Mental health in aviation

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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.

Contents

The life of an airline pilot can be stressful and demanding. Following recent
events
, mental health in aviation is gaining attention within the aviation industry. Airbus-319-cockpit-2-rr.jpg
The life of an airline pilot can be stressful and demanding. Following recent events , mental health in aviation is gaining attention within the aviation industry.

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]

Prevalence of disorders

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]

Mental illness is second to cardiovascular disease in reasons for losing an aviation license. [4] 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. [4] Detection is further complicated by the fact that few medical examiners fully understand the complexity and effects of the different disorders. [4] Additionally, psychiatrists are unfamiliar with the regulations of pilots suffering from mental health issues. [5] 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. [5]

Airlines are familiar with the consequences of mental illness, [6] 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. [6] 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. [6]

Causes

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. [7] Pilots are exposed to difficult working conditions that feature inconsistent schedules, extended periods away from home, and frequent encounters with fatigue. [7]

Mental illness is amplified by the lack of social support from home, a varying circadian rhythm, and the excessive job demands. [8] Experts and airlines have been aware of these issues from as early as 1985, yet very little information about mental health in aviation exists. [8] There is a macho attitude towards mental health in aviation, with a laissez-faire approach. [8]

Both males and females in aviation are equally susceptible to mental health issues. [9]

There is a negative stigma around mental health in aviation. [10] A study showed that pilots assumed fellow pilots who were unsociable most likely have a mental health illness. [10] 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. [10]

Solutions

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. [11] This questionnaire identifies certain individuals who are more at risk of mental health issues and allows the airline to then provide support for them. [11] 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. [11] 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. [12] The Federal Aviation Administration also announced that it will conduct research into newer and more relevant data concerning mental health within pilots. [13] 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. [6]

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. [14] The European Aviation Safety Agency also issued a similar statement, stating all pilots need to undergo psychological evaluation.[ citation needed ]

See also

Related Research Articles

A mental disorder, also referred to as a mental illness or psychiatric disorder, 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. It is usually associated with distress or impairment in important areas of functioning. There are many different types of mental disorders. Mental disorders may also be referred to as mental health conditions. Such features may be persistent, relapsing and remitting, or occur as single episodes. Many disorders have been described, with signs and symptoms that vary widely between specific disorders. Such disorders may be diagnosed by a mental health professional, usually a clinical psychologist or psychiatrist.

Stress management consists of a wide spectrum of techniques and psychotherapies aimed at controlling a person's level of stress, especially chronic stress, usually for the purpose of improving everyday functioning. 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, and sleep problems, as well as depression. The process of stress management is named as one of the keys to a happy and successful life in modern society. Life often delivers numerous demands that can be difficult to handle, but stress management provides a number of 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. 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.

<span class="mw-page-title-main">Personality test</span> Method of assessing human personality constructs

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 all the way from lack of adequate self-insight to downright dissimulation depending on the reason/motivation for the assessment being undertaken.

<span class="mw-page-title-main">Mental health</span> Level of psychological well-being

Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. 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, trauma, and self-actualization of one's intellectual and emotional potential, among others. From the perspectives of positive psychology or holism, mental health may include an individual's ability to enjoy life and to create a balance between life activities and efforts to achieve psychological resilience. Cultural differences, subjective assessments, and competing professional theories all affect how one defines "mental health". Some early signs related to mental health difficulties are sleep irritation, lack of energy, lack of appetite and thinking of harming yourself or others.

<span class="mw-page-title-main">Pilot error</span> Decision, action or inaction by a pilot of an aircraft

Pilot error generally refers to an accident in which an action or decision made by the pilot was the cause or a contributing factor that led to the accident, but also includes the 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.

<span class="mw-page-title-main">Paul E. Meehl</span> American psychologist (1920–2003)

Paul Everett Meehl was an American clinical psychologist, 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, and philosophy of science.

Gender is correlated with the prevalence of certain mental disorders, including depression, anxiety and somatic complaints. For example, women are more likely to be diagnosed with major depression, while men are more likely to be diagnosed with substance abuse and antisocial personality disorder. There are no marked gender differences in the diagnosis rates of disorders like schizophrenia and bipolar disorder. Men are at risk to suffer from post-traumatic stress disorder (PTSD) due to past violent experiences such as accidents, wars and witnessing death, and women are diagnosed with PTSD at higher rates due to experiences with sexual assault, rape and child sexual abuse. Nonbinary or genderqueer identification describes people who do not identify as either male or female. People who identify as nonbinary or gender queer show increased risk for depression, anxiety and post-traumatic stress disorder. People who identify as transgender demonstrate increased risk for depression, anxiety, and post-traumatic stress disorder.

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.

<span class="mw-page-title-main">Self-report inventory</span> Type of psychological test

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.

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.

Health issues of athletics concern the health and well-being of athletes who participate in an organized sport. If athletes are physically and mentally underdeveloped, they are susceptible to mental or physical problems. Athletes trying to improve their performance in sports can harm themselves by overtraining, adopting eating habits that damage them physically or psychologically, and using steroids or supplements.

<span class="mw-page-title-main">Germanwings Flight 9525</span> 2015 deliberate crash of an airliner in the French Alps

Germanwings Flight 9525 was a scheduled international passenger flight from Barcelona–El Prat Airport in Spain to Düsseldorf Airport in Germany. The flight was operated by Germanwings, a low-cost carrier owned by the German airline Lufthansa. On 24 March 2015, the aircraft, an Airbus A320-211, crashed 100 km north-west of Nice in the French Alps. All 144 passengers and all six crew members were killed.

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, ETA 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.

<span class="mw-page-title-main">Impact of culture on aviation safety</span>

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 52 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.

<span class="mw-page-title-main">Pilot fatigue</span> Reduced pilot performance from inadequate energy

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.

<span class="mw-page-title-main">Stress in the aviation industry</span> Pilots wellbeing whilst working

Stress in the aviation industry is a common phenomenon composed of three 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. An airline pilot can be an extremely stressful job due to the workload, responsibilities and 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. Being exposed to stress does not always negatively influence humans because it can motivate people to improve and help them adapt to a new environment. Unfortunate accidents start to occur when a pilot is under excessive stress, as it dramatically affects his or her physical, emotional, and mental conditions. Stress "jeopardizes decision-making relevance and cognitive functioning" and it is a prominent cause of pilot error. Being a pilot is considered a unique job that requires managing high workloads and good psychological and physical health. Unlike the other professional jobs, pilots are considered to be highly affected by stress levels. One study states that 70% of surgeons agreed that stress and fatigue don't impact their performance level, while only 26% of pilots denied that stress influences their performance. Pilots themselves realize how powerful stress can be, and yet many accidents and incidents continues to occur and have occurred, such as Asiana Airlines Flight 214, American Airlines Flight 1420, and Polish Air Force Tu-154.

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.

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