INTRODUCTION: Pilots' mental health has received increased attention following Germanwings Flight 9525 in 2015, where the copilot intentionally crashed the aircraft into the French Alps, killing all on board. An investigation of this incident found that the pilot had a depressive disorder.METHODS: This systematic review investigated peer reviewed studies of pilot mental health published since 1980. A total of 58 papers were identified.RESULTS: Two main methodologies have been employed: questionnaires and database record searches. Anxiety, depression, and suicide were the most commonly investigated mental health conditions. There were almost an equal number of studies that found a higher prevalence of psychological symptoms in pilots as those that found a lower prevalence, relative to controls or the general population. Prevalence rates were higher in studies relying solely on questionnaires than in studies employing database record searches.DISCUSSION: Prevalence estimates are closely associated with methodology, so it is difficult to determine the true rate. Factors that might account for low prevalence estimates include under-reporting of symptoms by pilots and a reluctance to diagnose on the part of health professionals. Factors that might account for high prevalence estimates include anonymous assessment, the use of questionnaires that do not align with clinical disorders, and inconsistent cut-off scores. It is recommended that future studies on prevalence use well-validated clinical measures, and that more research be conducted on the effects of particular disorders on job performance.Ackland CA, Molesworth BRC, Grisham JR, Lovibond PF. Pilot mental health, methodologies, and findings: a systematic review. Aerosp Med Hum Perform. 2022; 93(9): 696-708.