Aviation, Suicide, and the Germanwings Crash

Note: If you are struggling with thoughts of depression or suicide, please refer to the resources at the end of the post.

Four weeks ago tomorrow, a Germanwings A320 crashed in the French Alps resulting in the deaths of all 150 individuals on board. I will not recount the details here, but investigators who were able to reconstruct the events leading up to the crash found evidence from cockpit records that the first officer intentionally crashed the plane. This post highlights three issues related to the crash: the extreme rarity of all airline disasters, let alone those caused by deliberate pilot action; risks associated with the Werther effect; and government and airline regulations regarding pilots’ mental health issues.

From 1976 to 2013, there were only eight commercial aircraft accidents attributed to pilot suicide by the Aviation Safety Network. Out of millions of pilots, over one billion commercial flights, and many billions of passengers (counting repeats, obviously) that is a vanishingly small rate. An FAA review of aircraft-assisted pilot suicides in the US identified eight such events between 2003 and 2012, al limited to general aviation (i.e. non-commercial). This is a decrease by half from the previous review covering the decade before. Not only is pilot suicide incredibly rare, it is also becoming less frequent.

If this crash makes you more likely to drive instead of fly, you will be putting yourself at much greater risk. When airline traffic decreased by about 15-20 percent following the events of September 11, 2001, Gerd Gigerenzer estimated that fatal car crashes went up by about 10 percent (due to excess road miles driven), accounting for about 350 additional deaths.

In addition to a disproportionate fear response, widespread reporting of suicides can also inspire copycat behavior. This phenomenon is known as the Werther effect, named for the title character in Wolfgang von Goethe’s novel The Sorrows of Young Werther which was blamed for a rash of suicides amongst young males across Europe in the 1770s. This copycat behavior was popularized in Robert Cialdini’s book Influence and based on earlier research by David Phillips. In a 1980 paper, Phillips found that

After publicized murder—suicide stories there is an increase in noncommercial plane crashes and an increase in airline crashes. This increase in crashes persists for approximately nine days, and then the level of crashes returns to normal.

The paper is gated, but some figures from it can be found here. Evidence for the Werther effect implies that the media should be very careful with how they present stories of suicide. This piece by Matt Haig does a very good job of discussing the Germanwings incident and can be summarized by its title and opening blurb:

I’ve suffered from depression. The only life I’ve ever considered taking is my own. For 15 years I was depressive on and off, and the ignorant speculation about Andreas Lubitz’s mental health strikes me as being harmful.

Although the ultimate responsibility for safety lies with pilots, airlines and government agencies also have a responsibility to passengers to ensure that potentially suicidal pilots receive treatment and do not put others at risk. In the US, the FAA takes this duty very seriously. As one of my flight instructors said, “The FAA doesn’t care about you, they care about the people you might endanger.” In the 2003 report mentioned above, the authors note:

All pilots involved in these aircraft-assisted suicides were male, with a median age of 46 years. The pilot was the sole occupant in 7 of the 8 aircraft that were intentionally crashed. Four of the 8 pilots were positive for ethanol, and 2 of the 8 were positive for Selective Serotonin Reuptake Inhibitor (SSRI) antidepressants.

Unfortunately demographics of professional pilots overlap considerably with demographics most likely to commit suicide.

Current FAA aeromedical regulations require that individuals on one of four approved SSRIs undergo additional screening before before receiving their aviation medical certificate. Pilots with a diagnosed mental illness must also see an approved medical examiner every six months for a neurological screener. Airlines also typically require an annual MMPI screening for pilots. (Note that these regulations do not apply in Europe, and I am unfamiliar with the process there.) While this process is admirable in its emphasis on passenger safety, the increased burden on pilots is enough to persuade some to conceal their illness from the FAA, or worse, forego formal treatment altogether (self-medicating with other substances is all too common). The aviation industry has a long way to go in making mental health issues more open for discussion, as does much of society.

What can be done to preserve pilot and passenger safety? If you are a potential passenger, do not switch to driving when you hear about airline accidents. If you comment on these issues on social media, avoid glamorizing suicide. If you are a pilot or in the aviation community, be aware of FAA regulations, do not fly if you are in a mentally unsound state, and be willingly to openly discuss these issues. Finally, if you are experiencing mental health issues reach out to someone around you.

In the US:

  • Mental Health America has community support groups around the country. Their toll free number is (800) 969-6642.
  • Mental Health First Aid offers instruction in responding to mental health crises.
  • The FAA aeromedical office can be reached at (405) 954-4821.
  • For software developers, Open Sourcing Mental Illness is an effort by Ed Finkler to encourage wider discussion of mental health issues in our community. It is supported by EngineYard’s Prompt campaign. Ed has some great videos here.

