Flying Under the Radar: A Survey of Collegiate Pilots' Mental Health to Identify Aeromedical Nondisclosure and Healthcare-Seeking Behaviors

Main Article Content

Lauren Pitts
Emily Faulconer

Abstract

The disclosure of a new or existing mental health condition in a pilot complicates their medical certification status. It has been proposed that the threat of losing medical certification often discourages pilots from seeking treatment for mental health issues or disclosing such information to aeromedical professionals, contributing to a barrier to seeking healthcare that affects pilots of all certification levels. The current study focused on the nondisclosure and healthcare-seeking behaviors of the collegiate pilot population (N = 2,452) at a large, accredited, private institution that offers flight training in accordance with Pilot Schools (2022). Data collected from our anonymous online survey over the course of 30 days found that 56.6% of a sub-sample (n = 232) of collegiate pilots met the criteria for some degree of depression, and 13.8% reported the prevalence of self-injurious or suicidal ideation within the past two weeks. Additionally, 67.7% of the sample (N = 256) expressed concern about seeking care for mental health issues because of potential effects on their medical certification, while 29.3% admitted to withholding mental health information from aeromedical professionals out of concern for their medical certification. The current study found that the same barrier to healthcare present in the airline pilot and military populations is also present in the collegiate pilot population. While previous research has focused on healthcare aversion and nondisclosure in airline, commercial, and military pilot populations, these findings focus on collegiate pilots, a population not accounted for in existing studies. Further studies are necessary to explore additional factors contributing to the pilot healthcare barrier and nondisclosure in aeromedical settings.  

Article Details

Section
Peer-Reviewed Articles

References

Amster, D., Garber, M., & McQueen, D. (2012). Undisclosed medical conditions in the international aviation community: The risks of medical certification systems based upon voluntary self-disclosure. Issues in Aviation Law and Policy 12(1), 47-66. https://heinonline.org/HOL/P?h=hein.journals/isavialp12&i=52

Canfield, D. V., Salazar, G. J., Lewis, R. J., & Whinnery, J. E. (2006). Pilot medical history and medications found in post mortem specimens from aviation accidents. Aviation, Space, and Environmental Medicine, 77(11), 1171–1173.

Carmon, E., Erlich, Y., Gordon, B., Hermoni, D., Levy, Y., & Yemini, T. (2016). The ecology of medical care among Israeli military aviators. Aerospace Medicine and Human Performance, 87(12), 1036-1040. https://doi.org/10.3357/AMHP.4406.2016

Centers for Disease Control and Prevention. (2022). Web-based Injury Statistics Query and Reporting System (WISQARS). Atlanta, GA: National Centers for Injury Prevention and Control, Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/injury/wisqars/index.html.

Clark, J. M. (2016). Assuring safer skies: survey of aeromedical issues post-germanwings. Journal of Air Law and Commerce, 81(3), 351-376. https://heinonline.org/HOL/P?h=hein.journals/jalc81&i=378

Czeisler, M. É., Lane, R. I., Petrosky, E., Wiley, J. F., Christensen, A., Njai, R., Weaver, M. D., Robbins, R., Facer-Childs, E. R., Barger, L. K., Czeisler, C. A., Howard, M. E., & Rajaratnam, S. M. W. (2020). Mental health, substance use, and suicidal ideation during the COVID-19 pandemic — United States, June 24–30, 2020. MMWR. Morbidity and Mortality Weekly Report, 69(32), 1049–1057. https://doi.org/10.15585/mmwr.mm6932a1

The Federal Aviation Administration’s Oversight of Falsified Airman Medical Certificate Applications. 110th Congress. (2007). https://www.govinfo.gov/content/pkg/CHRG-110hhrg36735/html/CHRG-110hhrg36735.htm

Federal Aviation Administration. (2020). Chapter 9: Techniques of Flight Instruction. In Aviation Instructor's handbook. https://www.faa.gov/regulations_policies/handbooks_manuals/aviation/aviation_instructors_handbook/media/11_aih_chapter_9.pdf

Federal Aviation Administration. (2022). Guide for Aviation Medical Examiners. https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/media/guide.pdf

