What do you know about suicide?

 

You don’t have to be mentally ill to feel suicidal

 

Factors such as occupational stress and conflict, relationship breakdown, family bereavement, medical diagnosis, legal and financial difficulties can all be contributory/trigger factors. However, many people who kill themselves do have mental health difficulties, typically to a serious degree. Of the 4727 suicides recorded in 2013 in the UK (Department of Health 2015), 1272 were by people in contact with mental health services the year before they killed themselves. Sometimes it’s known about before the person’s death and sometimes not.

 

More men commit suicide than women

 

The UK Department of Health published a report on suicide rates within the general population in the UK February 2015 (Department of Health, 2015). Suicide occurs in people of all ages, including children, but adults in middle- and late-middle age have the highest suicide rate.  Suicide is the single biggest killer of men aged under 45 in the UK, with 76% of all suicides in 2014 being men.  The first ever comprehensive report on suicide across the world by the World Health Organisation (2014) suggests that one person in the word dies by suicide every 40 seconds (preventing suicide: a global imperative). 

 

Once you have tried to commit suicide you are more likely to try again

 

People who have tried to end their lives before are significantly more likely to eventually die by suicide than the rest of the population. However, prior suicide attempts are not always disqualifying for pilots.  The Civil Aviation Authorities in New Zealand and in Australia in particular, consider pilot’s background, engagement, insight, treatment sustained remission, support system, other conditions in granting aeromedical certification.  So a previous suicide attempt is not automatically disqualifying.  A study of US airforce pilots reported 79% who had attempted suicide were able to return to flight duties after treatment and successful aeromedical assessment. 

 

Talking about suicide with someone does not make it more likely they will go ahead with their plan to kill themselves.

 

Suicide is a taboo topic in society and is particularly difficult to talk about when you’re a pilot. Often, people feeling suicidal don’t want to worry or burden anyone with how they feel and certainly don't want to send alarm bells ringing or for things to get out of control, so they don’t discuss it. 

 

By asking directly about suicide you give someone permission to tell you how they feel. People who have felt suicidal will often say what a huge relief it is to be able to talk about what their experiencing. Once someone starts talking they’ve got a better chance of discovering other options to suicide.

 

Most suicidal people don’t actually want to die but they do want to stop living the life they have. 

 

They want to remove themselves from an unbearable situation, and for the pain to stop. The majority of people who feel suicidal do not actually want to die; they do not want to live the life they have and cannot see a way to resolve their situation. The distinction may seem small but it is in fact very important,  It is why talking through other options at the right time is so vital. Suicide is a decision made when other decisions seem impossible. Sometimes, in the heat of the moment, the whole of life can feel hopeless. Often in this situation, you can feel that other people will be better off without you.  People who kill themselves have often told someone that they do not feel life is worth living or that they have no future. Some may have actually said they want to die. While it’s possible that someone might talk about suicide as a way of getting the attention they need, it’s vitally important to take anybody who talks about feeling suicidal seriously.  Often, feeling actively suicidal is temporary, even if someone has been feeling low, anxious or struggling to cope for a long period of time. This is why getting the right kind of support at the right time is so important.

 

Who commits suicide?

 

It would be inaccurate to generalise, however, the following factors may make people more vulnerable to suicidal thinking and behaviour:

 

  •  life history – for example, having a traumatic experience during childhood, a history of sexual, physical or emotional abuse, or a history of parental neglect

  •  mental health – for example, developing a serious mental health condition, such as schizophrenia

  •  lifestyle – for example, chaotic misuse of drugs and alcohol 

  •  employment – such as poor job security, low levels of job satisfaction or being unemployed, high pressure, unrealistic targets, unsupportive work relationships 

  •  relationships – being socially isolated, being a victim of bullying or having few close relationships

  •  genetics and family history 

People who become suicidal are often:

  •  very sensitive to failure or criticism.

  •   socially isolated, feeling they had no friends

  •   unrealistic in setting themselves targets which were unachievable

  •   unable to cope with setbacks and disappointments

  •   unwilling to admit they are having problems they cannot solve alone

  •   reluctant seek help to solve their problems 

  •   reluctant to talk about their feelings

 

In addition, a stressful event may push a person "over the edge", leading to suicidal thinking and behaviour.  It may only take a minor event, such as having an argument with a partner. Or it may take one or more stressful or upsetting events before a person feels suicidal, such as the break-up of a significant relationship, a partner dying or a major set back at work.

 

Are Pilots particularly at risk of suicide? 

 

Severe psychological disturbance is a risk factor for suicide.  Severe psychological disturbance among pilots is rare but, nonetheless, pilots can suffer from a range of psychological difficulties just like anyone in any other other occupational group.   Logically, active pilots should have a lower rate of suicide than the general public because they are screened for the ability to withstand pressure and monitored for mental illness, physical illness and substance abuse.  They are also required to demonstrate problem solving skills and usually do not have prior suicide attempts. 

