By Jess McHugh
December 14, 2016
Vladimir Maravic/Getty Images

For commercial airline pilots—as with many Americans—talking about depression can be mired in stigma.

As the person responsible for both a crew and dozens of of passengers, there is a “generational mentality of pilots that the pilot is the infallible, almighty,” said Clayton Cowl, president of the Civil Aviation Medical Association and a specialist in aerospace medicine.

This mindset and other factors, including the fear that they will be suspended from flying if they seek help for depression, means that pilots suffering from depressive symptoms might not seek treatment for their mental health issues.

Depression and suicidal thoughts affect a significant number of pilots worldwide, according to an anonymous survey of 1,850 pilots conducted by the Harvard T.H. Chan School of Public Health.

The survey included responses from pilots in more than 50 countries, and U.S. pilots made up the largest percentage, accounting for about half of the people who answered mental health related questions on the larger survey. The questionnaire was conducted anonymously in order to broach a subject that can be taboo.

Of the 1,430 people who said they had worked as an airline pilot in the past seven days, 13.5 percent (193 people) met the criteria for depression, according to research published in the journal Environmental Health.

This number—while taken from a small sample—is nearly double the national average, according to CDC statistics. The CDC reported that 7.6 percent of people aged 12 or older experienced depression in any given two-week period, according to data collected in 2009-2012.

“We found that many pilots currently flying are managing depressive symptoms, and it may be that they are not seeking treatment due to the fear of negative career impacts,” said Joseph Allen, senior author of the study published in Environmental Health, according to a press release from Harvard. “There is a veil of secrecy around mental health issues in the cockpit.”

That veil of secrecy lifted in 2015 when a co-pilot with a recorded history of depression purposefully crashed a Germanwings plane into the Alps, killing himself and 150 passengers and crew on board. Federal regulators, airlines, and psychiatric professionals quickly rushed to determine how they could best prevent similar incidents in the future. In the U.S. in particular, however, federally-enforced preventative measures are limited.

The Federal Aviation Authority (FAA) requires pilots to have a physical health screening once or twice a year, depending on their age, to be cleared to fly. This examination includes questions on mental health and asks for any medications the person may be taking, but there is no specific psychiatric examination.

One of the obstacles to this system is that the medical examiners who conduct these screenings only see the pilots during these annual visits, as they are not a pilot’s regular physician. This lack of contact makes it difficult to develop the kind of trust in which a pilot would feel comfortable reporting symptoms of depression, according to Cowl.

“The ideal situation is developing a trust factor for doing that, and a lot of times the examiner is sort of looked at as a barrier as opposed to someone who’s there to help,” Cowl told Travel + Leisure.

Given the limited scope of the FAA’s screenings, the responsibility of keeping pilots and their passengers safe more often falls to individual airlines, pilot’s unions, and their healthcare providers. These entities were largely unable or unwilling to provide any information as to how they create systems through which their pilots can seek help for issues of depression.