Extramural Spotlight: Airline Pilot Mental Health

Posted on by Alexander C. Wu, ScD, MPH

In March 2015, Germanwings Flight 9525 crashed into the French Alps, killing all 150 people onboard. An investigation found that the copilot deliberately steered the plane into the mountainside. It also revealed that he had a history of depression. Among workers, untreated depression can affect the ability to perform tasks and—as the Germanwings incident shows—in rare instances, can result in devastating consequences. In one of the first studies of its kind, researchers at the NIOSH-funded Harvard Education and Research Center (ERC) looked at the prevalence of depression among commercial airline pilots.

Researchers used an anonymous web-based survey of pilots recruited from unions, airline companies, pilot groups, and aviation safety organizations to ask about depression and other health issues. Between April and December 2015, 1,837 airline pilots completed the survey. More than 12% of survey respondents who answered the survey’s health questions met the criteria for depression and 4% reported having suicidal thoughts within the prior two weeks. Pilots who reported using medication to aid sleep and who experienced sexual or verbal harassment were significantly more likely to be depressed. The findings were published in the journal Environmental Health.

There are an estimated 140,000 airline pilots internationally with about 70,000 in the U.S.[i] The majority of pilots are male and just over 4% of all pilots are female.[ii] In the U.S., the Department of Transportation, Federal Aviation Administration (FAA) sets requirements for aeromedical examiners (AMEs) to evaluate fitness of pilots. Only through self-disclosure are mental disorders discussed and noted in pilot health records. AMEs do not diagnose mental health conditions. Underreporting of mental health symptoms and diagnoses is probable among airline pilots due to the public stigma of mental illness and fear among pilots of being “grounded” or not fit for duty.

Estimates of depression or depressive symptoms among other high stress occupations include 12% among deployed and 13% among previously deployed U.S. military personnel,[iii] 7% among U.S. emergency medical technicians[iv], and 10–17% among U.S. police officers.[v]. Barriers to seeking treatment for mental health issues among high stress occupations are documented in the literature.[vi], [vii],[viii] Although different in degree and severity of stressors, commercial airline pilots may experience similar occupational and individual barriers to seeking treatment[ix]. These include shift-work, long and continuous hours, and increased stigma towards admitting one has mental health problems resulting from work.

Although this study relied on self-reports and represents a small sample of airline pilots, it indicates that there may be a significant number of working pilots suffering from depressive symptoms. The results highlight the need for the airline industry to increase its support of preventive treatment for depression and other mental health disorders among pilots. However, this study does not change the fact that flying on an airplane is still by far the safest form of public transportation. The next step is to study how sleep and circadian rhythm disturbances affect the risk of depression among this group of workers.

We would like to hear from you. Do you know where to find information on how to help others when they are experiencing depression? If you are an airline pilot, what mental health services (e.g. paid-leave, confidential reporting, leadership advocacy of mental health) does your organization provide for pilots experiencing mental illness?


Alexander C. Wu, ScD, MPH, is currently an Epidemic Intelligence Service Officer at the Centers for Disease Control and Prevention assigned to the Northwest Portland Area Indian Health Board in Portland, Oregon. He published this study while earning his doctorate at the Harvard T.H. Chan School of Public Health.

This blog is the first in a series highlighting extramural research funded by NIOSH through the Office of Extramural Programs.



[i] U.S. Department of Labor Bureau of Labor Statistics. Airline pilots, copilots, and flight engineers. Occupational Employment Statistics. 2015. http://www.bls.gov/oes/current/oes532011.htm#nat. Accessed 2 Mar 2016.

[ii] Women in Aviation International. Current statistics of women in aviation careers in U.S.: Pilots. 2013. https://www.wai.org/resources/waistats. Accessed 1 Feb 2016.

[iii] Gadermann AM, Engel CCC, Naifeh JA, Nock MK, Petukhova M, Santiago LP, et al. Prevalence of DSM-IV major depression among U.S. military personnel: Meta-analysis and simulation. Mil Med. 2012;177:47–59.View ArticleGoogle Scholar

[iv] Bentley MA, Crawford JM, Wilkins JR, Fernandez AR, Studnek JR. An assessment of depression, anxiety, and stress among nationally certified EMS professionals. Prehosp Emerg. 2013. doi:10.3109/10903127.2012.761307.Google Scholar

[v] Slaven JE, Mnatsakanova A, Burchfiel CM, Smith LM, Charles LE, Andrew ME, et al. Association of sleep quality with depression in police officers. Int J Emerg Ment Health. 2011;13:267–77.Google Scholar

[vi] Houdmont J, Leka S, Sinclair RR. Contemporary occupational health psychology: Global perspectives on research and practice, vol. 2. Oxford: Wiley-Blackwell; 2012.View ArticleGoogle Scholar

[vii] Barling J, Kelloway E, Frone M. Handbook of Work Stress. Thousand Oaks: Sage; 2005.Google Scholar

