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Longitudinal surveys of adults in the United States have shown that approximately 1 in 5 individuals experienced a mental illness in the prior year, with an increase in the observed prevalence over the last decade. Studies of physicians, including medical students, residents, and fellows, have shown that they also experience mental disorders, with some research (e.g., on depression) showing prevalence rates higher than those in the general population. Tragically, physicians also have higher suicide rates than the general population. In this commentary, the author discusses his own challenges with mental disorders beginning in early childhood. He shares how earlier trauma led to the emergence of symptoms that nearly caused him to withdraw from medical school during his first year, and he describes how support from a faculty member helped him receive psychiatric treatment that allowed him to successfully negotiate that serious crisis and experience a long, productive career. The author underscores how the idealized image of the physician as care giver rather than care receiver that many bring to their medical career, as well as the stigma associated with mental disorders, may prevent physicians from seeking care. He uses the narrative of his personal journey to make a plea to colleagues to share their own stories of mental illness and successful treatment, arguing that this is key to ultimately destigmatizing these issues for the profession of medicine., (Copyright © 2021 by the Association of American Medical Colleges.)

Background: The literature on loss and traumatic grief after disasters provides findings on the impact of losing a partner, child or close friend on partners, parents and friends. However, little attention has been given to the broader everyday social environment of deceased persons. The present study constitutes a qualitative exploration of the impact on colleagues and neighbors following the MH17 airplane disaster in the Ukraine, July 2014., Methods: Eighteen structured interviews were conducted with eleven colleagues and seven neighbors. The interviews focused on the relation(-ship) with the victim, on the disaster, the first days and weeks hereafter, and the status one and a half years after the crash., Results: Especially for colleagues and neighbors with an intensive, long-lasting relation and ties based on friendship and trust, the impact of the sudden death was large. The MH17 disaster was considered a special event, different from, for instance, an "ordinary" accident. It was actively covered by the media and a recurrent conversation topic in meetings with other people. In the workplace, employers and less involved colleagues show empathy for a limited period of time, but grief has an expiration date - a moment where it gets more difficult to others or influences productivity. The appreciation for rituals in the workplace or in the neighborhood varies., Conclusions: The interviews indicate a "hierarchy of bereavement". People are not part of the typical inner circle, but feel "affected" and experience little social recognition and acknowledgment, particularly in the longer term. As such, colleagues and neighbors may experience loneliness and/or isolation. Generally, there is no need to consult a practitioner, despite the experience of health complaints such as intrusive dreaming and lack of sleep.

Background: Previous latent trajectory studies in adult bereaved people have identified individual differences in reactions postloss. However, prior findings may not reflect the complete picture of distress postloss, because they were focused on depression symptoms following nonviolent death. We examined trajectories of symptom-levels of persistent complex bereavement disorder (PCBD), depression, and posttraumatic stress disorder (PTSD) in a disaster-bereaved sample. We also investigated associations among these trajectories and background and loss-related factors, psychological support, and previous mental health complaints., Methods: Latent class growth modeling was used to identify distinct trajectories of PCBD, depression, and PTSD symptoms in people who lost loved ones in a plane disaster in 2014. Participants (N = 172) completed questionnaires for PCBD, depression, and PTSD at 11, 22, 31, and 42 months postdisaster. Associations among class membership and background and loss-related variables, psychological support, and previous mental health complaints were examined using logistic regression analyses., Results: Two PCBD classes emerged: mild (81.8%) and chronic (18.2%) PCBD. For both depression and PTSD, three classes emerged: mild (85.6% and 85.2%), recovered (8.2% and 4.4%), and chronic trajectory (6.2% and 10.3%). People assigned to the chronic PCBD, depression, or PTSD class were less highly educated than people assigned to the mild/recovered classes., Conclusions: This is the first latent trajectory study that offers insights in individual differences in longitudinal symptom profiles of PCBD, depression, and PTSD in bereaved people. We found support for differential trajectories and predictors across the outcomes., (© 2018, The Authors. Depression and Anxiety published by Wiley Periodicals, Inc.)

