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Suicide and Murder-Suicide Involving Aircraft
Abstract
BACKGROUND: This is a systematic review of suicide and homicide-suicide events involving aircraft. In aeromedical literature and in the media, these very different events are both described as pilot suicide, but in psychiatry they are considered separate events with distinct risk factors.
METHODS: Medical databases, internet search engines, and aviation safety databases were searched in a systematic way to obtain relevant cases. Relevant articles were searched for additional references.
RESULTS: There were 65 cases of pilot suicide and 6 cases of passengers who jumped from aircraft found. There were also 18 cases of homicide-suicide found involving 732 deaths. Pilots perpetrated 13 homicide-suicide events. Compared to non-aviation samples, a large percentage of pilot suicides in this study were homicide-suicides (17%).
DISCUSSION: Homicide-suicide events occur extremely rarely. However, their impact in terms of the proportion of deaths is significant when compared to deaths from accidents. There is evidence of clustering where pilot suicides occur after by media reports of suicide or homicide-suicide. Five of six homicide-suicide events by pilots of commercial airliners occurred after they were left alone in the cockpit. This, along with a sixth incident in which active intervention by a Japan Air crew saved 147 lives, suggests that having two flight members in the cockpit is potentially protective. No single factor was associated with the risk for suicide or homicide-suicide. Factors associated with both events included legal and financial crises, occupational conflict, mental illness, and relationship stressors. Drugs and/or alcohol played a role in almost half of suicides, but not in homicide-suicides.
Kenedi C, Friedman SH, Watson D, Preitner C. Suicide and murder-suicide involving aircraft. Aerosp Med Hum Perform. 2016; 87(4):388–396.
... The pilot as a perpetrator crashes the aircraft intentionally with the motive to commit a homicide-suicide. It is mostly lethal for passengers and crew (Kenedi et al. 2016). The causation is multifactorial comprising (but not limited to) mental health, occupational, family and legal issues. ...
... Hence, every case of pilot homicide-suicide must be separated from incapacitation and considered on a case-by-case basis. There are only 17 known cases of pilot homicide-suicide with large aircraft, with and without passengers, in the history of aviation (Aviation Safety Network 2015; Kenedi et al. 2016). The prevention and handling of a pilot homicide-suicide differ from those of usual incapacitation. ...
... Four cases of pilot incapacitation were merged to create a general process model. Pilot homicide-suicide had to be considered on its own because each case shows a unique multifactorial causation(Kenedi et al. 2016;. For example, the cockpit crew members of Japan Airlines 350 (JL350) had actively intervened in suicidal actions of the captain during approach. ...
One main hurdle towards commercial airliners’ Reduced-Crew Operations (RCO) is how to encounter pilot incapacitation. The aim of this modelling study is to evaluate the potential effects of a single-pilot’s incapacitation on a future design approach to RCO. Most solutions propose a ground support of the pilot by a remote operator whom control should be handed over in case of an emergency. Both incapacitation and homicide-suicide have been discussed in the literature but neither of these events have been modelled nor evaluated empirically. We introduce a future operational design concept for RCO which includes a remote-copilot as ground support and automation tools monitoring pilot’s health and entries into aircraft systems. The hazard analysis technique System-Theoretic Process Analysis (STPA) was used to model and analyse scenarios of incapacitation/homicide-suicide. A hierarchical control structure showed how RCO can be embedded into commercial aviation. The STPA of pilot incapacitation and two scenarios of pilot homicide-suicide showed how unsafe control actions leading to an incident or accident after incapacitation/homicide-suicide could be prevented. The possible detection and take-over of control by the ground support in the case of incapacitation raised the question for detailed procedures on how to react to its detection. Either an autoland by the remote-copilot or by an affiliated system is possible. An additional breakup of data-link may only be solved by an automatic landing system on-board.
... Aircraft-assisted pilot suicide is an extremely rare event. However, the consequences may affect a large number of bystanders [1][2][3][4]. Regular aeromedical assessments are mandatory for pilots and several suicide risk factors, such as previous suicide attempts or acute major depressive disorder, limit or prevent fitness to fly [5,6]. Estimates of aircraft-assisted pilot suicides from the U.S. between 1993 and 2002 were 0.44% (16 of 3648 fatal accidents) [7] and between 2003 and 2012 were 0.22% (eight of 3596 fatal accidents), showing an overall 20-year period estimate of aircraft-assisted suicides in the United States (1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012) to be 0.33% (95% CI 0.21-0.49; ...
... After the deliberate Germanwings incident in the French Alps on 24 March 2015, there has been concern over a possible copycat effect in aircraft-assisted pilot suicides [2,4,[23][24][25]. The Germanwings incident shared some features with a fatal aviation crash in 2013 in Namibia [1,26]. ...
... Moreover, the pilot's actions were associated with an immeasurable amount of grief to those affected. Homicide-suicide committers share many similarities to suicide committers, but the impact of negative life events may differ [2,4,31,32]. ...
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.
... In a crisis, faced with limited coping mechanisms, fearing stigmatisation or the possible threat to their career from the regulating authority or employer who may be eager to dispense of their services, pilots tend to isolate, be reluctant to trust, and avoid seeking support (Kenedi, Hatters Friedman, Watson, & Preitner, 2016). The circular causality of withdrawal and isolation from a system that feels emotionally unsafe is exacerbated by guilt and shame, and fearing the punitive legal implications attributed to nondisclosure in some nations' aeromedical regulation (Brown & Moren, 2003;Catino & Patriotta, 2013;Jordaan, 2016). ...
... The complex balance of managing a mobile workforce with respect to operational risks and occupational wellbeing arose as a sub-theme. Flight operations management have the responsibility to manage their pilot workforce, but may encounter the distrust of their employees fuelled by observations of the manner in which performance failure or disciplinary procedures are addressed (Kenedi, et al., 2016). The style is often perceived as heavy handed, punitive, judgemental and inconsistent. ...
... The view of participants is that despite a management policy to create an open, inviting culture that encourages pilots to share their concerns, they actually convey an emotionally conflicting message that pilots cannot decipher. The message encourages pilots to entrust management with their wellbeing, but their reality may be to encounter concern about the operational impact rather than their individual needs (Kenedi, et al., 2016). Even if management is concerned with the individual's wellbeing, they themselves may be conflicted by the operational impact of the potential loss of the pilot's license or medical certificate if they are required to report them as a safety concern (Campion, 2017; Hubbard, 2006). ...
