Pilots and Mental Health

December 19, 2016

ACCORDING TO a newly published study by the Journal of Environmental Health, as many as 13 percent of airline pilots meet the threshold for clinical depression, and more than four percent — four percent! — admitted to having suicidal thoughts in the two weeks prior to taking the survey. Those are some frightening numbers, and not unsurprisingly the story is getting a lot of media pickup. “Think your job is depressing,” sang one headline. “Try being an airline pilot!”

Right, well, my personal opinion, speaking as just one of around 70,000 airline pilots in this country alone, is that I can hardly think of a less depressing job. Stressful at times, in its own peculiar ways, absolutely. But depressing?

Without wanting to discredit the hard work of researchers and mental health professionals out there, this study isn’t passing my smell test. At best, it feels sorely incomplete. My evidence to the contrary is anecdotal, for lack of a better term, but it’s meaningful just the same, I think, having been working in and around the business for over 25 years: I’ve known enough pilots to feel skeptical of the data. The idea that 12.4 percent of pilots might be clinically depressed is dubious enough; the idea that four percent are potentially suicidal is nothing if not outrageous.

We also need to look more closely at the metrics of the survey. For example, clinical depression, versus simply feeling depressed, or showing “signs of” depression, can be vastly different things.

Of course, without a medical or scientific background, and without fully understanding the nuances of the data — the depression questionnaire, to which around 1,500 pilots responded, is part of a screening protocol called PHQ-9 — it’s hard for a layperson like me to interpret what, exactly, the study reveals. As some have pointed out, the stats revealed by this study aren’t terribly different from those found in the general population. But because it involves pilots, it’s instantly a news story and ripe for embellishment. My disagreement is perhaps a response more to what the media is saying about the study, than what the study is actually saying about pilots. And the media has a well-established habit of taking what might be interesting and compelling scientific findings, and dumbing them down into sensationalist sound-bite nonsense. So, we’d be wise to withhold judgment.

The buzz here, of course, ties in with last year’s Germanwings pilot suicide crash, when a depressed (and quite possibly psychotic) first officer named Andreas Lubitz locked the captain out of the cockpit and flew his Airbus A320 into the Alps, killing everybody on board.

And so, now, people are wondering, how many pilots out there are ready to crack? Is the mental health of pilots being evaluated properly by airlines and government regulators?

The answer is yes, mostly.

First things first, though, let’s be wary of extrapolation. No, Andreas Lubitz was the not the first pilot to kill himself and his passengers. But the total number of pilot suicides, over the decades and within the enormous statistical complex of global air travel, is a tiny one. These incidents are what they are: outliers. By all accounts Lubitz shouldn’t have been near a cockpit in the first place. The system seems to have failed. But that’s not reason enough to suggest there’s some crisis at hand — hundreds of looming Lubitzes waiting to snap, with nothing to prevent them from doing so.

And in only the rarest cases does mental illness turn people violent. The idea that a depressed individual is likely to be a dangerous individual is an ignorant and unfair presumption about the nature of mental illness. As one Ask the Pilot reader puts it, “Lubitz didn’t kill those people because he was depressed; he killed them because he was evil.” Whatever Lubitz was suffering from, it was more than depression.

In the U.S., airline pilots undergo medical evaluations either yearly or twice-yearly, depending. A medical certificate must be issued by an FAA-certified physician. The checkup is not a psychological checkup per se, but the doctor evaluates a pilot on numerous criteria, up to and including his or her mental health. Pilots can be grounded for any of hundreds of reasons, from heart trouble or diabetes to, yes, depression and anxiety. It can and does happen. In addition, new-hire pilots at some airlines must undergo psychological examinations prior to being hired. On top of that, we are subject to random testing for narcotics and alcohol.

Pilots have plenty of things to worry about: job security, the anxieties of training, commuting to work from distant cities, the chronic fatigue that results from long hours spent aloft, and so on. But is this really that much worse or different from what you’ll find in other lines of work? Meanwhile, there are just as many pros as cons, if not more: a good salary (at least at the major carrier level), flexible schedules, long stretches of time at home, and the personal satisfaction, the coolness, that comes from flying planes. It’s a challenging job, and one that doesn’t come easy: the career path is long and unpredictable. But I hardly see it as an environment conducive to depression — or worse.