People can experience disasters vicariously (indirectly) via conversation, social media, radio, and television, even when not directly involved in a disaster. This study examined whether vicarious exposure to the MH17-airplane crash in Ukraine, with 196 Dutch victims, elicited affective and somatic responses in Dutch adults about 2,600 km away, who happened to participate in an ongoing diary study. Participants (n = 141) filled out a diary three times a day for 30 days on their smartphones. Within-person changes in positive affect (PA) and negative affect (NA) and somatic symptoms after the crash were studied. Additionally, we tested whether between-person differences in response could be explained by age, baseline personality (NEO-FFI-3), and media exposure. The MH17 crash elicited a small within-person decrease in PA and an increase in NA and somatic symptoms. This response waned after 3 days and returned to baseline at day four. The decrease in PA was larger in more extraverted participants but smaller in those higher on neuroticism or conscientiousness. The NA response was smaller in elderly. Personality did not seem to moderate the NA and somatic response, and neither did media exposure. Dutch participants showed small acute somatic and affective responses up till 3 days to a disaster that they had not directly witnessed. Vicariously experienced disasters can thus elicit affective-visceral responses indicative of acute stress reactions. Personality and age explained some of the individual differences in this reaction., (© 2018 The Authors. British Journal of Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

INTRODUCTION: Human factors have contributed to a constant increase in the level and numbers of aviation incident involvement. The primary objective of this study is to investigate the relationships between anticipated negative emotions (ANEs) and incident involvement among Chinese civil pilots. Furthermore, this paper examines the role of risk perception and proactive coping within the relationships in order to understand the mechanisms underlying pilots' involvement in air transport incidents. METHODS: A cross-sectional regression design was used to measure ANEs (Anticipated Negative Emotions Scale), proactive coping (Proactive Coping Scale), risk perception (Pilot Risk Perception Scale), and incident involvement (Hazardous Events Scale) among 295 Chinese civil pilots from China Southern Airlines. Mediation and moderating effects were explored using regression analyses and were confirmed by the bootstrapping approach. RESULTS: The results show that ANEs are significantly correlated with risk perception ( r = -0.55) and incident involvement ( r = 0.28). ANEs have a direct effect on pilot involvement in incidents and have an indirect effect on pilot incident involvement through the influencing of risk perception. Proactive coping was also found to weaken the direct effect of anticipated negative emotions on incident involvement. DISCUSSION: The safety benefits of proactive coping are more pronounced among pilots with high levels of ANEs. The practical implications of the study include recommendations relating to injury prevention efforts in incident involvement. Future research directions are also discussed. Wang H, Xu Q, Yang C, You X, Ji M. Anticipated negative emotions effect on incident involvement among civil pilots . Aerosp Med Hum Perform. 2019; 90(9):774-781.

Zhang JJ. You're the flight surgeon: airman with emotional trauma following deployments. Aerosp Med Hum Perform. 2019; 90(5):496-500.

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.

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., Competing Interests: The authors declare no conflict of interests.

Pilots who decide to continue a flight into deteriorating weather conditions, rather than turn back or divert, are a significant cause of fatal crashes in general aviation. Earlier research has suggested that cognitive biases such as the anchoring effect and confirmation bias are implicated in many decisions to continue into worsening weather. In this study, we explored whether a simple debiasing technique, 'considering the alternative', reduced the effect of these two potentially fatal biases. Despite the study being adequately powered, our attempts to reduce the effects of biases were both unsuccessful. Negative findings such as these are particularly useful in aviation, as they can provide information on what does not work in this high stakes industry, even though such strategies may work elsewhere., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

We examine whether reporting on violent and terrorist acts committed in July 2016 by persons who, among other characteristics, were suspected to have mental health issues did impact on mental illness stigma, and whether any changes added to changes observed after the Germanwings plane crash in 2015. Three identical online surveys (in 2014, 2015 and 2016) were conducted among persons >15 years old from an established market research panel in Germany (N=2195). Participants answered questions about a woman ("Anne") with either depression or schizophrenia as described in an unlabeled vignette. In the 2016 survey (<4 weeks after the attacks), we also elicited perceived causes of the violent incidents. Compared to 2014, the predicted probability to rate Anne as dangerous increased from 7% to 11%. Perceived unpredictability increased from 17% to 23%. Other stigma measures did not change significantly. No significant changes were visible between 2015 and 2016. Mental illness ranked third among the most important perceived causes for the attacks in 2016, after 'religious beliefs' and 'being manipulated by others'. Overall, the observed attitude changes were small. We discuss how the context of the attacks may have prevented further attitude change regarding persons with mental illness., (Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.)

