Stigma and the culture of silence in aviation

How to cite this work

Bentivegna, Leonel S. “Estigma y cultura del silencio: barreras culturales para la búsqueda de ayuda ante la ideación suicida en la aviación civil, con especial referencia a Latinoamérica” [Stigma and the culture of silence: cultural barriers to help-seeking for suicidal ideation in civil aviation, with particular attention to Latin America], September 2026. https://www.leobentivegna.com/en/articles/estigma-cultura-silencio-aviacion

1. Introduction

Suicidal ideation in civil aviation has, for a little over a decade now, become a growing concern for aviation authorities and for the organisations that represent people working in the sector. While the episode that put the issue on the international public agenda was the crash of Germanwings flight 9525, on 24 March 2015, in which a co-pilot with a history of depression and suicidal thoughts deliberately flew an Airbus A320 into the French Alps [1], the present study aims to shift the axis of the discussion away from that single event and its media coverage, towards a broader problem that has received far less attention in Spanish-language scholarship: the way stigma and the organisational culture of aviation act as concrete barriers to help-seeking for people going through suicidal ideation, among pilots as much as among cabin crew, ground staff and air traffic controllers.

To date, there is no Spanish-language research that specifically addresses the cultural factors of stigma in the Latin American aviation sector, which is a significant gap given that the region’s mental health treatment gap exceeds 77.9% according to figures from the Pan American Health Organization (PAHO) — that is, nearly eight in ten people with a mental health condition receive no professional care at all [2]. This study therefore hopes to help fill that gap by focusing on the cultural factors — public stigma, structural stigma and self-stigma, following Erving Goffman’s classic classification — that act as barriers to help-seeking among people performing risk-laden tasks within airport and aeronautical operations.

The aim of this work is to survey and analyse the scientific evidence available on stigma, institutional silence and the barriers to seeking help in civil aviation, broadening the focus beyond the figure of the airline pilot, on whom most of the international academic output is concentrated. The following section develops the conceptual framework of stigma drawing on Goffman’s sociology and Raewyn Connell’s work on masculinities, as tools for understanding why stigma takes particular hold in occupational settings marked by high physical and emotional demands. The international evidence on the culture of silence in aviation is then addressed, with particular attention to the studies by Wu and colleagues (2016) and by Minoretti (2025). The fourth section widens the lens to cabin crew, ground staff and air traffic control, drawing on the study by Osorio and colleagues (2013), carried out at a Colombian airport, and on the research by Jackson and Ross (2025) on workers under the Fly In, Fly Out (FIFO) arrangement, whose working dynamics bear a relevant resemblance to those of aeronautical crews. The fifth section focuses on the Latin American case, before closing with a general reflection on the lines of intervention that the literature recognises as most effective for breaking the silence.

2. Stigma as a construct: contributions from sociology and gender studies

On the concept of stigma, Erving Goffman defines it, in his classic work Stigma: Notes on the Management of Spoiled Identity, as a deeply discrediting attribute that reduces the person carrying a mental health condition, in the eyes of their social environment, to a spoiled or discredited identity [3]. Building on this reading, psychologist César Sierra argues that the phenomenon operates on at least three simultaneous, mutually reinforcing levels: public stigma, understood as the set of social prejudices against those who seek psychological help; structural stigma, that is, the institutional barriers and the insufficient resources devoted to mental health care; and self-stigma, the internalisation by the person themselves of the negative beliefs circulating in their environment [4]. This triad is particularly productive for thinking about aviation, since it allows a distinction between what an airline’s or an aeronautical authority’s organisational culture installs as the norm — structural stigma — what circulates informally among peers in the cockpit or the control tower — public stigma — and what each worker ends up believing about themselves when going through a crisis, which would be self-stigma proper.

Beyond this, the gender dimension is a second, unavoidable interpretive key. Raewyn Connell, in Masculinities, argues that the normative role attached to hegemonic masculinity requires men to repress vulnerability, pain and sadness, reading help-seeking as a loss of virility [5]. This reading is especially relevant to aviation, a historically masculinised sector — in the cockpit as much as in air traffic control and ramp maintenance work — where the professional ethos privileges self-control, self-sufficiency and unshakeable technical competence over any sign of emotional fragility [6]. It is worth noting that, while the growing incorporation of women into these roles could qualify this dynamic in the future, there is not yet data available to confirm to what extent the sector’s organisational culture has begun to shift in that direction.

