Mental health in aviation is a major concern among airlines, regulators, and passengers. This topic gained more attention after the 2015 Germanwings crash, which was deliberately caused by the plane's copilot. Little data exists on mental health in aviation, but steps to gather relevant information and provide better solutions are underway.
It should be mentioned that while much of the conversation about mental health in aviation is centered around pilots, this issue extends to other occupations in aviation. [1]
A study of 809 Brazilian pilots found that between 6.7 and 12% had a common mental disorder. For pilots with a heavy workload, this figure increased to 23.7%. [2] [3] Mental health problems are present in aviation, just like in any other industry, and it is important to have a wide variety of tests and screening processes to determine the true wellness of pilots. [3]
A 2016 study in the United States vetted by Harvard University revealed that of 3485 pilots across North and South America, Europe, Asia and Oceania, 233 pilots or 12.6% met the threshold to be diagnosed with depression as defined by the DSM-5. [4]
Mental illness is second to cardiovascular disease in reasons for losing an aviation license. [5] As a result, many pilots on anti-depressant drugs withhold this information from the governing body of aviation in their country due to fear of losing their license. [5] Detection is further complicated by the fact that few medical examiners fully understand the complexity and effects of the different disorders. [5] Additionally, psychiatrists are unfamiliar with the regulations of pilots suffering from mental health issues. [6] Even though pilots need to have their medical license renewed every 6 months by a certified medical examiner, there is little focus on mental health and no psychologist or psychiatrist follows up unless requested to do so by the pilot, which is rarely the case. [6]
Airlines are familiar with the consequences of mental illness, [7] which is why they administer personality tests during the selection process in order to identify any mental health issues. One example is the Minnesota Multiphasic Personality Inventory (MMPI). This long questionnaire can identify at risk candidates by asking a series of questions, worded differently, all around a similar subject. [7] However, because of the stigma in the aviation industry around mental illness, pilots tend to be extremely defensive about their results and may feel pressured to hide any signs of mental health issues. [7]
During the course of a pilot's career, the prominence of mental illness becomes an even bigger issue as the stresses of the occupation accumulate. [8] Pilots are exposed to difficult working conditions that feature inconsistent schedules, extended periods away from home, and frequent encounters with fatigue. [8]
Mental illness is amplified by the lack of social support from home, a varying circadian rhythm, and the excessive job demands. [9] Experts and airlines have been aware of these issues from as early as 1985, yet very little information about mental health in aviation exists. [9] There is a macho attitude towards mental health in aviation, with a laissez-faire approach. [9]
Both males and females in aviation are equally susceptible to mental health issues. [10]
There is a negative stigma around mental health in aviation. [11] A study showed that pilots assumed fellow pilots who were unsociable most likely have a mental health illness. [11] This identifies that even factors that are not signs of mental health can stigmatize others and the negative consequences of being identified as having mental health issues, even when this is not the case. [11]
Pilots and their employers must also be aware of recent life changes that may affect pilot performance and mental health characteristics. One such way is the Recent Life Change Questionnaire, which measures how susceptible someone is to change. [12] This questionnaire identifies certain individuals who are more at risk of mental health issues and allows the airline to then provide support for them. [12] It is crucial for airlines to develop a program to remove individuals who are in a high risk state and help them transition to a more suitable job. [12] Regulators are also considering implementing random psychological screenings to pilots, however it has been suggested that this will not be foolproof in eliminating mental health issues within pilots. [13] The Federal Aviation Administration also announced that it will conduct research into newer and more relevant data concerning mental health within pilots. [14] It is equally important for pilots to feel open about their mental health and not be afraid of losing their career. This can be accomplished by removing the stigma associated with mental health, encourage self-reporting, and having companies work with pilots to help them find other aviation jobs and provide wellness centers.[ citation needed ]
Throughout the hiring phase, pilots can be administered different personality tests to see if they are at risk of mental health issues. [7]
Following the Germanwings Flight 9525, both the IATA and the Civil Aviation Medical Association are looking into solutions, one being random psychological tests. The issue with a reactive instead of proactive method, is that rather than supporting pilots, it creates an even bigger stigma within the industry. [15] The European Aviation Safety Agency also issued a similar statement, stating all pilots need to undergo psychological evaluation.[ citation needed ]
A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is also characterized by a clinically significant disturbance in an individual's cognition, emotional regulation, or behavior, often in a social context. Such disturbances may occur as single episodes, may be persistent, or may be relapsing–remitting. There are many different types of mental disorders, with signs and symptoms that vary widely between specific disorders. A mental disorder is one aspect of mental health.
