Aeromedical management of US Air Force aviators who attempt suicide

Background: Little has been published about the aeromedical management and disposition of aviators who attempt suicide, and almost no such information about military aviators exists in the open literature. The few available d ata are scattered and frequently anecdotal. Methods: The authors reviewed a ll case reports of fliers evaluated at the USAF School of Aerospace Medicin e's Aeromedical Consultation Service (ACS) between 1981-96 for possible ret urn to flying duties after a suicide attempt, and prepared a representative case report. Results: Between 1981 and 1996, the ACS evaluated 14 trained aviators (pilots and other aircrew members, excluding flight surgeons) who had attempted suicide. Of these, 11 (79%) ultimately received a recommendat ion for return to flying duties. Conclusions: In most instances the underly ing stressors included failed intimate interpersonal relationships, adminis trative or legal problems, psychiatric disorders, death of spouse, or job c onflicts. Evidence of abuse of alcohol or other substances was found in 54% of an earlier, larger data set of attempters. Some data on aircrew suicide completion were available and are reported. The top medical priorities aft er such attempts should be to diagnose what is wrong, and to treat it. In s pite of the common assumption that a suicide attempt inevitably ends a mili tary flying career, some attempters can return to safe and effective flying duty after appropriate psychotherapy. If the flier regains physical and me ntal health and maintains them for at least 6 mo after treatment, then that flier may be evaluated by an outside aeromedical psychiatric consultant su ch as the ACS (to avoid transference issues between flier and therapist) fo r possible return to flying duties. Waiver action should be based on the un derlying psychiatric diagnosis, not the suicidal attempt itself. Follow-up may be accomplished through periodic mental health evaluations in conjuncti on with routine physical examination procedures. Issues involving substance abuse and security clearances must be handled through the appropriate chan nels.