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A pilot takes part in a demonstrate during a strike of the German airline Lufthansa pilots at Frankfurt Airport, Germany, Nov. 30, 2016. Reuters

Air travel has progressed from a luxury for the one percent to a mode of transportation for the masses. Almost 9 million commercial flights flew in the United States in 2015, but the safety of air travel is reliant upon the men and women in the cockpit, and a survey published Wednesday showed that they may not be getting the mental health attention they need.

The report by Harvard’s School of Public Health was the first to look into the mental health status of pilots. An anonymous survey was sent to 3,485 pilots and was completed by 1,837 of the recipients. The findings were published in the Journal of Environmental Health Wednesday.

The research found that 12.6 percent of the pilots who responded met a threshold for depression, a rate more than double that of adults overall in the U.S., and 4 percent of pilots reported having suicidal thoughts.

“Although results have limited generalizability, there are a significant number of active pilots suffering from depression symptoms,” the study concluded.

The crash of Germanwings flight 4U 9252 in 2015 put a spotlight on the mental health of airline pilots after investigators found that the co-pilot of the plane, Andreas Lubitz, deliberately piloted the plane into the French Alps, killing all 150 on board. Further investigation into the incident found that Lubitz had suffered from depression and consulted with various doctors in the weeks preceding the crash, though that information was not relayed to the airline.

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A French rescue worker inspects the site of the Germanwings crash in the French Alps, Mar. 29, 2015. The deliberate crash prompted agencies worldwide to investigate the mental health of pilots. Reuters

“The reluctance of pilots to declare their problems and seek medical assistance … needs to be addressed,” France’s air accident investigation agency BEA declared.

The U.S. Federal Aviation Administration convened following the crash to determine how best to treat mental health problems and the stigma surrounding them that may prevent self-reporting in pilots.

“There may be misperceptions that all mental illness is career ending,” the FAA said.

The FAA recommended better psychological training for aviation medical examiners, peer-to-peer support programs to encourage reporting, mental health literacy programs and airline support programs.

“Poor mental health is an enormous burden to public health worldwide. The tragedy of Germanwings flight 4U 9525 should motivate further research into assessing the issue of pilot mental health,” the Harvard study concluded. “Although current policies aim to improve mental health screening, evaluation, and record keeping, airlines and aviation organizations should increase support for preventative treatment.”