Stress management consists of a wide spectrum of techniques and psychotherapies aimed at controlling a person's level of psychological stress, especially chronic stress, generally for the purpose of improving the function of everyday life. Stress produces numerous physical and mental symptoms which vary according to each individual's situational factors. These can include a decline in physical health, such as headaches, chest pain, fatigue, sleep problems, and depression. The process of stress management is a key factor that can lead to a happy and successful life in modern society. Stress management provides numerous ways to manage anxiety and maintain overall well-being.
The Minnesota Multiphasic Personality Inventory (MMPI) is a standardized psychometric test of adult personality and psychopathology. A version for adolescents also exists, the MMPI-A, and was first published in 1992. Psychologists and other mental health professionals use various versions of the MMPI to help develop treatment plans, assist with differential diagnosis, help answer legal questions, screen job candidates during the personnel selection process, or as part of a therapeutic assessment procedure.
A personality test is a method of assessing human personality constructs. Most personality assessment instruments are in fact introspective self-report questionnaire measures or reports from life records (L-data) such as rating scales. Attempts to construct actual performance tests of personality have been very limited even though Raymond Cattell with his colleague Frank Warburton compiled a list of over 2000 separate objective tests that could be used in constructing objective personality tests. One exception, however, was the Objective-Analytic Test Battery, a performance test designed to quantitatively measure 10 factor-analytically discerned personality trait dimensions. A major problem with both L-data and Q-data methods is that because of item transparency, rating scales, and self-report questionnaires are highly susceptible to motivational and response distortion ranging from lack of adequate self-insight to downright dissimulation depending on the reason/motivation for the assessment being undertaken.
Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. According to the World Health Organization (WHO), it is a "state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and can contribute to his or her community". It likewise determines how an individual handles stress, interpersonal relationships, and decision-making. Mental health includes subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence, and self-actualization of one's intellectual and emotional potential, among others.
Social psychiatry is a branch of psychiatry that studies how the social environment impacts mental health and mental illness. It applies a cultural and societal lens on mental health by focusing on mental illness prevention, community-based care, mental health policy, and societal impact of mental health. It is closely related to cultural psychiatry and community psychiatry.
In aviation, pilot error generally refers to an action or decision made by a pilot that is a substantial contributing factor leading to an aviation accident. It also includes a pilot's failure to make a correct decision or take proper action. Errors are intentional actions that fail to achieve their intended outcomes. The Chicago Convention defines the term "accident" as "an occurrence associated with the operation of an aircraft [...] in which [...] a person is fatally or seriously injured [...] except when the injuries are [...] inflicted by other persons." Hence the definition of "pilot error" does not include deliberate crashing.
Paul Everett Meehl was an American clinical psychologist. He was the Hathaway and Regents' Professor of Psychology at the University of Minnesota, and past president of the American Psychological Association. A Review of General Psychology survey, published in 2002, ranked Meehl as the 74th most cited psychologist of the 20th century, in a tie with Eleanor J. Gibson. Throughout his nearly 60-year career, Meehl made seminal contributions to psychology, including empirical studies and theoretical accounts of construct validity, schizophrenia etiology, psychological assessment, behavioral prediction, metascience, and philosophy of science.
Suicide risk assessment is a process of estimating the likelihood for a person to attempt or die by suicide. The goal of a thorough risk assessment is to learn about the circumstances of an individual person with regard to suicide, including warning signs, risk factors, and protective factors. Risk for suicide is re-evaluated throughout the course of care to assess the patient's response to personal situational changes and clinical interventions. Accurate and defensible risk assessment requires a clinician to integrate a clinical judgment with the latest evidence-based practice, although accurate prediction of low base rate events, such as suicide, is inherently difficult and prone to false positives.
A self-report inventory is a type of psychological test in which a person fills out a survey or questionnaire with or without the help of an investigator. Self-report inventories often ask direct questions about personal interests, values, symptoms, behaviors, and traits or personality types. Inventories are different from tests in that there is no objectively correct answer; responses are based on opinions and subjective perceptions. Most self-report inventories are brief and can be taken or administered within five to 15 minutes, although some, such as the Minnesota Multiphasic Personality Inventory (MMPI), can take several hours to fully complete. They are popular because they can be inexpensive to give and to score, and their scores can often show good reliability.
