Survey shows one in eight pilots admits suffering from depression; doesn’t this matter, or will Google come to the rescue?

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Hundreds of commercial airline pilots worldwide may be flying with untreated depression because they fear being grounded or losing their jobs, a new survey suggests.

New survey finds hundreds of commercial airline pilots may be flying with untreated #depression Click To Tweet

The anonymous survey of about 1,850 pilots from more than 50 countries found that 14% of pilots who had worked within the past week had symptoms of depression. Four percent of pilots reported having suicidal thoughts within the two weeks prior to the survey, which was published in Environmental Health (online December 14, 2016).

The survey offers one of the first snapshots of mental health among commercial pilots, who often don’t disclose this type of illness to airline officials or aviation regulators because they fear negative career repercussions, said senior study author Dr. Joseph Allen, a public health researcher at Harvard University in Boston.

“It’s understandable that pilots are reluctant to fully disclose mental health issues because of the potential that they will be grounded or declared not fit for duty,” Allen said, according to Reuters.

With roughly 140,000 active pilots flying more than 3 billion people worldwide each year, the survey results should put the airline industry on notice that many pilots need better access to mental health screening and treatment, Allen added.

The new findings come a year and a half after a Germanwings co-pilot who suffered from depression deliberately crashed a plane into the French Alps, killing 150 people.

Globally, roughly 350 million people suffer from depression. Effective treatments exist, but many people don’t get them–often due to stigma.

To get a better picture of mental health among airline pilots, researchers conducted an anonymous online survey between April and December of 2015. Questions touched on a range of topics related to work and health in addition to depression, says Reuters. Most respondents came from the US, Canada and Australia.

Out of nearly 3,500 pilots who participated in the survey, 1,848 completed the questions about mental health. Within this group, 233 (12.6%) met the criteria for likely depression and 75 (4.1%) reported having suicidal thoughts within the previous two weeks.

Among 1,430 participants who reported working as an airline pilot in the previous seven days at the time of the survey, 193 (13.5%) met the criteria for depression. A greater proportion of male pilots than female pilots reported that “nearly every day” they had experiences of loss of interest, feeling like a failure, trouble concentrating, and thinking they would be “better off dead.”

Women were more likely than men to have at least one day of poor mental health during the previous month, and were more likely to have been diagnosed with depression. The study also found that depression was more likely when pilots took lots of sleep medication and when they experienced sexual or verbal harassment.

Limitations of the study include the lack of medical records or exams to assess mental health symptoms pilots reported in the survey, the authors note.

“The study likely underestimates the amount of depression that exists among pilots, however, it cannot address the severity of the symptoms and the extent of individual impairment,” Dr. Joseph Baskin, a psychiatrist at Cleveland Clinic in Ohio who wasn’t involved in the study, said.

Pilots may not tell their own doctors about feeling depressed because both having this diagnosis and taking antidepressants come with stigma and a fear of being grounded, said Dr. Blake Lollis, an aerospace medicine specialist at Yakima Valley Memorial Hospital in Washington who wasn’t involved in the study.

Still, this diagnosis isn’t as career-ending as it used to be, Lollis added. They may be cleared to fly, for example, while on anti-depressants, even if they would be grounded for severe depression accompanied by any psychotic symptoms.

“It is clear that depression is undertreated among pilots,” said Dr. Alpo Vuorio, an aviation medicine researcher at the University of Helsinki in Finland who wasn’t involved in the study. “I hope that current discussions after the Germanwings accident has helped pilots to seek help more openly,” Vuorio said.

Steve’s Take:

Thousands, if not millions, of airline passengers are being flown by depressed and suicidal pilots, a study suggests.

Data on depression rates among pilots have been hard to come by, but a new study that surveyed active pilots found that nearly 13% met the threshold for depression–and about a third as many reported having suicidal thoughts. Worse than that, a noted psychiatrist from the Cleveland Clinic, Dr. Joseph Baskin, says it’s likely higher.

Why does this matter? Well, statistically at least, one out of your next eight commercial flights will have a pilot on board suffering from mental illness, namely depression.

The 2015 crash of Germanwings Flight 9525, which was caused intentionally by a co-pilot who had undergone treatment for suicidal tendencies, killed all 150 people on board and triggered a conversation about mental health among pilots.