This study adopted a qualitative research design with a phenomenology approach to explore the phenomenon of peer support and its role and contribution as an effective response to addressing the wellbeing of pilots. The study occurred in a South African aviation context.
Peer support addressing the wellbeing of pilots is still in its infancy globally. Five themes emerged from this current study on peer support in aviation that contribute to the miniscule body of knowledge. The first theme depicted the complex relationship between the wellbeing of pilots and medical certification of occupational fitness duty. The second recounted pilots’ experience of their workplace as emotionally unsafe, and deficient in recognising the occupational and operational stressors they encounter. The conceptualisation of peer support emerged as the third theme, expounding on the role of the peer, the principles on which the peer support process is founded, and its hypothetical alignment with peer coaching. Theme four related the multi-dimensional contribution of peer support, while the factors critical to integrating successful and sustainable peer support emerged as the last theme.
The study concluded that the aviation industry needs to adopt a more inclusive and integrated definition of safety than its present approach which focuses primarily on operational safety.
... Если он не будет обнаружен, то преступление, могут квалифицировать как естественную причину смерти. Способом ПГСУ явилось крушение самолета, которое встречается очень редко [46]. Как показало исследование, оно было обнаружено в 18 случаях убийств-самоубийств, в результате которых погибло 732 человека. ...
... Наличие двух членов экипажа в кабине самолета потенциально защищает от совершения такого ПГСУ. Факторами СП и ПГСУ являлись юридический и финансовый кризисы, профессиональные конфликты, психические расстройства и стрессы в межличностных отношениях [46]. ...
... The poison in the dart is used as an inconspicuous method of killing (quickly decays, leaves no traces) If it is not detected, then the crime can be qualified as a natural cause of death. The PHSU method was the plane crash, which is very rare [46]. The study showed that it was found in 18 cases of homicide-suicide, which resulted in the death of 732 people. ...
Posthomicidal suicide (PHSU) is a rare occurrence in life. Despite this, it is presented in cultural works, in particular,
there are works describing the PHSU in sculpture and opera performances. The purpose of the study is to find cases of
PHSU in Russian-language fiction and to conduct a comparative analysis with scientific publications. Materials and
methods. Considered 10 literary texts published in Russian in 1880-2013 (novels – 6, stories – 2, narrative – 1, poem –
1); in nine cases it was a completed PHSU, in one it was an attempt. Results. Most often, PHSU met in detective novels by famous foreign writers (A. Christie, J. Simenon, R. Stout), translated into Russian, although it was the subject of
investigation in three works (in two cases as corpus delicti and in one as a possible plot). In the domestic literature,
PHSU was described extremely rarely, despite the mass of modern research on artistic thanatology in Russia. According to our data, the most informative of the Russian authors are the works of F.M. Dostoevsky, who can rightfully be
considered not only an outstanding psychopathologist among writers, but also an unsurpassed suicidologist. According
to the classification, nine texts usually described spousal (partnership) or family PHSUs, the death toll, as a rule, is
two. The time criteria of the PHSU (24-72 hours) met in seven cases out of nine. The connection between murder and
suicide allowed us to qualify two more PHSUs as post-murder suicides. The aggressors were more often younger than
their victims, possibly due to the absence of children's PHSUs, in four cases out of nine they were committed by women and they occurred outside the home. The most common methods of murder and suicide were firearms (pistols),
their coincidence was found in five cases. Four aggressors (psychosis, epilepsy, depression, alcohol abuse) and three
victims (psychosis, two cases of alcohol abuse) suffered from mental disorders, four murderers had suicidal thoughts
and intentions; in alcoholic intoxication were respectively - two and four heroes of the works. In literary texts, many
topical scientific and practical issues are raised: a rare way of PHSU (car accident of an aggressor and victim), tragic
death of loved ones, unequal marriage and domestic violence as factors of murder and suicide, stigmatization (selfstigmatization) and post-traumatic stress disorders in children of participants of PHSU, motives PHSU in adolescents
and their prevention; "Perfect kill" and "perfect way to kill". Conclusion. PHSU in the literature is described quite
realistically, which can be used for scientific, practical and educational purposes.
Keywords: post-homicidal suicide (criteria, factors, motives, age and gender groups, place and weapon of murder
/ suicide), works of fiction, prevention
... Triggers included mental illness, but also legal, financial, occupational and relationship problems. 1 Here, we examine automobile driver suicide (which has been reported in many countries over several decades), which also results in loss and possibly murder. It has two forms. ...
... The intentions of pilots and drivers when they kill themselves and others are unknown. However, the term murder-suicide is used in connection with plane crash deaths, 1,16 and is used here for consistency. ...
Objective:
We aim to explore the phenomenon of suicide by driving one vehicle into another, and draw attention to the cost to occupants of targeted vehicles.
Method:
We examined academic literature, court and newspaper reports, and online sources.
Results:
Driver suicide may be achieved by colliding with a fixed object or another vehicle. When a second vehicle is targeted, the occupants of that vehicle experience property loss, and potentially physical and psychiatric injury, or death. Driver suicides are associated with death of another person, in 11.3% of cases. Some suicidal individuals are able to act with great consideration for the consequences of their actions.
Conclusion:
Every effort must be made to help suicidal people with mental disorders or other predicaments. There is a need for public discussion of suicide by targeting an oncoming vehicle. It is less likely that suicide drivers who target other vehicles are unable to choose and more likely they have not considered the consequences of their actions.
... Despite these limitations, the present study has shed new light on blood biomarker screening of SOD by plasma metabolites. Evaluating severity of depression (SOD), especially suicidal ideation (SI), is crucial not only in psychiatric settings but also primary care and social situations to prevent suicidal incidents [64,65], and hopefully SOD and SI evaluation systems with plasma metabolites will be developed for use in simple and easy evaluation kits for clinical practices and at medical checkups in the future. ...
