Panic disorder in military aviators: a retrospective study of prevalence

The occurrence of panic disorder (PD) among military pilots and navigators poses questions with respect to medical care and waiver policy, but the prevalence of such disorders is unclear. We studied the epidemiology of PD in a USAF aircrew population.

Occurrence of PD during the period 2001-2008 was determined using the USAF Aeromedical Information Management Waiver Tracking System, a database containing medical disqualifications and waivers for the entire population of both qualified and disqualified (grounded) USAF aviators.

The mean annual USAF pilot and navigator population averaged 17,727 during the study period. The database yielded nine cases labeled as PD. After records review by two experienced aeromedical psychiatrists, only three of the nine cases met diagnostic criteria for PD. Estimated annual PD prevalence was 0.002% (2/100,000) in USAF pilots and navigators. Annual prevalence of PD was 2.7% in the general U.S. population 18 yrS. of age and older and 2.4% in a group of manager/professionals. Odds ratios were 1228 (55/27,269) and 1089 (49/24,175) for the general population and manager/professionals, respectively.

One of three individuals with PD received a waiver to resume flying after successful treatment. Five of the six cases not meeting criteria for PD (but suffering from varying degrees of situational and/or stress related anxiety) were flying with waivers. The negligible annual PD prevalence in USAF pilots and navigators likely reflects lower aircrew vulnerability to PD because of selection and training processes and does not pose a disease burden upon force strength.