3. The culture of silence in aviation: international evidence

As for the empirical evidence on the aeronautical sector itself, the essential reference remains the study carried out by Alexander Wu and his team at the Harvard T.H. Chan School of Public Health, published in 2016 in Environmental Health [7]. The authors administered an anonymous online survey to 3,485 airline pilots, of whom at least half — 1,866 participants — completed it, and found that 233 of them, or 12.6%, met the threshold for depression on the PHQ-9 questionnaire, while 75 pilots, 4.1% of the sample, reported having had suicidal thoughts in the two weeks prior to the survey [8]. It is telling that the authors themselves chose to guarantee participants’ absolute anonymity, not even collecting IP addresses, precisely to work around pilots’ fear that their answers might reach the aeronautical authority and put their medical certificate at risk. This methodological design is, in itself, an indicator of the scale of the problem under study: if a scientific survey needs to shield itself in this way to obtain honest answers, it might be assumed that under-reporting through official channels is, at the very least, considerable.

Likewise, the narrative review published by Piercarlo Minoretti in 2025 in Cureus synthesises the evidence accumulated between 2010 and 2025 on the barriers and facilitators of access to mental health care among commercial airline pilots [9]. The author identifies five main barriers: a predominant culture of silence and stigma; fear of losing one’s job and aeronautical medical certification; distrust regarding the confidentiality of evaluation processes; regulatory and procedural restrictions; and, lastly, organisational and logistical obstacles to accessing treatment. Minoretti argues that aviation’s occupational culture has historically privileged self-sufficiency and unshakeable professional competence, traits that, while they may offer functional advantages during high-risk flight operations, end up hindering the recognition, disclosure and proper management of psychological distress. In a convergent vein, the International Civil Aviation Organization noted, in a working paper presented to its 41st Assembly, that among the main obstacles to help-seeking in aviation are the stigma tied to the sense of personal failure that accompanies any mental health diagnosis, and the fear that one’s aeronautical medical certificate will be restricted, suspended or revoked [10].

Along these lines, the Task Force set up by the European Union Aviation Safety Agency (EASA) after the Germanwings accident acknowledged, in its final report of July 2015, that fewer than 0.5% of the pilot population used the employee assistance programmes available at European airlines, and attributed that under-use to stigma, understood as the widespread belief among pilots that any psychological problem known to the organisation would immediately result in the loss of their licence or medical certificate and, consequently, of their livelihood [11]. In response to this diagnosis, the Task Force recommended implementing peer support programmes, now required under European regulation CAT.GEN.MPA.215. In the context of US aviation, however, the Chair of the National Transportation Safety Board (NTSB), Jennifer Homendy, stated in December 2023 that the risk to operational safety does not come from pilots seeking help, but from the culture of silence surrounding mental health in the sector [12]. This statement, made nearly a decade after the Germanwings accident, suggests that the cultural change the industry itself calls for remains, to date, an unfinished process.

4. Beyond the cockpit: ground staff, cabin crew and air traffic control

The academic output reviewed so far concentrates almost exclusively on the figure of the airline pilot, which leaves relatively unattended other figures within aeronautical operations who share much of the same risk profile: extreme responsibility for human lives, irregular shift work, exposure to periodic medical certification, and an occupational culture that prizes self-control above all else. In the case of air traffic controllers, the study by María Alejandra Osorio and her team, carried out at a Colombian airport and published in the Revista Colombiana de Salud Ocupacional in 2013, found that 88% of the controllers assessed showed behavioural alterations associated with work-related stress, compared with 80% among airport firefighters used as a comparison group [13]. Although the authors did not specifically investigate suicidal ideation or the cultural barriers to seeking help, but rather the relationship between work stress and general mental health as measured through the Goldberg questionnaire, the study is valuable because it documents, with hard data and in a Latin American context, the scale of psychological distress among airport workers other than pilots — a population on which, at least as of this writing, no specific research on stigma and help-seeking has been published in the region.

For its part, and although it is a sector formally distinct from aviation, the research by Jordan Jackson and Victoria Ross on workers under the Fly In, Fly Out (FIFO) arrangement in Australia, published in 2025, offers a relevant comparative framework for thinking about other figures within air operations who, like ground staff posted to remote bases or maintenance personnel on rotating shifts, share with FIFO workers prolonged separation from family and dependence on an employer who controls, besides their wages, the very logistics of their return home [14]. Based on surveys of 138 workers, the authors identified four major barriers to seeking and offering help around suicidal ideation: fear of negative consequences for one’s employment, which turned out to be the most salient theme in the whole study; distrust of leadership and of the organisation’s culture around mental health; lack of knowledge and confidence in how to respond when a colleague discloses suicidal ideation; and fear of negative reactions from one’s immediate environment [15]. It might be assumed — though this is a hypothesis beyond the scope of the present work, and one that would warrant future research — that these same four barriers operate analogously among ground and cabin staff in Latin American commercial aviation, insofar as they share with FIFO workers membership in masculinised industries marked by high physical demands and strong institutional dependence.