Evaluating the severity of depression (SOD), especially suicidal ideation (SI), is crucial in the treatment of not only patients with mood disorders but also psychiatric patients in general. SOD has been assessed on interviews such as the Hamilton Rating Scale for Depression (HAMD)-17, and/or self-administered questionnaires such as the Patient Health Questionnaire (PHQ)-9. However, these evaluation systems have relied on a person’s subjective information, which sometimes lead to difficulties in clinical settings. To resolve this limitation, a more objective SOD evaluation system is needed. Herein, we collected clinical data including HAMD-17/PHQ-9 and blood plasma of psychiatric patients from three independent clinical centers. We performed metabolome analysis of blood plasma using liquid chromatography mass spectrometry (LC-MS), and 123 metabolites were detected. Interestingly, five plasma metabolites (3-hydroxybutyrate (3HB), betaine, citrate, creatinine, and gamma-aminobutyric acid (GABA)) are commonly associated with SOD in all three independent cohort sets regardless of the presence or absence of medication and diagnostic difference. In addition, we have shown several metabolites are independently associated with sub-symptoms of depression including SI. We successfully created a classification model to discriminate depressive patients with or without SI by machine learning technique. Finally, we produced a pilot algorithm to predict a grade of SI with citrate and kynurenine. The above metabolites may have strongly been associated with the underlying novel biological pathophysiology of SOD. We should explore the biological impact of these metabolites on depressive symptoms by utilizing a cross species study model with human and rodents. The present multicenter pilot study offers a potential utility for measuring blood metabolites as a novel objective tool for not only assessing SOD but also evaluating therapeutic efficacy in clinical practice. In addition, modification of these metabolites by diet and/or medications may be a novel therapeutic target for depression. To clarify these aspects, clinical trials measuring metabolites before/after interventions should be conducted. Larger cohort studies including non-clinical subjects are also warranted to clarify our pilot findings.
... Indeed, Harris et al. (2015) put forward that being able to control the aircraft from the ground may lead to enhanced, not reduced levels of safety. Whilst pilot homicide-suicide is rare and can stem from a variety of causes outside the direct control of airlines (Kenedi et al., 2016), 40-50 rapid and gradual decompression events occurring worldwide annually (Aviation Medical Society of Australia and New Zealand, 2000). The authors believe hazards, such as rapid decompression, that may result in incapacitation could highlight a key benefit for enhancing safety though a change to distributed crewing configurations. ...
Changes to crewing configurations in commercial airlines are likely as a means of reducing operating costs. To consider the safety implications for a distributed crewing configuration, System Theoretic Accident Model and Processes (STAMP) was applied to a rapid decompression hazard. High level control structures for current operations and distributed crewing are presented. The CONOPS generated by STAMP-STPA for distributed crewing, and design constraints associated with Unsafe Control Actions (UCAs) are offered to progress the route to certification for distributed crewing, and improve safety in current operations. Control loops between stakeholders were created using System-Theoretic Process Analysis (STPA). The factors leading to the Helios 255 incident demonstrated the redundancy that a ground station could offer without the risk of hypoxia, during a decompression incident. STPA analysis also highlighted initial UCAs that could occur within the hypothetical distributed crewing configuration, prompting consideration of design constraints and new CONOPS for ground station design.
... We could not provide a general control loop. There are a variety of causes for homicide-suicide but only very few events so that every case had to be considered as unique (Kenedi, Friedman, Watson, and Preitner, 2016;Rice and Sher, 2016;Sturup and Caman, 2015). ...
After the Germanwings flight 4U9525, mental health issues of pilots have been raised as a hazard to flight safety. Pilot homicide-suicide, as a special subtype of pilot incapacitation, can be examined at different levels of commercial aviation. We extended the System Theoretic Process Analysis (STPA), based on the System Theoretic Accident Modelling and Process (STAMP), to pilot behaviour to investigate how these knock-out events may be encountered in the whole system. Several safety actions have been identified to prevent hazardous pilot behaviour caused by medical incapacitation and homicidal-suicidal behaviour at different levels of the system. Pilot incapacitation is already handled very well in practice with respect to the regulations and procedures in current usage. In contrast, the prevention of pilot homicide-suicide is currently managed by aeromedical decisionmaking regulations and pilot support programs. The design of the flight deck compartment door and the balancing of privacy laws and public safety remain trade-offs amid a medical risk
... Hence, the development of a new aircraft model enables adding novel automation tools to recover from all possible hazardous events on-board of the single-pilot aircraft. There are many types of technical incidents and failures (Bailey et al. 2017;Harris 2018) usually characterized by high workload as well as human-related incidents like pilot incapacitation, homicide-suicide (Kenedi et al. 2016), and terrorist attacks. Consequently, we adapted the WDA of MCO by Stanton et al. (2016a) by the addition of the purpose-related function of "Recover" (Fig. 1). ...
The aim of the present paper is to demonstrate how a subset of methods from Cognitive Work Analysis (CWA) in combination with Social Network Analysis (SNA) can be used to analyse the effects of a reduced crew in a legacy system of a commercial airliner’s two-pilot-crew operations. Whereas existing research approaches have used different methodological approaches such as classical workload evaluations, we focus on social organisation and cooperation at early conceptual design stages. A case study of Reduced-Crew Operations (RCO) in commercial aviation highlights how Work Domain Analysis, Control Task Analysis and Social Organization and Cooperation Analysis were applied to allocate functions and identify future automation requirements. Furthermore, the SNA shows the possible interactions in future RCO. The effect of technological failure on the network architecture’s resilience is also explored. A proposal on how to react to a data-link outage and break-up in RCO is made with respect to limitations in technology. In this way, the work can foster identifying automation requirements and related possible failures at early stages in the design process.
... Cinco de los seis eventos de homicidios y suicidios de una muestra de pilotos estudiada por Kennedy y colaboradores sucedieron después de que los responsables se quedaran solos en la cabina y entre los factores asociados se identificaron tanto los conflictos legales como financieros, el estrés ocupacional, las enfermedades mentales y la disfunción de pareja. En el caso del copiloto de Germanwings, todos esos factores, excepto la disfunción de pareja, estuvieron presentes 16 . ...
La salud mental es un componente fundamental del bienestar humano, cuando este componente se ve afectado en la vida de un individuo que tiene bajo su responsabilidad la vida de otras personas, nadie está exento de poder sufrir las consecuencias de dicha inestabilidad. Mayday Catástrofes Aéreas: Vuelo 9525 Germanwings - Asesinato en el aire (2016) relata lo acontecido en torno al copiloto responsable de la catástrofe, nos adentra en la mente del perpetrador, situándonos en el contexto en el cual se desenvolvía y permitiéndonos comprender en retrospectiva los puntos fundamentales que pudieron haber servido como señales de alarma y nos invita a reflexionar acerca de las vías de prevención que potencialmente pudieron haberse implementado. Si bien las condiciones orgánicas del copiloto mostraron ser saludables, una combinación de ansiedad y depresión detonadas por la carga laboral y la falta de pertenencia pudieron ser abordadas desde la medicina preventiva y el lifestyle medicine.Los pilotos y copilotos componen un gremio de profesionistas expuestos a estilos de vida que pueden afectar su estabilidad y salud mental y es por ello que se resalta la importancia de la implementación de medidas preventivas, mismas que pudieron aplicarse para evitar la tragedia del Germanwings 9525 que despegó del Aeropuerto de Barcelona con ciento cincuenta personas a bordo, mas nunca llegó a su destino. En el presente artículo se discute la importancia de abordar mediante modelos multinivel la salud de los pilotos y copilotos a propósito del caso del Germanwings, desde el enfoque de la medicina preventiva.
