The Psychological Impact on Chinese Pilot Students During the Pandemic – The Lesson Learned
Yıl 2023,
, 330 - 336, 15.11.2023
Chien-tsung Lu
,
Ming Cheng
Xinyu Lu
,
Haoruo Fu
Öz
This study was intrigued by routine onsite observation among pilot students who were concerned about the market downturn during the pandemic and career uncertainty in the post-pandemic time. The purpose of this study was to discover how COVID-19 affected pilot students and how they reacted and were accustomed to the pandemic regulations. Human Factors, psychological issues, and the status of safety culture were also surveyed. Purposive sampling was used to select two Chinese Civil Aviation Regulation (CCAR) Part 141 flight schools to participate in an online survey. The Cronbach’s alpha, and Spearman’s Correlation Coefficient were calculated. The findings exemplify the emergence of Human Factors and psychological issues, while the flight school’s safety culture remains strong. Simultaneously, the result of this study provides a reference for stakeholders at flight training institutes for coping with future similar crises.
Kaynakça
- Adjekum, D.K. (2014). Safety culture perceptions in a collegiate aviation program: a systematic assessment.
Journal of Aviation Technology and Engineering, 3(2), 44-56.
- Adjekum, D.K. & Tous, M.F. (2020). Assessing the relationship between organizational management factors and
resilient safety culture in a collegiate aviation program with Safety Management System (SMS). Safety Science,
131(2020), 1-15,
- Aircraft Owners & Pilots Association (AOPA). (May 2020). COVID-19 Flight Operation Guide, Resume and
Sustaining Operation. Retrieved from https://www.aopa.org//media/Files/AOPA/Home/News/coronavirus-
resources/COVID-19-Flight-Operations-v4-051220.pdf
- Beckman, W., Siao, D., Smith, C. & Corns, K. (2019). Collegiate program safety culture-survey-a comparison of
disciplines. International Symposium on Aviation-Psychology, 127-132, Retrieved from
https://corescholar.libraries.wright.edu/isap_2019/22/
- Buysse, D. J., Reynolds III, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: a
new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193-213. Retrieved from
https://pubmed.ncbi.nlm.nih.gov/2748771/
- Boyd, D.D. (2021). General aviation flight safety during the COVID-19 Pandemic. Aerospace Medicine and Human
Performance, 92(10), 773-779,
- Brynes, K.P., Rhoades, D.L., Williams, M.J., Arnaud, A.U. & Schneider, A.H. (2022). The effect of a safety crisis on
safety culture and safety climate: The resilience of a flight training organization during COVID-19, Transport
Policy, 117(2022), 181-191.
- Caron, J. (2020). Asleep at the york? Fighting fatigue in General Aviation. FAA Safety Briefing. Retrieved on June
15, 2022, Retrieved from https://www.faa.gov/news/safety_briefing/2020/media/JulAug2020.pdf
- Callaway, E. (2022, June 23). What Omicron’s BA.4 and BA.5 variants mean for the pandemic. The Natures.
Retrieved from: https://www.nature.com/articles/d41586-022-01730-y
- Carleton, R.N., Norton, P., & Asmundson, G.J.G. (2007). Fearing the unknown: a short version of the intolerance of
uncertainty scale. Journal of Anxiety Disorders, 21(1) 105-117.