This paper reviews aeromedical decision-making in psychiatry. It explains the "one-percent rule", the general medical criteria for fitness for flying and how they are applied to psychiatric disorders., (© Georg Thieme Verlag KG Stuttgart · New York.)

A breakdown analysis of civil aviation accidents worldwide indicates that the occurrence of runway excursions represents the largest portion among all aviation occurrence categories. This study examines the human risk factors associated with pilots in runway excursions, by applying a SHELLO model to categorize the human risk factors and to evaluate the importance based on the opinions of 145 airline pilots. This study integrates aviation management level expert opinions on relative weighting and improvement-achievability in order to develop four kinds of priority risk management strategies for airline pilots to reduce runway excursions. The empirical study based on experts' evaluation suggests that the most important dimension is the liveware/pilot's core ability. From the perspective of front-line pilots, the most important risk factors are the environment, wet/containment runways, and weather issues like rain/thunderstorms. Finally, this study develops practical strategies for helping management authorities to improve major operational and managerial weaknesses so as to reduce the human risks related to runway excursions., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

On March 24, 2015, a Germanwings aircraft crashed in the Alps. The suicidal copilot killed himself and 150 others. Pilot suicide is rare, but does happen. This research analyzed the National Transportation Safety Board's accident database (eADMS) looking for pilots who died by suicide in flight. Fifty-one suicides were identified. Gender, age, and other characteristics were examined. Average age of suicidal pilots was 38, significantly different from the average age of 45 for all male pilots involved in aircraft accidents. A discriminant function accurately identified suicidal incidents at 96%. There was a high false-positive rate limiting the usefulness of the discriminant function., (© 2015 The American Association of Suicidology.)

Objective: The present study was designed to investigate the frequency of media stigmatization of mentally ill persons after the crash of the "Germanwings"-aircraft on March 2015., Method: Evaluation of 251 texts, which were published in 12 national German newspapers. Categorical distinction between risky coverage and explicit characteristics of stigmatization., Results: In 64.1 % of the evaluated texts, a psychiatric disease of the co-pilot was discussed as the possible cause of the crash, making this the most widely-used explanation in the media that we view "risky coverage". Characteristics of explicit stigmatization were found in 31.5 % of the texts. Most prominent category of explicit stigmatization was the rubric "Metaphorical language/dramatizations". It was found in 23.5 % of the articles., Conclusion: Predominantly risky coverage of mentally ill persons has occured in the wake of a spectacular crime. By obtaining professional expertise of psychiatrists and consistent interpretation of journalistic guidelines, unintended effects of stigmatization could be avoided in the future., (© Georg Thieme Verlag KG Stuttgart · New York.)

In 2009, a commercial airplane crashed near Amsterdam. This longitudinal study aims to investigate (1) the proportion of survivors of the airplane crash showing a probable posttraumatic stress disorders (PTSD) or depressive disorder, and (2) whether symptoms of PTSD and depression were predicted by trauma characteristics. Identifying these trauma characteristics is crucial for early detection and treatment. Of the 121 adult survivors, 82 participated in this study 2 months after the crash and 76 participated 9 months after the crash. Risk for PTSD and depression was measured with the self-report instruments Trauma Screening Questionnaire and Patient Health Questionnaire-2. Trauma characteristics assessed were Injury Severity Score (ISS), hospitalisation, length of hospital stay, and seating position in the plane. Two months after the crash, 32 participants (of N=70, 46%) were at risk for PTSD and 28 (of N=80, 32%) were at risk for depression. Nine months after the crash, 35 participants (of N=75, 47%) were at risk for PTSD and 24 (of N=76, 35%) were at risk for depression. There was a moderate correlation between length of hospital stay and symptoms of PTSD and depression 9 months after the crash (r=.33 and r=.45, respectively). There were no differences in seating position between participants at high risk vs. participants at low risk for PTSD or depression. Mixed design ANOVAs showed also no association between the course of symptoms of PTSD and depression 2 and 9 months after the crash and ISS or hospitalisation. This suggests that health care providers need to be aware that survivors may be at risk for PTSD or depression, regardless of the objective severity of their physical injuries., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Posttraumatic stress (PTS) is common in survivors from life-threatening events. Little is known, however, about the course of PTS after life threat in the absence of collateral stressors (e.g., bereavement, social stigma, property loss) and there is a scarcity of studies about PTS in the long term. This study assessed the short- and long-term course of PTS, and the influence of gender, education and age on the level and course of PTS, in survivors from a non-fatal airliner emergency landing caused by engine failure at an altitude of 1 km. There were 129 persons on board. A survey including the Impact of Event Scale was distributed to 106 subjects after 1 month, 4 months, 14 months, and 25 months, and to 95 subjects after 19 years (response rates 64-83%). There were initially high levels of PTS. The majority of changes in PTS occurred from 1 to 4 months after the event. There were small changes from 4 to 25 months but further decrease in PTS thereafter. Female gender was associated with higher levels of PTS whereas gender was unrelated to the slope of the short- and long-term trajectories. Higher education was related to a quicker recovery although not to initial or long-term PTS. Age was not associated with PTS. The present findings suggest that a life-threatening experience without collateral stressors may produce high levels of acute posttraumatic stress, yet with a benign prognosis. The findings further implicate that gender is unrelated to trajectories of recovery in the context of highly similar exposure and few collateral stressors.

