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Pilot Work Related Stress (WRS), Effects on Wellbeing and Mental Health, and
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 The International Journal of Aerospace Psychology

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Pilot Work Related Stress (WRS), Effects on

Wellbeing and Mental Health, and Coping Methods

Joan Cahill , Paul Cullen , Sohaib Anwer , Simon Wilson & Keith Gaynor

To cite this article: Joan Cahill , Paul Cullen , Sohaib Anwer , Simon Wilson & Keith
Gaynor (2021): Pilot Work Related Stress (WRS), Effects on Wellbeing and Mental
Health, and Coping Methods, The International Journal of Aerospace Psychology, DOI:
10.1080/24721840.2020.1858714

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THE INTERNATIONAL JOURNAL OF AEROSPACE PSYCHOLOGY
https://doi.org/10.1080/24721840.2020.1858714

Pilot Work Related Stress (WRS), Effects on Wellbeing and

Mental Health, and Coping Methods
a
Joan Cahill , Paul Cullena, Sohaib Anwera, Simon Wilsonb, and Keith Gaynorc
a
Centre for Innovative Human Systems, School of Psychology, Trinity College Dublin (TCD), Dublin, Ireland;
b
School of Computer Science & Statistics, Trinity College Dublin (TCD), Dublin, Ireland; cSchool of Psychology,
University College Dublin (UCD), Dublin, Ireland

ABSTRACT
Objective: The objective of this study is to investigate the relationship
between sources of work-related stress (WRS) for pilots, effects on
wellbeing, and coping mechanisms.
Background: Recent studies have measured depression levels in pilots
but not the relationship between depression levels and coping
strategies.
Methods: An anonymous web-based survey was conducted with
commercial pilots.
A regression model was advanced to analyze the relationship
between each frequency level of each coping strategy and PHQ-9
Scores, and the Odds ratio was interpreted.
Results: Sources of WRS impact on the physical, social, and psycholo­
gical health of pilots. Not all pilots are suffering. Over half met thresh­
old for mild depression. Nearly 60% are using coping mechanisms to
manage WRS and its impact on wellbeing. Pilots using coping mechan­
isms such as sleep management, taking physical exercise, and diet
management were found to have lower depression severity levels.
The findings of this study underscore the need to advance new
tools to enable pilot self-management of their health and wellbeing.
This includes new training tools, enhanced checklists, and new digital
tools to support wellbeing awareness, stress coping, and risk identifi­
cation both inside and outside the cockpit.
Conclusions: Airlines and pilots need the right tools to safeguard the
wellbeing and mental fitness of pilots and ensure flight safety. Pilots,
airlines, and aviation regulators can learn from the existing use of
coping strategies by pilots.

Introduction
Introduction to the Research Problem
Pilots experience many physiological, psychological, and environmental stressors (Cullen
et al., 2016, 2017). Since the Germanwings 9525 accident in 2015, the issue of managing and
supporting pilot mental health (MH) issues and addressing work-related stress (WRS) has
been gaining increased attention. The European Aviation Safety Authority (European
Union Aviation Safety Agency [EASA], 2019) has introduced new rulemaking in relation
to the management of MH issues in pilots. More recently, the industry and pilot groups are

CONTACT Joan Cahill [email protected] Centre for Innovative Human Systems, School of Psychology, Trinity College
Dublin, College Green, Dublin 2, Ireland.
© 2021 Taylor & Francis Group, LLC
2 J. CAHILL ET AL.

addressing the promotion of positive wellbeing and the practice of healthy behaviors for
aviation professionals (Cullen et al., 2020; Flight Safety Foundation, 2020).
People vary in relation to their ability to cope successfully with stress (including WRS).
The practice of healthy behaviors strengthens the person’s resistance to stress (Morimoto &
Shimada, 2015). The substitution of maladaptive coping with more adaptive coping is an
important component of therapeutic interventions for WRS. Common stress coping stra­
tegies include exercise, the practice of relaxation techniques and seeking social support and/
or social participation.
Self-efficacy is defined as a person’s belief that they can succeed in a specific situation.
One’s sense of self-efficacy can play a major role in how one approaches goals, tasks, and
challenges – including the management of WRS. Research indicates that a high level of self-
efficacy can help employees cope more effectively cope with WRS (Jordan et al., 2016).
Further, the promotion of self-efficacy is a key element for success in interventions designed
to reduce depressive symptoms in late life (Blazer, 2002).
Recent studies have measured depression levels in pilots (Pasha & Stokes, 2018; Wu et al.,
2016), but the relationship between mental health outcomes and coping strategies has not
been explored.
Past research by Cahill et al. (2019b, 2018, 2019a) has indicated the following:

(1) The job is a source of WRS and contributing to burnout.

(2) Sources of WRS have a negative impact on pilot wellbeing, performance, and safety.
(3) Pilots have normalized the level of suffering.
(4) Overall, pilots are coping well with sources of WRS – but there is a variance here.
(5) Some pilots are using physical exercise and sleep management strategies to support
stress management and develop resilience.

Thus, it is necessary to explore pilot stress-coping practices in more detail, to understand

whether coping abilities and the practice of stress coping behaviors influence the health of
pilots.

Paper Introduction
This paper reports on the analysis of an anonymous web-based survey addressing pilot
WRS and its impact on wellbeing, performance, and safety (N = 1059 pilots). Specifically, it
focuses on findings pertaining to sources of WRS, impact of WRS on wellbeing (including
MH), prevalence of depression/MH issues, use of coping strategies and the relationship
between coping strategies and health outcomes – in particular, depression severity.
First, a background of this research is provided. The data collection and analysis
methodologies are then presented. The findings of the online survey are outlined, including
findings pertaining to WRS, the impact of WRS on pilot wellbeing, pilot depression severity
levels, pilot-coping strategies, and the relationship between pilot-coping strategies and
depression severity outcomes. The findings of this research are then discussed. This
includes the implications in terms of new training concepts, new checklists for use both
while on and off duty, new digital tools, and safety behavior frameworks. Finally, some
preliminary conclusions drawn.
 INTERNATIONAL JOURNAL OF AEROSPACE PSYCHOLOGY 3

Theoretical Background
Eudaimonia, Positive Psychology & Resilience
In Aristotelian ethics, the concept “Eudaimonia” refers to the condition of human flourish­
ing or “living well” (Kenny, 2011). This concept is taken up in “positive psychology”
frameworks which focus on the positive aspects of the human experience that make life
worth living and developing resilience (Seligman, 2002).
Resilience is defined as the ‘demonstration of positive adaptation in the face of significant
adversity (Fikretoglu & McCreary, 2012). According to Fikretoglu and McCreary (2012), it
is a response to stressful circumstances as opposed to a trait or capacity residing in the
person. The “Soldier Adaptation Model” provides a conceptual framework for conceptua­
lizing resilience processes. As argued by Fikretoglu and McCreary (2012), a soldier’s
appraisal and coping responses influence the outcome of their experience of demanding
events. This process is influenced both by the individual characteristics of the soldiers and
by the characteristics of their organization (Bliese & Castro, 2003).

