Mental health disorders, behavioral health problems, fatigue and sleep outcomes in remotely piloted aircraft/manned aircraft pilots, and remotely piloted aircraft crew, U.S. Air Force, 1 October 2003-30 June 2019.

U.S. Air Force (USAF) manned aircraft (MA) pilots and remotely piloted aircraft (RPA) pilots and their non-pilot crew form part of the forward-most contingent of airpower. Limited information exists on the incidence of mental health (MH) disorders, behavioral health (BH) problems, sleep disorders, and fatigue among these groups. Incidence rates and incidence rate ratios of these conditions were calculated among all active component USAF members during the period from 1 October 2003 to 30 June 2019. Compared to those in all other USAF occupations, RPA and MA pilots had statistically significantly lower risk of MH and BH outcomes while RPA crew shared a risk similar to other USAF members, although with higher risk of post-traumatic stress disorder and lower risk of substance- and alcohol-related disorders. This pattern was similar for fatigue outcomes except RPA crew had slightly higher risk. All 3 occupational groups had elevated risk for sleep disorders, and RPA pilots had 32% higher risk compared to those in all other USAF occupations. This study highlights that pilots have lower risk and/or reporting tendency for MH disorders, BH problems, and fatigue, while sleep disorders are common among service members in all of these (RPA/MA pilot, RPA crew) occupations.