... Kenedi, Friedman, Watson, and Preitner (2016) examined 65 cases of pilot suicide, of which 18 were determined to have been H-Ss resulting in 732 deaths. Of these H-Ss by aircraft, 13 were perpetrated by the pilots themselves.Pre-event stressors included legal, financial, occupational and relational stressors. ...
Combined homicide‐suicide (H‐S) is a phenomenon described as an offender committing a homicidal act followed by their suicide. Current literature on H‐S is dominated by a focus on men and their particular set of motivations and actions, primarily because females constitute only a small fraction of the cases of completed H‐S. This review begins by analyzing this data and integrating females within two subclassifications of H‐S: the psychopathology of the actor (or perpetrator), and the actor's relationship to her homicide victims. Within the relational subcategory of H‐S, females are: (1) underrepresented when victims are their spouses or intimate partners (consortial H‐S); (2) more prevalent when victims are their own children (filial H‐S); and (3) with rare exceptions, not represented in extrafamilial, adversarial and pseudo‐commando H‐S perpetrators. This review includes female bombers in this gender comparison.
... In general aviation in the United States, pilot aircraft-assisted suicide rates in a 20-year period was positively determined in 0.33% (24/7,244) of fatal aircraft accident cases (1). Pilot murder-suicides, where it has been concluded through post-accident analysis and investigation that the pilot deliberately crashed a commercial aircraft killing the pilot and all others on board have occurred in six instances over the past 30 years (2). The most recent of these was the Germanwings pilot murder-suicide crash in 2015 on a commercial flight between Barcelona and Dusseldorf (3), an incident which brought this phenomenon to public attention and led to the regulator, the European Aviation Safety Authority, to require that airline pilots in the EU be psychologically assessed prior to joining an airline and for crew to have access to pilot peer support programmes. ...
The medical risks to pilots, whether to their physical or mental health, are clearly theoretically raised during the COVID-19 pandemic for the reasons outlined in this paper, and access to medical and psychological support should be improved in order to address pilot stress, distress and the potential for increased pilot suicides as a direct result of economic effects of the pandemic.The links between pilot suicides and social change, such unemployed threats and financial recession, have not been studied. Significant and sudden changes in society may increase suicide risk and serious mental health problems may affect pilots equally. After the 9/11 terrorist attacks, for example, the risk of suicide by aircraft in the year following the attack was almost four times the average risk in the five years prior to the terrorist attack. This paper discusses the potential causes of mental health problems to pilots resulting from COVID-19.Pilot aircraft-assisted suicide in commercial aviation is a rare phenomenon. In general aviation in the United States, pilot aircraft-assisted suicide rates in a 20-year period was positively determined in 0.33% (24/7244) of fatal aircraft accident cases (Vuorio et al., 2014). Pilot murder-suicides, where it has been concluded through post-accident analysis and investigation that the pilot deliberately crashed a commercial aircraft killing the pilot and all others on board have occurred in six instances over the past thirty years (Kenedi et al., 2016). The most recent of these was the Germanwings pilot murder-suicide crash in 2015 on a commercial flight between Barcelona and Dusseldorf (Germanwings Accident Investigation, 2016), an incident which brought this phenomenon to public attention and led to the regulator, the European Aviation Safety Authority, to require that airline pilots in the EU be psychologically assessed prior to joining an airline and for crew to have access to pilot peer support programmes. The regulator also required aviation medical examiners to focus greater attention on pilot mental health and well-being in their annual pilot assessments (EASA, 2018). It is noteworthy that the pilot of the Germanwings aircraft suffered with financial problems in addition to other significant mental health problems.The links between pilot suicides and social change, such unemployed threats and financial recession, have not been studied, given the low numbers of pilot suicide cases as well as the unpredictability and infrequency of recession, coupled with methodological challenges such as suitable comparison groups and the absence of baseline measures. However, it has been found that significant sudden changes in society may increase the number of pilot suicides. For example, after the 9/11 terrorist attacks in New York, the risk of suicide by aircraft in the year following the attack was almost four times the average risk in the five years prior to the terrorist attack (Vuorio et al., 2018a). Although we are unable to precisely determine a causal link between societal changes on pilot suicide, it is arguably feasible that significant, sudden and adverse changes in society can have an impact on pilot mental health. Due to the deleterious effects of COVID-19 on society generally, and on aviation specifically, we are living through the most significant and enduring aviation crisis in the history of modern commercial aviation. Thousands of air crew worldwide including pilots and cabin crew, are threatened with redundancy, unwelcome changes to their employment contracts such as increased duty times and lower pay, and the prospect that some may never fly for a living again. Currently a large proportion of pilots are furloughed or out of work. As they find employment, it is very likely that their job demand and workload will increase. Additionally, some pilots are self-employed and continue to work on zero-hours contracts and are without employment protection or health care support.A study of 424 pilots over 35 years ago has shown that during an occupational dispute, the stress experienced by pilots had a significant impact on their mental health (Cooper & Sloan, 1985). This study also demonstrated that the combination of factors including career development, autonomy at work, organizational climate and family support and cohesion are important regarding job satisfaction, but also potentially increase the risk of accidents if work and personal stress levels are left unchecked. It has been shown that economic crises increase the mental burden on work and workload (Kronenberg & Boehnke, 2019). In addition to this, it is well established that an economic downturn is associated with an increase in suicides in the general population (Barr et al., 2012;Milner et al., 2015).The social, economic, employment and personal challenges of COVID-19 in society threatens several factors important for pilots' mental well-being. The current situation is compounded by the additional social stress brought about by social and physical distancing measures brought in to contain the spread of infection. A recent position paper by the UK Academy of Medical Sciences offers a strategy for how to study and to take account of the psychological, social and neuroscientific aspects of the pandemic (Holmes et al., 2020). It is recognized that the pandemic may increase suicide rates just as Acute Respiratory Syndrome (SARS) did in 2003 (Tsang et al., 2004;Nickell et al., 2004;Yip et al., 2010). This risk is increased due to economic prolonged downturn, which particularly affects aviation. The most significant and concerning effects may only become apparent in the future. Another threat concerns pilots who themselves have suffered with infection with COVID-19. Although infection may be asymptomatic in many instances, it may lead to serious mental and neurological problems in those who have been hospitalised due to the effects of the virus and also side-effects of hospitalisation and treatment (Holmes et al., 2020;Troyer et al., 2020). It has been reported that those people who suffered serious infection with SARS were at increased risk of post-traumatic stress disorder and depression (Tsang et al., 2004;Nickell et al, 2004). Post-traumatic stress disorder has been shown to be associated with fatal aircraft accidents (Laukkala et al. 2018).One challenge in health care generally, and in aviation medicine specifically, is how to best prevent or mitigate the risk of mental health problems and especially suicide risk during the COVID-19 pandemic whilst airline employees suffer a threat to their job and livelihoods due to economic effects. It is important to note that each time a pilot visits their aeromedical examiner (AME ) or aviation psychologist, there may be a fear the loss of their medical certification (Bor et al., 2017). It has been shown that pilots may be reluctant to report to their AME conditions that could affect crew licensing due to their concerns that this could affect their livelihoods (Vuorio et al., 2018b). Private medical insurance and support and company-organised occupational healthcare is not available to many pilots. It is not yet possible to determine how physical health, routine medical checks and AME visits by pilots have been affected by the COVID-19 pandemic and it is possible some pilots will have avoided seeking health care during this time for economic, infection risk and occupational threat reasons. Some regulators, such as European Aviation Safety Agency (EASA) have allowed pilots to renew their medical certificates by accessing AME's remotely and by extending the validity of their licences, reducing contact between airline crew and medical specialists.The medical risks to pilots, whether to their physical or mental health, are clearly theoretically raised during the COVID-19 pandemic for the reasons outlined in this paper, and access to medical and psychological support should be improved in order to address pilot stress, distress and the potential for increased pilot suicides as a direct result of economic effects of the pandemic.