That said, pilots are human beings, and no profession is bulletproof against every human weakness. Whether the result of stress or more serious mental illness, pilots sometimes need help — just as professionals in any industry do. And they can get it:

If a pilot is having an issue, airlines have become more supportive and proactive than you might expect, while ALPA and other pilot unions have medical and mental health staff that pilots can contact any time. There are protocols in place, and if a pilot has an issue, he or she can simply pick up the phone, usually with little worry of any long-term career implications. Sure, there is still some stigma, and certain pilots would be reluctant to self-report, but I reckon this is a lot less true today than it once was. The FAA, meanwhile, now permits pilots to take certain anti-depressants (albeit after a waiting period and in accordance with strict guidelines). In all but the rarest cases, a pilot with a mental health issue is not an unsafe pilot, never mind a suicidal killer.

We can further debate the merits of additional psychological testing, but at a certain point I’m uncertain what more we should want or expect. In the end, we’re forced to rely on a set of presumptions — it comes down to trust, if you will. As a pilot I do not come to work wondering if one of my colleagues is going to kill me. And passengers shouldn’t either. On the contrary. I don’t want this to sound like an airline commercial or an FAA press release, but you can confidently presume that the people flying your plane are exactly what you expect them to be: well-trained professionals for whom safety is their foremost priority.

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17 Responses to “Pilots and Mental Health”
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  1. Art Knight says:

    “Journalism” died a long time ago. They did it to themselves. It started with William Randolph Hearst. I could go on, but I won’t.

  2. Bill H says:

    Not too long ago a doctor I was seeing informed me that a medication I was taking had been the subject of a study which suggested that it might cause cancer, and wondered why I laughed. I told him that there would undoubtedly be another study next month that would suggest that it caused Altzheimers, and one a month after that which suggested it caused heath attacks and another in yet another month which suggested it caused terminal stupidity. He got my point.

    • Art Knight says:

      To Bill H who wrote: Not too long ago a doctor I was seeing informed me that a medication I was taking had been the subject of a study which suggested that it might cause cancer, and wondered why I laughed. I told him that there would undoubtedly be another study next month that would suggest that it caused Altzheimers, and one a month after that which suggested it caused heath attacks and another in yet another month which suggested it caused terminal stupidity. He got my point.

      You are spot on! Professors and researchers live off of grants. That is how they buy their beans!

  3. Furloaded says:

    Here’s John Olivers take on scientific studies and the media


  4. Richard says:

    As a psychologist (now retired), I feel I should pipe up about this. I agree with Patrick that when the media report on a single study, especially without putting it in the context of the larger body of research — which most of the general public has neither the inclination nor the patience to read through, not to mention understand — it’s interpreted as way, way more important than it actually is.

    However, for studies like this one, even though smoke doesn’t necessarily mean fire, you’d be pretty dumb to not go and check it out. That’s really the point of research in general — to say, hey, this is interesting. Maybe we should investigate things further.

    Of course, all jobs come with their own stressors. My next course of action, if I ruled the world, would be to study the ones that are endemic to commercial pilots. For example, Patrick made a good point about chronic fatigue. I’m wondering how much that relates not just to the long hours aloft, but to the continual disruption of a pilot’s circadian rhythm. Circadian issues and mood problems go hand in hand.

    I’m also thinking about the long-term effect of essentially holding hundreds of persons’ lives in your hands every single work day. Obviously it’s very seldom a part of your conscious awareness, but I wonder how that unconscious knowledge affects the body and mind.

  5. ReadyKilowatt says:

    “What’s that? You hate your job? There’s a support group for that. It’s called everyone, we meet at the bar.”

    -Drew Carey.

  6. Simon says:

    I’m pretty sure this study would not have received as much media attention if it had compared results of pilots to let’s say bus drivers or surgeons.

    But by showing results for pilots alone, the media infers this is an aviation problem and can immediately go into holy-fsck-my-hair’s-on-fire mode. Everybody can tweet and retweet about it, magazines sell another billion copies, three dozen new experts a day appear out of nowhere, politicians can debate new legislation to show they’re on top of things, and we can all start worrying about yet another threat to our well-being. As if our fear of islamic terrorists and gluten weren’t already enough to handle.

  7. Speed says:

    And finally …

    Lies, Damned Lies, and Medical Science
    Much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong. So why are doctors—to a striking extent—still drawing upon misinformation in their everyday practice? Dr. John Ioannidis has spent his career challenging his peers by exposing their bad science.


    Trust but verify.

  8. Speed says:

    First, here is a link to the actual published paper.

    Second, the paper provides the following background information, “The United States (U.S.) leads the world in the percent of people (21%) who will have a mood disorder, including MDD, over their lifetime.”