- Civil Aviation Administration of China (CAAC), (2017, July 19). Flight School Quality Management System and
Safety Management System Guides. AC-141-FS-2017-07. Retrieved from: http://www.caac.gov.cn/XXGK
/XXGK/GFXWJ/201709/P020170918398558423322.pdf
- Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression: development of the 10-item
Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry, 150(6), 782-786. Retrieved from
https://pubmed.ncbi.nlm.nih.gov/3651732/
- Dattel, A.R., Lubner, M. E., Gao, P., & Xie, H. (2021). Attitudes to Wearing Face Masks at US Collegiate Aviation
Programs. Conference proceedings of the 2021 HFES 65th International Annual Meeting. Retrieved from
https://journals.sagepub.com/doi/pdf/10.1177/1071181321651195
- Easy Correlation Graph (n.d). Correlation graphic tool. Retrieved from https://ezcorrgraph.firebaseapp.com/
- Europe Union Aviation Safety Agency (EASA) (20 October 2020), The fatigue of aviation personnel in the context
of COVID-19. Retrieved from: https://www.easa.europa. eu/community/system/files/2020-10/Fatigue/20in/20
Aviation/20Personnel/20in/20 COVID-19%20v1.0.pdf
- Federal Aviation Administration (FAA). (2010). AC 120-100 Basic Aviation Fatigue. Washington D.C. Retrieved from
https://www.faa.gov/documentLibrary/media/ Advisory_Circular/AC%20120-100.pdf
- Flight Safety Foundation (FSF) (2020 May). Pandemic Non-medical operation safety aspects supplemental
materials. Retrieved from https://flightsafety.org/wp-content/uploads/2020/03/COVID-19-Roadmap-V2.pdf
- Freeze, C. (2022). COVID-19: Safeguarding the profession's present and future. Airline Pilots Association
International, Retrieved from: https://www.alpa.org/news-and-events/air-line-pilot-magazine/COVID-19-
safeguarding
- Giuntella, O., Hyde, K., Saccardo, S. & Sadoff, S. (Feb. 10, 2021). Lifestyles and mental health disruptions during
COVID-19, Proceedings of National Academy of Science. https://doi.org/10.1073/pnas.201663211
- Hilditch C.J., Flynn-Evans, E.E. (2022 May). Fatigue, schedules, sleep, and sleepiness in U.S. commercial pilots
during COVID-19. Aerosp Med Hum Perform, 93(5):433-441.
- International Air Transportation Association (IATA). (2020 June). Mitigating human factors hazards in the
context of the operating environment during and post COVID-19. Safety Navigating the Industry Restart. Bulletin
1. Retrieved from: https://www.iata.org/contentassets/ 5c8786230ff34e2da406c72a52030e95/bulletin-1-
mitigating-human-factors-on-the-aviations-supply-chain-atcos-and-dispatchers.pdf
- IATA. (2020 Oct.). Guidance for Managing Pilot Training and Licensing During COVID-19 Operations (Ed. 2).
International Aviation Transportation Association, Retrieve from https://www.iata.org/contentassets/
c0f61fc821dc4f62bb6441d7abedb076/iata-guidance-for-managing-pilot-training-licensing-during-COVID19-
ed-2.pdf
- IATA. (2021, June), SIRM Special COVID-19 bulletin, Ed2. Retrieved from https://www.iata.org/contentassets/
b1398419a96142a4b128a19dce8a6ba1/sirm-special-COVID-19-bulletined2.pdf?__cf_chl_tk=
r7jd9Jpz6wl1Dm2gZDifZgU4TKxWH2SDKRT0aP4X0UA-1646266137-0-gaNycGzNCn0
- IATA. (2022). Considerations for Navigating the Restart and Recovery of Air Traffic. Retrieved from
https://www.iata.org/globalassets/iata/programs/COVID/considerations-for-navigating-the-restart-and-
recovery-of-air-traffic.pdf
- Jin, L., & Lu, C-t. (2019). A Case Study of Taxiway Landing (1982-2016). 20th International Symposium on Aviation
Psychology, 7-12. Retrieved from https://corescholar.libraries.wright.edu/isap_2019/2
- Johnson, E. (2021 Oct.). Flight database reveals risky errors by out-of-practice pilots. Retrieved from
https://www.bloomberg.com/news/newsletters/2021-10-15/flight-database-reveals-risky-errors-by-out-of-
practice-pilots
- Kim, S., Wong, A.K.F., Han, H. & Yeung, M.W. (2022). Airline employee’s stress amidst the COVID-19 pandemic and
its job-related consequences, Asia Pacific Journal of Tourism Research, 27(1), 30-47,
- Keller, J., Mendonca, F.C., & Cutter, J.E. (2019). Collegiate aviation pilots: analyses of fatigue related decisions
making scenarios. International Journal of Aviation, Aeronautics, and Aerospace, 6(4), 1-24. Retrieved from
https://commons.erau.edu/ijaaa/vol6/iss4/9/
- Kilic, B. (2019). HFACS analysis for investigating human errors in flight training accidents. Journal of Aviation, 3(1),
28-37.