... Przyczynami były kryzysy finansowe, prawne, konflikty pracownicze, choroby psychiczne i czynniki stresogenne często współwystępujące z nadużywaniem narkotyków i alkoholu. (Kenedi, Friedman, Watson, Preitner, 2016). ...
Książka opisuje osoby uprawiające sportylotnicze, doktórych zaliczamy:
• akrobację lotniczą
• spadochroniarstwo
• szybownictwo
• sport samolotowy
• sport śmigłowcowy
• lotniarstwo
• paralotniarstwo
• baloniarstwo
... Another possible category is "murder-accidents", which might be implicated in, for example, deaths related to burnt out houses [22]. Further possible categories are "aircraft-assisted pilot suicides" [23][24][25][26][27][28] and "suicide bombings" [17,29], although whether these can be considered murder-suicides is controversial. We propose establishing the category of "consensual murder-suicides" [30] as a subcategory of murder-suicides to facilitate the analyses of those cases involving possible mutual agreement between the participants. ...
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.
The provision of pilot peer support in commercial aviation is a recent recommendation following the Germanwings pilot suicide–murder crash in 2015. Conducted in a South African aviation context, this study explored the phenomenon of peer support and its role and contribution as an effective response to addressing the emotional well-being of pilots. A qualitative phenomenological research design was followed using Rubin and Rubin’s in-depth, semi-structured interview technique to understand lived experiences of peer support. Nine interviews were held, six with airline pilots – a combination of peers and flight operations managers – and three with mental health professionals (MHPs). Braun and Clarke’s thematic analysis (TA) method elicited themes in relation to peer support and the mental health and well-being of pilots. Four themes emerged relating to (a) the conceptualization of peer support, the role of the peer, and the principles on which the process is founded; (b) pilots’ experience of their workplace as emotionally “unsafe” and deficient in acknowledging the nature of different emotional stressors; (c) the well-being of pilots and medical certification of fitness for duty; and (d) the multidimensional contribution of peer support and factors critical to integrating successful and sustainable peer support. This study underscores the importance of developing a more integrated definition of safety in aviation that incorporates supporting the mental health and well-being of pilots. This paper addresses the role and contribution of peer support and considers some of the challenges to its integration as a safety initiative.
Inhibitory SGLT2, czyli inhibitory kotransportera glukozowo-sodowego 2 są nową klasą leków przeciwcukrzycowych, które obniżają poziom glukozy we krwi, działając głównie poprzez zmniejszenie wchłaniania zwrotnego glukozy w kanaliku proksymalnym nerki. Biorąc pod uwagę ich działanie wewnątrznerkowe i pozanerkowe, sugeruje się, że zapewniają działa-nie renoprotekcyjne i kardioprotekcyjne u pacjentów z cukrzycą typu 2, u których występuje bardzo duże ryzyko nefropatii oraz niewydolności serca. W wielu badaniach dowiedziono, że zmniejszają ryzyko trwałego pogorszenia czynności nerek, oraz terapii nerkozastępczej. Ponadto znacznie obniżają częstość hospitalizacji oraz śmierci z przyczyn sercowo-naczyniowych. Dane te dostarczają merytorycznych dowodów do stosowania inhibitorów SGLT2 w zapobieganiu poważnym chorobom nerek i uszkodzenia mięśnia sercowego u osób z cukrzycą typu 2. Po-niższa praca zawiera najnowsze informacje o mechanizmie działania i skuteczności inhibitorów SGLT2, głównie dapagliflozyny, kanagliflozyny oraz empagliflozyny.
Die zugrunde liegende Studie beschäftigte sich erstmals mit der wissenschaftlichen Untersuchung von Amokfahrten in Deutschland zwischen 2000 und 2017 und schloss 22 von 46 ausgewerteten Strafakten in die nähere Betrachtung ein. Die überwiegend männlichen Einzeltäter waren mittleren Alters, ledig und planten ihre Taten nur selten. Die Tatsituation entstand überwiegend zufällig und endete zumeist mit der Festnahme des Täters. Neben finanziellen und sozialen Schwierigkeiten der Täter fielen insbesondere die vorangehende ambulante und/oder stationäre Behandlung aufgrund einer psychischen Erkrankung auf. Dabei war die Hälfte aller Täter psychotisch. In nahezu allen Fällen zeigte sich gemäß der Warnverhaltentypologie mindestens eine auffällige Verhaltensweise im Vorfeld der Tat. Obwohl diese Auffälligkeiten für Personen oder Institutionen wahrnehmbar sind, wurde nur selten darauf reagiert. Einleitung
Pilot homicide-suicides occur very rarely in commercial aviation. Nonetheless, when a crash like Germanwings flight 4U9525 has occurred, the stakeholders take action to improve current standards to help prevent new cases. The EASA-led task-force has proposed several recommendations. The System Theoretic Accident Process Analysis (STPA) of the accident investigates how European countermeasures have been improved the system at different levels. The new minimum cockpit occupancy of two personnel was tied to a safety and risk assessment by the operator whereas the cockpit door design was not changed. On a higher level a psychological health assessment for initial medicals class 1 has been added. Pilot support programs, an improvement of aeromedical services and a random drugs/alcohol screening complement the actions is being undertaken. Conflicts with privacy laws and medical confidentiality could not be solved entirely and are still being debated.