The practice of the military psychiatrist comprises different perspectives, including a characteristic operational dimension. The unexpected is frequent in overseas missions, as illustrated by the crash of the Air Algeria flight in July 2014 in Mali and the deployment of French forces in the management of this disaster.This article reports on the medical-psychological intervention carried out in this context.

Aircraft assisted suicides were studied in the United States, United Kingdom, Germany, and Finland during 1956-2012 by means of literature search and accident case analysis. According to our study the frequency varied slightly between the studies. Overall, the new estimate of aircraft assisted suicides in the United States in a 20-yr period (1993-2012) is 0.33% (95% CI 0.21-0.49) (24/7244). In the detailed accident case analysis, it was found that in five out of the eight cases from the United States, someone knew of prior suicidal ideation before the aircraft assisted fatality. The caveats of standard medico-legal autopsy and accident investigation methods in investigation of suspected aircraft assisted suicides are discussed. It is suggested that a psychological autopsy should be performed in all such cases. Also the social context and possibilities of the prevention of aviation-related suicides were analyzed. In addition, some recent aircraft assisted suicides carried out using commercial aircraft during scheduled services and causing many casualties are discussed.

In the article the clinical justification of medico-psychological care to the victims of technogenic accidents and catastrophes with prevalence of anxious and depressive symptoms of non-psychotic register is described. The necessity of differentiated approach is analyzed in accomplishing of psychotherapy of this contingent of patients taking into account the high level of anxiety, emotional stress, decreased mood, low levels of the quality of life in the remote period of strong stressful factor's action.

Background: Is there a "killing zone" (Craig, 2001)-a range of pilot flight time over which general aviation (GA) pilots are at greatest risk? More broadly, can we predict accident rates, given a pilot's total flight hours (TFH)? These questions interest pilots, aviation policy makers, insurance underwriters, and researchers alike. Most GA research studies implicitly assume that accident rates are linearly related to TFH, but that relation may actually be multiply nonlinear. This work explores the ability of serial nonlinear modeling functions to predict GA accident rates from noisy rate data binned by TFH., Method: Two sets of National Transportation Safety Board (NTSB)/Federal Aviation Administration (FAA) data were log-transformed, then curve-fit to a gamma-pdf-based function. Despite high rate-noise, this produced weighted goodness-of-fit (Rw(2)) estimates of .654 and .775 for non-instrument-rated (non-IR) and instrument-rated pilots (IR) respectively., Conclusion: Serial-nonlinear models could be useful to directly predict GA accident rates from TFH, and as an independent variable or covariate to control for flight risk during data analysis. Applied to FAA data, these models imply that the "killing zone" may be broader than imagined. Relatively high risk for an individual pilot may extend well beyond the 2000-h mark before leveling off to a baseline rate., (Published by Elsevier Ltd.)

The aim of this study is to identify protective and risk factors related to the development of posttraumatic stress disorder (PTSD) on a sample of survivors from a single plane crash. Eighteen survivors were examined 6 months following the event. The subjects all underwent psychiatric interviews, Clinician-Administered PTSD Scale structured interviews, personality and cognitive tests. Only 38.9% of them presented with all of the symptoms of PTSD; 22.2% showed no symptoms for PTSD; remaining survivors exhibited emotional/affective symptoms related to the event. In addition to the severity of the traumatic event itself, other risk factors identified were the loss of a relative, the manifestation of depressive symptoms, and the severity of physical injuries sustained. Low levels of hostility and high levels of self-efficacy represented protective factors against developing PTSD., (© 2013 American Academy of Forensic Sciences.)

