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

Commercial Aircraft-Assisted Suicide Accident Investigations Re-Visited—Agreeing to Disagree?

Background: The number of aircraft-assisted suicides can only be considered a rough estimate because it is difficult and, at times, impossible to identify all cases of suicide. Methods: Four recent reports of accidents occurring in 1997 in Indonesia, 1999 in Massachusetts in the United States, 2013 in Namibia, and 2015 in France related to commercial aircraft-assisted suicides were analyzed. This analysis relied on data extracted from the accident reports that supported aircraft-assisted suicide from the: (a) cockpit voice recorder (CVR) and flight data recorder (FDR), (b) medical history, (c) psychosocial history, (d) toxicology, (e) autopsy, and (f) any methodology that utilized aviation medicine. There are some limitations in this study. Although all analyzed accident investigations followed ICAO Annex 13 guidelines, there is variability in their accident investigations and reporting. In addition, accident investigation reports represent accidents from 1997 to 2015, and during this time, there has been a change in the way accidents are reported. The nature of this analysis is explorative. The aim was to identify how the various aircraft accident investigators concluded that the accidents were due to suicidal acts. Results: In all four accident reports, FDR data were available. CVR data were also available, except for one accident where CVR data were only partially available. Comprehensive medical and psychosocial histories were available in only one of four of the accident reports. Conclusion: To prevent accidents involving commercial aircraft, it is necessary to identify the causes of these accidents to be able to provide meaningful safety recommendations. A detailed psychological autopsy of pilots can and likely will assist in investigations, as well as generate recommendations that will substantially contribute to mitigating accidents due to pilot suicide. Airborne image recording may be a useful tool to provide additional information about events leading up to a crash and thus assist in accident investigations.

Pilot Mental Health, Methodologies, and Findings: A Systematic Review

INTRODUCTION: Pilots’ mental health has received increased attention following Germanwings Flight 9525 in 2015, where the copilot intentionally crashed the aircraft into the French Alps, killing all on board. An investigation of this incident found that the pilot had a depressive disorder.METHODS: This systematic review investigated peer reviewed studies of pilot mental health published since 1980. A total of 58 papers were identified.RESULTS: Two main methodologies have been employed: questionnaires and database record searches. Anxiety, depression, and suicide were the most commonly investigated mental health conditions. There were almost an equal number of studies that found a higher prevalence of psychological symptoms in pilots as those that found a lower prevalence, relative to controls or the general population. Prevalence rates were higher in studies relying solely on questionnaires than in studies employing database record searches.DISCUSSION: Prevalence estimates are closely associated with methodology, so it is difficult to determine the true rate. Factors that might account for low prevalence estimates include under-reporting of symptoms by pilots and a reluctance to diagnose on the part of health professionals. Factors that might account for high prevalence estimates include anonymous assessment, the use of questionnaires that do not align with clinical disorders, and inconsistent cut-off scores. It is recommended that future studies on prevalence use well-validated clinical measures, and that more research be conducted on the effects of particular disorders on job performance.Ackland CA, Molesworth BRC, Grisham JR, Lovibond PF. Pilot mental health, methodologies, and findings: a systematic review. Aerosp Med Hum Perform. 2022; 93(9): 696–708.

Typology of murder-suicides in Berlin according to a longitudinal study based on autopsy files

Murder-suicides are defined as the murder of at least one person and the suicide of the offender following the murder. The intention to commit suicide must be primary. In most cases, a male offender kills a female victim after a separation. The current analysis was the first analysis of the typology of murder-suicides in Berlin. We analyzed the autopsy files of the Institute for Forensic Medicine of the Charité University Medicine Berlin and of the City Institute for Forensic Medicine Berlin. We performed descriptive and statistical analyses of cases between 2005 and 2013. We identified 17 murder-suicides. All 17 offenders were male, and 20 of the victims (90%) were female. The offenders used firearms in the majority of the cases. In seven cases, the victims and offenders were at least 80 years old. The average age of the offenders was 63 years. Disease was the motive in 6 cases involving older offenders. Our study might support the development of prevention strategies. In this regard, it is important to build a database for murder-suicides in Germany and other countries, to formulate a uniform definition of murder-suicide, to carry out nationwide interdisciplinary studies on this topic and to improve the existing health care structures, especially for older adults and people with depression.

Strategies to Promote Social Connections Among Older Adults During "Social Distancing" Restrictions

Older age and medical comorbidity are factors associated with more severe illness and risk of death due to COVID-19 infection. Social distancing is an important public health strategy for controlling the spread of the virus and minimizing its impact on the older adult population. It comes at a cost, however. Loneliness is associated with myriad adverse health outcomes, one of which is impaired immune functioning, which adds even greater risk for coronavirus infection, complications and death. Older adults, therefore, are at compound risk, making effective management of loneliness and social isolation in our older patients a high priority target for preventive intervention. In this paper, the authors describe a cognitive-behavioral framework for social connectedness, including evidence-informed strategies clinicians can use to help patients develop a "Connections Plan" to stay connected and promote their social, mental, and physical health during "social distancing" restrictions. This set of strategies can be provided during brief (30 minute) telephone sessions and is analogous to creating a "Safety Plan" for suicide risk. The approach is illustrated with three case examples.