Wellbeing, Mental Health & Mental Wellbeing in Work

The concept of “wellbeing” refers to a person’s overall health and wellbeing. As defined by
Engel (1977), this span’s their physical, social, and psychological/emotional health. In
The “Six-factor Model of Psychological Well-being” defines six factors that contribute to
an individual’s psychological well-being, contentment, and happiness (Ryff & Singer, 2006).
This includes positive relationships with others, personal mastery, autonomy, a feeling of
purpose and meaning in life, and personal growth and development (Ryff & Singer, 2006).
Mental health is a key part of our wellbeing. The World Health Organization (WHO)
defines mental health as “a state of well-being in which every individual realizes his or her
own potential, can cope with the normal stresses of life, can work productively and
fruitfully, and is able to make a contribution to her or his community” (World Health
Organisation [WHO], 2018, p. 1). Related to this, is the concept of “mental wellbeing at
work.” This is defined as the interaction between the working environment, the nature of
the work and the individual’ (National Institute for Health & Care Excellence [NICE],
2009, p. 8).

Stress & Work-Related Stress (WRS)

Work has the potential to negatively impact on mental health particularly in the form of
stress. Stress is “any experience or sensation that creates physiological, psychological and
behavioural imbalance within a person” (Flinchbaugh et al., 2015; Houtman & Jettinghoff,
2007; Lazarus, 1990). Research shows that prolonged stress is linked to psychological
conditions such as anxiety and depression, as well as physical conditions such as heart
disease, back pain, and headache.
Personal stressors refer to issues or events outside the workplace, like family problems,
health challenges, or financial issues that can contribute to stress.
Work-Related Stress (WRS) is “the response people may have when presented with work
demands and pressures that are not matched to their knowledge and abilities, and which
challenge their ability to cope” (Leka et al., 2003, p. 3). Personal stressors can worsen WRS.
4 J. CAHILL ET AL.

Self-Management of Health & Wellbeing

Self-management of health is a new strategy to managing health conditions including
chronic health conditions. Individuals actively manage issues identified with their illness
or condition. Overall, the emphasis is on the responsibility of the person – who in turn is
supported by their family, work, community, and health service/providers.

Pilots & Depression Severity

An anonymous study of commercial airline pilots in Brazil found the prevalence of pilots
with common mental disorders (CMD), such as mixed anxiety and depression, to be 6.7%
(Feijó et al., 2012). A 2016 study of pilot mental health indicated that 12.6% of respondents
met the threshold for experiencing depression in the last fortnight (Wu et al., 2016).
Research undertaken by Bor et al. (2017) suggests that common psychological problems
in pilots include adjustment disorder, mood disorder, anxiety and occupational stress,
relationship problems, sexual dysfunction, and alcohol problems. Further, a systematic
review of 20 studies examining depression in airline pilots found that the prevalence of
major depressive disorder experienced by commercial airline pilots ranged from 1.9% to
12.6% (Pasha & Stokes, 2018).

Safety-II & Behavior-Based Safety

Safety-II emphasizes the value of using both proactive and predictive safety/risk manage­
ment approaches (Hollnagel, 2014; Hollnagel et al., 2015). Central to Safety-II concepts is
the importance attributed to learning from normal operations, including when things go
well. Safety-II is underpinned by open communication (for example, cockpit briefings and
debriefing) and teamwork between crew members (Hollnagel, 2014; Hollnagel et al., 2015).
Behavioral-based safety (BBS) is a defined as a “reinforcement action taken by an
organization’s management to identify the immediate and root causes of unsafe behavior
and then apply corrective measures to reduce unsafe actions by employees” (Safeopedia,
2020, p. 1). It involves a partnership between management and employees that continually
focuses an employees’ attention on their daily safety behaviors (Cooper, 2009).

Safety/Risk, Management, Pilot Wellbeing & Mental Health: The Regulatory

Approach
The objective of an airline Safety Management System (SMS) is to provide a structured
management approach to control safety risks in operations (European Union Aviation
Safety Agency [EASA], 2018; Skybrary, 2019). In theory, an SMS addresses all risks.
According to ICAO Doc 9859 (2013), an SMS may include both proactive and reactive
methods and techniques. The term “Safety II” is not defined in ICAO’s (2013) recommen­
dations. However, ICAO’s (2019) “Global Aviation Safety Plan,” refers to the future
implementation of predictive risk management practices by 2027.
Crew Resource Management (CRM) training is mandated for all pilots and is a key
component of an airline’s SMS. Typically, this includes information about the practice of
“safety behaviors” and associated Crew Resource Management (CRM) theories (EASA,
 INTERNATIONAL JOURNAL OF AEROSPACE PSYCHOLOGY 5

2017a, 2017b). As argued by Cahill et al. (2019b), CRM training largely relates to certain
bio-medical aspects of health (for example, fatigue), the avoidance of unsafe substances (for
example, alcohol, and drugs), and certain socio-cognitive dimensions of performance (for
example, crew teamwork). Safety behavior is conceived from an operational perspective
(while on duty). Currently, it is not in framed in terms of maintaining a healthy lifestyle,
which has implications in terms of pilot performance and flight safety (Cahill et al., 2019b).
Pilot health and fitness (including mental health) is assessed annually in accordance with
mandatory rules regarding aero-medical assessment (Bor et al., 2010). There are very clear
guidelines concerning the impact of a psychiatric disorder on pilots (Dickens, 2016). All
regulatory bodies distinguish between conditions that result in mandatory exclusion from
flying, and those that allow a pilot to fly under controlled conditions (Dickens, 2016).
Recently, EASA introduced new rules pertaining to pilot mental fitness (EASA, 2019).
These rules span three key areas – psychological testing of aircrew pre-employment in line
flight, access to a psychological support/peer support resource, and substance abuse testing
on a random basis. European airlines are required to demonstrate compliance with these
rules by 2021.