The primary objective of this paper was to integrate two research traditions, social cognition approach and individual state approach, and to understand the relationships between locus of control (LOC), risk perception, flight time, and safety operation behavior (SOB) among Chinese airline pilots. The study sample consisted of 193 commercial airline pilots from China Southern Airlines Ltd. The results showed that internal locus of control directly affected pilot safety operation behavior. Risk perception seemed to mediate the relationship between locus of control and safety operation behaviors, and total flight time moderated internal locus of control. Thus, locus of control primarily influences safety operation behavior indirectly by affecting risk perception. The total effect of internal locus of control on safety behaviors is larger than that of external locus of control. Furthermore, the safety benefit of flight experience is more pronounced among pilots with high internal loci of control in the early and middle flight building stages. Practical implications for aviation safety and directions for future research are also discussed., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Introduction: Spatial disorientation (SD) has plagued aviation since its inception, contributing to numerous lost lives, destroyed or damaged aircraft, and a reduction in operational mission effectiveness. Military rotary-wing (RW) operations are not immune. The U.S. Army has retired many "legacy aircraft" represented in older studies, developed new training regimens for aircrew, continued to expand its night vision capabilities, and has prosecuted combat operations for some 10 yr utilizing new tactics, techniques, and procedures. For these reasons, it is important and relevant to re-engage the subject of SD among accidents within the Army's RW community., Methods: The U.S. Army's Combat Readiness/Safety Center database at Fort Rucker, AL, was queried for the previous 10 yr RW mishaps from fiscal year (FY) 2002 through FY 2011 (FY11 current through 01 July). Accidents identified as having SD as a contributing factor were selected., Results: From FY 2002 to FY 2011, there were 100 Class A through C rotary-wing flight mishaps involving SD. This represents 11% of all Class A through C rotary-wing flight accidents for this period. Of the 100 SD-related accidents, 22% involved fatalities, and 39% involved fatalities and/or injuries. The total number of RW SD-related accidents with fatalities represents 31% of the total helicopter accidents with fatalities for the 10-yr period., Discussion: This review of accident data confirms that SD remains a substantial issue for the Army aviation community and reinforces the importance and relevance of SD awareness, research, education, and training in RW operations.

In this paper we examined plan continuation error (PCE), a well known error made by pilots consisting in continuing the flight plan despite adverse meteorological conditions. Our hypothesis is that a large range of strong negative emotional consequences, including those induced by economic pressure, are associated with the decision to revise the flight plan and favor PCE. We investigated the economic hypothesis with a simplified landing task (reproduction of a real aircraft instrument) in which uncertainty and reward were manipulated. Heart rate (HR), heart rate variability (HRV) and eye tracking measurements were performed to get objective clues both on the cognitive and emotional state of the volunteers. Results showed that volunteers made more risky decisions under the influence of the financial incentive, in particular when uncertainty was high. Psychophysiological examination showed that HR increased and total HRV decreased in response to the cognitive load generated by the task. In addition, HR also increased in response to the financially motivated condition. Eventually, fixation times increased when uncertainty was high, confirming the difficulty in obtaining/interpreting information from the instrument in this condition. These results support the assumption that risky-decision making observed in pilots can be, at least partially, explained by a shift from cold to hot (emotional) decision-making in response to economic constraints and uncertainty.

Background: : Individuals who have experienced traumatic events often share their experiences in story form. This sharing has consequences for both storytellers and listeners. Understanding the experience of both members of the listener-storyteller dyad is of value to nurses who are often the listener within the nurse-patient dyad., Objective: : The aim of this study was to illuminate the experiences of the listener and the storyteller when a traumatic event is shared within the dyad., Methods: : The phenomenon was explored using an interpretive phenomenological approach. Participants consisted of 12 dyads, each with a storyteller and a listener. The storytellers were individuals who had been involved in U.S. Airways Flight 1549 when it crash-landed in the Hudson River in January 2009. Each storyteller identified a listener who had listened to them share their story of this event, dubbed The Miracle on the Hudson. In-depth interviews were conducted with each storyteller and each listener., Results: : Five essential themes emerged from the data: Theme 1, The Story Has a Purpose; Theme 2, The Story as a Whole May Continue to Change as Different Parts Are Revealed; Theme 3, The Story Is Experienced Physically, Mentally,Emotionally, and Spiritually; Theme 4, Imagining the "What" as well as the "What If"; and Theme 5, The Nature of the Relationship Colors the Experience of the Listener and the Storyteller. Roy's Adaptation Model of Nursing was found to be applicable to the findings of this study., Discussion: : For the participants in this study, the experience of sharing a traumatic event involved facts, feelings, and images. The story evolved as it was remembered, told, and listened to in a nonlinear, multifaceted way. The listener and the storyteller collaborated, adapted, and responded physically, mentally, emotionally, and spiritually.

