Vuorio Alpo, Bor Robert, Budowle Bruce, Gray Alastair, Suhonen-Malm Anna-Stina
Department of Forensic Medicine, University of Helsinki, Helsinki, Finland.
Mehiläinen Airport Health Centre, Vantaa, Finland.
Front Public Health. 2025 Mar 18;13:1505004. doi: 10.3389/fpubh.2025.1505004. eCollection 2025.
The U.S. Federal Aviation Administration (FAA) recently provided detailed instructions on how Aviation Medical Examiners (AMEs) should assess and evaluate pilots for post-traumatic stress disorder (PTSD). The European, Australian and International Civil Aviation Organization guidelines for the assessment of PTSD in aviation are general guidelines and do not address the unique and specific circumstances of a flight crew . The starting point of the U.S. FAA's guidance is an already-established clinical PTSD diagnosis since it is known that PTSD compromises aviation safety and has been related to fatal aviation accidents. According to the FAA's guidance, a PTSD assessment is undertaken based on whether the condition is symptomatic and medicated, or whether more than 2 years have elapsed since showing symptoms and receiving medication. The International Classification of Diseases (ICD) criteria for stress disorders have changed between versions ICD-10 and the soon-to-be-released ICD-11. The new ICD-11 criteria are discussed in this article in the context of aviation health. Additionally, PTSD, potentially caused by an incident of turbulence, is discussed in the context of aviation mental health. There are currently no published studies on turbulence-caused mental trauma. We have identified in this article potential factors which are related to pilots' and cabin crew's stressors in incidents of severe and extreme turbulence. Three recommendations are provided: (1) harmonize assessment practices of PTSD internationally; (2) healthcare professionals taking care of traumatized flight crew should have a follow-up guide that takes specific and local conditions into account, and ensures the identification of patients who require follow-up treatment as early as possible; and (3) aviation health care professionals should consider ICD-11 diagnostic criteria as the information may be more useful in the assessment and diagnosis of aviation-related trauma.
美国联邦航空管理局（FAA）近期就航空体检医师（AME）应如何评估飞行员的创伤后应激障碍（PTSD）提供了详细指导。欧洲、澳大利亚及国际民航组织关于航空领域PTSD评估的指南均为一般性指南，未涉及飞行机组人员的独特具体情况。美国联邦航空管理局指导意见的出发点是已确立的临床PTSD诊断，因为众所周知PTSD会危及航空安全且与致命航空事故有关。根据联邦航空管理局的指导意见，PTSD评估基于该病症是否有症状且正在接受药物治疗，或者自出现症状并接受药物治疗以来是否已过去两年以上。国际疾病分类（ICD）中关于应激障碍的标准在ICD - 10版本与即将发布的ICD - 11版本之间有所变化。本文在航空健康背景下讨论了新的ICD - 11标准。此外，还在航空心理健康背景下讨论了可能由颠簸事件引发的PTSD。目前尚无关于颠簸导致精神创伤的已发表研究。我们在本文中确定了与严重和极端颠簸事件中飞行员及客舱机组人员压力源相关的潜在因素。并提出了三项建议：（1）在国际上统一PTSD评估做法；（2）照顾受过创伤的飞行机组人员的医疗保健专业人员应拥有一份考虑到具体和当地情况的后续指导，并确保尽早识别出需要后续治疗的患者；（3）航空医疗保健专业人员应考虑ICD - 11诊断标准，因为该信息在评估和诊断与航空相关的创伤时可能更有用。
