Pilot Mental Health, Negative Life Events, and Improving Safety with Peer Support and a Just Culture.

BACKGROUND: In the last 35 yr, 17 commercial aviation accidents and incidents, with 576 fatalities, could likely have been attributed to mental disease of a pilot. Screening tools for mental health risks in airline pilots are needed. There is growing interest in pilot peer-support programs and how to incorporate them in a just culture, meaning that pilots can report mental health complaints without a risk of job or income loss. We combined findings from aviation accidents and incidents with a search of scientific literature to provide data-based recommendations for screening, peer-support, and a just culture approach to mental health problems. METHODS: Commercial aviation accidents and incidents in which a mental disorder of a pilot was thought to play a role were reviewed. Subsequently, PubMed and PsychInfo literature searches were performed on peer-support programs, just culture human resource management, and the risk of negative life events on developing suicidal ideation and behavior in comparable professional groups. RESULTS: Lethal accidents were mostly related to impaired coping with negative life events. Negative life events are clearly related to suicidal thoughts, attempts, and completed suicide. A protective effect of peer-support programs on mental health problems has not been established, although peer-support programs are generally appreciated by those involved. We did not find relevant literature on just culture. DISCUSSION: Negative life events are likely a useful screening tool for mental health risks. There is still a lack of evidence on how peer-support groups should be designed and how management of mental health risks can be implemented in a just culture.