Airline Approaches to Managing Pilot Health & Wellbeing

Airlines follow existing guidance pertaining to aeromedical assessment of pilots, as man­
dated by the regulatory authorities. The health of a commercial airline pilot is assessed
annually. Licenses and flying privileges can be suspended if serious health problems
(including MH issues) are detected. Given that their license is at stake, pilots are likely to
under report MH issues. Further, pilots are not likely to approach aeromedical examiners
for help.
Presently, the primary focus of airline wellbeing interventions pertains to the manage­
ment of crew fatigue and alertness (Cahill et al., 2019a). Risks pertaining to crew fatigue are
monitored as part of airline SMSs (Cahill et al., 2019b). Currently, sources of WRS and
wellbeing factors (spanning the three pillars of wellbeing) are not properly defined within
existing airline safety management systems (Cahill et al., 2019a).
Stress management forms part of an airline’s Crew Resource Management (CRM)
syllabus as defined by EASA (2017a). Specific stress management modules have been
successfully implemented and positive outcomes realized (Moriarty, 2015). However, the
guidance material does not explicitly mention WRS and techniques for managing WRS/
wellbeing issues across the three pillars of wellbeing. Moreover, the guidance does not
address the links between the home/work interface, and stress coping behaviors while on
and off duty.
Following from Crew Resource Management (CRM) and Threat & Error Management
(TEM) concepts, pilots follow strict procedures in terms of crew briefing at the pre-flight
planning and briefing stage (Cahill, 2010). However, existing airline briefing processes do
not address WRS/wellbeing issues. Moreover, specific pre-flight checklists (i.e. standard
operating procedures – SOP) do not include human factors checks in relation to crew
wellbeing and the joint crew state (Cahill, 2010).
In addition, some airlines provide psychological support using a peer-support service
(Atherton 2019). As reported by Atherton (2019), this includes American Airlines, British
Airways, Lufthansa, KLM and Qantas have provided peer support services for several years.
6 J. CAHILL ET AL.

Pilot Stress Coping, Training & Operational Tools

Currently, pilots adopt their own coping mechanisms, relying on themselves as opposed to
their employers (Cahill et al., 2019a). Past research undertaken by authors indicates that
some Pilot self-manage their health and wellbeing – with some using sleep diaries and
adopting exercise routines (Cahill et al., 2018).
Several pilot checklists have been advanced to address pilot risk assessment at an
operational level (and fitness for flight). This includes the I’m Safe Checklist (Houston,
2019) and the Personal Minimums Checklist (Federal Aviation Authority [FAA], 2009,
2020). However, these do not address the three pillars of wellbeing.

Materials & Methods

Survey Design
An anonymous web-based survey was completed by commercial pilots over a fifteen-month
period (between 7 November 2018 and 24 January 2020). Participants were invited to
participate in an anonymous web-based online survey examining the effects of work-
related stress (WRS) on pilot wellbeing, and the associated impact on performance and
flight safety. The survey also investigated coping methods, attitudes to talking about mental
health issues, and perceptions of the airline role in relation to managing WRS and wellbeing
issues.
The survey incorporated several standardized instruments to measure levels of common
mental health issues which have been widely validated and have good psychometric proper­
ties. These are these Patient Health Questionnaire −9 (PHQ-9; Kroenke et al., 2001), the
Oldenburg Burnout (Demerouti et al., 2003), and the Oldenburg Burnout (Modified
Instrument; Demerouti et al., 2019). Further, the survey design also drew upon prior research
undertaken by the authors pertaining to a biopsychosocial model of pilot wellbeing, the factors
that can positively and negatively influence a pilot’s physical, mental and social health, and the
ensuing impact on pilot performance and flight safety (Cahill et al., 2018; Cullen et al., 2017).
First, pilots received background information about the study. They then completed the
electronic consent. Following this, they completed questions for each of the nine sections
(part 2 to part 10). This was followed by a debriefing which included contacts information
for relevant support groups and Pilot Support Groups.
Pilots were recruited using social media platforms such as LinkedIn and Twitter.
The survey was powered by the SurveyMonkey service and did not collect any identifying
information about the person. Further, no internet protocol (IP) addresses were collected. It
was assumed that each participant was a pilot and only completed one survey. Several
questions in the survey required knowledge that would only be readily available to pilots.
An active pilot (coauthor in this study: PC) reviewed surveys for potential non-pilot
participants. All surveys passed this screening. Ethics approval was granted by the School
of Psychology, Trinity College Dublin (TCD), Ireland.

Survey Structure, Topics & Inclusion of Specific Survey Instruments

The survey was divided into eleven sections as follows:
 INTERNATIONAL JOURNAL OF AEROSPACE PSYCHOLOGY 7

● Part 1: Briefing & Consent

● Part 2: About You/Personal Details
● Part 3: About Your Job
● Part 4: Overall Health
● Part 5: Job Satisfaction & Sources of Work-Related Stress
● Part 6: Coping Strategies
● Part 7: Work & Impact on Wellbeing
● Part 8: Work & Impact on Performance/Safety
● Part 9: Mental Health (Attitudes, Talking About Mental Health & Experience)
● Part 10: Airline Practices & Promoting Pilot Wellbeing/Mental Health
● Part 11: Thank You & Debriefing

Survey instruments were embedded in parts 4 and 7. Part 4 elicited feedback about the
participant’s overall health. Questions were posed in relation to sleep, exercise and diet. This
section also incorporated the “Patient Health Questionnaire-9 (PHQ-9)” – a nine-item ques­
tionnaire used to measure and detect/diagnose depression severity (Kroenke et al., 2001). The
PHQ-9 was chosen as it is both sensitive and specific in its diagnoses (Kroenke et al., 2001).
Part 7 elicited feedback about work and impact on wellbeing. Here, there was focus on
eliciting feedback about burnout. As conceived by Demerouti et al. (2001), burnout consists
of two main symptoms. This includes, high levels of exhaustion and a distant/cynical
attitude toward work (Demerouti et al., 2001). As such, this section included questions
derived from the Oldenburg Burnout instrument (OLBI 8; Demerouti et al., 2003), and the
Oldenburg Burnout (Modified Instrument; Demerouti et al., 2019). According to
Demerouti et al., the OLBI has been shown to be a better predictor of long-term health
than of depression and anxiety (Demerouti et al., 2019).

Overview of Data Analysis

The purpose of the data analysis was (1) identify sources of WRS and wellbeing impact, (2)
measure depression levels in pilots, (3) to examine the use of coping strategies (CS), and (4)
to examine the relationship between coping strategies used by pilots and their mental
health – specifically depression severity levels.

● In relation to (1), sources of WRS and wellbeing impact were reported based on pilot
self-reported data.
● In relation to (2), depression levels were scored using the PHQ-9 depression severity
scale (Kroenke et al., 2001). Please see Appendix A for an example of this.
● In relation to (3), we examined prevalence of pilots using CS and the most frequently
used CS.
● In relation to (4), an ordered logistic regression model was advanced to explore the
relationship between the PHQ-9 scores and each of the coping strategies for WRS (i.e.
those listed in the survey).

Please note that thus-far, the data analysis has not addressed burnout.
8 J. CAHILL ET AL.