- Leib, S., & C-t. Lu (2013). A gap analysis of airport safety using ICAO SMS perspectives: A field study of Taiwan.
Journal of Aviation Technology and Engineering, 2(2), 63-70.
- Liu, J., Liu, M., & Liang, W. (2022). Perspectives: The Dynamic COVID-Zero Strategy in China. China CDC Weekly,
4(4), 74-75.
- Lu, C-t., Bos, P., & Caldwell, W. (2007). System safety application: Constructing a comprehensive aviation system
safety management model (ASSMM). International Journal of Applied Aviation Studies, 7(1), 28-45.
- Lu, C-t., Kemp, A. C., Dalal, J., & Tassawar, U. (2021). System Safety Analysis of Southwest Airlines Flight 1480.
International Journal of Crisis Management.
- Lu, C-t., Wang, C., & Jin, L. (2020). Qingdao airlines emergency management system analysis. International
Journal of Crisis Management, 10(1), 29-36.
- Masrani, P. (n.d.). The dirty dozens of human factors and return to flying with COVID. International Civil Aviation
Organization, Retrieved from: https://www.icao.int/safety/aviation-medicine/
AvMedSARS/The%20Dirty%20Dozen%20of%20Human%20Factors%20and%20Return%20to%20Flying%20with%20C
OVID.PDF
- Miani, P., Kille, T., Lee, S.Y., Zhang, Y. & Bates, P.R. (2021). The impact of the COVID-19 pandemic on current tertiary
aviation education and future careers: Students’ perspective. Journal of Air Transport Management, 94, 102081,
- National Health Center (NHC). (July 2020). What are the criteria to determine low, medium and high-risk areas?
Experts: Criteria based on three factors. Retrieved from http://en.nhc.gov.cn/2020-07/10/c_81045.htm
- Olaganathan, R. & Amihan, R.A.H. (2021), Impact of COVID-19 on pilot. proficiency-A risk analysis, Global Journal
of Engineering and Technology Advances, 06(03), 1-13,
- Reason, J. (1997). Managing the risks of organizational accidents. Aldershot: Ashgate.
- Salkovskis, P.M., Rimes, K. A., Warwick, H.M.C., & Clark, D.M. (2002). The Health Anxiety Inventory: development and
validation of scales for the measurement of health anxiety and hypochondriasis. Psychological Medicine,
32(05), 843-853,
- Schaper, D. (2021, February 12). Concerns over idle pilots: Deteriorating working conditions and higher stress
levels. NPR. Retrieved from https://www.npr.org/2021/02/12/967458725/concerns-over-idle-pilots-
deteriorating-working-conditions-and-higher-stress-lev
- Shandong Nanshan International Flight Co. Ltd, (2021). Emergency Plan for Prevention and Control of
Coronavirus Delta Version. Binzhou, Shandong, China: Author. (In Chinese, hardcopy).
- Spitzer, R.L., Kroneke, K. & Williams, J.B.W. (2006). A brief measure for assessing generalized anxiety disorder.
Arch Intern Med, 166(10), 1092-1097,
- Tisdall, L., Zhang, Y. & Zhang. A. (2021). COVID-19 impacts on general aviation- Comparative experiences,
governmental responses, and policy imperatives. Transport Policy, 110(2021), 273-280,
- Vuorio, A. & Bor, R. (2020). Black Swan pandemic and the risk of pilot suicide, Frontiers in Public Health.
- Wang, C., Cheng, Z., Yue, X. & McAleer, M. (2020). Risk management of COVID-19 by universities in China. Journal
of Risk and Financial Management, 13(36), 1-6,
- Wang, C. & Zhao, H. (2020). The impact of COVID-19 on anxiety in Chinese universities students. Frontiers in
Psychology, 1-8.
- Wiegmann, D.A, & Shappell, S. A. (2003). Human error approach to aviation analysis – the Human Factors
Analysis and Classification System. Milton Park, UK. Taylor & Francis.
