Presenting problems in a pilot peer support program: a descriptive study from commercial aviation

BACKGROUND: Peer support programmes are mandated for commercial pilots in parts of Europe and increasingly promoted internationally, but case-level evidence of effectiveness remains limited. AIMS: To describe presenting problems in a large pilot peer support cohort, examine associations with occupational factors, and assess severity change over an episode of support. METHODS: We conducted a retrospective audit of 830 de-identified peer support cases from a programme serving pilots across 25 airlines in 12 European countries between 2019 and 2025. Presenting concerns were grouped into nine categories for analysis. Associations with sex, job role, and work status were examined, and severity improvement was modelled using logistic regression. RESULTS: Most cases involved male pilots, and the most common concerns were training and checks, relationships, and health-related issues. Severity decreased significantly between entry and closure, with 86% of cases improving and fewer than 1% worsening. Pilots who were unfit for work at programme entry had higher odds of improvement than those in work. Personal relationship cases had lower odds of improvement than training-related cases. CONCLUSIONS: Pilots used peer support mainly for occupational, interpersonal, and health-related stressors rather than acute crisis. Peer support may act as tertiary preventive support within aviation safety systems, although some interpersonal difficulties may be less amenable to short-term peer support alone and may require additional support pathways.