Selective Serotonin Reuptake Inhibitors: Medical History of Fatally Injured Aviation Accident Pilots

Sen, Ahmet; Akin, Ahmet; Canfield, Dennis V.; Chaturvedi, Arvind K. · 2007 · ROSA P / United States. Department of Transportation. Federal Aviation Administration. Office of Aviation. Civil Aerospace Medical Institute

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Summary

This study investigates the medical history and reporting practices of 61 U.S. civilian pilots who were fatally injured in aviation accidents between 1990 and 2001 and were found to have selective serotonin reuptake inhibitors (SSRIs) in their postmortem toxicology screens. SSRIs are widely prescribed for depression but are not approved for use by U.S. civilian aviators. While a prior study identified the presence of these drugs in the fatalities, it remained unclear whether these pilots had disqualifying psychological conditions or had properly reported their medication use during mandatory aviation medical examinations. This research aimed to determine the prevalence of unreported SSRI use and psychological disorders among these pilots and to assess the role of these factors in the accidents. The researchers retrieved aeromedical records from the Federal Aviation Administration’s (FAA) Medical Certification Database and accident investigation reports from the National Transportation Safety Board (NTSB) Aviation Accident Database. Of the 61 pilots, 59 had records in the FAA database; two lacked records due to missing medical certificates or holding Canadian certifications. The study analyzed self-reported histories of psychological conditions, SSRI use, and driving under the influence (DUI) from past medical examinations, comparing these against personal medical records obtained through NTSB investigations. Statistical analysis was performed to evaluate trends in SSRI-involved fatalities over the 12-year period. The results revealed a significant underreporting of SSRI use and psychological conditions. Although 22 of the 59 pilots with FAA records had self-reported DUI convictions, only 7 (12%) had reported disqualifying psychological conditions in past examinations, and only 3 of those reported SSRI use. Of the 7 who reported conditions, 6 were subsequently reissued medical certificates after claiming they were no longer taking SSRIs or suffering from the conditions. In contrast, NTSB investigations revealed that 12 of the 61 pilots (20%) had a history of psychological conditions or SSRI use documented in personal medical records, none of which were reflected in the FAA database for 10 of those pilots. Furthermore, psychological conditions or drug use were determined to be the probable cause or a contributing factor in 19 of the 61 accidents (31%). The proportion of SSRI-involved fatalities increased significantly from 0.26% in 1991 to 5.88% in 2001. The study concludes that a substantial number of pilots used SSRIs and suffered from psychological conditions without reporting them to the FAA, despite holding valid medical certificates. The authors note that even pilots with medical backgrounds, including psychiatrists and psychologists, failed to disclose their conditions. The findings suggest that current regulations, which prohibit SSRI use, may encourage non-disclosure rather than compliance. The authors imply that a supervised treatment protocol, similar to those in Canada and Australia, might improve reporting rates and safety. They recommend that Aviation Medical Examiners exercise caution when certifying airmen with vague psychological signs, given the increasing societal use of antidepressants and the associated safety risks of unreported medication use.

Key finding

Psychological conditions and/or SSRI use were determined to be the cause or a factor in 19 of the 61 fatal aviation accidents, and 88 percent of the pilots had not self-reported these conditions or drug use in their last aeromedical examinations.

Methodology

dataset

Sample size: 61

Provenance

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