This study, published in the journal Environmental Health, is the first to examine the mental health of airline pilots outside the context of a crash investigation, regulator-mandated health exam, or identifiable self-reports. It’s thought that pilots are extremely reluctant to seek mental health treatment given the stigma and professional implications mental illness holds in the industry, says STAT News.

“Our results should not be surprising,” said Dr. Joseph Allen, an assistant professor of exposure assessment science at the Harvard T.H. Chan School of Public Health and the study’s senior author. “The idea that pilots can be susceptible to mental health issues just like the rest of us should not be shocking. Unlike the rest of us, though, not all pilots have the ability to seek treatment or counseling due to fear of repercussions.”

The researchers collected 1,837 anonymous survey responses from airline pilots around the world, whom they solicited with emails and advertisements through pilot unions, professional groups, and aviation publications. The survey covered various work and health topics, and included several questions that called on specialized pilot knowledge, to confirm that the volunteers were indeed pilots.

They evaluated participants’ likelihood of depression based on nine questions often used in clinical settings, and additionally asked if participants had ever been diagnosed with depression or sleep disorder.

They found that while only 3.1% of pilots had been diagnosed with depression, nearly 13% met the threshold for a depression diagnosis. That rate is on par with other stressful occupations, including military personnel and police officers, but is about twice as high as the general US population.

Twice as high? Sorry, but that’s not a profession I’m interested in, not that I could have ever qualified to be a commercial pilot.

The survey found that depression was at higher levels among pilots who use sleep-aid medication and pilots experiencing sexual or verbal harassment.

And lastly, researchers found that 4.1% of pilots reported having thoughts of being better off dead or self-harm within the two weeks prior to the survey.

In light of the study’s release, Allen said he hopes airlines can create an environment in which pilots feel more comfortable coming forward to seek treatment. And, Allen emphasized the new findings, while informative about pilots’ mental health, shouldn’t change passengers’ confidence in flying.

“Flying is the safest form of transportation and this study doesn’t change that,” Allen said. “The Germanwings pilot wasn’t just suicidal. He was homicidal. I think it’s critical the flying public hears that.”

“As is always a limitation of self-report research, this is based on subjective as opposed to objective determinations,” wrote Anna Donnla O’Hagan and Johann Issartel, who coauthored a study on the correlation between work hours and depression in pilots, STAT News noted. “Self-report research can be biased by potential misunderstanding of posed questions, social desirability as well as cognitive difficulties associated with recall. This can lead to people both under- and over-reporting. Therefore, the prevalence of depressive symptoms and suicidal thoughts may in fact be much higher among pilots than observed in this study.”

Still, O’Hagan and Issartel wrote, the study’s findings mirror those of their paper, which pointed to long work hours and job-related fatigue as potential contributing factors for pilots with depression.

James Record, former airline pilot and adjunct aviation professor at Dowling College, said, “The difficulty is they charge $125,000 for (commercial pilot) training. Where do you come up with that kind of money? What if you don’t make it through training? What if you have a medical problem half way through? Then you’re sitting there with a $125,000 debt to pay off…and you’re starting earnings usually amount to $20,000 a year for the first few years.”

With the new breed of pilots coming in saddled with huge training debts that will take decades to pay off while barely earning minimum wage, there goes the image of Ray Bans and Porsches out the window.

Depression affects a significant number of today’s pilots, and some of them say they’ve considered suicide, which experts say is a call to action for better treatment for this group. But what action, exactly?

We need to remove the depression stigma from pilots and get them the help they need and deserve. This isn’t a political issue. It’s a health and safety issue. And now that it’s out in the open I say we, the general public, should contact our congressional reps and demand that this problem be dealt with effectively and fairly–now. It’s the Federal Aviation Administration, which certifies commercial pilots, which must heed this call and take the appropriate action.

Steve's Take: This may be a mute point as @Google will soon be flying our planes Click To Tweet

Post Script:

After mentioning the pilot survey to a colleague, his reaction was: “Soon Google will be driving our cars, trains and boats, and even flying our planes, and we’ll all be much safer.” I’m not sure how soon this might happen, but point taken.