We applied a systems theoretical hazard analysis to the accident of JL350 to reanalyze this unique case of pilot homicide-suicide from a contemporary perspective. It is the only known case in which people had survived the crash. Having collected all information on the accident, we present a comprehensive analysis of the homicide-suicide and its countermeasures established afterwards. This sheds light on how the Japanese system of commercial aviation has responded. An aeromedical research center provides the Japanese aviation society with the latest knowledge on medicine, including mental health, to keep the stakeholders informed which enables them to react to changing requirements. In Europe, similar countermeasures were recommended decades later to address the mental health issues of pilots.
Risk prediction is an important method used by physician to decide whether to refer
a patient for diagnostic tests or prescribe treatment. Traditionally, the physician assesses risk on the basis of his knowledge and experience, but predictive models has been proposed to improve this assessment. Machine learning can be utilized to further improve currently used models, which will benefit patients. In this chapter, based on a literature review, the need for predictive models use is justified and the models used so far are compared to new models based on machine learning. The new models have not been used in clinical practice so far, but due to their higher accuracy and prospects for creating new, better models, they may be an important aspect
of personalized medicine in the future.
Over the past decade, artificial intelligence has become a popular topic among the
scientific community and beyond. A lot of positive expectations related to artificial intelligence and its influence on certain processes, not only in the field of technology but also in medicine, require familiarization with the basics of its functioning. This chapter attempts to present the above issues in a way that is accessible to people not related to this subject. Where possible, technical jargon has been abandoned in order to better explain the concepts related to artificial intelligence and bring the subject to a wider audience. The following chapter focuses on the application
of machine learning in medicine as well. Artificial intelligence tools help to organize and extract meaning from the vast amount of clinical and population data and to make proper decisions.
Homicide–suicide is the phenomenon in which an individual kills 1 or more people and commits suicide. Research on homicide–suicide has been hampered by a lack of an accepted classification scheme and reliance on media reports. Mass murder–suicide is gaining increasing attention particularly in the United States. This article reviews the research and literature on homicide–suicide, proposing a standard classification scheme. Preventive methods are discussed and sociocultural factors explored. For a more accurate and complete understanding of homicide–suicide, it is argued that future research should use the full psychological autopsy approach, to include collateral interviews.
Niewystarczające wydzielanie insuliny lub defekt jej działania jest głównym proble- mem współczesnej diabetologii. Z tej przyczyny poszukiwanie jej analogów a także dobór od- powiedniej terapii pozwalającej odwzorować funkcje trzustki jest jednym z ważniejszych zadań współczesnej medycyny. Odkrycie w 1922 roku insuliny pozwoliło, aby cukrzyca ze śmiertelnej stała się jedynie chorobą przewlekłą. Następne odkrycia takie jak biosynteza ludzkiej insuliny oraz opracowanie nowoczesnych analogów insuliny pozwoliły na lepsze zrozumienie choroby a także poprawę rezultatów klinicznych. Pomimo niemal 100 lat od tego odkrycia terapia insu- liną stwarza wiele wyzwań, a nowe preparaty wykazują coraz lepsze właściwości. Obecnie bada- nia nad nowymi preparatami insulinowymi skupiają się między innymi na dostosowaniu czasu działania w zależności od potrzeb terapeutycznych czy też opracowaniu alternatywnych dróg podania. Przegląd doniesień na temat nowych preparatów insulinowych oraz alternatywnych dróg podania pozwoli ocenić przypuszczalny kierunek rozwoju dalszych badań, a także spojrzeć na przyszłe możliwości terapii.
Vuorio A, Laukkala T, Navathe P, Budowle B, Eyre A, Sajantila A. Aircraft-assisted pilot suicides: lessons to be learned. Aviat Space Environ Med 2014; 85:841–6. 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.
Homicide-followed-by-suicide (referred to as "homicide-suicide") incidents are rare events but can have a profound impact on families and communities. A better understanding of perpetrator characteristics and how they compare with those of other homicide suspects and suicide decedents might provide insight into the nature of these violent acts. This report is based on 2003-2005 data from 17 US states participating in the National Violent Death Reporting System, a unique, incident-based, active surveillance system that integrates data on violent deaths from multiple sources. Of the 408 homicide-suicide incidents identified, most incidents were committed with a firearm (88.2%) and perpetrated by males (91.4%), those over 19 years of age (97.6%), and those of white race (77.0%); however, just over half of filicide (killing of children)-suicides (51.5%) were perpetrated by females. Over 55% of male homicide-suicide perpetrators versus 26.4% of other male suicide decedents had prior intimate partner conflicts (P < 0.001). In fact, having a history of intimate partner conflicts was even common among homicide-suicide perpetrators who did not victimize their intimate partners. Recognition of the link between intimate partner conflicts and homicide-suicide incidents and strategies involving collaboration among the court/legal and mental health systems might prevent these incidents.
Suicide is the 11 th leading cause of death in the United States. The objective of this study is to document the characteristics of aviation-related suicides and suicide attempts.
Aviation accidents reported by the National Transportation Safety Board between 1983 and 2003 were screened for cases in which suicide was listed as a probable cause. For each suicide case, two accidents were randomly selected as controls, matched on sex of pilot, type of flight, state, and year of occurrence. Mantel-Haenszel summary Chi-square tests were used to compare cases to controls. Conditional logistic regression modeling was performed to assess the association of pilot and flight characteristics with suicide-related crashes.
During the 21-yr study period, 37 pilots committed or attempted suicide by aircraft, with 36 resulting in at least one fatality. All the cases were men and involved general aviation flights. Toxicological test results revealed that 24% of the cases had used alcohol and 14% had used other illicit drugs. Underlying factors included domestic and social problems (46%), legal trouble (40%), and pre-existing psychiatric conditions (38%). Compared with controls, suicide cases involved younger pilots (p < 0.05), were less likely to have another occupant (p < 0.0001), were more destructive to the aircraft (p < 0.0001), and were more likely to have occurred away from the airport (p < 0.0001).