5. Stigma in a Latin American key

As for the Latin American case specifically, the available evidence is still fragmentary and comes mostly from institutional and journalistic sources rather than from academic research specifically focused on the aeronautical sector. In Mexico, for instance, data presented to the Chamber of Deputies by the Colegio de Pilotos Aviadores de México (the Mexican airline pilots’ association) indicate that 57% of pilots avoid seeking psychological help for fear of stigma, while 67% fear that doing so could cost them the licence that allows them to fly and, with it, their livelihood [16]. In the same presentation, Deputy Pérez Díaz described flight crews as subject to irregular schedules, constant pressure, accumulated fatigue, family separation and permanent emotional strain, while Captain Domínguez Catzin argued for the need for a paradigm shift, moving from a punitive model to a civil culture — from silence to support, and from stigma to prevention [17]. It should be noted that, while valuable as official figures presented before a legislative body, these data do not come from a peer-reviewed scientific study, which is a limitation to bear in mind when weighing their scope.

More broadly, and beyond the aeronautical sector but useful for contextualising the cultural terrain on which stigma operates in the region, PAHO notes that in the Americas nearly 80% of suicide deaths are male — four out of every five cases — despite women reporting higher rates of depression and anxiety [18]. Read together with Connell’s account of hegemonic masculinity as a mandate of self-sufficiency and emotional control, this statistic suggests that the cultural barriers documented in international civil aviation — fear of stigma, institutional distrust, and self-sufficiency understood as a professional virtue — find in Latin America a particularly fertile cultural terrain for their reproduction, insofar as they overlap with regional patterns of masculinity and with a structural gap in access to mental health care that, as noted at the start of this work, leaves over 77.9% of the population with a mental health condition without professional care [19]. It is not possible, however, to confirm with the evidence currently available to what extent this overlap translates into higher rates of suicidal ideation among Latin American aeronautical personnel relative to their peers elsewhere — a question that clearly remains an open agenda for future research in regional aeronautical psychology.

6. Towards breaking the silence: closing remarks

By way of closing, and without claiming to exhaust a problem that far exceeds the limits of the present study, the literature reviewed here converges on peer support programmes, non-punitive disclosure policies, and mental health training for aeromedical examiners as the most effective facilitators for reversing the culture of silence described throughout this work [20]. These are, in short, interventions that act on structural stigma rather than on public stigma or self-stigma taken in isolation, which is consistent with the evidence pointing to direct social contact with people who have gone through and overcome a recovery process as the most effective strategy against mental health stigma, more so than purely theoretical or informational talks [21]. What remains, then, is the need for future research in airport management and Latin American aeronautical psychology to survey, with methodology of its own and adjusted to the region, both the prevalence of suicidal ideation among ground staff, cabin crew and air traffic controllers, and the cultural particularities that in each country shape people’s willingness to seek help. The limitations noted here, far from closing the issue, constitute an agenda for future work.

7. Artificial intelligence as a possible facilitator: assisting whoever receives the disclosure

As for possible technological interventions that could complement the peer support programmes reviewed in the previous sections, the accelerated rise of generative artificial intelligence enables, at the very least, a working hypothesis that deserves to be explored with the care the topic demands. Before advancing that hypothesis, it should be noted that much of the available literature on artificial intelligence and suicide prevention has focused on developing conversational agents aimed directly at the person in crisis, an approach whose safety is far from proven. Wojciech Pichowicz and his team assessed, in a study published in 2025 in Scientific Reports, the ability of 29 publicly available AI conversational agents to respond to simulated scenarios of escalating suicide risk, built from the Columbia-Suicide Severity Rating Scale, and found that most of the agents evaluated fell short of minimum standards of adequacy, particularly when it came to providing accurate information about emergency resources [22].

Given this evidence, and in keeping with the approach adopted for this study, it seems more prudent to think of artificial intelligence not as a direct interlocutor for the person going through suicidal ideation, but as a tool to assist whoever receives the disclosure — that is, the fellow crew member, the controller on duty, the ramp technician, or the volunteer in a peer support programme. Among the four barriers Jackson and Ross documented in their study of FIFO workers were both the fear of negative reactions and the lack of knowledge and confidence in how to respond when a colleague discloses suicidal ideation — a factor that shapes not only help-seeking but, just as importantly, help-offering by the immediate environment [23]. Shifting the object of technological intervention from the person at risk to the person receiving the signal would, at least conceptually, sidestep much of the safety risk flagged by Pichowicz and his team, since the system would never converse with someone actually going through a real suicidal crisis.

