Monday 18 December 2017

Two years after Germanwings crash, is there still stigma in the cockpit?

Mind matters

Patricia Casey

Next month will mark two years since the Germanwings airplane crash, which killed all 150 passengers and crew, en route from Barcelona to Düsseldorf. What was remarkable about this plane crash was that the pilot, Andreas Lubitz, had a history of depression, and that depression had recurred, but was seemingly missed by the many doctors whom he visited. This shocking and tragic event led to the airline industry worldwide to examine the mental health of pilots.

A study published by Alexander Wu from Harvard T.H. Chan School of Public Health, was published in the December 2016 issue of Environmental Health, was the first to examine the mental health of pilots. Data was gathered between April and December 2015, in the immediate aftermath of the Germanwings tragedy. It found that 12pc of commercial pilots around the world suffered with depression, and in the two weeks before the study, 4pc had suicidal thoughts.

The study, based on an anonymous web-based survey, was given to 3,500 pilots from round the globe. Respondents were from countries such as the US, Australia and Canada. Just over 50pc of subjects completed the anonymous questionnaire. Of the 1,848 respondents, around 12.5pc reached the symptom threshold for clinical depression. Approximately 4pc had thoughts of being better off dead, or of self-harm, in the two weeks before the survey.

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." Among the associated risk factors were using a lot of sleeping medication and having a history of sexual or verbal harassment.

One of the problems with studies such as this is the use of very basic questionnaires to test for clinical depression, in this instance the Patient Health Questionnaire 9. This nine-item checklist does not explore the context of the symptoms, so a bereaved person might score positive on it as might somebody who has recently been made redundant. In other words, 12.5pc may have clinical depression, but this then needs to be explored in a face-to-face interview.

Another flaw was the absence of medical records to further evaluate the nature and severity of the depressive symptoms. Moreover, it was not possible in a study such as this to establish how the symptoms impacted on the pilots' day-to-day life and work.

The fact that this was a screening for the illness rather than a definitive diagnosis was lost in the headlines that followed: "Prozac Pilots", "Thousands of passengers being flown by depressed and suicidal pilots" or "Think your job is depressing: try being an airline pilot". And there are occupational reasons why pilots could become depressed. They have to fly to and through different time zones, they work shifts, they have long periods away from home, and the lives of hundreds of people are in their hands at any one time.

The 12.5pc may be an underestimation if the respondents didn't disclose their mood disturbance, although in an anonymous web-based survey, this is less likely than in postal questionnaires. On the other hand, it may have over-estimated the level because of the checklist approach.

How does the 12.5pc figure compare with other professions? This is a difficult question to answer without carrying out studies on different occupational groups using the same methods. In general the 12.5pc is higher than the 16.19pc found in other transportation workers or the 14.6pc rate found in those working in social services in the US.

Many commentators spoke of the silence around depression in the cockpit and that pilots may be reluctant to seek treatment because it would be the death knell for their career.

In 2010, the FAA announced that pilots with mild-to-moderate depression could continue flying if they were taking one of four approved antidepressants for 12 months with satisfactory results.

It is to be hoped that the glimpse into the levels of possible depression in this occupation provided by this study will further encourage treatment-seeking and end the stigma that may still be lurking in the cockpit.

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