When we board a plane, we trust we’ll reach our destination — and that the people at the controls are prepared in every possible way to do their job.

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Flying remains one of the safest ways to travel. But a new study raises concerns about the mental health of some of the nation’s pilots. An anonymous survey of nearly 1,850 pilots conducted by researchers at Harvard T.H. Chan School of Public Health found that hundreds of commercial airline pilots currently flying may be clinically depressed.

The findings come a year-and-a-half after a Germanwings co-pilot who suffered from depression deliberately crashed a plane into the French Alps, killing 150 people. And it is the first study to ever examine airline pilots’ mental health — with a focus on depression and suicidal thoughts — outside of the information derived from aircraft accident investigations, regulated health examinations, or identifiable self-reports, all of which are records protected by civilian aviation authorities and airline companies.

Researchers note that for those sources of information, there is a strong disincentive for pilots to accurately report if they are suffering from depressive symptoms.

“They may not be seeking treatment due to fear of negative career impacts,” said one researcher.

“We found that many pilots currently flying are managing depressive symptoms, and it may be that they are not seeking treatment due to the fear of negative career impacts,” Joseph Allen, assistant professor of exposure assessment science and senior author of the study, said in a statement. “There is a veil of secrecy around mental health issues in the cockpit. By using an anonymous survey, we were able to guard against people’s fears of reporting due to stigma and job discrimination.”

Respondents to the web-based survey came from over 50 countries. Of the 1,848 people who completed the questions about mental health, 233 (12.6 percent) met the criteria for likely depression, and 75 (4.1 percent) reported having suicidal thoughts within the previous two weeks. Of 1,430 who reported working as airline pilots in the last seven days at the time of the survey, 193 (13.5 percent) met the criteria for depression.

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More male pilots than female pilots reported they had experiences “nearly every day” of loss of interest, feeling like a failure, trouble concentrating, and thinking they would be better off dead. Female pilots were more likely to have at least one day of poor mental health during the previous month, and were more likely to have been diagnosed with depression.

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Depression was also more likely among pilots who used higher levels of sleep aid medication and those who were experiencing sexual or verbal harassment.

“Our study hints at the prevalence of depression among pilots — a group of professionals that is responsible for thousands of lives every day — and underscores the importance of accurately assessing pilots’ mental health and increasing support for preventative treatment,” Alex Wu, a doctoral student at Harvard Chan School and first author on the paper, said in statement.