Ordered Logistic Regression Model & Interpreting the Odds Ratio

The objective was to model the relationship between each frequency level of each coping
strategy and PHQ-9 Scores. Following this, we interpreted the Odds ratio, to assess
statistically significant coping strategies. Logistic regression is a statistical method for
analyzing a dataset in which there are one or more independent variables that determine
an outcome. The outcome is measured with a dichotomous variable (in which there are only
two possible outcomes). The response variable Y is assumed to be binary (i.e. either a failure
or success). In our case, we took the 2 outcomes of the response variable to be: (1) Pilot has
a PHQ-9 score below 10 (Yi ¼ 0Þ or (2) Pilot has a PHQ-9 score of at least 10 ðYi ¼ 1Þ. See
Appendix A: PHQ Scores & Depression Severity. We are interested in drawing inferences
on coping strategies and how they’re related to Depression Severity levels. That is co-
relation not causality (coping strategy causing the PHQ score to be below 10 or vice versa).
This analysis does not consider interaction between different coping methods.
Interpretation of results addressed the odds ratio. If the Odds Ratio is less than 1, then it’s
associated with a probability of having a lower depression severity level. Statistically
significant coping strategies were set at p = .05. For more, please see Appendix C. It should
be noted that the p-value tells us only whether a coping strategy at a certain frequency level
was statistically significant. The odds ratio is what tells us whether that coping strategy is
associated with a higher (if > 1) or lower (<1) depression severity level.

Results
Participant Profiles
1059 pilots completed the online survey (128 female and 895 male). 36 pilots did not give
their gender. 77.5% (n = 821) completed the PHQ. Overall, survey respondents can be
described as male (87.5%), full time (86.9%), married or cohabiting with partner (71.3%),
and based in home country (80.2%). Table 1 below provides a summary of respondent ages.
Table 2 provides a summary of respondent time working as a commercial pilot.
In general, the Pilots surveyed were a reasonably healthy population in terms of their
health behaviors. Most participants reported obtaining between 7 and 8 hours sleep on non-
duty days (37.5% reported 8 hours of sleep, while 28.4% reported 7 hours). Respondents
reported obtaining considerably less sleep during duty periods (41.4% obtaining 6 hours,
and 26.4% 7 hours, 12% 8 hours). The vast majority exercise regularly (24.7% three times
a week, 19.9% twice a week, and 18.3% once a week). Further, the majority reported eating

Table 1. Ages of respondents.

<25 25–35 36–45 46–55 56–65 NA
4.6% 26.5% 30.7% 25.9% 11.7% 0.7%

Table 2. Time working as a pilot.

<2 years 2–5 years 6–10 years 11–15 years 16–20 years 21–25 years 26–30 years 30 years
5.7% 10.4% 15.5% 15.1% 16.0% 12.2% 11.3% 13.8%
 INTERNATIONAL JOURNAL OF AEROSPACE PSYCHOLOGY 9

a healthy diet (87.8%) while off duty, although that number is lower when pilots were on
duty (38.5% said they had a healthy diet on workdays).

Experience of WRS
As indicated in Figure 1, the majority of pilots reported that WRS sources have an impact
on their performance – 63.7% (468) agree, and 19.7% (145) strongly agree that certain WRS
sources have an impact on their performances.

Sources of WRS
As indicated in Figure 2, the top four sources of WRS are working irregular hours, working anti-
social hours, divergence of values between pilots and management and working long duties.

Wellbeing Issues Experienced Due to the Job

As indicated in Figure 3, the job has effects across the three pillars. The main impact is on
bio pillar (sleep, musculoskeletal symptoms), and social sphere (family life, participating in
social events), but also impacts on MH. Sleep difficulties (81.0%) were reported as the most
common wellbeing issue that respondents either attributed to the job or believed to be
worsened by the job. This is followed closely by musculoskeletal symptoms (73.5%) and

Figure 1. Pilot experiences of work-related stress (WRS).

10 J. CAHILL ET AL.

Figure 2. Sources of work-related stress (WRS).

Figure 3. Wellbeing issues suffered due to the job.

 INTERNATIONAL JOURNAL OF AEROSPACE PSYCHOLOGY 11

then digestive symptoms (58.5%). Other impacts include social isolation (49.9%), marital/
family discord (42.9%), respiratory symptoms (32.3%), and psychological distress (36.9%).
Although psychological distress was ranked the third lowest in terms of wellbeing
impact, most respondents indicated that the environment in which Pilots work can con­
tribute to the onset of or worsen an existing mental health issue (58.4% participants agreed,
while 33.5% strongly agreed).

Prevalence of Depression
77.5% of survey respondents (821 pilots) answered the questions that were used to calculate
the PHQ-9 score. As indicated in Figure 4, not all pilots are suffering. The results suggest
that 43.0% are not experiencing depression, while 40.0% met the threshold for mild clinical
depression. A very low number met the threshold for moderately severe (4.4%) or severe
depression (1.6%). The average PHQ-9 score was 6.03, while the median score was 5 (i.e.
half of the pilots had a score greater than 5). 25% of the pilots had a PHQ-9 score greater
than 8. 8.4% of pilots (n = 877) rated their mental/emotional health as being either Bad or
Very Bad (8.4% of respondents). For a full breakdown of depression severity levels in the
dataset, please see Appendix B.
Pilots seem self-aware of the state of their mental health – the PHQ-9 scores accurately
reflected the self-reported mental health states, as shown in Figure 5 below.

Figure 4. PHQ-9 scores for pilots.

12 J. CAHILL ET AL.

Figure 5. Self-reported mental health.

Pilots of all ages suffer equally – there is no evidence that any age group suffers to
a greater or less degree. There was no evidence for PHQ-9 scores differing across operation
types. There was no visible relationship between roster type and PHQ-9 scores.

Prevalence of Coping Strategies

Pilots were questioned as to whether they had any coping strategies that helped them deal
with WRS. 783 answered this question. The majority of pilots are using CS (59.3% using CS,
40.7% not using CS).

Most Frequently Reported/Used Coping Strategies

As depicted in Figure 6, the top coping strategy appears to be Exercise (11.7% once a month,
8.0% 2–3 times per month, once a week 14.3%, Several times a week 46.2%, Daily 11.8%).
This was followed by focusing on sleep/relaxation (5.09% once a month or less, 6.03% 2–3x
a month, 11.3% once a week, 39.4% several times a week, 26.1% daily). Focusing on diet was
third (7.1% once a month or less, 5.9% 2–3 times per month, 10.3% once a week, 39.8%
several times per week, 20.8% daily).
 INTERNATIONAL JOURNAL OF AEROSPACE PSYCHOLOGY 13

Figure 6. Coping strategies for WRS.

Coping Methods & PHQ Scores

Table 3 below presents the distribution of PHQ scores for using and not using CS. As
indicated in Table 3, there was not much of a difference between the two groups.
This was followed by a one-way ANOVA to determine whether the average PHQ scores
differed across the two groups. We found no evidence of this being the case (see boxplot
depicted in Figure 7 below).

Coping Strategies & PHQ Scores

The three coping strategies associated with odds of having a higher depression severity
level are:

(1) Discussing WRS with colleagues 2–3 times a month

(2) Focusing on relaxation behavior once a week
(3) Focusing on relaxation behavior several times a week

The coping strategies most associated with lower depression severity levels are

(1) Focussing on sleep daily

(2) Focussing on exercise several times a week
(3) Focussing on exercise daily
(4) Focussing on exercise 2 to 3 times a month
14 J. CAHILL ET AL.