Objective: This study investigated whether stress training introduced during the acquisition of simulator-based flight skills enhances pilot performance during subsequent stressful flight operations in an actual aircraft., Background: Despite knowledge that preconditions to aircraft accidents can be strongly influenced by pilot stress, little is known about the effectiveness of stress training and how it transfers to operational flight settings., Method: For this study, 30 participants with no flying experience were assigned at random to a stress-trained treatment group or a control group. Stress training consisted of systematic pairing of skill acquisition in a flight simulator with stress coping mechanisms in the presence of a cold pressor. Control participants received identical flight skill acquisition training but without stress training. Participants then performed a stressful flying task in a Piper Archer aircraft., Results: Stress-trained research participants flew the aircraft more smoothly, as recorded by aircraft telemetry data, and generally better, as recorded by flight instructor evaluations, than did control participants., Conclusions: Introducing stress coping mechanisms during flight training improved performance in a stressful flying task., Application: The results of this study indicate that stress training during the acquisition of flight skills may serve to enhance pilot performance in stressful operational flight and, therefore, might mitigate the contribution of pilot stress to aircraft mishaps.

Accidents and incidents often occur, because a basic and seemingly simple rule is 'forgotten', either unintentionally (error, lapse) or with some degree of deliberate negligence (violation). The present experiment examined the utility of a rehearsal and a last-minute reminder in reducing the magnitude of deviations from an important safety rule by qualified, but relatively inexperienced pilots, specifically, remaining above an altitude of 500-ft. A single rehearsal flight entailing a search for a target on the ground increased the minimum altitude in later flights, but this positive effect did not completely generalize when the target on the ground was changed. These results suggest that the rehearsal flight was encoded in a context-specific manner. The addition of an explicit, last minute reminder about the mandated minimum altitude just before each test flight failed to significantly alter the pilots' behavior. The results are discussed with respect to their theoretical and practical implications., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Aircraft evacuation effectiveness is a critical but challenging issue in the civil aviation industry. This paper explores the cabin safety perceptions of passengers from their emergency evacuation experiences in an actual aviation accident. A questionnaire survey and in-depth interviews were conducted with China Airlines flight CI-120 passengers. The qualitative and quantitative results provide insights into passengers' views of cabin safety. The in-depth interview results show that passenger safety education requires more instructions about the use of emergency equipment. The data from the passenger perception questionnaire were analyzed using the factor analysis method; the findings indicate that crew assistance and emergency procedures are the most important factors. The results are likely to be of value to the aviation industry when taking into account passenger perceptions in implementing safety programs., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

It is well known that people often continue to rely on initial misinformation even if this information is later corrected and even if the correction itself is remembered. This article investigated the impact of emotionality of the material on people's ability to discount corrected misinformation. The focus was on moderate levels of emotionality comparable to those elicited by real-world news reports. Emotionality has frequently been shown to have an impact upon reasoning and memory, but the generality of this influence remains unclear. In three experiments, participants read a report of a fictitious plane crash that was initially associated with either an emotionally laden cause (terrorist attack) or an emotionally more neutral cause (bad weather). This initial attribution was followed by a retraction and presentation of an alternative cause (faulty fuel tank). The scenarios demonstrably affected participants' self-reported feelings. However, all three experiments showed that emotionality does not affect the continued influence of misinformation.

