Harvard Chan School of Public Health Study makes findings about Pilot Mental Health; is there a second iteration which can detect Pilot Mental Problems?

harvard chan Pilot Depression
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Pilot Depression

New Pilot Mental Health Findings by Harvard Chan School of Public Health

Addressing Mental Health Issues Among Pilots

By Alexander C. Wu, Deborah Donnelly-McLay, Marc G. Weisskopf,Eileen McNeely, Theresa S. Betancourt and Joseph G. Allen

Pilot Depression study harvard chan

An interesting new study about pilot mental health has been published by these distinguished members of the Harvard T.H. Chan School of Public Health, an academic research institution of “dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere.”

The FAA’s Pilot Fitness Aviation Rulemaking Committee (ARC) issued a Committee Report, November, 2015, which made the following recommendations (abbreviated):

  1. “ENHANCE AME TRAINING The Federal Aviation Administration (FAA) should ensure all Aviation Medical Examiners (AME) demonstrate knowledge in assessing basic mental health concerns, and enhance AME training on this topic.

  1. PSYCHOLOGICAL TESTING The ARC does not recommend mandating formal psychological testing during the pilot hiring process nor as part of routine FAA aviation medical examinations beyond those which already exist.

Rationale:  The Aviation Rulemaking Committee (ARC) found no convincing data to conclude that adding psychological testing to the hiring process or to the routine medical examinations enhance the ability to assess the mental fitness of the pilot workforce.

  1. PILOT ASSISTANCE PROGRAMS Air carriers should develop effective pilot assistance programs.

  1. AIR CARRIER EDUCATION Air carrier operators should be encouraged to implement mental health education programs for pilots and supervisors that improve awareness and recognition of mental health issues, reduce stigmas, and promote available resources to assist with resolving mental health problems.

  1. INFORMATIONAL MATERIAL ON PILOT SUPPORT PROGRAMS The FAA should assemble and disseminate information on benchmark pilot support programs, which includes pilot assistance programs, to serve as a resource for air carriers to develop new or improve existing programs.

  1. MEDICAL PROFESSIONAL REPORTING Encourage advocacy for a uniform national policy on mandatory reporting of medical issues that affect public safety.

  1. TWO PERSONS ON FLIGHTDECK AND FLIGHTDECK ACCESS The ARC recommends no changes to the guidance found in FAA Order 8900.1, “Procedures for Opening, Closing, and Locking Flight Deck Doors” concerning two persons on the flightdeck and flightdeck access


  1. AIRCRAFT DESIGN STANDARDS The ARC believes existing aircraft and flightdeck door design standards are adequate and no changes are required by the FAA.


As the trade press [FAA: No Psychological Testing Needed of Airline Pilots] reported, “[p]sychological tests are ineffective because they reveal a pilot’s mental health for only a moment in time without providing insight into whether the pilot will suffer problems later.”

The Harvard study made the following conclusions:

“Hundreds of pilots currently flying are managing depressive symptoms perhaps without the possibility of treatment due to the fear of negative career impacts. This study found 233 (12.6%) airline pilots meeting depression threshold and 75 (4.1%) pilots reporting having suicidal thoughts. Although results have limited generalizability, there are a significant number of active pilots suffering from depressive symptoms. We recommend airline organizations increase support for preventative mental health treatment. Future research will evaluate additional risk factors of depression such as sleep and circadian rhythm disturbances.”

This conclusion was based on an analytical test which the Harvard Chen faculty professors used. The academics relied on the “Job Content Questionnaire and the Centers for Disease Control – National Center for Health Statistics (CDC-NCHS) National Health and Nutrition Examination Survey (NHANES) (CDC-NCHS 2011–2012), which previous researchers applied to evaluate U.S. flight attendant health.” And the study made the following judgment as to clinical depression among these anonymous pilots/responders:

“We evaluated depressive symptoms via the Patient Health Questionnaire (PHQ-9) depression module utilized in previous NHANES surveys (e.g., NHANES 2005–2006 and 2011–2012), which is well validated and used in clinical studies assessing depression [26, 27]. Briefly, the PHQ-9 depression module asks nine questions, which are the nine criteria for diagnosing depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders, Edition 4 (DSM-IV) [26]. Researchers record scores as frequency of depression symptoms over the past two weeks [26]. Response categories include “not at all,” “several days,” “more than half the days” and “nearly every day” and given a score ranging from 0 to 3, respectively. Total summed scores per participant range from 0 to 27. Studies evaluating validity of PHQ-9 report a total score of 10 or greater had an 88% sensitivity and 88% specificity for depression [26] with a kappa of 0.56 to 0.74 between PHQ-9 diagnosis and diagnosis by an independent mental health professional [28, 29]. Therefore, we refer to meeting the cut-off of having a PHQ-9 total score of 10 as depression.”

An independent assessment of the size of the depressed pilot population is very useful, but within this technical statistical paper there may be a more useful tool for airlines.

The study relies on a test instrument to determine mental health; can that assessment tool be used to assess a pilot’s depression on a real time basis? Maybe because the Job Content Questionnaire may not be a good method for field use because the Harvard Chan questionnaire was administered

  • anonymously?
  • because it was part of a large sample survey?
  • because it measured depression at a moment in time?
  • because of any number of other controls in an academic study as opposed to real world application?

Whatever the distinctions or invalidating factors for use of this instrument or something comparable among the universe of real pilots,

 →  it would seem to be appropriate for the Harvard T.H. Chan School of Public Health to assess the applicability of some test to help airlines identify pilots for whom intervention is appropriate?

→  Might Pilot Fitness Aviation Rulemaking Committee might ask  Alexander C. Wu, Deborah Donnelly-McLay, Marc G. Weisskopf,Eileen McNeely, Theresa S. Betancourt and Joseph G. Allen for their help in devising a real time test?

→  A real time test would be of great value to aviation!!!

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