Table 3. Distribution of pilots using and not

using CS and PHQ-9 scores.
Yes No
Count 464 319
Percentage 59.2% 40.8%
Avg PHQ-9 Score 5.86 6.31

Figure 7. Boxplot – existence of coping strategies and depression severity.

All the statistically significant “focusing on sleep” frequency levels (F3 and F4) are
associated with lower PHQ severity levels.
For a full list of statistically significant coping strategies – please see Appendix C.

Discussion
Coping
This research presents a picture of pilots that are coping and adopting strategies to enable
them to cope with different sources of WRS. Fatigue and sleep management is a key
strategy, along with exercise and the management of diet. These strategies enable some
pilots to cope in a work environment that is detrimental for others. To this end, we would
recommend that pilots use these strategies to manage WRS/wellbeing challenges (including
MH) and increase their resilience.
 INTERNATIONAL JOURNAL OF AEROSPACE PSYCHOLOGY 15

It should be noted that the regression model tells us about the probability of the strategy
making a difference to depression severity. The impact of using individual coping mechan­
isms to manage specific sources of stress (and associated contributory factors to depression
outcomes) is not known. Further, this model is on a “per strategy” basis and does not
include the interaction between strategies. Potentially, those pilots with the best outcomes
may be using one or more coping strategies. If this relationship is better understood, then
further lessons might be learned in terms of the application of specific strategies.
Further, an understanding of pilot-coping strategies might underscore interventions at
different levels. Potential interventions are likely to be multi-component, spanning different
socio-technical dimensions (i.e., training, culture, technology, and process design). These
are discussed in more detail below.

Training
Current training does not focus on the promotion of resilience and the development of
coping skills (i.e. learning how to be resilient to challenges and practice self-management
techniques)- linking to preventative mental health approaches. Overall, the objective of
such training should be to increase a pilot’s ability to cope. Pilots need to be trained in
terms of (a) awareness of stress/WRS and its impact on wellbeing including MH, (b) MH
awareness, (c) stress coping methods and self-managing wellbeing, (d) risk identifying in
relation to their own wellbeing/MH (i.e. detecting potential for problem and managing
this). Educational strategies are required to promote learning about personal health,
maintaining work-family balance, and using coping strategies that suit the person and
specific occupational and home/work interface demands. Pilots might also benefit from
training in meditation and mindfulness. Such training might go beyond traditional
classroom formats and include online materials and the use of serious games or other
interactive formats.

New Checklists (On & Off Duty)

This research indicates the requirements for augmenting existing checklists for use by
pilots – both while on and off duty. Typically, pilots use checklists as part of the operation –
both pre-flight, during and post flight. Amendments to existing pre-flight checklists are
required for use by pilots as part of their pre-flight briefing (i.e. in the cockpit and/or the
crew briefing room), so that they can both individually and jointly evaluate their health and
wellbeing. Table 4 below provides an example of an extended version of the “I’m Safe

Table 4. Enhanced I’m safe checklist.

I Illness & Do I have an illness or any symptoms of an illness?
Wellbeing Am I feeling good/well? How is my overall health and wellbeing? Physical health? Emotional/
Psychological Health? What’s my mood and attitude like?Social Health? Have I seen family/
friends? Getting help/support if needed?
M Medication Have I been taking prescription or over-the-counter drugs?
S Stress & Stress Am I under psychological pressure from the job? Worried about financial matters, health problems
Coping or family discord?Am I actively managing my stress? Exercise? Social? Do I need help?
A Alcohol Have I been drinking within eight hours? Within 24 hours?
F Fatigue Am I tired and not adequately rested? Have I been managing my sleep?
E Eating & Exercise Am I adequately nourished and hydrated? Am I taking physical exercise?
16 J. CAHILL ET AL.

Checklist” (Houston, 2019). The items in red indicate the additional content included in the
checklist.
Overall, this augmented checklist addresses a positive definition of wellbeing and
not simply illness. The objective is to nudge the pilots to assess (1) their health status
in relation to all three pillars of wellbeing, and (2) how they are coping (i.e. use of
coping strategies). In relation to (1), this includes current emotional (i.e. mood and
attitude) and social state. Further, physical exercise is also incorporated. In relation to
(2), stress coping is included alongside stress levels. As demonstrated in this research,
the practice of healthy behaviors (i.e. use of coping strategies such as sleep manage­
ment, taking physical exercise and manging diet and nutrition) is associated with lower
depression levels.
Further, checklists might be developed for use by pilots while off duty – linking to the
management of the home/work interface. Again, it is proposed that the checklist items
would link to the findings of this analysis – in terms of (1) and (2) as defined above. For an
example of this, please see Table 5.

New Digital Tool (Inside & outside the Cockpit)

This research underscores the need for new digital tools to support pilot self-management
of wellbeing and safety behavior. This might involve the advancement of a mobile phone
App with different wellness functions. For example, the App might include the following
functions:

(1) Promote awareness of WRS and its impact on wellbeing (including MH)
(2) Support the development and maintenance of coping skills
(3) Enable pilot routine self-assessment of their own wellbeing – linked to auto-
harvested and self-reported data
(4) Enable pilot reporting of their wellness information to the airline (i.e. integrated with
airline SMS and flight planning/rostering systems)
(5) Enable pilot management of crisis situations (access to supports – including in
person support)

In relation to (3), the implementation of a self-assessment function might take various

forms. For example, it might be simple reminder to pilots to assess their current state and
what they are doing to manage this (i.e. nudge to use coping strategies). In this way, it would
promote the use of healthy behaviors/coping strategies which this research has identified as
being associated with lower depression levels. A more sophisticated version might provide

Table 5. Reporting wellbeing management across the three pillars.

How Am I Doing? What Can I Do to Improve this?
Current Rating/Status? What Am I Currently Doing to
Pillar Example (Good, Ok, Poor) Improve this?
Biological Sleep, Diet, Exercise
Psychological Attitude to life, Mood, Stress Management,
Use of Coping Strategies
Social Support Network, Social Support
 INTERNATIONAL JOURNAL OF AEROSPACE PSYCHOLOGY 17

a wellbeing score based on data integrated from diverse sources (for example, sleep and
exercise data auto-harvested from a Fit-Bit or other wearable device that the pilot may use)
and data self-reported by the pilot.
Pending pilot consent and appropriate protections, wellbeing data might be shared in a de-
identified format with the pilot’s airline, so that it could be used from an operational and safety
management perspective. Individual pilot data might be aggregated at a fleet level, to ensure
optimum flight planning and rostering/scheduling of crew. Moreover, data pertaining to pilot
wellbeing could be incorporated in safety/risk assessments and safety promotion activities. Lastly,
specific data might be shared with aeromedical examiners, to support fitness to fly assessments,
pending pilot agreement. This would necessitate common agreement and strategies across the key
stakeholders (i.e. pilots, airlines, aeromedical examiners, regulators etc.) as to the appropriate use of
personal and health data for the purpose of preventing and managing wellbeing issues amongst
pilots, while also addressing issues pertaining to fitness to fly. The requirements for such tools are
discussed in more detail in a separate paper (Cahill et al., 2020).