- Wu, X.O. & Shila, J.J. (2021) COVID-19 impacts on collegiate aviation training., 96th International Symposium on
Aviation Psychology, 104-109. Retrieved from https://corescholar.libraries.wright.edu/isap_2021/18/
- Vink, N. (2021). The effect on human performance and well-being of air traffic management operational staff
through the COVID-19 Pandemic. 91st International Symposium on Aviation Psychology, 370-375. Retrieved from
https://corescholar.libraries.wright.edu/isap_2021/62
- Zimmerman, M., Chelminski, I., McGlinchey, J. B., & Posternak, M. A. (2008). A clinically useful depression outcome
scale. Comprehensive Psychiatry, 49(2), 131-140,
Yıl 2023,
, 330 - 336, 15.11.2023
Chien-tsung Lu
,
Ming Cheng
Xinyu Lu
,
Haoruo Fu
Kaynakça
- Adjekum, D.K. (2014). Safety culture perceptions in a collegiate aviation program: a systematic assessment.
Journal of Aviation Technology and Engineering, 3(2), 44-56.
- Adjekum, D.K. & Tous, M.F. (2020). Assessing the relationship between organizational management factors and
resilient safety culture in a collegiate aviation program with Safety Management System (SMS). Safety Science,
131(2020), 1-15,
- Aircraft Owners & Pilots Association (AOPA). (May 2020). COVID-19 Flight Operation Guide, Resume and
Sustaining Operation. Retrieved from https://www.aopa.org//media/Files/AOPA/Home/News/coronavirus-
resources/COVID-19-Flight-Operations-v4-051220.pdf
- Beckman, W., Siao, D., Smith, C. & Corns, K. (2019). Collegiate program safety culture-survey-a comparison of
disciplines. International Symposium on Aviation-Psychology, 127-132, Retrieved from
https://corescholar.libraries.wright.edu/isap_2019/22/
- Buysse, D. J., Reynolds III, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: a
new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193-213. Retrieved from
https://pubmed.ncbi.nlm.nih.gov/2748771/
- Boyd, D.D. (2021). General aviation flight safety during the COVID-19 Pandemic. Aerospace Medicine and Human
Performance, 92(10), 773-779,
- Brynes, K.P., Rhoades, D.L., Williams, M.J., Arnaud, A.U. & Schneider, A.H. (2022). The effect of a safety crisis on
safety culture and safety climate: The resilience of a flight training organization during COVID-19, Transport
Policy, 117(2022), 181-191.
- Caron, J. (2020). Asleep at the york? Fighting fatigue in General Aviation. FAA Safety Briefing. Retrieved on June
15, 2022, Retrieved from https://www.faa.gov/news/safety_briefing/2020/media/JulAug2020.pdf
- Callaway, E. (2022, June 23). What Omicron’s BA.4 and BA.5 variants mean for the pandemic. The Natures.
Retrieved from: https://www.nature.com/articles/d41586-022-01730-y
- Carleton, R.N., Norton, P., & Asmundson, G.J.G. (2007). Fearing the unknown: a short version of the intolerance of
uncertainty scale. Journal of Anxiety Disorders, 21(1) 105-117.
- Civil Aviation Administration of China (CAAC), (2017, July 19). Flight School Quality Management System and
Safety Management System Guides. AC-141-FS-2017-07. Retrieved from: http://www.caac.gov.cn/XXGK
/XXGK/GFXWJ/201709/P020170918398558423322.pdf
- Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression: development of the 10-item
Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry, 150(6), 782-786. Retrieved from
https://pubmed.ncbi.nlm.nih.gov/3651732/
- Dattel, A.R., Lubner, M. E., Gao, P., & Xie, H. (2021). Attitudes to Wearing Face Masks at US Collegiate Aviation
Programs. Conference proceedings of the 2021 HFES 65th International Annual Meeting. Retrieved from
https://journals.sagepub.com/doi/pdf/10.1177/1071181321651195
- Easy Correlation Graph (n.d). Correlation graphic tool. Retrieved from https://ezcorrgraph.firebaseapp.com/
- Europe Union Aviation Safety Agency (EASA) (20 October 2020), The fatigue of aviation personnel in the context
of COVID-19. Retrieved from: https://www.easa.europa. eu/community/system/files/2020-10/Fatigue/20in/20
Aviation/20Personnel/20in/20 COVID-19%20v1.0.pdf
- Federal Aviation Administration (FAA). (2010). AC 120-100 Basic Aviation Fatigue. Washington D.C. Retrieved from
https://www.faa.gov/documentLibrary/media/ Advisory_Circular/AC%20120-100.pdf
- Flight Safety Foundation (FSF) (2020 May). Pandemic Non-medical operation safety aspects supplemental
materials. Retrieved from https://flightsafety.org/wp-content/uploads/2020/03/COVID-19-Roadmap-V2.pdf
- Freeze, C. (2022). COVID-19: Safeguarding the profession's present and future. Airline Pilots Association
International, Retrieved from: https://www.alpa.org/news-and-events/air-line-pilot-magazine/COVID-19-
safeguarding
- Giuntella, O., Hyde, K., Saccardo, S. & Sadoff, S. (Feb. 10, 2021). Lifestyles and mental health disruptions during
COVID-19, Proceedings of National Academy of Science. https://doi.org/10.1073/pnas.201663211
- Hilditch C.J., Flynn-Evans, E.E. (2022 May). Fatigue, schedules, sleep, and sleepiness in U.S. commercial pilots
during COVID-19. Aerosp Med Hum Perform, 93(5):433-441.