On this basis, a design with two complementary components could be envisaged. The first would consist of prior training, through conversational simulation scenarios, in which someone serving in a peer support role practises — before the situation arises in real life — how to respond to a disclosure of suicidal ideation without minimising it or improvising a clinical intervention that is not theirs to make. The second would consist of a discreet consultation channel, available at the very moment the support person is handling the situation or immediately afterwards, offering targeted guidance on what to ask, what to avoid saying, and which local resource to refer to, without ever substituting for professional referral.

It should be noted, however, that this proposal is only consistent with the general diagnosis of this study if at least two design conditions are met. First, the system should depend on the peer support programme itself or on the union organisation, not on the airline or the aeronautical authority, and should record no identifying information whatsoever about the person at risk; otherwise, there would be a risk of reproducing, under a novel technological guise, the same structural distrust of the institution that this study identified as the most persistent cultural barrier. Second, the system should have explicit escalation criteria, capable of interrupting automated assistance and immediately referring to a human resource upon any mention of a plan, a method or a concrete timeframe, in line with the warning issued by the team behind VERA-MH, an open safety-evaluation framework for mental health conversational agents, when it notes that the field still lacks clear, shared standards comparable to those that already govern civil aviation in other risk domains [24].

In sum, artificial intelligence could operate, in the specific area examined here, not as a substitute for human connection but as scaffolding that strengthens whoever already occupies, in practice, the role of informal first responder within aeronautical occupational culture. This remains, in any case, a working hypothesis that would require, before any concrete implementation, both technical validation specific to the aeronautical context and institutional governance that verifiably guarantees the separation between the support programme and medical certification processes. Its development is therefore proposed here as one of the lines of future research and intervention arising from this work.

Notes

1. On the accident and its psychiatric background, see Bureau d’Enquêtes et d’Analyses (BEA), Final Report: Accident on 24 March 2015 at Prads-Haute-Bléone (Alpes-de-Haute-Provence, France) to the Airbus A320-211, Registered D-AIPX, Operated by Germanwings, March 2016.
2. Pan American Health Organization (2024). World Suicide Prevention Day 2024. See https://www.paho.org/es/campanas/dia-mundial-prevencion-suicidio-2024
3. Goffman, Erving (2006). Estigma: La identidad deteriorada. Amorrortu. [Spanish edition of Stigma: Notes on the Management of Spoiled Identity.]
4. Sierra, César (2026). “La barrera invisible de la salud mental”, Consultorsalud, 26 August 2026. See https://consultorsalud.com/estigma-salud-mental-barreras-acceso-atencion/
5. Connell, Raewyn W. (1995). Masculinities. Polity Press.
6. On the occupational culture of self-sufficiency and unshakeable competence in aviation, see Minoretti, Piercarlo (2025). “Barriers and Facilitators to Mental Health Support Among Airline Pilots: A Narrative Review”, Cureus, 17(8), e91340.
7. Wu, Alexander C., Donnelly-McLay, Deborah, Weisskopf, Marc G., McNeely, Eileen, Betancourt, Theresa S. and Allen, Joseph G. (2016). “Airplane pilot mental health and suicidal thoughts: a cross-sectional descriptive study via anonymous web-based survey”, Environmental Health, 15(1), p. 121.
8. See https://doi.org/10.1186/s12940-016-0200-6
9. Minoretti, Piercarlo (2025). “Barriers and Facilitators to Mental Health Support Among Airline Pilots: A Narrative Review”, Cureus, 17(8), e91340. Doi 10.7759/cureus.91340.
10. International Civil Aviation Organization (2022). Mental Health in Aviation, working paper A41-WP/256, 2 August 2022. See https://www.icao.int/sites/default/files/Meetings/a41/Documents/WP/wp_256_es.pdf
11. European Union Aviation Safety Agency (2015). Germanwings Task Force: Final Report, July 2015. See https://www.easa.europa.eu/sites/default/files/dfu/germanwings-task-force-final-report.pdf
12. Statement quoted in “Pilots say they’re afraid to seek mental health care. The FAA says it’s listening”, NPR, 6 December 2023. See https://www.npr.org/2023/12/06/1217591486/pilots-mental-health-treatment-lose-license-ntsb-faa
13. Osorio, María A., Rodríguez, Claudia M., Parra, Liliana, Acosta, Martín and Cruz, Ángela M. (2013). “Estrés y salud mental en controladores de tránsito aéreo y bomberos de un aeropuerto de Colombia”, Revista Colombiana de Salud Ocupacional, 3(2), pp. 7–11.
14. Jackson, Jordan and Ross, Victoria (2025). “Understanding Suicide Stigma in Fly In, Fly Out Workers: A Thematic Analysis of Attitudes Towards Suicide, Help Seeking and Help Offering”, International Journal of Environmental Research and Public Health, 22(3), p. 395.
15. Doi 10.3390/ijerph22030395.
16. “Salud mental para personas tripulantes de aeronaves”, Noticias del estado de Puebla, 2026. See https://municipiospuebla.mx/nota/economia/salud-mental-para-personas-tripulantes-de-aeronaves
17. Ibid.
18. Pan American Health Organization (2024). World Suicide Prevention Day 2024. See https://www.paho.org/es/campanas/dia-mundial-prevencion-suicidio-2024
19. Ibid.
20. See Minoretti (2025), op. cit., and European Union Aviation Safety Agency (2015), op. cit.
21. Sierra, César (2026), op. cit.
22. Pichowicz, Wojciech, Kotas, Michał and Piotrowski, Patryk (2025). “Performance of mental health chatbot agents in detecting and managing suicidal ideation”, Scientific Reports, 15(1), 31652. Doi 10.1038/s41598-025-17242-4.
23. Jackson and Ross (2025), op. cit.
24. Bentley, Kate H., Belli, Luca, Chekroud, Adam M., Ward, Emily J., Dworkin, Emily R., Van Ark, Emily, Johnston, Kelly M., Alexander, Will, Brown, Millard and Hawrilenko, Matt (2026). “AI Chatbot Suicide Risk Detection and Response: Human Validation Study of the Open-Source VERA-MH Safety Evaluation”, JMIR AI, 5. Doi 10.2196/92817.