EASA Rule Making & Stakeholder Tools/Perspectives

Airlines and pilots need the right tools to safeguard the wellbeing and mental fitness of
pilots and ensure flight safety. This research indicates the existing regulation is not going far
enough. From an ethos perspective, the focus should be on prevention (and not simply
detection), and the promotion of all three pillars of wellbeing and not simply psychological
wellbeing.
As defined previously, the existing IR do not address interventions at the pilot self-
management level. Further, they are conceived from an operational perspective and do
address WRS and associated risks from the perspective of managing the work/life interface.
It is not likely that EASA can mandate the use of new self-management tools by pilots.
However, these might be considered as “best practice” and considered in terms of EASA’s
Guidance Material pertaining to safety promotion and CRM training.
Existing CRM and stress management training might be strengthened to include the
practice of healthy behaviors across the three pillars, fostering coping ability and skills,
the application of specific coping strategies, and risk identification both inside and
outside the cockpit.
Currently, sources of WRS and wellbeing factors (spanning the three pillars of well­
being) are not properly defined within existing airline SMS’s. From a safety/risk manage­
ment perspective, airline safety management systems should manage human factors risks
linking to the three pillars of wellbeing. Critically, existing fatigue risk management
systems (and by implication airline rostering/flight planning systems) need to be extended
to consider the relationship between fatigue risk and the other dimensions of a pilot’s
wellbeing. As noted above, this would require making use of a pilot’s wellbeing data
within the airline SMS.

Safety Behavior
This research calls for a new framework in relation to defining safety behavior for pilots.
This framework should be underpinned by (1) a focus on pilot wellness – the “biopsycho­
social,” (2) on managing the home/work interface and the intersections between the two
18 J. CAHILL ET AL.

which impacts wellness and (3), on the relationship between WRS, pilot wellbeing, perfor­
mance, and safety. Overall, the management of health and wellbeing both inside and outside
work should be considered a core safety behavior. This follows a collective approach to
“behavior-based safety” and has implication at an operational level (i.e. design of airline
processes and systems) and pilot level (i.e. self-management of heath while on and off duty).
Behavior change for both pilots (i.e. employees) and airlines (i.e. employers), with support
from the regulator, is required. At a conceptual level, this is in line with a systematic
approach to human factors and Safety-II concepts.

Limitations
Survey participants were recruited using social media. There may be issues pertaining to
self-selection of candidates (i.e. bias in relation to interest in wellbeing). Survey data were
self-reported. There is a potential bias in terms of the respondent’s own perception. Further,
survey data is cross-sectional in nature. The results can only be used to evaluate the sample
for the time-period during which this data was collected. Thus, no cause-and-effect rela­
tionship can be drawn from the findings. Additional research (for example, one to one
interview with pilots) is required to unpack specific WRS issues and wellbeing factors as
emerged in both the workshop and survey feedback.
As noted previously, the model does not tell us whether a coping strategy made
a difference. Strategies are associated with lower or high depression severity levels only.
To assess the effectiveness of a coping strategy, would require significant observation of
pilots over a period of time (while controlling all other variables) and asking them to use
certain coping mechanisms to see whether they might make a difference over the time
period. Further, the regression model is on a per strategy basis – it does not consider
interactions between different strategies.
This research reflects the perspective of one stakeholder group (namely pilots). As such,
it needs to be validated with other stakeholder groups. This might include clinicians,
occupational health and safety experts, airline management, and the aviation authorities.
Moreover, there is a specific requirement to engage with both airlines and the aviation
authorities, in terms of advancing a road map for rulemaking and the implementation of
solutions at an airline level.

Areas for Further Analysis

As noted previously, our current model is on a “per strategy” basis. A future analysis will
focus on interactions across coping methods.
Exercise and sleep management at different frequency levels are being associated with lower
depression severity levels. It is not currently clear how frequency relates to the likelihood of it
being associated lower depression severity. Further analysis will address how frequency links
with the likelihood of the strategy being associated with lower depression severity.
The existing analysis uses the pilots PHQ-9 scores as our response variable. For future
research, it would be interesting to use other variables lining to the data collected in the
survey. As such, the next phase of data analysis will address engagement, emotional
exhaustion, and burnout.
 INTERNATIONAL JOURNAL OF AEROSPACE PSYCHOLOGY 19

In addition, participatory co-design activities will also be undertaken with different

stakeholders to address wellbeing interventions (training, checklists, digital tools) at differ­
ent levels (pilot, airline, regulator).
Lastly, the job of being a commercial pilot has some positive effects. Further, certain
technical and non-technical aspects of the “flying task” has positive wellbeing implications
(Cahill, 2010). Additional research may address the positive impacts of the job (in addition
to sources of WRS and its negative impacts).

Conclusion
All stress cannot be removed from the work-life of pilots. A high-stress situation is not always
detrimental for a person’s wellbeing. The use of coping strategies such as managing sleep and
exercise enables a person to manage WRS in a healthy manner and build resilience.
The wellbeing of pilots is being negatively affected by certain sources of WRS. Strategies
such as sleep management and taking regular physical exercise enable some pilots to cope in
a work environment that is detrimental for others. Critically, these strategies enable pilots to
increase their resilience to wellbeing challenges (including MH challenges) and are asso­
ciated with lower depression severity levels.
This research has led to evidence-based recommendations for interventions to promote
wellbeing (including positive mental health and mental wellbeing) in the workplace, both at
an airline level and pilot self-management level (including while on and off duty). Overall,
airline organizations might increase their support for preventative mental health treatment,
and supporting pilot training in relation to adopting healthy behaviors, using specific
coping strategies, and risk identifying behavior. Future research might address the intro­
duction of new training tools, checklists, and digital tools, to support pilot management of
specific sources of WRS both inside and outside work.
The results of this study should be interpreted with potential limitations in mind. Next
steps will involve further analysis of survey data – in particular, in relation to pilot burnout.
Participatory co-design activities will also be undertaken with stakeholders to define the
requirements for new training tools, checklists, and digital tools, along with a suitable
implementation approach.

Acknowledgments
The authors would like to thank pilots for their participation in this study. The views expressed in this
study do not represent the views of the authors employers.

Disclosure Statement
This is to acknowledge that the authors have not received any financial interest or benefit from the
direct applications of our research.

ORCID
Joan Cahill http://orcid.org/0000-0001-6944-744X
20 J. CAHILL ET AL.