 

However, pilots are in many ways a unique, and at times, unusual, occupational group. Their working environment and shift patterns for pilots can be especially challenging, both psychologically and physiologically.  The discomfort of the aircraft environment, the ongoing professional scrutiny and regulation, the disruption to sleep, jet lag, shift work, the inability to plan and have control over social and family life and many other aspects of a pilot’s life, can all create significant stress.  

 

So there are major risks inherent in the pilot’s working environment. This is not to say that all pilots are likely to become mentally ill, suicidal or do not live fulfilling lives, but not being able to manage these significant challenges would be a major cause for concern and a reason not to select a candidate for pilot training in the first place. 

 

Suicide, suicide by pilot and murder-suicide

 

The Germanwings disaster of 2015 has clearly raised the profile of mental health issues in aviation and in particular the whole issue of suicide and pilots. Suicide by pilot refers to an aviation disaster in which pilots deliberately crash or attempt to crash an aircraft as a way to kill themselves (pilot suicide).

 

Whilst suicide is unfortunately common (in 2014 the World Health Organisation suggested that one person in the world dies by suicide every 40 seconds), Suicide by Pilot is not. Aviation is rarely impacted by the intentional destruction of aircraft by pilots.  However, in the last 60 years of aviation there have been crashes with clear evidence of suicidal intent or in which elects strongly suggest that pilots had a role in intentionally destroying the aircraft.   One study has estimated that the rate of fatal crashes attributable to suicide in general aviation in the UK is around 2.4%. This compares favourably with estimates of fatal car crashes which has been put at between 2-7%.

 

The most common type of pilot suicide occurs amongst private pilots.  A study of 37 cases of pilot suicide identified domestic and social problems being a contributory factor in 46% of cases, legal trouble in 41% and psychiatric conditions in 38% of cases.  Suicide by pilot is unusual in that far fewer victims have suffered from a psychiatric disorder at the time of their death. However in about half of the events recorded in the literature, the pilot had been using drugs, usually alcohol or antidepressants that would ban them from flying. Pliots with a history of mental illness or who die with psychotropic medication in their system may be more likely to be classified as suicide if they die in a plane crash.

 

In order for an aircraft crash to be classified as suicide there has to be compelling evidence for this, established through a psychological post-mortem.  For example a suicide note, previous attempts, threats of suicide or a history of mental illness would constitute evidence.

 

Very occasionally, as in the recent case of the 2015 Germanwings and 2013 Namibian LAM crash, pilots attempt to crash an aircraft as a way to kill themselves and others, either on board or on the ground.  This is called pilot murder-suicide and is thankfully a very rare occurrence.  There have been six documented pilot murder suicides involving commercial flights since 1982.  When it does occur the impact in terms of the proportion of deaths is significant when compared to deaths from accidents. There is as yet, little published information about the phenomenon specifically in pilots although in psychiatry there is an extensive literature which demonstrates that suicide and homicide suicide are distinct forms of pathology, with different risk factors associated with each condition. 

 

What do we know about Murder-Suicide in pilots?

 

Motives for murder suicide are extremely complex.  The primary motive can be murder or suicide.  Where murder is the primary motive this would involve for example killing a partner out of anger or revenge then committing suicide because of guilt or to avoid punishment.  Where suicide is the primary motive, for example a father who commits suicide, kills his children, seeing this as his only escape from a difficult child custody battle but would not leave his children fatherless.  Murder suicide can be either planned or impulsive.   Studies suggest that most pilots who commit murder suicide appear to have had some premeditation beforehand.  In a review of five of the six events listed below, the perpetrator pilot of commercial airliners waited for their copilot colleague to leave the flight deck.  

 

Murder-Suicide with an airline pilot as perpetrator 

 


Data adapted from Suicide and Murder Suicide involving aircraft: Kenedi, Friedman, Watson and Preitner.   

Aerospace Medicine and Human Performance. Vol 87. No 4. April 2016.

Factors identified in murder suicides involving aircraft include occupation or workplace conflict, financial problems. mental illness, relationship break downs, ongoing legal issues or impending criminal investigations.  From studies of murder suicide by pilots, mental illness has not been shown to be a significant factor, rather perpetrators seem to have had other stressors, often multiple factors such as financial or relationship problems.  There have been no reported murder suicides involving pilots who were female.  Studies of non-aviation murder-suicides report that approximately only 10% of victims are unrelated to the perpetrator.  In adversarial type murder suicides, the perpetrator perceives that they have been wronged for example by an employer or someone in authority.  The perpetrator may target a single person who is seen as the persecutor.  

 

Unlike the vast majority of murder suicide cases where family members are often victims, murder suicide where aircraft are involved rarely involve family members as victims.  Murder suicide by aeroplane allows the perpetrator a high probability of lethality and the possibility of killing a large number of people unknown to the perpetrator, at once. 

 

 

Most people have thought of suicide from time to time and not all people who die by suicide have mental health problems at the time of death.

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