Recent survey found pilots flying with depressive symptoms: What’s New?

The study had a questionable response rate and many methodological limitations. Some of these limitations were acknowledged by the authors, who mentioned the inability to draw causal inferences due to the study design and mentioned the reduced generalizability to the general population of airline pilots. The fact that Wu et al. have linked their research to the Germanwings tragedy has undoubtedly triggered the media hype around this study.

Despite the study’s methodological flaws and the biased interpretation, the conclusion of Wu et al. provides just another confirmation of what is already known in the aeromedical community: pilots might be flying while having mental health problems including depressive symptoms. Aeromedical experts are fully aware of this, such as is illustrated by the recent recommendations of the Aerospace Medical Association Working Group on Pilot Mental Health (2016) which were endorsed by European Society of Aerospace Medicine (ESAM), European Association of Aviation Psychologists (EAAP), and the European Cockpit Association (ECA).  

We know that mental health problems, and particularly depressive symptoms, are common in the general population, medical students, nurses, and physicians (e.g. WHO, 2012; Rotenstein et al. (2016). There is no reason to believe that pilots would be very different from the general population or other skilled professionals. Based on the available aviation and non-aviation data, the aeromedical community has sufficient evidence that there may be pilots out there flying with mental health problems including depressive symptoms. We also believe that there may be pilots who will not report their problems to the AME, because they fear the consequences for their career. There is no need to wait for results of more prevalence studies, because the available evidence is already sufficient to command attention towards early identification of cases, prevention, guidance, and optimal treatment of pilots with mental health problems.

Prerequisites for early identification and optimal treatment are a trustful relationship between AMEs and pilots and a work environment in which pilots have no fear of negative career impacts when they report their problems. An important element of such a favourable work environment is the availability of Peer Support Programmes (PSP) set up to assist and guide pilots towards the proper support and help in case of decrease of mental fitness.

In the aftermath of the Germanwings accident in March 2015, the European Commission set up a Task Force under the lead of the European Aviation Safety Agency (EASA) in order to provide the European Aviation industry with proposals to address a number of potential safety issues concerning flight crew mental fitness.

In that context EASA has proposed several measures to ameliorate the AME’s psychological and anamnestic skills. In cooperation with EAAP and ECA, ESAM has launched an initiative to facilitate a trustful relationship between AME and Pilot. 

One of the key solutions that have been identified by the Task Force to address mental health issues are Peer Support Programmes. In view of this current rulemaking on Peer Support Programmes (PSP), undertaken by EASA, it is paramount for PSP stakeholders to establish the key requirements that any PSP should meet in order to ensure proper and successful functioning of such programmes. Therefore, ESAM, EAAP, ECA, and Foundation Mayday have started the European Pilot Peer Support Initiative (EPPSI). The purpose of this non-profit initiative is to facilitate communication between stakeholders and interested parties engaged or planning to get engaged in Peer Support Programmes (PSP) and to exchange and promote best practices, advice and information on PSP and thereby to further optimize flight crew physical and mental fitness during a lifelong career (see: http://www.eppsi.eu)

References

Aerospace Medical Association Working Group on Pilot Mental Health (2016). Pilot mental health: expert working group recommendations  –  revised 2015. Aerosp Med Hum Perform;  87(5): 505–507.

Independent (2016). Hundreds of airline pilots are suicidal or thinking of self-harm, study finds. http://www.independent.co.uk/news/science/pilots-suicide-self-harm-study-germanwings-harvard-a7475046.html

Rotenstein LS, Ramos MA, Torre M, et al. (2016). Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA; 316(21):2214-2236

Telegraph (2016). Thousands of airline pilots flying every day with suicidal thoughts, says landmark study.  http://www.telegraph.co.uk/news/2016/12/15/thousands-airline-pilots-flying-suicidal-thoughts-harvard/

WHO (2012). Depression A Global Public Health Concern -  Marcus M, Yasamy MT, van Ommeren M, Chisholm D, Saxena S. WHO Department of Mental Health and Substance Abuse. http://www.who.int/mental_health/management/depression/who_paper_depression_wfmh_2012.pdf

Wu AC, Donnelly-McLay D, Weisskopf MG, McNeely E, Betancourt TS, Allen JG. (2016). Airplane pilot mental health and suicidal thoughts: a cross-sectional descriptive study via anonymous web-based survey. Environmental Health 15:121. DOI 10.1186/s12940-016-0200-6