Weather conditions are significant hazards impacting the safe and efficient operation of aircraft. In this study, a large number of pilots were surveyed regarding weather events, and the circumstances associated with those events. Pilots completed a web-based questionnaire containing demographic questions, a risk perception scale, a hazardous events scale, and a pilot judgment scale. The pilots who reported a flight in which they penetrated weather without authorization or were concerned about the weather also completed 53 questions regarding their weather encounter. Usable data were obtained for 364 participants: 144 who reported flying into weather, 114 who experienced a flight on which weather was a concern, and 106 who reported no flights on which weather was entered or was a major concern. Significant differences were evident between the three groups on the measures of pilot judgment, personal minimums, and hazardous events where pilots flying into weather recorded the poorest scores (least conservative minimums, most hazardous events, and poorest judgment). Significant differences were also noted between the two weather groups for a number of circumstances surrounding the events. Compared to the in-weather group, pilots in the near-weather group had acquired greater instrument hours, were older, and were more likely to have an instrument rating. Their aircraft were more likely to have an autopilot. More pilots in the in-weather group (28%) reported that they would be much more careful in the future regarding weather, compared to 17% of the near-weather group. The study provides data not previously obtained on both the situational and personal characteristics that are related to involvement in different degrees of weather-related encounters. These data should promote a better understanding of these individuals and the situations in which they are involved, and should inform future research and intervention efforts., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Emergency mental health (EMH), a field that is often not well represented when considering emergency preparedness, is nonetheless a vital component to any disaster response. Emergency mental health issues must be considered not only for victims of disasters and their families, friends, and coworkers but also for both on-scene and off-scene responders and members of the community who may have witnessed the disaster. This article describes the EMH preparation for and response to the crash of Continental Airlines flight 3407 in western New York on February 12, 2009, killing all 49 crew and passengers on board and 1 person on the ground. It describes aspects of the response that went as planned and highlights areas for improvement. The lessons learned from this EMH preparation and response can be used to inform future planning for disaster response.

This article reviews the literature on mental health of volunteers after working in disasters. When mobilized they often are a community's major source for rescue and recovery. PsychINFO, PubMED, and Web of Science were searched for relevant articles published until October 2009. Of 448 articles screened, only 9 articles fulfilled our inclusion criteria. They examined the aftermath of earthquakes (4 articles), terrorist bombings (1), explosions (1), aviation disasters (1), tsunami (1), and a bus accident (1).Findings showed that, compared with professional workers, volunteers tend to have higher complaint levels. The following factors were found to contribute to mental health complaints of volunteers: Identification with victims as a friend, severity of exposure to gruesome events during disaster work, anxiety sensitivity, and lack of postdisaster social support. The review reveals the need for more research regarding predictors of stress in volunteers.

The medico-psychological emergency unit in Seine-Saint-Denis (93) was involved in managing the families of the victims of the AF447 flight crash which took place on the night of 31 May and 1 June 2009 between Rio de Janeiro (Brazil) and Paris. It is interesting to study the system set up at the airport, the symptomatology observed, and the parameters of the efficiency of the care provided.

Study Design: Descriptive questionnaire study., Objective: This preliminary study was undertaken to try and develop an understanding of the factors that may affect recovery in aircrew with musculoskeletal disabilities., Summary of Background Data: Clinical recovery from musculoskeletal disabilities is generally achieved after the patient undergoes definitive therapy and rehabilitation. However, a proportion of patients may continue to suffer from morbidity and pain long after clinical and radiological finality has been reached. In these cases, psychosocial factors may have played a contributory role. There has been no research documenting or studying such factors in aviation and pilots in particular., Methods: The study was carried out at the Department of Human Engineering from 2004 to 2006. A detailed questionnaire was designed to elicit basic clinical details and psychosocial factors at work and home., Results: A total of 57 male aircrew participated voluntarily in this study. Of these, 41 (71.9%) achieved normal recovery, whereas in the remaining 16 (28.1%), recovery was considered delayed. The mean age of aircrew in the normal recovery group (33.1 +/- 4.6 years) was slightly higher than those in the delayed group (31.0 +/- 3.2 years). All the aircrew who had delayed recovery had a spinal disability, whereas spinal disabilities constituted only 46.3% in the normal recovery group. Of the spinal disabilities in aircrew with delayed recovery, 12 had low backache. Aircraft accidents and ejection accounted for almost one-fifth of the total disabilities (n = 11, 21.9%). The respondents identified multiple sources of emotional support viz., friends, family, and parents., Conclusion: A hypothetical model is proposed that possibly explains to some extent the role of psychosocial factors affecting recovery in aircrew with musculoskeletal disabilities. Further research in psychological and emotional consequences of trauma, in particular ejection and the best means/timings to address these, is recommended.