[viii] Cooper CL. Organizational stress: A review and critique of theory, research, and applications. Thousand Oaks: Sage; 2001.Google Scholar

[ix] Bor R, Field G, Scragg P. The mental health of pilots: An overview. Couns Psychol Q. 2002. doi:10.1080/09515070210143471.Google Scholar

Posted on by Alexander C. Wu, ScD, MPH

11 comments on “Extramural Spotlight: Airline Pilot Mental Health”

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    This study serves as a “wake up call” for the FAA to take positive steps to address the stress associated with the working hours of the pilots and also focus attention on mental health issues in its quest of addressing the health issues of the pilots. More funding may be needed to increase health care services of our pilots. Thank you

    Go to http://www.iswap.org for updated pilot statistics on pilot numbers, under documents. The Harvard study has some flaws, but is a start. Plus, some airlines are using mental health diagnoses to get rid of pilots, so pilots tend to resist going to a psychiatrist!

    A pilots mental health is very crucial as he is responsible for the safety , well-being, and most importantly – the lives oh the cabin crew and the passengers aboard. There should be strict and regular psychiatric evaluation of the pilot as well as random blood tests (for alcohol, drugs, etc.). These are important protocols which should be followed by all airline companies internally.

    nice article!
    mental health is indeed the most important thing that not everyone is aware of. many things can make people experience mental disorders, but there are also many ways to avoid it. thanks for sharing!

    My ex-husband is a pilot who has experienced depression, PTSD, suicidal thoughts and other mental health issues while on the job. He explained to me that he could not seek out medical treatment because the federal regulations would require him to be grounded (during which time he would not be paid) for three months after starting an antidepressant or similar medication so that the effect can be monitored. Any adjustment in medication or dosage would restart the 3 month period. He simply could not afford to go unpaid for several months.

    Which is more unsafe: a pilot on antidepressants or a suicidal, depressed pilot with untreated PTSD? I don’t know.

    Muy buen artículo. La salude mental de un piloto es crucial.

    From Google Translate: Very good article. The mental health of a pilot is crucial.

    Reporting my depression, and being treated cost me my Job as a major airline pilot. My suggestion for any pilot with depression, is hide it, lie, and don’t report it. Trust me, if you do, self disclose, be prepared to find a new career. The new SSRI program wasn’t available for me, but the odds of one of the four approved drugs working for you is about 30%.

    Fred, I am sorry that you lost your job as an airline pilot and there was not an SSRI program available for you. Your candid comment highlights the continuing need for airline companies to decrease perceived and real barriers for pilots to seek help and receive treatment that does not penalize their courage and honesty. I also hope the science in pharmaceutical treatment options makes progress to make them more effective. The overarching goals of our research were to bring airline pilot mental health to light and to encourage the airline industry to decrease barriers for pilots to seek and receive help. I hope the majority of commercial airline pilots who read this blog work for a company which supports employee mental health and provides financial support to those dealing with depression.

    I am a female student pilot who would have been a licensed pilot two years ago if only I’d lied about the SSRI I was taking. I was warned by other pilots not to disclose my medication, but, being a painfully dedicated rule follower, I was honest. That action began a lengthy, invasive, and costly ($8,000 so far) process of pursuing a special issuance medical certificate. In the future I’ll be able to get a Basic Med for my private pilot endeavors. For this first medical certificate, however, my HIMS AME has required reports from a neuropsychologist, a psychiatrist, all of my regular doctors (including my dermatologist), my flight instructor, and my ex-husband. The last piece he wants before he submits his report to the FAA is for me to get blood tests every three weeks for four months to check that I have not had any alcohol ($139 for each test, plus $22/6 minutes of my HIMS AME’s time to review the report). I have never had a DUI or been diagnosed as an alcoholic. This is because I told the psychiatrist that I occasionally drank too much in my 20s. I am now 40.

    What has disturbed me most about this whole process is how casually every FAA-approved healthcare professional that I have seen has suggested that I simply stop taking the SSRI. That seems to me like an absolutely ludicrous suggestion. First, the absence of medication is not the absence of a disorder. They want me flying around up there WITHOUT the medication that has been helping me to perform better across the board? Second, they want me, after working for years with a therapist, a dietician, a trainer, and my primary care physician and as the last piece of the wellness puzzle, deciding to try an SSRI that appears, after years of being monitored, to have greatly contributed to my overall health, they want me to just STOP taking it? Even though the sudden cessation of an SSRI can cause extreme depression and suicidal ideation, which seems like something they should know, considering it’s written right on the bottle?

    I’m glad the FAA is taking mental health seriously, but the process appears to have room for improvement. No wonder there’s such a low percentage of female pilots! I read right here on CDC’s site that women are more likely than men to pursue or receive any mental health treatment. I wonder if maybe part of the answer could be to require all pilots to have an annual mental health assessment and then offer resources if they’re needed?

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Page last updated: September 11, 2019