References

Documents

• European Union Aviation Safety Agency (EASA). Germanwings Task Force: Final Report, July 2015.
• “Salud mental para personas tripulantes de aeronaves”, Noticias del estado de Puebla, 2026.
• “Pilots say they’re afraid to seek mental health care. The FAA says it’s listening”, NPR, 6 December 2023.
• International Civil Aviation Organization. Mental Health in Aviation, working paper A41-WP/256, 2 August 2022.
• Pan American Health Organization. World Suicide Prevention Day 2024.

Bibliography

• Bentley, Kate H., Belli, Luca, Chekroud, Adam M., Ward, Emily J., Dworkin, Emily R., Van Ark, Emily, Johnston, Kelly M., Alexander, Will, Brown, Millard and Hawrilenko, Matt. “AI Chatbot Suicide Risk Detection and Response: Human Validation Study of the Open-Source VERA-MH Safety Evaluation”, JMIR AI, 5, 2026.
• Connell, Raewyn W. (1995). Masculinities. Polity Press.
• Goffman, Erving (2006). Estigma: La identidad deteriorada. Amorrortu.
• Jackson, Jordan and Ross, Victoria. “Understanding Suicide Stigma in Fly In, Fly Out Workers: A Thematic Analysis of Attitudes Towards Suicide, Help Seeking and Help Offering”, International Journal of Environmental Research and Public Health, 22, 3, 2025, p. 395.
• Minoretti, Piercarlo. “Barriers and Facilitators to Mental Health Support Among Airline Pilots: A Narrative Review”, Cureus, 17, 8, 2025, e91340.
• Osorio, María A., Rodríguez, Claudia M., Parra, Liliana, Acosta, Martín and Cruz, Ángela M. “Estrés y salud mental en controladores de tránsito aéreo y bomberos de un aeropuerto de Colombia”, Revista Colombiana de Salud Ocupacional, 3, 2, 2013, pp. 7–11.
• Pichowicz, Wojciech, Kotas, Michał and Piotrowski, Patryk. “Performance of mental health chatbot agents in detecting and managing suicidal ideation”, Scientific Reports, 15, 1, 2025, p. 31652.
• Sierra, César. “La barrera invisible de la salud mental”, Consultorsalud, 26 August 2026.
• Wu, Alexander C., Donnelly-McLay, Deborah, Weisskopf, Marc G., McNeely, Eileen, Betancourt, Theresa S. and Allen, Joseph G. “Airplane pilot mental health and suicidal thoughts: a cross-sectional descriptive study via anonymous web-based survey”, Environmental Health, 15, 1, 2016, p. 121.