Aviation crashes caused by suicide differ from unintentional aviation accidents in pilot characteristics, crash circumstances, and outcomes.
Our laboratory was interested in epidemiological and toxicological findings from aircraft-assisted pilot suicides. Between 1993-2002 there were 3,648 fatal aviation accidents. The NTSB determined that 16 were aircraft-assisted suicides; 15 from intentional crashing of an aircraft and 1 from exiting the aircraft while in-flight. All pilots involved in these aircraft-assisted suicides were male, with a median age of 40 years. Seven of the 14 pilots for which specimens were available were positive for disqualifying substances. Based on the few cases conclusively attributed to suicide, death by the intentional crashing of an aircraft appears to be an infrequent and uncommon event.
Homicide-suicide represents a single episode of violence which may decimate an entire family. This study aimed to further describe motives and context of these tragedies. Psychological autopsies were completed for 18 homicide-suicide cases in Dallas, Texas. This included postevent interviews with surviving family members and review of police and coroner records. Two-thirds of perpetrators had made either verbal or written threats prior to the homicide-suicide. A simplified typology describing victim-perpetrator relationship and motive type is suggested for future studies and clinical ease. Two-thirds of perpetrators fell into the category of Intimate-Possessive, most of whom were depressed men who were abusing substances and undergoing separation. Additional categories included Intimate-Ailing, Filial-Revenge, Familial-Psychotic, and Friend-Psychotic. Further, implications from this psychological autopsy study regarding risk assessment include use of collateral interviews regarding threats and past violence.
© 2015 American Academy of Forensic Sciences.
In 2006, 67 persons were killed in aircraft accidents in Germany and involving German aircrafts abroad. In spite of extensive investigation of each aircraft accident, there are no reliable data as to the number of suicides by aircraft. We report on a 50-year-old man who committed suicide by willfully crashing his Beech "Sierra" aircraft minutes after take off from an airport close to the town of Rendsburg, Germany. Before killing himself, the intoxicated pilot had sent an SMS announcing his suicide plans to a friend. The findings of the medico-legal investigation and the results of a review of aircraft accident reports by the German Federal Bureau of Aircraft Accidents Investigation (BFU) regarding suicidal plane crashes are presented.
There is disagreement in the suicide literature on the value of suicide notes as a data source, particularly regarding the extent to which suicide decedents who write notes differ from those who do not. Using 10 years of suicide cases from Summit County, Ohio, these two groups were compared on 40 variables including sociodemographic characteristics, reported affect before death, precipitating events, physical and mental health status and care, and method of suicide. The only differences found were that note writers were more likely to have lived alone and had made prior suicide threats. These findings suggest that for research purposes, suicide cases with and without notes are essentially similar.
There has been recent widespread media coverage of events that involve murder-suicide. In this paper, the author does an extensive literature review of studies about murder-suicide. The purpose is to determine whether the incidence of murder-suicide is increasing and what its risk factors are. The results of this review show that the incidence of murder-suicide remains at under 0.001%. Risk factors for murder-suicide are based on relationship between perpetrator and victims, history of domestic violence, sex or perpetrator and victim, age of perpetrator, presence of divorce/separation, use of weapon, and history of mental illness. This paper shows that the incidence of murder-suicide is low, stable, and similar to what has been reported in the past. There are, however, some distinct risk factors for murder-suicide including: substance abuse (not as common), mostly male perpetrators, depression (more common), and older male caregivers are at risk.
The authors evaluated data on 182 fatally injured and 96 nonfatally injured drivers involved in vehicular crashes over a 6-year period. Only 1.7% of the total fatal crashes were considered to have been suicides, and 1% of the nonfatal crashes were deemed suicide attempts. Neither group of drivers had unusually high incidences of previous suicidal ideation or behavior, but both groups tended to be socially deviant, with above average levels of psychopathology and social aggressiveness. Crash victims in both groups also had poor driving records and high rates of alcohol abuse, findings that have important implications for accident prevention.
The average increase in motor vehicle fatalities is 9.12 percent in the week after a suicide story. The more publicity given
to the story, the greater the rise in motor vehicle deaths thereafter. This rise apparently occurs because suicide stories
stimulate a wave of imitative suicides, some of which are disguised as motor vehicle accidents.
Twelve couples in cases of murder-suicide were compared to 24 couples in cases of homicide during the period 1978 to 1987 in Albuquerque, N.M. Data were obtained from police, the courts, hospital records, and interviews with friends and family of the deceased. The most striking findings were that perpetrators of murder-suicide were depressed (75%) and men (95%), while perpetrators of homicide were not depressed and one-half were women. The data indicate that the murder-suicide and homicide groups are two different populations.
Intentional aircraft crashes are a dramatic cause of death. The entire set of fatalities due to this cause of death in the United States has not been described. Mortality data from aircraft crashes determined as being due to suicide were obtained from National Center for Health Statistics (NCHS) and National Transportation Safety Board (NTSB) data sources. The NCHS reported that, between 1979 and 1989, ten persons committed suicide by aircraft crashes. Twenty aircraft crash fatalities were also reported during the period in which the intent of death could not be determined as either suicide, homicide, or accidental. White middle-aged males accounted for the majority of deaths. The NTSB reported, for the years 1979-89, that nine fatal aircraft accidents were suicide. All fatalities were male pilots operating small fixed wing aircraft. NTSB investigations identified evidence for important adverse psychologic factors in most pilots.
Approximately 2-3% of all fatal air accidents may be attributed to suicide, and in many other accidents in aviation there are grounds for inferring that self-destructive or suicidal behavior was involved. Narcissistic personality traits are of paramount importance for the choice of this suicide method. Precursors include undetected depressions, alcoholism, and family problems of pilots.
A review was undertaken of 415 general aviation accidents. Three were definite cases of suicide and in another seven it seemed possible that the deceased had taken their own lives. Therefore, in the United Kingdom, suicide definitely accounts for 0.72% of general aviation accidents and possibly for more than 2.4%. The latter accords more closely with the findings from Germany than from the United States. Previous psychiatric or domestic problems and alcohol misuse are features of these cases. Aerobatics before the final impact is another frequent finding. The investigation of fatal accidents involving "pilot error" is incomplete without an examination of the victim's social and psychological history. An assessment of a pilot's mental well-being is an essential part of aviation medical examinations.