- International Air Transportation Association (IATA). (2020 June). Mitigating human factors hazards in the
context of the operating environment during and post COVID-19. Safety Navigating the Industry Restart. Bulletin
1. Retrieved from: https://www.iata.org/contentassets/ 5c8786230ff34e2da406c72a52030e95/bulletin-1-
mitigating-human-factors-on-the-aviations-supply-chain-atcos-and-dispatchers.pdf
- IATA. (2020 Oct.). Guidance for Managing Pilot Training and Licensing During COVID-19 Operations (Ed. 2).
International Aviation Transportation Association, Retrieve from https://www.iata.org/contentassets/
c0f61fc821dc4f62bb6441d7abedb076/iata-guidance-for-managing-pilot-training-licensing-during-COVID19-
ed-2.pdf
- IATA. (2021, June), SIRM Special COVID-19 bulletin, Ed2. Retrieved from https://www.iata.org/contentassets/
b1398419a96142a4b128a19dce8a6ba1/sirm-special-COVID-19-bulletined2.pdf?__cf_chl_tk=
r7jd9Jpz6wl1Dm2gZDifZgU4TKxWH2SDKRT0aP4X0UA-1646266137-0-gaNycGzNCn0
- IATA. (2022). Considerations for Navigating the Restart and Recovery of Air Traffic. Retrieved from
https://www.iata.org/globalassets/iata/programs/COVID/considerations-for-navigating-the-restart-and-
recovery-of-air-traffic.pdf
- Jin, L., & Lu, C-t. (2019). A Case Study of Taxiway Landing (1982-2016). 20th International Symposium on Aviation
Psychology, 7-12. Retrieved from https://corescholar.libraries.wright.edu/isap_2019/2
- Johnson, E. (2021 Oct.). Flight database reveals risky errors by out-of-practice pilots. Retrieved from
https://www.bloomberg.com/news/newsletters/2021-10-15/flight-database-reveals-risky-errors-by-out-of-
practice-pilots
- Kim, S., Wong, A.K.F., Han, H. & Yeung, M.W. (2022). Airline employee’s stress amidst the COVID-19 pandemic and
its job-related consequences, Asia Pacific Journal of Tourism Research, 27(1), 30-47,
- Keller, J., Mendonca, F.C., & Cutter, J.E. (2019). Collegiate aviation pilots: analyses of fatigue related decisions
making scenarios. International Journal of Aviation, Aeronautics, and Aerospace, 6(4), 1-24. Retrieved from
https://commons.erau.edu/ijaaa/vol6/iss4/9/
- Kilic, B. (2019). HFACS analysis for investigating human errors in flight training accidents. Journal of Aviation, 3(1),
28-37.
- Leib, S., & C-t. Lu (2013). A gap analysis of airport safety using ICAO SMS perspectives: A field study of Taiwan.
Journal of Aviation Technology and Engineering, 2(2), 63-70.
- Liu, J., Liu, M., & Liang, W. (2022). Perspectives: The Dynamic COVID-Zero Strategy in China. China CDC Weekly,
4(4), 74-75.
