errand that required riding in a car") classified in "general avoidance" in the original paper of [START_REF] Stewart | Driving and riding avoidance following motor vehicle crashes in a non-clinical sample: Psychometric properties of a new measure[END_REF], has been classified in "Riding avoidance" in our case. In addition, our results are consistent with those from previous international studies using this scale [START_REF] Blachnio | Polish adaptation of the driving and riding avoidance scale[END_REF][START_REF] Stewart | Driving and riding avoidance following motor vehicle crashes in a non-clinical sample: Psychometric properties of a new measure[END_REF][START_REF] Taylor | Measuring anxiety-related avoidance with the Driving and Riding Avoidance Scale (DRAS)[END_REF], with the main situation avoided for the three groups being "I avoided driving a car if I could". However, there was a strong quantitative difference between the scores according to driving anxiety intensity. Similar to previous research using the DRAS, the scores were significantly higher in the four dimensions (general avoidance, traffic avoidance, weather/darkness avoidance and riding avoidance) for the extremely anxious group than the other two groups [START_REF] Stephens | The impacts of anxiety over driving on self-reported driving avoidance, work performance and quality of life[END_REF].

Our data are also in agreement with previous research showing that driving anxiety was associated with poorer perceived quality of life [START_REF] Costa | Demographics, clinical characteristics and quality of life of Brazilian women with driving phobia[END_REF][START_REF] Hempel | Scared behind the wheel: What impact does driving anxiety have on the health and well-being of young older adults?[END_REF].

This was most evident with the extremely anxious group, who rated higher negative impacts on all aspects of daily life (place of residence, daily activities, overall quality of life and shame related to driving anxiety) than the moderately (and mildly) anxious group. The notion of shame is clearly important to consider in the context of the quality of life as it can have strong psychological impact in terms of self-esteem [START_REF] Velotti | Faces of shame: Implications for self-esteem, emotion regulation, aggression, and well-being[END_REF].

Regarding work, as described by [START_REF] Stephens | The impacts of anxiety over driving on self-reported driving avoidance, work performance and quality of life[END_REF] the reported impact of anxiety on work was lower when compared to the reported impact on general quality of life.

However, people with extreme driving anxiety reported a strong impact of this anxiety on their occupational life, indicating negative impacts on quality of work life, performance and career direction. Driving anxiety may impede access to a job and our findings provide evidence of this. For example, unemployed people were over-represented in the extreme anxious group and two-thirds of the extremely anxious group reported that driving anxiety has already been a barrier to getting a position. Those in the extremely anxious group were also likely to leave a position as a result of their anxiety. Thus, we observed that people with extreme driving anxiety have concerns about their driving skills (DCQ: "People will think I am a bad driver") and perceive that this anxiety has significant negative impacts on their quality of daily life and work. It is known that quality of daily life and occupational life interact with stress and general anxiety, which are linked to well-being. Therefore, it is plausible that driving anxiety may play a detrimental role in general well-being. All these aspects are interconnected and should be considered collectively to better understand how to improve well-being for those with anxiety over driving.

Limitations and further research

We used two questionnaires in the framework of this survey: the DCQ and the DRAS.

Both were translated to French for the purpose of this study. French validated versions of these questionnaires did not exist, and the sample used here did not allow such validation.

Therefore, analyses were conducted to confirm the most appropriate factor structure for the scales prior to use. This follows previous examples using the DCQ [START_REF] Taylor | Psychometric properties of the Driving Cognitions Questionnaire, Driving Situations Questionnaire, and Driving Behavior Survey[END_REF] and DRAS [START_REF] Taylor | Measuring anxiety-related avoidance with the Driving and Riding Avoidance Scale (DRAS)[END_REF] where the original factors structures could not be replicated, and new structures were proposed. The analyses of the French data showed similar structures as reported previously [START_REF] Blachnio | Polish adaptation of the driving and riding avoidance scale[END_REF][START_REF] Stephens | The impacts of anxiety over driving on self-reported driving avoidance, work performance and quality of life[END_REF][START_REF] Taylor | Measuring anxiety-related avoidance with the Driving and Riding Avoidance Scale (DRAS)[END_REF]. Therefore, there is evidence to suggest the scales were robust to translation.

