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There are various questionnaires with various degrees of complexity available for assessing mental health
and behavioural aspects of an individual’s health. The questions below may serve to promote a relevant
ICAO Preliminary Unedited Version — October 2008 I-3-6
discussion between the medical examiner and the pilot. To encourage dialogue, it is recommended that no
written record of the conversation is retained (other than a record that mental health and behavioural
topics were discussed) unless some item of immediate flight safety risk is uncovered - this understanding
should be made clear to the pilot at the outset, thus increasing the likelihood of a frank discussion. It is to
be expected that only rarely will any formal action need to be considered by the medical examiner to
protect flight safety in the light of response to such questions, since the main aim is to discover
behavioural patterns or mental aspects that are amenable to change before they become sufficiently severe
to affect the medical fitness.
The questions suggested address those conditions that are most common in the age range of professional
pilots and those which are most likely to affect performance on the flight deck. Statistics show that the
main psychiatric conditions in this context are mood disorders and certain anxiety disorders, especially
panic episodes. Additionally, in many Contracting States, excessive alcohol intake and use of illicit drugs
in the general population are occurring with increasing frequency, and pilots are not immune from these
social pressures. Questions have been developed to address these issues as well.
In developing the questions, a review of the literature was undertaken by specialists in the field, with the
aim of choosing simple questions that can be completed quite quickly. The vast majority of pilots will
respond to all questions in the negative, and it is unnecessary to request pilots without any relevant
problems to undertake a prolonged screening questionnaire. Those who answer positively, or with
uncertainty, can be engaged in further dialogue by the medical examiner. The aim is to encourage pilots
to consider their lifestyle and thereby improve the likelihood that they will remain in good mental health
during their careers; this, of course, includes the avoidance of problematic use of psychoactive
substances. Occasionally, the medical examiner may find conditions that are amenable to medical support
or even treatment; it is important to detect these at an early stage, before they become significant
problems and before they have a long term impact on the pilot’s medical fitness and on flight safety.
The questions below may not represent the most suitable questions for the pilot populations of all States,
but they offer guidance - a starting point - for States that intend to implement 6.3.1.2.1 and wish to
develop an approach that includes these important aspects of medical fitness.
The questions do not necessarily have to be posed verbally by the medical examiner but could, for
example, be given to the applicant to read and to answer in writing.
Suggested questions for depression:
1) During the past three months, have you often been bothered by feeling down, depressed or hopeless?
2) During the past three months, have you often been bothered by having little interest or pleasure in
doing things?
3) During the past three months, have you been bothered by having problems falling asleep, staying
asleep, or sleeping too much, that is unrelated to sleep disruption from night flying or transmeridian
operations?
4) In the past three months, has there been a marked elevation in your mood lasting for more than one
week?
ICAO Preliminary Unedited Version — October 2008 I-3-7
Suggested questions for anxiety/panic attack:
1) In the past three months, have you had an episode of feeling sudden anxiety, fearfulness, or
uneasiness?
2) In the past three months, did you experience sensations of shortness of breath, palpitations (racing
heart beat) or shaking while at rest without reasonable cause?
3) In the past year have you needed to seek urgent medical advice because of anxiety?
Suggested questions concerning alcohol use:
1) Have you ever felt that you should cut down on your drinking?
2) Have people annoyed you by criticizing your drinking?
3) Have you ever felt guilty about your drinking?
4) Have you ever needed a drink first thing in the morning?
5) How many alcoholic drinks would you have in a typical week?
6) How many alcoholic drinks would you have on a typical day when you are drinking?
Suggested questions concerning drug use:
1) Have you used drugs other than those required for medical reasons?
2) Which non-prescription (over-the-counter) drugs have you used? When did you last use this drug(s)?
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Manual of Civil Aviation Medicine 1(20)