Objective: The presence of social psychological pressures on pilot decision making was assessed using qualitative analyses of critical incident interviews., Background: Social psychological phenomena have long been known to influence attitudes and behavior but have not been highlighted in accident investigation models., Method: Using a critical incident method, 28 pilots who flew in Alaska were interviewed. The participants were asked to describe a situation involving weather when they were pilot in command and found their skills challenged. They were asked to describe the incident in detail but were not explicitly asked to identify social pressures. Pressures were extracted from transcripts in a bottom-up manner and then clustered into themes., Results: Of the 28 pilots, 16 described social psychological pressures on their decision making, specifically, informational social influence, the foot-in-the-door persuasion technique, normalization of deviance, and impression management and self-consistency motives., Conclusion: We believe accident and incident investigations can benefit from explicit inclusion of common social psychological pressures., Application: We recommend specific ways of incorporating these pressures into theHuman Factors Analysis and Classification System.

Objective: The aim is to establish the extent to which the high false-alarm rate of air traffic control midair conflict alerts is responsible for a "cry wolf' effect-where true alerts are not responded to and all alerts are delayed in their response., Background: Some aircraft collisions have been partly attributed to the cry wolf effect, and in other domains (health care and systems monitoring), there is a causal connection between false-alarm rate and cry wolf behavior. We hypothesized that a corresponding relationship exists in air traffic control (ATC)., Method: Aircraft track and alert system behavior data surrounding 495 conflict alerts were analyzed to identify true and false alerts, trajectory type, and controller behavior. Forty-five percent of the alerts were false, ranging from 0.28 to 0.58., Results: Although centers with more false alerts contributed to more nonresponses, there was no evidence that these were nonresponses to true alerts or that response times were delayed in those centers. Instead, controllers showed desirable anticipatory behavior by issuing trajectory changes prior to the alert. Those trajectory pairs whose conflicts were more difficult to visualize induced more reliance on, and less compliance with, the alerting system., Conclusion: The high false-alarm rate does not appear to induce cry wolf behavior in the context of en route ATC conflict alerts., Application: There is no need to substantially modify conflict alert algorithms, but the conflict alert system may be modified to address difficult-to-visualize conflicts.

Introduction: The associations of pilot error with the type of flight operations and basic weather conditions are well documented. The correlation between pilot characteristics and error is less clear. This study aims to examine whether pilot age is associated with the prevalence and patterns of pilot error in air taxi crashes., Methods: Investigation reports from the National Transportation Safety Board for crashes involving non-scheduled Part 135 operations (i.e., air taxis) in the United States between 1983 and 2002 were reviewed to identify pilot error and other contributing factors. Crash circumstances and the presence and type of pilot error were analyzed in relation to pilot age using Chi-square tests., Results: Of the 1751 air taxi crashes studied, 28% resulted from mechanical failure, 25% from loss of control at landing or takeoff, 7% from visual flight rule conditions into instrument meteorological conditions, 7% from fuel starvation, 5% from taxiing, and 28% from other causes. Crashes among older pilots were more likely to occur during the daytime rather than at night and off airport than on airport. The patterns of pilot error in air taxi crashes were similar across age groups. Of the errors identified, 27% were flawed decisions, 26% were inattentiveness, 23% mishandled aircraft kinetics, 15% mishandled wind and/or runway conditions, and 11% were others., Conclusions: Pilot age is associated with crash circumstances but not with the prevalence and patterns of pilot error in air taxi crashes. Lack of age-related differences in pilot error may be attributable to the "safe worker effect."

This article discusses the cultural aspects of High Reliability Organizations (HROs), such as air navigation services. HROs must maintain a highly professional safety culture and constantly be prepared to handle crises. The article begins with a general discussion of the concept of organizational culture. The special characteristics of HROs and their safety culture is then described. Finally the article illustrates how Critical Incident Stress Management (CISM) is becoming an ingrained feature of the organizational culture in air traffic control systems. Critical Incident Stress Management is a prevention program that can successfully guard against the negative effects of critical incidents. The CISM program of DFS (Deutsche Flugsicherung) was recently evaluated by the University of Copenhagen. This evaluation not only confirmed the successful prevention of negative effects at the operation's employee level (especially air traffic controllers), but also showed a sustained improvement of its safety culture and its overall organizational performance. The special aspects of cross-cultural crisis intervention and the challenges it faces, as well as the importance of prevention programs, such as CISM, are illustrated using the examples of two aircraft accidents: the crash landing of a calibration aircraft and the Lake Constance air disaster.