    Third, according to the Depression and Bipolar Support Alliance, “Major depressive disorder affects approximately 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older, in a given year. (Archives of General Psychiatry, 2005 Jun; 62(6): 617-27)”

    At first glance this indicates that the pilot population is more than three times more likely to be “depressed” than the general population. Warning! Warning! That does not compute.

    And finally, I’ve noticed recently that many people are using the phrase, “That depresses me” when talking about politics, the economy, child-rearing and other news and routine challenges of daily living. They aren’t clinically (or in any other way) depressed. They aren’t even sad. They are using a popular phrase the has nothing to do with real depression.

  9. Bernard says:

    Remember how mad you get about the coverage of aircraft accidents in the media? Imagine being a scientist spending months on a thorough scientific study with 2,000 respondents (that’s a lot!) and then someone calling it “sorely incomplete at best” based on personal experience.

    Also, please imagine being your colleague with suicidal thoughts and being described as “ready to crack”. That’s offensive and is enforcing the taboo around mental health, making it harder to seek help. In the U.S. 3.7% of people have suicidal thoughts (see link). The percentage of 4.1% for pilots is hardly higher. Only a fraction actually attempts suicide and practically no-one wants to harm others in the process.

    The scientific article itself does not help in this matter: it starts off mentioning German Wings and mental health in the first line, then mentioning depression in the second line and suicidal thoughts in the fourth.

    Original scientific article (I missed the link in your post):

    Suicide Statistics:

  10. Charles says:

    I’ve been diagnosed with bipolar depression and have been clinically depressed. I’ve experienced suicidal ideation. I have never, however, actually tried to kill myself. In fact, I have never come even close.

    More to the point: I have never once in my entire life thought of killing anyone else.

    I find it deeply, extremely, offensive; even bigoted; that so many people think that depression or hypomania somehow makes me or anyone else suffering from them dangerous, let alone homicidal. Lubitz didn’t kill those people because he was depressed; he killed them because he was evil. It wasn’t born of depression or mania, but profound narcissism, sociopathy, and moral callousness.

    Why don’t you test pilots for those things? The statistics on mental illness show that people suffering from depression, bipolar, even schizophrenia are actually less dangerous to others than average, far more likely to be victims of violence on average.

    I know you are trying to reassure people as to the safety of commercial aviation. But look at the statistics


    Depression isn’t a major factor. The other major incident that leaps to mind, Egypt Air 990, wasn’t driven by clinical depression, but likely anger with his supervisor and coworkers who were on the plane. Homicides are not driven by depression, but anger hatred jealousy etc.

    Please rethink your approach – we need allies, not more bigots demeaning and discriminating against us.

  11. Total says:

    2000 people (or nearly 2000) is an enormously *large* sample size.

    • Total says:

      It would be nice if you noted that you edited the article to remove the remark about the sample size being small.

      • Patrick says:

        I made several changes to the story on the wise advice of readers — you among them. Typing in a note for each edit would make the whole piece look and sound awkward.

        But, I’ll do it here: I initially wrote that the sample size of pilots who took the depression story (it was about 1,400), was “relatively tiny.” Yes, that’s a small fraction of all the airline pilots out there in America (around 70,000). However, when it comes to research protocols, this actually represents a very large sample size.

  12. Mark Maslowski says:

    Although I’m not a medical professional, it is my understanding that there is a significant difference between feeling depressed and clinical depression. Clinical depression is not caused by external events, like a loss or a job. It’s an illness, not a reaction. In fact, many people have stimulating, rewarding jobs and are still clinically depressed. But, and this is not uncommon for those with depression, they hide it really, really well and it can be exceedingly difficult to diagnose.

    Although measurable statistics are hard to find, the numbers in this study are similar to estimates in the general population. Not so surprising.

    • dave says:

      Agreed, pilots are people too.

      there will be a percentage of ALL humans that have depression, and yes, suicidal thoughts. It is inevitable, i’m sorry.
      That being said, i don’t know if that puts the general public at risk, more than being around those driving cars, or carrying loaded guns.
      Mental Health, and illness is a ‘hidden’ issue, that a lot of media and such tend to not deal with very well.

    • Rod says:

      It’s been said (with what degree of accuracy I know not) that practically the only extended period in his adult life when the Italian writer Primo Levi was NOT clinically depressed was when he was in Auschwitz. It’s a truly odd feature of depression that mortal danger very often causes the victim to snap out of it, at least for the duration.

      I believe that the relative number of admissions to psychiatric hospitals in the UK prior to and following the outbreak of WWII tell a similar story.