March 27, 2015

expert reaction to mental state of A320 crash co-pilot

Reports in the media have been speculating as to the mental state of the co-pilot who was flying the A320 plane which crashed in the French Alps.

Dr Paul Keedwell, Consultant Psychiatrist and Specialist in Mood Disorders, said:

“Murder suicide is extremely rare: it is committed by 2-3 people in every million per year (0.0002-0.0003% of the population per year), and this rate is stable over time. For obvious reasons we cannot know the perpetrator’s mental state at the time of the homicide in these cases.

“Among cases of murder suicide in general the rate of previously diagnosed depression varies from 40 to 60%, depending on the context. Of those who are depressed, very few are being treated for it. It is important to realise that most murder-suicide involves a man and his spouse so this is where most of the data will come from. Murder suicide in pilots or in gun massacres is vanishingly rare.

“In the vast majority of cases of depression, suicide is the main risk, not violence.

“So, depression is not in itself a sufficient explanation for murder suicide, but early detection and adequate treatment might reduce the risk.

“In such a rare event it is difficult to be confident about other risk factors, but these include male gender, recent or impending divorce or separation, alcohol and/or drug misuse in the past and at the time of the act, personality disorder (especially impulsive or psychopathic types) and ready access to a deadly weapon.”

Prof. Seena Fazel, Professor of Forensic Psychiatry and Wellcome Trust Senior Research Fellow, University of Oxford, said:

“It is very difficult to comment on this particular case as the information is so limited, and speculation about underlying causes could be stigmatizing and damaging. But it is important to bear in mind that depression is a treatable disease, and the presence of a depressive illness in the past does not necessarily tell us anything about someone’s current mental health.

“Furthermore, research on mass killings associated with suicide suggests that mental illness at the time of death is rare, and the individuals perpetrating them seem to be motivated by a complex set of individual and social factors that interact in unpredictable ways. This has meant that it is not possible to identify high risk individuals.

“Even the more common but still rare outcome of suicide is very difficult to predict, and screening tools are limited by large number of false positives which would overwhelm health services if they led to interventions. For example, based on the likely properties of current suicide screening tools based on a recent review, if you apply a reasonably good screen to 100,000 persons, for whom you expect 10 to die from suicide (based on population averages), this suicide screening tool would lead to 8 correct screens, two missed suicides, but importantly nearly 30,000 persons who would be identified at high risk but would not die from suicide.”

Prof. Sir Simon Wessely, President of the Royal College of Psychiatrists, said:

“The loss of the GermanWings Airbus is a ghastly horror. Until the facts are established, we should be careful not to rush judgements. Should it be the case that one pilot had a history of depression, we must bear in mind that so do several million people in this country.

“It is also true that depression is usually treatable. The biggest barrier to people getting help is stigma and fear of disclosure. In this country we have seen a recent fall in stigma, an increase in willingness to be open about depression and most important of all, to seek help.

“We do not yet know what might be the lessons of the loss of the Airbus, but we caution against hasty decisions that might make it more, not less, difficult for people with depression to receive appropriate treatment. This will not help sufferers, families or the public.”

Dr Sarah Bailey, Senior Lecturer, Department of Pharmacy & Pharmacology, University of Bath, said:

“We cannot comment on this co-pilots history – we know nothing about him and speculation about a person’s mental health is always damaging to that individual’s family and to others. We run the risk of stigmatizing people with depression.

“We know that depression is an illness that occurs in episodes, and tends to recur. Depression is estimated to affect 1 in 6 adults in the UK. It is very common.  When people are able to recognize their symptoms and access the right treatment then it is possible to lead a full life, including holding down a responsible job.

“I am not aware that there are any studies linking suicide to mass death, it is presumably a very rare occurrence.”

Dr Ali Haggett, Research Fellow, Centre for Medical History, University of Exeter, said:

“It is too premature to comment specifically on the mental health of this pilot, since his medical records have not yet been confirmed and we do not yet actually know whether his mental health caused him to take a break in his training – and the airline confirm that he had passed all necessary tests a) to resume training and b) to fly the aircraft.

“However, if it is confirmed that he had a history of mental illness and depression, what we do know is that disclosure and help-seeking is a significant problem for men and that, in the UK for example, 75% of suicides are in men.  These statistics have remained relatively stable since the beginning of the twentieth century, and indicate that there is something very wrong with our ability to detect and treat mental health issues in men.  I have just submitted a book for publication on male mental illness (A History of Male Psychological Disorders in Britain, 1945-1980 (Palgrave Macmillan, September 2015), and what this illustrated was that men often find it difficult to recognise symptoms of depression (initially, or indeed in relapse) – and that if they do realise something is wrong, they find it much harder to seek help.  This is a complex problem, but is in part bound up with our western model of masculinity, which promotes strength and coping – both attributes that are threatened by the unfortunate association with mental illness and ‘weakness’.  Disclosure is also complicated in occupations where it would affect a person’s fitness to practice (for example, the medical profession – where there has been consistently a higher level of drug and alcohol abuse and mental illness than in the general population).  We know that men are more likely to self-medicate with alcohol and to present with psychosomatic or physical symptoms, which are less-obviously ‘psychological’ and may not be identified by the medical profession as having an emotional cause.

“The media reports so far have been broadly unhelpful.  If it is to be confirmed that the pilot had mental health problems, reports of ‘mass murder’ by a ‘madman’, serve only to reinforce the damaging stereotypes already associated with serious mental illness.  It does appear, at this stage of the investigation, that the pilot passed the required tests at that stage indicated that he was fit to fly.  There is certainly no reason why people with a history of depression cannot go on to perform well in high-level occupations, and there is no evidence that people with depression are likely to be more violent or wish to take others with them in suicide.  We also know from those who have attempted suicide that it is more usually about feeling trapped in a situation from which there appears to be no other alternative – and not about harming others.

“If a history of mental illness is confirmed, what this incident does serve to illustrate is that as a society, we need to do more in terms of understanding and detecting depression and other mental health conditions – particularly in men.”

Declared interests

None declared