In the UK (from the BBC article above):

  • Rethink Mental Illness has more than 200 mental health services and 150 support groups across England. Its number is 0300 5000 927.
  • Samaritans provides 24-hour emotional support for people who are experiencing feelings of distress or thoughts of suicide. Its number is 08457 90 90 90.
  • Papyrus works with young people to prevent suicide. Its helpline number is 0800 068 4141

Internationally:

  • You can find a list of suicide prevention hotlines by country here.

Does State Spending on Mental Health Lower Suicide Rates?

branchtoon.com

That’s the title of a new paper (gated) in the Journal of Socio-Economics by Justin Ross, Pavel Yakovlev, and Fatima Carson. Here’s the abstract:

Using recently released data on public mental health expenditures by U.S. states from 1997 to 2005, this study is the first to examine the effect of state mental health spending on suicide rates. We find the effect of per capita public mental health expenditures on the suicide rate to be qualitatively small and lacking statistical significance. This finding holds across different estimation techniques, gender, and age groups. The estimates suggest that policies aimed at income growth, divorce prevention or support, and assistance to low income individuals could be more effective at suicide prevention than state mental health expenditures.

Their paper asks an interesting question, and apparently they are among the first to attempt an answer using empirical data. Suicide is one of the oldest topics of interest for social scientists, going back to Émile Durkheim‘s 1897 publication.

The main problem with the paper’s analysis is the use of observational data to make a causal claim.* As the authors themselves point out, state mental health spending is remarkably stable to the point that if a year of data were missing it could be interpolated by averaging the years before and after. There’s really no exogenous change observed in the sample period–no instance of a state dramatically increasing or reducing its spending is mentioned–so the comparisons are mostly between rather than within states. This setup fails to provide evidence for the authors’ claims such as, “a one percent increase in public mental health expenditures per capita would reduce the incidence of suicide among that group by 0.91 per 100,000 women in this age group [25-64].”

Fig. 1: Ross, Yakovlev, and Carson (2012)

Given the large between-state differences, a cleaner design might have looked at suicide risk for individuals who moved from one state to another. Of course, this introduces the problem that individuals who commit suicide never move to another state afterward. Furthermore, this individual-level data would like be difficult to collect. However, even a small survey of individuals would be a nice complement to this paper’s focus on aggregate statistics. (The authors are careful to point out that their paper does not assess the effectiveness of mental health treatment on suicide outcomes.)

On the positive side, it is nice to see a null finding published in a journal. Findings that are “qualitatively small lacking statistical significance” are not often seen in print even when they are justified. I only wonder in this case whether the findings will hold up.

Some other posts that I have written on mental health issues can be found here and here.

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*Yes, the same could be said of much social science. That doesn’t make it OK, nor does it mean that NSF Political Science should be defunded.

Are Assassins Crazy?

The answer to this probaby depends on the image that pops into your head when you hear the word “assassin,” which in turn probably depends (for American readers) on whether you’re old enough to remember the JFK assassination or the attempt on Ronald Reagan’s life by John Hinckley. It turns out that this question has been asked for over 150 years. One of the earliest answers was called the M’Naghten rule (pronounced–and sometimes spelled–“McNaughton”).

The M’Naghten rule resulted from the attempted assassination of Robert Peel by Daniel M’Naghten. His case was decided by a specific series of criteria, the most important of which was whether or not the individual knew that what he was doing was wrong. This rule was the primary legal doctrine for the insanity defense in the Anglophone world until at least 1953, when it was judged to be obsolete.

I became interested in this history when reading Destiny of the Republic, about the assassination of James Garfield. I won’t go into details about his case, but they are interesting in their own right and the book is highly recommended. Allow me to share the author’s description of the rule’s impact, which reminded contemporaries of an earlier attempt on Queen Victoria’s life by Edward Oxford:

“We have seen the trials of Oxford and MacNaughtan conducted by the ablest lawyers of the day,” Queen Victoria had written in disgust to Peel after the M’Naghten ruling, “and they they allow and advise the Jury to pronounce the verdict of Not Guilty on account of Insanity,–whilst everybody is morally convinced that both malefactors were perfectly conscious and aware of what they did!” Before her eventual death in 1901, at the age of eighty-one, Queen Victoria would survive several more assassination attempts. Her husband, who had lived to witness four of them, was convinced that the would-be assassins had been encouraged by Oxford’s acquittal.

This last part strikes me as interesting because of its irony: supposedly insane individuals were thought to be more likely to attempt assassinations when the likelihood of punishment was reduced.*

What does this mean for contemporary political science? Over the past 35 years, and particularly in the last decade and a half, the question of whether assassins, terrorists, insurgents and the like are rational has been a critical but mostly unproven assumption in empirical research on political violence. If it turns out that assassins are more likely to strike in countries where the M’Naugton rule was in effect, this would suggest (but obviously not prove) that assassins respond to changing costs and benefits of their actions.

Further reading: Experts Disagree on Psychological State of Norwegian Killer (via @intelwire)

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* Note: I am not in any way advocating for a lack of legal sympathy for mental conditions. This post is meant to demonstrate the possible rationality of a supposedly irrational act.