References
Atherton, M. (2019). A question of psychology. Retrieved March 6, 2019, from https://www.aer
osociety.com/news/a-question-of-psychology/
Blazer, D. G. (2002). Self-efficacy and depression in late life: A primary prevention proposal. Aging &
Mental Health, 6(4), 315–324. https://doi.org/10.1080/1360786021000006938
Bliese, P. D., & Castro, C. A. (2003). The soldier adaptation model (SAM): Applications to peace­
keeping research. In T. W. Britt & A. B. Adler (Eds.), The psychology of peacekeeping: Lessons from
the field (Vol. 2003, pp. 185–203). Praeger.
Bor, R., Eriksen, C., Oakes, M., & Scragg, P. (Eds). (2017). Pilot mental health screening and
assessment. Ashgate Publications.
Bor, R., Field, G., & Scragg, P. (2010). The mental health of pilots: An overview. Counselling
Psychology Quarterly, 15(3), 239–256. https://doi.org/10.1080/09515070210143471
Cahill, J. (2010). Flight crew task performance and the requirements for a new tool supporting the
pre-flight, flight planning and briefing task [Doctoral dissertation, Trinity College Dublin, Dublin,
Ireland. Thesis 9479.1, TCD E-Thesis Access]. http://stella.catalogue.tcd.ie/iii/encore/record/C__
Rb16723129__Scahill%2C%20joan__Orightresult__U__X4?lang=eng&suite=cobalt
Cahill, J., Cullen, P., Anwer, S., Gaynor, K., & Wilson, S. (2020). The requirements for new tools for
use by pilots and the aviation industry to manage risks pertaining to Work-Related Stress (WRS)
and wellbeing, and the ensuing impact on performance and safety. Technologies, 8(3), 40. https://
doi.org/10.3390/technologies8030040
Cahill, J., Cullen, P., & Gaynor, K. (2018, September 20-21). Estimating the impact of work-related
stress on pilot wellbeing and flight safety [Paper presentation]. 2nd International Symposium on
Human Mental Workload: Models and Applications (H-WORKLOAD 2018), Amsterdam,
Netherlands Aerospace Centre (NLR), The Netherlands.
Cahill, J., Cullen, P., & Gaynor, K. (2019b, May 7-10). Estimating the impact of work-related stress on pilot
wellbeing and flight safety. Proceedings of the International symposium on Aviation Psychology.
Cahill, J., Cullen, P., & Gaynor, K.(2019a). Interventions to support the management of work-related
stress (WRS) and wellbeing/mental health issues for commercial pilots. Cogn Tech Work, 22, 517–
547. Springer. https://doi.org/10.1007/s10111-019-00586-z
Cooper, D. (2009). Behavioral safety: A framework for success. B-Safe Management Solutions Inc.
Cullen, P., Cahill, J., & Gaynor, K. (2016, November). Managing mental health issues in pilots [Paper
presentation]. The Human Factors in Aviation Safety Conference.
Cullen, P., Cahill, J., & Gaynor, K. (2017, October 23-25). Pilot wellbeing [Paper presentation]. Flight
Safety Foundation 2017 – 70th International Air Safety Submit (IASS), Dublin.
Cullen, P., Cahill, J., & Gaynor, K. (2020). Turbulent times. Part of School of Psychology, TCD
website. https://www.tcd.ie/cihs/assets/pdf/TurbulentTimes.pdf
Demerouti, E., Bakker, A. B., Nachreiner, F., & Schaufeli, W. (2001). The job demands-resources model of
burnout. Journal of Applied Psychology, 86(3), 499. https://doi.org/10.1037/0021-9010.86.3.499
Demerouti, E., Bakker, A. B., Vardakou, I., & Kantas, A. (2003). The convergent validity of two
burnout instruments: A multitrait-multimethod analysis. European Journal of Psychological
Assessment, 19(1), 12. https://doi.org/10.1027//1015-5759.19.1.12
Demerouti, E., Veldhuis, W., Coombes, C., & Hunter, R. (2019, February). Burnout among pilots:
Psychosocial factors related to happiness and score on simulator training. Ergonomics, 62(2), 233–
245. American Psychological Association. Epub 2018 Jun 18. PMID: 29648499. https://doi.org/10.
1080/00140139.2018.1464667
Dickens, P. (2016). Beyond germanwings flight 9525: Pilot mental health and safety. EAAP.
Engel, G. (1977). The need for a new medical model: A challenge for biomedical science. Science, 196
(4286), 126–129. https://doi.org/10.1126/science.847460
European Union Aviation Safety Agency (EASA). (2017a). Guidance for CRM implementation.
Retrieved July 17, 2019, from https://www.easa.europa.eu/document-library/general-publica
tions/crm-training-implementation
 INTERNATIONAL JOURNAL OF AEROSPACE PSYCHOLOGY 21

European Union Aviation Safety Agency (EASA). (2017b). Crew resource management in practice.
European Aviation Safety Agency.
European Union Aviation Safety Agency (EASA). (2018). European Aviation Safety Agency.
Retrieved July 17, 2019, from https://www.easa.europa.eu/easa-and-you/safety-management
/safety-management-system/sms-easa-rules
European Union Aviation Safety Agency (EASA). (2019). Commission regulation (EU) No 965/2012 on Air
Operations and associated EASA decisions (AMC, GM and CS-FTL.1), consolidated version for easy access
rules, revision 12, March 2019. Part ORO, Annex II, Part ORO, ORO.GEN.200 Management Systems and
associated Acceptable Means of Compliance (AMCs) and Guidance Material (GMs). https://www.easa.
europa.eu/sites/default/files/dfu/Air%20OPS%20Easy%20Access%20Rules_Rev.12_March%202019.pdf
Federal Aviation Authority (FAA). (2009). PAVE—Personal minimums checklists. Federal Aviation
Administration, Safety Team. Retrieved March, 12, 2020, from https://www.faa.gov/training_
testing/training/fits/guidance/media/personal%20minimums%20checklist.pdf
Federal Aviation Authority. (FAA). (2020). PAVE - Personal minimums checklists. Federal Aviation
Administration, Safety Team. Retrieved March, 12, 2020, from https://www.faa.gov/regulations_
policies/handbooks_manuals/aviation/phak/media/02_phak_toc.pdf
Feijó, D., Luiz, R. R., & Camara, V. M. (2012). Common mental disorders amongst civil aviation pilots.
Aviation, Space, and Environmental Medicine, 83(5), 509–513. https://doi.org/10.3357/ASEM.3185.2012
Fikretoglu, D., & McCreary, D. R. (2012). Psychological resilience: A brief review of definitions, and key
theoretical, conceptual, and methodological issues (Technical Report DRDC Toronto TR 2012-012).
Defense Research and Development, Canada. https://cradpdf.drdc-rddc.gc.ca/PDFS/unc121/p536951_
A1b.pdf
Flight Safety Foundation. (2020). An aviation professional’s guide to wellbeing. https://flightsafety.org/
wp-content/uploads/2020/04/Guide-to-Wellbeing.pdf
Flinchbaugh, C., Luth, M., & Li, P. (2015). A challenge or a hindrance? Understanding the effects of
stressors and thriving on life satisfaction. International Journal of Stress Management, 22(4),
323–345. https://doi.org/10.1037/a0039136
Hollnagel, E. (2014). Safety-I and safety-II: The past and future of safety management. Ashgate.
Hollnagel, E., Wears, R. L., & Braithwaite, J. (2015). From safety-I to safety-II: A white paper. Published by The
Authors.
Houston, S. (2019). Pilot risk management: There’s a checklist for that! The Balance Careers. https://www.
thebalancecareers.com/the-i-m-safe-checklist-282948
Houtman, I., & Jettinghoff, K. (2007). Raising Awareness of Stress at Work in Developing Countries
A modern hazard in a traditional working environment. WHO Protecting Workers Health, Series 6.
WHO Press.
International Civil Aviation Authority (ICAO). (2013). Safety management manual, 3rd ed. Doc
9859, Safety Management Manual (SMM) Order Number: 9859.
International Civil Aviation Authority (ICAO). (2019). Global Aviation Safety Plan (GASP). Doc
1004. International Civil Aviation Authority. Retrieved July 17, 2019, from https://www.icao.int/
publications/pages/publication.aspx?docnum=10004
Jordan, T., Khubchandani, J., & Wiblishauser, M. (2016). The impact of perceived stress and coping adequacy
on the health of nurses: A pilot investigation. Nursing Research and Practice, 2016, Article ID 5843256.
Hindawi Publishing Corporation. https://doi.org/10.1155/2016/5843256
Kenny, A. (2011). Aristotle: The eudemian ethics. Oxford University Press.
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (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
Lazarus, R. S. (1990). Theory-based stress measurement. Psychological Inquiry, 1(1), 3–13. https://doi.
org/10.1207/s15327965pli0101_1
Leka, S., Griffiths, A., & Cox, T. (2003). Work organisation & stress: Systematic problem approaches for
employers, managers and trade union representatives. (Protecting Workers’ Health Series: No. 3).
World Health Organization.
22 J. CAHILL ET AL.