The data reported here showed that the impact of driving anxiety extends to occupational life in a detrimental way. However, our sample was not representative of the entire French population, in particular in terms of occupational status. Consequently, these first results about the occupational life of people experiencing driving anxiety warrant further exploration and replication using a more representative sample.

Our sample was also comprised mainly of women. This has been the case in several studies on this topic (Munjack, 1984;[START_REF] Taylor | The extent and characteristics of driving anxiety[END_REF]; see also [START_REF] Taylor | Driving-related fear: A review[END_REF] for a review). However, this does not necessarily indicate that women experience more driving anxiety than men. Indeed, it seems that women are more prone to participate to online surveys than men [START_REF] Smith | Does gender influence online survey participation? : A record-linkage analysis of university faculty online survey response behavior[END_REF], which can at least partly explain the rate of women in our study and other international studies. The relationship between gender and intensity of driving anxiety (with men over-represented and under-represented in mildly and extremely anxious group, respectively) should also be interpreted with caution. Indeed, some gender stereotypes associated with driving can have an impact on the expression of driving anxiety in men and women. Women are generally perceived as having poorer driving skills and lack of self-control despite being considered as prudent, whereas men are generally perceived as more skilled and self-controlled although careless [START_REF] Degraeve | Social representations associated with men and women drivers among French adolescents and adults. Effects of the perceiver's age, sex, and socioeconomic status[END_REF][START_REF] Granié | Gender stereotypes associated with vehicle driving among French preadolescents and adolescents[END_REF]. These gender stereotypes may influence the way men and women talk about their driving weaknesses, with men being less likely than women to confess their fear of driving and the intensity of this fear.

It is not currently clear whether driving anxiety is a specific anxiety or if it is a component of a general anxiety trait, which may be expressed when driving, or when considering driving. Driving as a whole may be considered as a stressful activity because of the associated inherent risk [START_REF] Bowen | Factors underpinning unsafe driving: A systematic literature review of car drivers[END_REF]. This may lead to a greater manifestation of anxiety as a driver or passenger. Future research in this area, should consider personality traits and perceived skills (measured objectively and subjectively).

Conclusion

To conclude, this survey is the first study addressing driving anxiety in a French sample. The results are consistent with the international literature on the topic about 1) concerns about driving, 2) anxiety related avoidance, 3) quality of life. In addition, our results, bring highlight for the first time the perceived impact of driving anxiety on occupational life in people with driving anxiety in France. The use of three levels of driving anxiety intensity also demonstrates the need to distinguish between moderate and extreme anxiety in future research. Further research is required to elucidate the extent of driving anxiety in our modern societies and to better assess any gender effect.

  occupational orientation (F(2,287) = 25.51, p < .001), work performance (F(2,287) = 24.56, p < .0001) and quality of work (F(2,287) = 25.48, p < .0001) according to intensity of anxiety.

Table 1 .

 1 Repartition of the sample according to age, gender, licence, place of residence and according to driving anxiety.

		Total	Mild	Moderate	Extreme
		(N = 304)	(n = 98)	(n = 136)	(n = 70)
		%	%	%	%
	Sample	100	32.2	44.7	23.0
	Sex**
	Males	20.1	30.6	16.9	11.4
	Females	79.9	69.4	83.1	88.6

Table 2 .

 2 DCQ mean score (SD) for each of the four factors identified by the PCA in all respondents who reporting driving (n = 250) and across anxiety groups.

	All	Mild	Moderate	Extreme

(F(2,247) = 28.82, p < .001) and fear for others (F(2,247) = 47.07, p < .001). Post-hoc

Table 3 .

