As the holiday season unfolds over the next few weeks, some 45 million Americans will put themselves in the hands of two people: the pilot and co-pilot of the aircraft they have just boarded.
In recognition of that fact, and not to dampen anyone’s holiday cheer, we are releasing the results of a first-of-its-kind study we conducted on the mental outlook of a sampling of airline pilots. Our research provides a sobering look inside the cockpit, and concludes that pilots are depressed at roughly the same rate as those working in other high-stress occupations.
Specifically, hundreds of pilots — up to 13.5 percent of the 1,848 surveyed — may be clinically depressed, and around 4.1 percent struggle with thoughts of self-harm or suicide. That’s according to the new study conducted by our team at Harvard T.H. Chan School of Public Health, published today in the journal Environmental Health.
To be clear: Commercial airline travel is by far the safest form of public transportation available. Pilots undergo extensive training and routine health checks to ensure they are capable of safely and effectively performing their job of transporting nearly 2.25 million people daily above the clouds. But accidents do occur, and some, tragically, are due to the deliberate action of pilots.
The Germanwings crash that killed 150 people in March of 2015 was made even more tragic after an investigation found the pilot suffered from depression and had deliberately steered the aircraft into the French Alps. That event coupled with a scarcity of research on pilot mental health prompted our team to investigate further.
With the help of an airline captain on our research team, we crafted a survey, called The Airline Pilot Health Study, specifically tailored to assess the health of airline pilots. It built upon past Harvard Chan School research on aviation and flight attendant health.
Because of the stigma surrounding mental illness and the fear that honest participation in our study could affect career interests among airline pilots, we made the survey completely anonymous. No personal information was asked for or collected.
We contacted airline companies, unions and airline pilot groups to generate support for and distribute the survey, conducted online between April and December of 2015. It contained questions on everything from demographics, work history and workplace conditions, to past and present general health, health behaviors and mental health. The airline captain on our research team verified that each survey was completed by airline pilots by checking selected validation questions embedded in the survey.
Nearly 1,850 pilots from around the world answered the questions on mental health. What developed was a picture of airline pilot depression that’s likely much larger than realized. Roughly 1 in every 8 pilots met the criteria for probable depression; 75 pilots reported suicidal thoughts, such as thinking they would be better off dead.
[See: 9 Things to Do or Say When a Loved One Talks About Taking Their Life.]
Our study is the first to describe airline pilot mental health — with a focus on depression and suicidal thoughts — beyond identifiable records protected by civilian aviation authorities and airline companies. Such identifiable records may not paint an accurate portrait of the mental health issues pilots are managing. Fear of potential career repercussions stemming from honest disclosure has helped create a culture in which commercial pilots may feel safer concealing these struggles.
More action is needed to improve the mental health of airline pilots and to support their path to preventive treatment. While our study only sampled about 1.3 percent of the estimated 140,000 airline pilots worldwide — and it did not confirm the diagnosis of depression among participants — we believe it delivers a potent message.
Flying Depressed: What Can Be Done?
Following the Germanwings crash, some new recommendations to address pilot mental health have surfaced. The Federal Aviation Administration released a fact sheet on pilot mental health in June of 2016, outlining an approach that includes enhanced education and training for aviation medical examiners, or AMEs. These are physicians who are certified by the FAA to perform flight physical examinations. AMEs currently only receive at least three weeks of training on mental health in medical school, and only two hours in AME basic training. Because AMEs do not diagnose mental health conditions, a flaw in the current approach is that it relies only on pilots self-reporting any mental health issues. And a previous study of pilots involved in accidents found that antidepressant use is underreported.
The FAA also calls for enhanced reporting and treatment of mental health issues for pilots. The FAA does not recommend psychological testing.
After the Germanwings crash, the European Aviation Safety Agency, or EASA, convened a task force, which just published recommendations this month. They include that:
— All pilots should have access to a support program to help with mental illness.
— Airlines should be required to perform a psychological assessment of pilots before the start of employment.
— Drug and alcohol testing of flight and cabin crew should be required upon employment; after a serious incident or accident, with due cause (i.e., following reasonable suspicion); and on an unannounced basis after rehabilitation and return to work.
Earlier this year, EASA called for strengthening the initial and continuing medical examinations of pilots by including comprehensive mental health assessments and increasing the quality of the examinations. Other researchers recommend reducing barriers for pilots to report and access treatment for mental health issues starting at the top, with industry or airline leadership endorsing efforts by pilots to seek treatment; emphasizing how treatment will affect workplace performance; and tailoring treatments to involve workplace-relevant scenarios. Examples of these could include education on how accessing treatment and getting help can prevent worsening of mental health or reduce lost work days due to illness in the long term. Tailoring treatment to the workplace could include scenarios where pilots are trained on how to talk about depression with other pilots or co-workers.
[See: Am I Just Sad or Actually Depressed?]
Should the Public Be Concerned About Flying?
The answer is “no.” The data clearly show that air travel is by far the safest form of public transportation. The purpose of our study is to shed light on the often hidden mental health issues airline pilots face, not to cause undo alarm. The stigma of mental health issues often prevents those afflicted from seeking treatment. But airline pilots face an additional barrier — they run the risk of jeopardizing their careers if they are declared unfit to fly.
Our findings really should not be that surprising — airline pilots can suffer from depression, just like the rest of us. They have similar depression-prevalence rates to those working in other high-stress occupations. For police officers, emergency medical technicians and previously deployed military, for example, the rate of depression ranges from 7 to 17 percent. Now the goal is to find workable solutions. And to combat the silence.
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Study Reveals Depression, Suicidal Thoughts Not Uncommon in Airline Pilots originally appeared on usnews.com