Moriarty, D. (2015). Practical human factors for pilots. London, UK: Academic Press.
Morimoto, H., & Shimada, H. (2015). The relationship between psychological distress and coping
strategies: Their perceived acceptability within a socio-cultural context of employment, and the
motivation behind their choices. International Journal of Stress Management, 22(2), 159–182.
https://doi.org/10.1037/a0038484
National Institute for Health & Care Excellence (NICE). (2009). Mental wellbeing at work. National
Institute for Health & Care Excellence. https://www.nice.org.uk/guidance/ph22
Pasha, T., & Stokes. (2018). Reflecting on the germanwings disaster: A systematic review of depression and
suicide in commercial airline pilots. Front. Psychiatry, 9, 89. https://doi.org/10.3389/fpsyt.2018.00086
Ryff, C. D., & Singer, B. H. (2006). Best news yet on the six-factor model of wellbeing. Social Science
Research, 35(4), 1103–1119. https://doi.org/10.1016/j.ssresearch.2006.01.002
Safeopedia. (2020). Behaviour based safety. safeopedia.com
Seligman, M. (2002). Authentic happiness: Using the new positive psychology to realize your potential
for lasting fulfillment. Free Press.
Skybrary. (2019, January 23). Safety management systems. Eurocontrol. https://www.skybrary.aero/
index.php/Safety_Management_System
World Health Organisation (WHO). (2018). Mental health: Strengthening our response. World Health
Organisation. https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-
response
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(1), 1–12. https://doi.org/10.1186/s12940-016-0200-69

Appendix A. Scoring of depression severity levels

Score Depression Severity

0–4 Minimal/None
5–9 Mild
10–14 Moderate
15–19 Moderately severe
20–27 Severe

Appendix B. Breakdown of depression severity in dataset

Depression Severity No of pilots

None 353 (43.00%)
Mild 328 (40.00%)
Moderate 91 (11.08%)
Moderately Severe 36 (4.38%)
Severe 13 (1.58%)
 INTERNATIONAL JOURNAL OF AEROSPACE PSYCHOLOGY 23

Appendix C. Ordered logistic regression model

The results of the model are as follows. Frequency levels as F1 = 2–3 times a month, F2 = Once per
week, F3 = Several times a week, F4 = Daily. This is just for the sake of quickly typing up the results.
Highlighted in green are the statistically significant coping strategies at p = .05.

Parameter Value Std Error t-value p-value Odds Ratio

Exercise – F1 −0.66 0.32 −2.04 .04 0.52
Exercise – F2 0.23 0.25 −.92 .3 1.26
Exercise – F3 −0.77 0.22 −3.50 .0004 0.46
Exercise – F4 −0.69 0.29 −2.37 .01 0.50
Diet – F1 0.50 0.36 1.39 .17 1.09
Diet – F2 0.31 0.30 1.04 .30 1.37
Diet – F3 0.34 0.22 1.50 .13 1.40
Diet – F4 −0.42 0.27 −1.5 .12 0.66
Sleep – F1 0.50 0.36 1.39 .17 1.65
Sleep – F2 −0.44 0.30 −1.45 .15 0.66
Sleep – F3 −0.46 0.24 −1.02 .05 0.63
Sleep – F4 −0.89 0.26 −3.36 .0007 0.41
Relaxation behavior – F1 −0.009 0.32 −0.03 .98 1.00
Relaxation behavior – F2 0.49 0.30 1.63 .10 1.64
Relaxation behavior – F3 0.46 0.24 −1.92 .05 2.50
Relaxation behavior – F4 0.09 0.48 0.18 .86 1.09
Talk about stress – F1 −0.09 0.23 −0.34 .74 0.92
Talk about stress – F2 0.19 0.30 0.65 .5 1.21
Talk about stress – F3 0.04 0.28 0.15 .8 1.04
Talk about stress – F4 0.47 0.44 1.06 .29 1.60
Organized supports – F1 0.30 0.49 0.61 .54 1.35
Organized supports – F2 0.38 1.19 0.32 .70 1.47
Organized supports – F3 −0.34 0.76 −0.44 .66 0.72
Organized supports – F4 −1.06 1.32 −0.90 .42 0.35
Discuss w/ colleagues – F1 0.04 0.21 0.21 .83 1.05
Discuss w/ colleagues – F2 −0.31 0.25 −1.24 .22 0.73
Discuss w/ colleagues – F3 −0.20 0.25 −0.80 .42 0.82
Discuss w/ colleagues – F4 0.92 0.44 2.07 .03 2.51
Discuss w/ fam/fr – F1 −0.05 0.22 −0.22 .83 0.95
Discuss w/ fam/fr – F2 −0.3 0.25 −1.22 .22 0.74
Discuss w/ fam/fr – F3 −0.04 0.26 −0.17 .86 0.96
Discuss w/ fam/fr – F4 −0.12 0.45 −0.26 .80 0.89
β10 −1.09 0.21 −5.08 4 × 10 7
β20 0.99 0.21 4.64 3 × 10 6
β30 2.34 0.25 9.38 7 × 10 21
β40 3.70 0.35 10.31 6 × 10 21

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