 3 DCQ mean item scores (SD) in all respondents who reporting driving (n = 250) and separately for each anxiety groups.

			All	Mild	Moderate	Extreme
		Items	(n = 250)	(n = 97)	(n = 117)	(n = 36)
	4 I cannot control whether other cars will hit me	2.91 (1.37)	2.47 (1.15)	3.03 (1.40)	3.67 (1.45)
	15 I will hold up traffic / people will be angry	2.57 (1.45)	1.98 (1.05)	2.67 (1.51)	3.86 (1.25)
	1 I will not react fast enough	2.56 (1.17)	2.09 (0.78)	2.70 (1.19)	3.39 (1.42)
	8 People will think I am a bad driver	2.50 (1.36)	1.87 (0.87)	2.63 (1.39)	3.75 (1.38)
	13 I will cause an accident	2.44 (1.28)	1.73 (0.73)	2.71 (1.29)	3.50 (1.34)
	9 I will injure someone	2.41 (1.25)	1.78 (0.88)	2.60 (1.22)	3.50 (1.30)
	20	I will lose control of myself and will act stupidly or	2.38 (1.42)	1.58 (0.83)	2.58 (1.40)	3.89 (1.30)
		dangerously
	2 People I care about will criticise me	2.26 (1.21)	2.05 (1.00)	2.26 (1.24)	2.83 (1.46)
	5 Other people will notice that I am anxious	2.22 (1.25)	1.46 (0.76)	2.44 (1.33)	3.56 (1.36)
	10 I will not be able to think clearly	2.21 (1.36)	1.45 (0.80)	2.34 (1.27)	3.83 (1.30)
	19 People riding with me will be hurt	2.19 (1.23)	1.68 (0.91)	2.38 (1.22)	2.92 (1.44)
	14 I will be stranded	2.18 (1.34)	1.60 (0.87)	2.23 (1.33)	3.56 (1.42)
	11 I will die in an accident	2.12 (1.26)	1.61 (0.73)	2.24 (1.34)	3.08 (1.48)
	17 People will laugh at me	2.07 (1.33)	1.54 (0.94)	2.18 (1.40)	3.14 (1.31)
	12 I will be trapped	2.06 (1.37)	1.41 (0.69)	2.12 (1.40)	3.61 (1.42)
	7 I will be injured	2.04 (1.12)	1.62 (0.80)	2.08 (1.04)	3.06 (1.39)
	6 I will tremble and not be able to steer	1.94 (1.34)	1.24 (0.54)	1.97 (1.28)	3.75 (1.34)
	18 I will be unable to move	1.74 (1.27)	1.14 (0.38)	1.76 (1.22)	3.25 (1.65)
	3 I will be unable to catch my breath	1.63 (1.04)	1.23 (0.57)	1.69 (1.00)	2.53 (1.50)
	16 My heart will stop beating	1.54 (1.12)	1.10 (0.31)	1.61 (1.19)	2.50 (1.58)
		Mean	1.20 (0.87)	0.63 (0.43)	1.31 (0.75)	2.36 (0.82)

Table 4 .

 4 DRAS mean scores (SD) for each of the four factors identified through the PCA, for all the licenced drivers (n = 280) and separately for each anxiety group.

	4.1 Total avoidance. Among licenced drivers (n = 280), 10.7% (n = 30) reported
	never driving because of driving anxiety. Among unlicensed drivers (n = 24), 58.3% (n = 14)
	reported this was due to driving anxiety. Of the 44 people who never drive, none were
	classified as the mildly anxious, 14 (31.8%) were moderately anxious (which corresponds to
	10.3% of the group) and 30 (68.2%) were extremely anxious (which corresponds to 42.9% of
	this group).

3.4.2 Main avoided situations.

Similar to the DCQ, the DRAS results were obtained only from driving licence holders (n = 280). The PCA showed a 4-factor solution: general avoidance, traffic avoidance, weather/darkness avoidance and riding avoidance (Table

4

; see supplementary material for further details). The Kaiser-Meyer-Olkin test was 0.924, demonstrating good suitability of the data for the PCA. The questionnaire demonstrated good internal consistency (α = 0.93) for the total score and for each of the four factors (See Table

4

for Cronbach alphas).

Table 7 .

 7 Repartition of the sample according to driving anxiety and French socio-professional categories.

	French socio-professional	Total	Mild	Moderate	Extreme
	categories	% (n)	%	%	%
	Self-employed and farm operator	33.9 (103)	30.6	35.3	35.7
	Managerial and highly qualified	9.2 (28)	13.3	7.4	7.1
	worker
	Intermediate profession, employees	20.7 (63)	12.2	22.1	30
	and factory workers
	Retired	4.3 (13)	5.1	5.2	1.4
	Students	24.7 (75)	34.7	24.3	11.4
	Other unemployed	7.2 (22)	4.1	5.9	14.3

Note that because of a technical issue, one item is missing in our survey ("I avoided driving in a car on a motorway"). Consequently, the total score is 57 instead of 60.

Acknowledgments

The authors would like to acknowledge Achot Khalafian for his support using limesurvey software as well as Joanne Taylor for her feedbacks during the design of the questionnaire. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.