Abstract
If you have thought twice about boarding an airplane in recent months, you are most assuredly not alone. Since the tragic collision of an American Airlines plane and a military helicopter in late January, the media has bombarded the public with a never-ending stream of near misses and fatal crashes in our skies.
However, while it may seem to the general public that there has been a startling increase in air travel mishaps, statistics do not bear this out. According to the NTSB, there were 115 aviation accidents and incidents globally from January 1st through mid-February of 2025. 1 During the same period last year, there were 187. Nevertheless, though 2025 saw fewer accidents, several of these occurrences have been severe, which means more coverage and attention, leading to a greater mental impact on travelers’ psyches. It is not that flying has become more dangerous, but that the danger that does exist is at the forefront of our minds.
In fact, flying today is safer than ever. According to Arnold Barnett, professor of statistics at MIT, in the United States and similar countries with high aviation standards, the risk of death per passenger is now about 1 in 100 million. 1 Globally, 12 million people board flights daily, and most days not a single traveler is even injured, let alone killed. While the number of global flights (and therefore passengers) has continually increased, the safety statistics continue to improve. In recent decades overall aviation accident rates have decreased by 45%, with the fatal accident rate dropping a hefty 68%. In other words, the recent incidents are not an indication of increasing danger in air travel but instead are the result of a set of incidents that has shifted our attention to the small risk that does exist.
That does not mean that there is no room for improvement in aviation safety. In early aviation, mechanical error accounted for a major share of accidents and casualties. These days, with improved technology and a multi-layered system of safety protections, it is incredibly rare that these issues will cause a plane to crash. Instead, human error has become the weakest link in modern aviation safety; human error is responsible for 70%–80% of all civil and military aviation accidents today. 2
Whether one is a pilot, air traffic controller, cabin crew member, or maintenance worker, the pressure is high, and the stakes are life and death. These jobs are both mentally and physically strenuous, and anyone who is not in top form could be a potential danger.
Some stressors are inherent in the job. Pilots and cabin crew who are working long-haul flights that cross time zones will almost certainly experience some level of fatigue and jet lag. Maintenance workers also face rigorous and fluctuating schedules. While maximum shift lengths and required rest periods can reduce the immediate effects of this type of work, inadequate sleep can eventually lead to a range of both physical and mental symptoms. Studies on daylight saving time show that even a one-hour time change disrupts circadian rhythm. This disruption has been linked to heightened mood disorders, depression, anxiety, and substance use. It also increases production of inflammatory markers and elevates heart rate and blood pressure—factors that together raise the risk of heart attack and stroke. 3 These types of changes can also affect the body’s regulation of essential functions like appetite, mood, and, most significantly, sleep. Sleep disturbance makes people groggy, fatigued, and less focused, leading to mistakes at work, which in the aviation field can be deadly.
Among airline workers, these physiological disruptions often intersect with high-stress work environments, further compounding the risk for mental health disorders. Due to privacy concerns and lack of reporting, the exact prevalence of poor mental health among aviation crews is difficult to determine. Still, the Lived Experience Wellbeing Survey Project (active since 2016) has found “high levels” of self-reported mental health issues among safety-critical aviation workers in Europe. 4 The survey has further revealed that the same staff—pilots, cabin crew, air traffic control, and maintenance—do not always feel that their organizations are supportive of these challenges.
Studies in non-aviation industries have shown that even moderate levels of psychological distress can result in an increase in work-related accidents. 4 This research also confirms that work-related stress triggers the body’s fight-or-flight response, which, when activated over extended periods of time, can adversely impact performance, making individuals less focused and more likely to engage in impulsive and risk-taking behavior.
Work-related stress among aviation workers in particular has been shown to lead to anxiety, depression, burnout, and Posttraumatic Stress Disorder (PTSD), significantly impacting performance. 5 This can result in decreased situational awareness and attention, reduced workload capacity, and slower response time, which, especially in the presence of sudden, unexpected startle situations, are well-known precursors to aviation accidents.
Recently, organizations such as the Royal Aeronautical Society have highlighted the importance of recognizing the psychosocial risks within the aviation industry, acknowledging that addressing them should be just as important as managing physical safety risks. 4 While aviation organizations have noted the mental health dangers associated specifically with incident-related stress and have policies in place to manage the physical rigors of the job, general work-related stress, with its significant impact, merits the same consideration. Thus, the early identification and timely intervention of mental health issues are essential to increasing overall aviation safety.
Of course, interventions are only helpful if employees are willing to use them. One such intervention, a pilot peer support program mandated in 2018, has a typical usage rate of 3%−4%. 4 With data revealing a 12%−15% incidence rate of mental distress in pilots, it is curious that usage of the support program is so low. In a 2023 study, 72% of pilots admitted that they have avoided health care for fear of jeopardizing their job, leading them to conceal symptoms and use medications and treatments outside of a doctor’s care. 6 The unregulated use of certain common medications to manage anxiety or depression can lead to undesirable outcomes (including cardiac problems), posing additional risks to flight safety and security. As a matter of fact, in official accident records, the unreported use of medications was causally linked to 4%–5% of fatal aviation accidents. 7
Mental health disorders are currently one of the most common reasons, after cardiovascular disease, for the revocation of an aviation license, so it is no surprise that pilots would be hesitant to seek mental health support. 5 Entities like the United States National Transportation Safety Board and the Federal Aviation Administration are hoping to address this stigma through collaboration and research. For example, the recent “Navigating Mental Health in Aviation” summit, an in-person roundtable discussion on mental health concerns in the aviation community, brought together safety experts from the aviation industry, academia, the mental health profession, and the government to examine the unintended consequences of the current system. 8
There is also the hope that, like the technological advances that made flying mechanically safer, newer technology could be used to monitor and enhance the mental health of aviation professionals and even intervene when human error is likely. A multifaceted approach, including virtual reality-enhanced cognitive behavioral exposure therapy, stress inoculation training, and similar stress management techniques along with technologies that may include wearable sensors, virtual and mixed reality, and Artificial Intelligence (AI), may be used at several points in an individual’s career, from preliminary assessment to training to monitoring on-the-job performance and providing assistance when necessary.
Previous research in integrating digital tools for similar purposes in other high-stress professions (e.g., first responders, military, astronauts) has shown particular promise.9,10 For instance, the traditional route of using personality questionnaires during the selection and training process is often ineffective because individuals are under pressure to provide socially desirable answers to the questions. 5 If instead that same person could be observed reacting to a high-stress situation in a virtual environment, perhaps while wearing biometric sensors, evaluators could get a clearer idea of that person’s mental readiness to handle the job. Targeted training interventions can then be introduced to strengthen any identified areas of weakness.
Studies have proven that fusing multiple dynamic physiological signals can determine the unique physiology of an individual under stress versus that same individual while not under stress. 11 These physiological profiles, gathered during preliminary evaluation, could help develop a personalized regimen of stress inoculation training to provide individuals the tools needed to increase their mental resilience. These same profiles could also be used down the line for early identification of compromised physiological and cognitive states, allowing for more timely intervention. 5
Since the inception of flight, technology has continually revolutionized safety measures in the aviation industry. From automating navigation to simulator training to computerized traffic collision avoidance systems and AI weather forecasting, digital solutions abound. Now it is time to address the mental health crisis in aviation in much the same way. Using technology to assist in identifying and managing stress levels in aviation workers, all while adhering to ethical guidelines and data privacy restrictions, will significantly enhance safety and security for all, workers and passengers alike.