- Lu, C-t., Bos, P., & Caldwell, W. (2007). System safety application: Constructing a comprehensive aviation system
safety management model (ASSMM). International Journal of Applied Aviation Studies, 7(1), 28-45.
- Lu, C-t., Kemp, A. C., Dalal, J., & Tassawar, U. (2021). System Safety Analysis of Southwest Airlines Flight 1480.
International Journal of Crisis Management.
- Lu, C-t., Wang, C., & Jin, L. (2020). Qingdao airlines emergency management system analysis. International
Journal of Crisis Management, 10(1), 29-36.
- Masrani, P. (n.d.). The dirty dozens of human factors and return to flying with COVID. International Civil Aviation
Organization, Retrieved from: https://www.icao.int/safety/aviation-medicine/
AvMedSARS/The%20Dirty%20Dozen%20of%20Human%20Factors%20and%20Return%20to%20Flying%20with%20C
OVID.PDF
- Miani, P., Kille, T., Lee, S.Y., Zhang, Y. & Bates, P.R. (2021). The impact of the COVID-19 pandemic on current tertiary
aviation education and future careers: Students’ perspective. Journal of Air Transport Management, 94, 102081,
- National Health Center (NHC). (July 2020). What are the criteria to determine low, medium and high-risk areas?
Experts: Criteria based on three factors. Retrieved from http://en.nhc.gov.cn/2020-07/10/c_81045.htm
- Olaganathan, R. & Amihan, R.A.H. (2021), Impact of COVID-19 on pilot. proficiency-A risk analysis, Global Journal
of Engineering and Technology Advances, 06(03), 1-13,
- Reason, J. (1997). Managing the risks of organizational accidents. Aldershot: Ashgate.
- Salkovskis, P.M., Rimes, K. A., Warwick, H.M.C., & Clark, D.M. (2002). The Health Anxiety Inventory: development and
validation of scales for the measurement of health anxiety and hypochondriasis. Psychological Medicine,
32(05), 843-853,
- Schaper, D. (2021, February 12). Concerns over idle pilots: Deteriorating working conditions and higher stress
levels. NPR. Retrieved from https://www.npr.org/2021/02/12/967458725/concerns-over-idle-pilots-
deteriorating-working-conditions-and-higher-stress-lev
- Shandong Nanshan International Flight Co. Ltd, (2021). Emergency Plan for Prevention and Control of
Coronavirus Delta Version. Binzhou, Shandong, China: Author. (In Chinese, hardcopy).
- Spitzer, R.L., Kroneke, K. & Williams, J.B.W. (2006). A brief measure for assessing generalized anxiety disorder.
Arch Intern Med, 166(10), 1092-1097,
- Tisdall, L., Zhang, Y. & Zhang. A. (2021). COVID-19 impacts on general aviation- Comparative experiences,
governmental responses, and policy imperatives. Transport Policy, 110(2021), 273-280,
- Vuorio, A. & Bor, R. (2020). Black Swan pandemic and the risk of pilot suicide, Frontiers in Public Health.
- Wang, C., Cheng, Z., Yue, X. & McAleer, M. (2020). Risk management of COVID-19 by universities in China. Journal
of Risk and Financial Management, 13(36), 1-6,
- Wang, C. & Zhao, H. (2020). The impact of COVID-19 on anxiety in Chinese universities students. Frontiers in
Psychology, 1-8.
- Wiegmann, D.A, & Shappell, S. A. (2003). Human error approach to aviation analysis – the Human Factors
Analysis and Classification System. Milton Park, UK. Taylor & Francis.
- Wu, X.O. & Shila, J.J. (2021) COVID-19 impacts on collegiate aviation training., 96th International Symposium on
Aviation Psychology, 104-109. Retrieved from https://corescholar.libraries.wright.edu/isap_2021/18/
- Vink, N. (2021). The effect on human performance and well-being of air traffic management operational staff
through the COVID-19 Pandemic. 91st International Symposium on Aviation Psychology, 370-375. Retrieved from
https://corescholar.libraries.wright.edu/isap_2021/62
- Zimmerman, M., Chelminski, I., McGlinchey, J. B., & Posternak, M. A. (2008). A clinically useful depression outcome
scale. Comprehensive Psychiatry, 49(2), 131-140,