Aircraft-Assisted Pilot Suicides in the General Aviation Increased for One-Year Period after 11 September 2001 Attack in the United States.

Pilot aircraft-assisted suicides (AAS) are rare, and there is limited understanding of copycat phenomenon among aviators. The aim of this study was to evaluate the possible effect the 11 September 2001, terrorist attacks had on pilot AASs in the U.S. Fatal aviation accidents in the National Transportation Safety Board (NTSB) database were searched using the following search words: "suicide", "murder-suicide" and "homicide-suicide". The timeline between 11 September 1996, and 11 September 2004, was analyzed. Only those accidents in which NTSB judged that the cause of the accident was suicide were included in the final analysis. The relative risk (RR) of the pilot AASs in all fatal accidents in the U.S. was calculated in order to compare the one, two, and three-year periods after the September 11 terrorist attacks with five years preceding the event. The RR of a fatal general aviation aircraft accident being due to pilot suicide was 3.68-fold (95% confidence interval 1.04⁻12.98) during the first year after 11 September 2001, but there was not a statistically significant increase in the later years. This study showed an association, albeit not determinate causal effect, of a very specific series of simultaneous terrorist murder-suicides with subsequent pilot AASs.

Copycats in Pilot Aircraft-Assisted Suicides after the Germanwings Incident.

Aircraft-assisted pilot suicide is a rare but serious phenomenon. The aim of this study was to evaluate changes in pilot aircraft-assisted suicide risks, i.e., a copycat effect, in the U.S. and Germany after the Germanwings 2015 incident in the French Alps. Aircraft-assisted pilot suicides were searched in the U.S. National Transportation Safety Board (NTSB) accident investigation database and in the German Bundestelle für Flugunfalluntersuchung (BFU) Reports of Investigation database five years before and two years after the deliberate crash of the Germanwings flight into the French Alps in 2015. The relative risk (RR) of the aircraft-assisted pilot suicides was calculated. Two years after the incident, three out of 454 (0.66%) fatal incidents were aircraft-assisted suicides compared with six out of 1292 (0.46%) in the prior five years in the NTSB database. There were no aircraft-assisted pilot suicides in the German database during the two years after or five years prior to the Germanwings crash. The relative aircraft-assisted pilot suicide risk for the U.S. was 1.4 (95% CI 0.3-4.2) which was not statistically significant. Six of the pilots who died by suicide had told someone of their suicidal intentions. We consider changes in the rate to be within a normal variation. Responsible media coverage of aircraft incidents is important due to the large amount of publicity that these events attract.

Attention-Deficit/Hyperactivity Disorder and Fatal Accidents in Aviation Medicine.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with symptoms of inattention and/or hyperactivity-impulsivity that interfere with functioning and/or development. ADHD occurs in about 2.5% of adults. ADHD can be an excluding medical condition among pilots due to the risk of attentional degradation and therefore impact on flight safety. Diagnosis of ADHD is complex, which complicates aeromedical assessment. This study highlights fatal accident cases among pilots with ADHD and discusses protocols to detect its presence to help to assess its importance to flight safety. METHODS: To identify fatal accidents in aviation (including airplanes, helicopters, balloons, and gliders) in the United States between the years 2000 to 2015, the National Transportation Safety Board (NTSB) database was searched with the terms ADHD, attention deficit hyperactivity disorder, and attention deficit disorder (ADD). RESULTS: The NTSB database search for fatal aviation accidents possibly associated with ADHD yielded four accident cases of interest in the United States [4/4894 (0.08%)]. Two of the pilots had ADHD diagnosed by a doctor, one was reported by a family member, and one by a flight instructor. An additional five cases were identified searching for ADD [5/4894 (0.1%)]. Altogether, combined ADHD and ADD cases yielded nine accident cases of interest (0.18%). DISCUSSION: It is generally accepted by aviation regulatory authorities that ADHD is a disqualifying neurological condition. Yet FAA and CASA provide specific protocols for tailor-made pilot assessment. Accurate evaluation of ADHD is essential because of its potential negative impact on aviation safety.Laukkala T, Bor R, Budowle B, Sajantila A, Navathe P, Sainio M, Vuorio A. Attention-deficit/hyperactivity disorder and fatal accidents in aviation medicine. Aerosp Med Hum Perform. 2017; 88(9):871-875.

Bipolar Disorder in Aviation Medicine.

BACKGROUND: One of the most difficult challenges in aviation medicine is to diagnose, as early as possible, pilots with psychiatric disorders that may impair pilot performance and increase the risk of incidents and accidents. This diagnosis applies particularly to bipolar disorder (BD), where return to flying duty is not an option in the majority of cases. BD is a long-term mental disorder presenting remittent depressive, hypomanic, manic, or mixed episodes between low symptomatic or asymptomatic intermediate periods. Onset in most cases is in late teen or early adult years. Suicidal intentions and suicide risk are significantly elevated in individuals with BD compared to the general population. METHODS: A systematic literature search was performed of BD and aviation accidents and the National Transportation Safety Board database of fatal general aviation accidents was searched. One case report and two database reports of interest from 1994 to 2014 were identified. RESULTS: The findings set a minimum frequency of BD in general aviation fatalities to be approximately 2 out of 8648 (0.023%) in the United States. DISCUSSION: The reported incidence may underestimate the real number of BD cases for several reasons, including the fact that the medical history of pilots is not always available or is sometimes not the primary interest of a safety investigation. This study suggests that the demarcation of psychiatric disorder related to fitness to fly is an important step in safety.Vuorio A, Laukkala T, Navathe P, Budowle B, Bor R, Sajantila A. Bipolar disorder in aviation medicine. Aerosp Med Hum Perform. 2017; 88(1):42-47.