In 1997 the Swedish Parliament decided, in accordance with the so-called Vision Zero, that one official goal for the national traffic safety effort is that the number of traffic fatalities in the year 2007 must not exceed 270. In order to monitor efforts toward this hard-won goal, it is of course of utmost importance that official statistics on traffic deaths are reliable. In a meticulous analysis of all 580 officially registered traffic deaths in Sweden in 1999, we found that 490 were true accidental deaths, while 18 were suicides, 12 were deaths due to indeterminate causes, 59 were natural deaths and 1 case was not possible to evaluate due to missing data. Thus, only 84% of the officially registered "accidental traffic deaths" were bona fide accidents. In order to enhance the reliability of the official statistics, we suggest that regulations concerning police investigation and medicolegal autopsy of all unnatural deaths be adhered to all deaths reported to the Swedish National Road Administration should be checked in the database of autopsied cases in the National Board of Forensic Medicine in order to exclude natural deaths the time delay (1.5 years) to complete the official Cause-of-Death Register be shortened criteria for the classification of manner of death in "borderline" cases be suggested for international acceptance.
Little has been published about the aeromedical management and disposition of aviators who attempt suicide, and almost no such information about military aviators exists in the open literature. The few available data are scattered and frequently anecdotal.
The authors reviewed all case reports of fliers evaluated at the USAF School of Aerospace Medicine's Aeromedical Consultation Service (ACS) between 1981-96 for possible return to flying duties after a suicide attempt, and prepared a representative case report.
Between 1981 and 1996, the ACS evaluated 14 trained aviators (pilots and other aircrew members, excluding flight surgeons) who had attempted suicide. Of these, 11 (79%) ultimately received a recommendation for return to flying duties.
In most instances the underlying stressors included failed intimate interpersonal relationships, administrative or legal problems, psychiatric disorders, death of spouse, or job conflicts. Evidence of abuse of alcoholor other substances was found in 54% of an earlier, larger data set of attempters. Some data on aircrew suicide completion were available and are reported. The top medical priorities after such attempts should be to diagnose what is wrong, and to treat it. In spite of the common assumption that a suicide attempt inevitably ends a military flying career, some attempters can return to safe and effective flying duty after appropriate psychotherapy. If the flier regains physical and mental health and maintains them for at least 6 mo after treatment, then that flier may be evaluated by an outside aeromedical psychiatric consultant such as the ACS (to avoid transference issues between flier and therapist) for possible return to flying duties. Waiver action should be based on the underlying psychiatric diagnosis, not the suicidal attempt itself. Follow-up may be accomplished through periodic mental health evaluations in conjunction with routine physical examination procedures. Issues involving substance abuse and security clearances must be handled through the appropriate channels.
Selective serotonin reuptake inhibitors (SSRIs) are popularly prescribed for treating depression. With a few exceptions, these psychotropic medications are not approved by aeromedical regulatory authorities for use by aviators. Since SSRIs have the potential for impairing performance and causing drug-drug interactions, the prevalence of SSRIs in pilot fatalities of civil aviation accidents was evaluated.
Postmortem samples from pilots involved in fatal civil aircraft accidents are submitted to the Civil Aerospace Medical Institute (CAMI) for toxicological evaluation. Findings from such evaluations are maintained in the CAMI Toxicology Database. This database was examined for the presence of SSRIs in pilot fatalities of the accidents that occurred during 1990-2001.
Out of 4,184 fatal civil aviation accidents from which CAMI received samples, there were 61 accidents in which pilot fatalities had SSRIs. Of these accidents, 56 were of the general aviation category, 2 were of the air taxi and commuter category, 2 were of the agricultural category, and 1 was of the ultralight category. Blood concentrations of SSRIs in the fatalities were 11-1121 ng x ml(-1) for fluoxetine; 47-13102 ng x ml(-1) for sertraline; 68-1441 ng x ml(-1) for paroxetine; and 314-462 ng x ml(-1) for citalopram. In 39 of the 61 pilots, other drugs--for example, analgesics, antihistaminics, benzodiazepines, narcotic analgesics, and/or sympathomimetics--and/or ethanol were also present. As determined by the National Transportation Safety Board, the use of an SSRI [with or without other drug(s) and/or ethanol] has been a contributory factor in at least 9 of the 61 accidents.
Numbers of SSRI-involved accidents were low, and blood SSRI concentrations in the associated pilot fatalities ranged from subtherapeutic to toxic levels. However, the interactive effects of other drug(s), ethanol, and/or even altitude hypoxia in producing adverse effects in the pilots cannot be ruled out. Findings from this study should be useful in investigating SSRI and other substance-involved accidents and in making decisions concerning the use of SSRIs in aviation.
The purpose of this phenomenological study was to identify commonly occurring factors in filicide-suicide offenders, to describe this phenomenon better, and ultimately to enhance prevention of child murder. Thirty families' files from a county coroner's office were reviewed for commonly occurring factors in cases of filicide-suicide. Parental motives for filicide-suicide included altruistic and acutely psychotic motives. Twice as many fathers as mothers committed filicide-suicide during the study period, and older children were more often victims than infants. Records indicated that parents frequently showed evidence of depression or psychosis and had prior mental health care. The data support the hypothesis that traditional risk factors for violence appear different from commonly occurring factors in filicide-suicide. This descriptive study represents a step toward understanding filicide-suicide risk.
To calculate the prevalence of homicide followed by suicide (homicide/suicide) and provide contextual information on the incidents and demographic information about the individuals involved using data from a surveillance system that is uniquely equipped to study homicide/suicide.
Data are from the National Violent Death Reporting System (NVDRS). This active state-based surveillance system includes data from seven states for 2003 and 13 states for 2004. The incident-level structure facilitates identification of homicide/suicide incidents.
Within participating states, 65 homicide/suicide incidents (homicide rate = 0.230/100,000) occurred in 2003 and 144 incidents (homicide rate = 0.238/100,000) occurred in 2004. Most victims (58%) were a current or former intimate partner of the perpetrator. Among all male perpetrators of intimate partner homicide 30.6% were also suicides. A substantial proportion of the victims (13.7%) were the children of the perpetrator. Overall, most victims (74.6%) were female and most perpetrators were male (91.9%). A recent history of legal problems (25.3%), or financial problems (9.3%) was common among the perpetrators.
The results support earlier research documenting the importance of intimate partner violence (IPV) and situational stressors on homicide/suicide. These results suggest that efforts to provide assistance to families in crisis and enhance the safety of IPV victims are needed to reduce risk for homicide/suicide. The consistency of the results from the NVDRS with those from past studies and the comprehensive information available in the NVDRS highlight the promise of this system for studying homicide/suicide incidents and for evaluating the impact of prevention policies and programs.