Gilbody, S., Richards, D., Brealey, S., & Hewitt, C. (2007). Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): a diagnostic meta-analysis. Journal of general internal medicine, 22(11), 1596–1602. https://doi.org/10.1007/s11606-007-0333-y

Goebert, D., Thompson, D., Takeshita, J., Beach, C., Bryson, P., Ephgrave, K., Kent, A., Kunkel, M., Schechter, J., & Tate, J. (2009). Depressive symptoms in medical students and residents: A Multischool Study. Academic Medicine, 84(2), 236–241. https://doi.org/10.1097/acm.0b013e31819391bb

Henson, M. (2021, December 16). ‘He felt trapped’: Parents of UND student killed in plane crash push for more mental health help for pilots. https://www.inforum.com/newsmd/he-felt-trapped-parents-of-und-student-killed-in-plane-crash-push-for-more-mental-health-help-for-pilotsInforum.

Hoffman, W., Chervu, N., Geng, X., & Üren, A. (2019). Pilots’ healthcare seeking anxiety when experiencing chest pain. Journal of Occupational & Environmental Medicine, 61(9), 401–405. https://doi.org/10.1097/jom.0000000000001662

Hoffman, W. R., Barbera, R. D., Aden, J., Bezzant, M., & Uren, A. (2021). Healthcare related aversion and care seeking patterns of female aviators in the United States. Archives of Environmental & Occupational Health, 77(3), 234–242. https://doi.org/10.1080/19338244.2021.1873093

Hoffman, W. R., Aden, J., Barbera, R. D., Mayes, R., Willis, A., Patel, P., & Tvaryanas, A. (2022a). Healthcare avoidance in aircraft pilots due to concern for aeromedical certificate loss. Journal of Occupational & Environmental Medicine, 64(4). https://doi.org/10.1097/jom.0000000000002519

Hoffman, W.R., Bjerke, E., Tvaryanas, A. (2022b). Breaking the pilot healthcare barrier. Aerospace Medicine and Human Performance 93(8), 649-650. https://doi.org/10.3357/AMHP.6063.2022

Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of general internal medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

McLaughlin, C. G. (2004). Delays in treatment for mental disorders and health insurance coverage. Health Services Research, 39(2), 221–224. https://doi.org/10.1111/j.1475-6773.2004.00224.x

Medical Standards and Certification, 14 C.F.R. § 67 (2022). https://www.ecfr.gov/current/title-14/chapter-I/subchapter-D/part-67

Miller, E., Dulski, J. (2022). Time to UpLift!. SAAC NOTAM, 6. https://saac.aero.und.edu/docs/newsletters/2022-spring-1.pdf

Mirza, A. A., Baig, M., Beyari, G. M., Halawani, M. A., & Mirza, A. A. (2021). Depression and anxiety among medical students: A brief overview. Advances in Medical Education and Practice, Volume 12, 393–398. https://doi.org/10.2147/amep.s302897

Pilot Schools, 14 C.F.R. § 141 (2022). https://www.ecfr.gov/current/title-14/chapter-I/subchapter-H/part-141

Post, R.M., Weiss, S.R. (1988). Sensitization and kindling phenomena in mood, anxiety, and obsessive-compulsive disorders: the role of serotonergic mechanisms in illness progression. Biol Psychiatry, 44(3), 193-206. doi: 10.1016/s0006-3223(98)00144-9.

Rotenstein, L. S., Ramos, M. A., Torre, M., Segal, J. B., Peluso, M. J., Guille, C., Sen, S., & Mata, D. A. (2016). Prevalence of depression, depressive symptoms, and suicidal ideation among medical students. Journal of the American Medical Association, 316(21), 2214–2236. https://doi.org/10.1001/jama.2016.17324

Spitzer, R. L., Williams, J. B., & Kroenke, K. (n.d.). Patient Health Questionnaire (PHQ) Screeners Instruction Manual. Pfizer, Inc. https://www.phqscreeners.com/

Wu, A. C., Donnelly-McLay, D., Weisskopf, M. G., McNeely, E., Betancourt, T. S., & Allen, J. G. (2016). Airplane Pilot Mental Health and Suicidal Thoughts: A cross-sectional descriptive study via anonymous web-based survey. Environmental Health, 15(121). https://doi.org/10.1186/s12940-016-0200-6