The psychology of fear of flying (part II): a critical evaluation of current perspectives on approaches to treatment.

This is the second of a two part review which critically evaluates research published in disparate sources into the psychological treatment of fear of flying. Part I established fear of flying as a complex heterogeneous clinical phenomenon. This paper discusses the way in which evidence from clinical trials translates to best practice in treating fear of flying. Published research on psychological interventions uses terminology which bears a close resemblance to cognitive behavioural therapy. It is, however, questionable whether some treatment approaches reflect the implementation of the cognitive behavioural model as it is described in the wider literature on the treatment of anxiety disorders. This review evaluates a synthesis of published research which considers fear of flying and related anxiety disorders with the aim of deriving best practice. It concludes that the most effective psychological interventions will be those based on an accurate functional assessment of an individual and their social context relevant to fear of flying and not merely a set of standard and invariant protocols. Most published research has been carried out on participants who self refer or volunteer for treatment and it is probable that this is a biased clinical group which may distort reported efficacy and treatment outcomes. It concludes by highlighting directions for future research and the development of psychological treatments for fear of flying.

The psychology of fear of flying (part I): a critical evaluation of current perspectives on the nature, prevalence and etiology of fear of flying.

Fear of flying, its nature, prevalence, etiology and treatment, has been the subject of a substantial quantity of research over the past 30 years. With the exception of a dated review of treatment methods however, there has been no evaluation of this expanding body of evidence, its contribution to theory and influence on clinical practice. Published research has also generally failed to apply developments in the understanding and treatment of anxiety disorders generally to fear of flying. This review provides a critical evaluation of the existing literature and what it reveals about theory and practice. It does this from the perspective of Cognitive Behavioural Therapy. The evidence reviewed demonstrates that fear of flying is a heterogeneous phenomenon which is acquired under the influence of complex psychological, social and physiological factors unique to each affected individual. Effective psychological interventions must therefore be founded on a comprehensive functional assessment of each individual, a finding which is considered in detail in the second part of this review.

Psychological factors in airline passenger and crew behaviour: a clinical overview.

Air travel places unique physical and psychological demands on the traveller and air crew. This paper presents a general overview of the psychological aspects of air travel and specifically how air travel affects airline passenger and crew behaviour. It covers travel and stress, the effects of travel on behaviour, fear of flying, disruptive passenger behaviour and crew mental health, highlighting what insights clinical psychology can offer in relation to these.

Trends in disruptive passenger behaviour on board UK registered aircraft: 1999-2003.

Objective. To review the trends in disruptive passenger behaviour on board UK registered commercial aircraft since the inception of annual reporting from April 1999. Design. Retrospective examination of data made available by the Civil Aviation Authority (CAA) on a common reporting basis. Methods. The CAA requires airlines to submit details of incidents on a standard form. Data has been collected continuously since the start of the reporting system in 1999 and the results are published annually on the Department for Transport website. Results. An annual average of 106 million airline passengers travelled on UK aircraft over the past 4 years and an average of 1040 incidents of disruptive passenger behaviour were recorded for each year. One-fifth of these incidents was deemed to be serious. On average, a serious incident of disruptive passenger behaviour occurs on board in 1 in 30,000 flights or for every 2 million passengers carried. Excessive alcohol use and illegally smoking on board aircraft are implicated in more than 80% of incidents. The typical perpetrator is male and between 30 and 49 years of age. Conclusion. The available data suggests that disruptive passenger behaviour is not a widespread problem on board UK aircraft although there is some evidence of low-level anti-social behaviour. There appears to be a decline in the number of incidents, possibly due to stricter enforcement of air travel rules and regulations, courts handing out custodial sentences to perpetrators and media reports of cases as well as greater self-restraint among airline passengers in the post-September 11, 2001 era.

'I'm not picking up a heart-beat': Experiences of sonographers giving bad news to women during ultrasound scans.

This study explores the experiences of obstetric sonographers imparting diagnostic information which may be considered 'bad news' to expectant mothers. Semi-structured interviews were conducted with nine sonographers at two London Hospitals to elicit their experiences of giving bad news. Themes which emerged then formed the basis for a quantitative survey of 180 practising obstetric sonographers in England. Their perception of what constitutes 'bad news' was examined. It was found that sonographers were predominantly concerned with lack of time and the unpredictability of the patient's reaction when giving bad news. Staff working in settings where there was a clear protocol specifying how to proceed following disclosure of bad news experienced less stress than those working without such a protocol. These findings have implications for psychologists working with patients who suffer pregnancy loss who may consider provision of support and counselling skills training for sonographers.