Mental distress or psychological distress encompasses the symptoms and experiences of a person's internal life that are commonly held to be troubling, confusing or out of the ordinary. Mental distress can potentially lead to a change of behavior, affect a person's emotions in a negative way, and affect their relationships with the people around them.
Mental health literacy has been defined as "knowledge and beliefs about mental disorders which aid their recognition, management and prevention. Mental health literacy includes the ability to recognize specific disorders; knowing how to seek mental health information; knowledge of risk factors and causes, of self-treatments, and of professional help available; and attitudes that promote recognition and appropriate help-seeking". The concept of mental health literacy was derived from health literacy, which aims to increase patient knowledge about physical health, illnesses, and treatments.
Psychological evaluation is a method to assess an individual's behavior, personality, cognitive abilities, and several other domains. A common reason for a psychological evaluation is to identify psychological factors that may be inhibiting a person's ability to think, behave, or regulate emotion functionally or constructively. It is the mental equivalent of physical examination. Other psychological evaluations seek to better understand the individual's unique characteristics or personality to predict things like workplace performance or customer relationship management.
The health issues of athletics concern their physical and mental well-being in organized sport. If athletes are physically and mentally underdeveloped, they are susceptible to mental or physical problems. Efforts to improve performance can lead to harm from overtraining, adopting eating habits that damage them physically or psychologically, like using steroids or supplements.
Pilot decision making, also known as aeronautical decision making (ADM), is a process that aviators perform to effectively handle troublesome situations that are encountered. Pilot decision-making is applied in almost every stage of the flight as it considers weather, air spaces, airport conditions, estimated time of arrival and so forth. During the flight, employers pressure pilots regarding time and fuel restrictions since a pilots’ performance directly affects the company’s revenue and brand image. This pressure often hinders a pilot's decision-making process leading to dangerous situations as 50% to 90% of aviation accidents are the result of pilot error.
Culture can affect aviation safety through its effect on how the flight crew deals with difficult situations; cultures with lower power distances and higher levels of individuality can result in better aviation safety outcomes. In higher power cultures subordinates are less likely to question their superiors. The crash of Korean Air Flight 801 in 1997 was attributed to the pilot's decision to land despite the junior officer's disagreement, while the crash of Avianca Flight 052 was caused by the failure to communicate critical low-fuel data between pilots and controllers, and by the failure of the controllers to ask the pilots if they were declaring an emergency and assist the pilots in landing the aircraft. The crashes have been blamed on aspects of the national cultures of the crews.
The International Civil Aviation Organization (ICAO) defines fatigue as "A physiological state of reduced mental or physical performance capability resulting from sleep loss or extended wakefulness, circadian phase, or workload." The phenomenon places great risk on the crew and passengers of an airplane because it significantly increases the chance of pilot error. Fatigue is particularly prevalent among pilots because of "unpredictable work hours, long duty periods, circadian disruption, and insufficient sleep". These factors can occur together to produce a combination of sleep deprivation, circadian rhythm effects, and 'time-on task' fatigue. Regulators attempt to mitigate fatigue by limiting the number of hours pilots are allowed to fly over varying periods of time.
In aviation, pilot stress is common, with three primary sources: physiological stressors, psychological stressors, and environmental stressors. Professional pilots can experience stress in flight, on the ground during work-related activities, and during personal time because of the influence of their occupation. The job of airline pilot can be extremely stressful due to its often high workload and its responsibilities, including assuring the safety of the thousands of passengers they transport around the world. Chronic levels of stress can negatively impact one's health, job performance and cognitive functioning.
The Cook–Medley Hostility Scale (Ho) is a standard in psychology designed to measure an individual's personality and temperament, specifically degrees of hostility. Initially developed as a scale for the Minnesota Multiphasic Personality Inventory (MMPI), scores from the hostility scale represent the individual's disposition towards cynicism and chronic hate. Scores from the scale have been used by studies as a predictor of the measured individual's risk of developing certain health problems as well as the success of their interpersonal relationships.
The social determinants of mental health (SDOMH) are societal problems that disrupt mental health, increase risk of mental illness among certain groups, and worsen outcomes for individuals with mental illnesses. Much like the social determinants of health (SDOH), SDOMH include the non-medical factors that play a role in the likelihood and severity of health outcomes, such as income levels, education attainment, access to housing, and social inclusion. Disparities in mental health outcomes are a result of a multitude of factors and social determinants, including fixed characteristics on an individual level – such as age, gender, race/ethnicity, and sexual orientation – and environmental factors that stem from social and economic inequalities – such as inadequate access to proper food, housing, and transportation, and exposure to pollution.