Mental health and well-being among military remotely piloted aircraft systems personnel: a systematic review

Vollständiger Abstract

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Introduction Remotely piloted aircraft systems (RPAS) are integral to military operations. Although geographically removed from the battlefield, RPAS personnel are exposed to operational, organisational and moral stressors. This review synthesises evidence on the mental health and well-being of military RPAS personnel. Methods This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Cochrane methodology. The protocol was preregistered on PROSPERO. Searches were conducted in MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, ScienceDirect and PILOTS for studies from January 2002 to June 2025. Peer-reviewed studies examining mental health outcomes among military RPAS personnel were included while grey literature and technical repositories were screened for context. Study quality was assessed using NICE (National Institute for Health and Care Excellence) public health guidance checklists. Given variation in study designs and outcome measures, findings were synthesised narratively. Results Fourteen studies met the inclusion criteria, comprising nine cross-sectional surveys, two retrospective record analyses, one cohort study, one physiological experiment and one qualitative study. The prevalence of probable post-traumatic stress disorder (PTSD) ranged from 3.3% to 6.7%, which is broadly comparable to other military populations. Psychological distress was reported in 13.0%–16.0% of personnel, and high emotional exhaustion in 25.0%–37.0%. Suicidal ideation ranged from 4.4% to 8.0%. Subthreshold PTSD symptoms, sleep disturbance and functional impairment were frequently reported. The identified risk factors were predominantly organisational rather than combat-related, including long working hours, shift instability, understaffing, role conflict and sleep disruption. Protective factors included leadership support, team cohesion, adequate sleep and positive help-seeking attitudes. Conclusions RPAS personnel do not show significantly higher rates of diagnosable mental disorder than other military groups. However, they do experience considerable occupational strain. Across the literature, adverse outcomes were more often linked to chronic organisational stressors than to direct battlefield exposure. Future research should prioritise longitudinal designs, comparative cohorts and the evaluation of targeted occupational interventions. PROSPERO registration number CRD42022329937