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In this photo released on March 27, 2015, Andreas Lubitz participates in the Frankfurt City Half-Marathon on March 14, 2010.

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The disturbing downing of a Germanwings A320 plane in the French Alps has put the spotlight on assessing the mental health of new pilots and supporting them as they endure what is a high-stress environment that could trigger problems later.

German media are reporting the existence of doctors' notes that point to a mental illness that co-pilot Andreas Lubitz hid from his employer. The nature of that illness is unknown, although earlier reports said the 27-year-old Mr. Lubitz had experienced a depressive episode after completing his training and Germany's aviation body advised him to undergo regular psychological evaluations.

"I am careful when there is a judicial inquiry, but everything points to a criminal, mad, suicidal action that we cannot comprehend," French Prime Minister Manuel Valls said in an interview with the French news channel iTELE.

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As investigators comb through Mr. Lubitz's belongings and speak to family, friends and co-workers, the case highlights the challenges in assessing how would-be pilots might be unsuitable for the pressures of the cockpit and whether the medical exam system can assess mental health problems.

"The biggest problem with any mental-health issue is the willingness of the pilot to voluntarily disclose what's going on in their head," said Dr. Randy Knipping, a Toronto-based aviation medical examiner for Transport Canada and for the U.S. Federal Aviation Administration.

"A lot of times pilots will withhold or conceal their feelings, thoughts and experiences. So it's very difficult," he said, adding that sometimes doctors can rely on non-verbal cues during medical exams to probe any distress or problems.

According to Transport Canada, all commercial pilots must meet medical requirements outlined under Canadian Aviation Regulations in order "to confirm their physical and mental fitness to fly."

That means being seen by a medical doctor before getting a Transport Canada certificate. Further examinations take place on a regular basis, depending on the type of licence, age and health of the pilot.

"Under strict Transport Canada guidelines, Civil Aviation Medical Examiners review every pilot's medical history to ensure there are no signs of psychosis or suicidal behaviour," the Transport Canada statement added.

Dr. Knipping said the nature of the medical examination will vary depending on the physician and whether the doctor carries out "a good structured interview that captures the full spectrum of health issues."

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"Remember we're not just evaluating pilots for their mental health, we're evaluating their vision, hearing, their balance, their co-ordination, we're doing a physical exam. So the mental status is part of that. But it's not that we have specialized psychological testing that we do," he said.

"For example, we wouldn't do a psychological psychometric testing on every pilot, just because we're not mandated to do that. And these testing protocols would not be able to pick up somebody who's withholding or concealing," he added.

Given the social stigma and fears over job security, pilots are not alone in thinking twice before disclosing a problem – and headlines like Killer in the cockpit (The Independent) and Killer pilot suffered from depression (Daily Mirror) will only add to the stigma, mental-health groups say.

"Clearly assessment of all pilots' physical and mental health is entirely appropriate – but assumptions about risk shouldn't be made across the board for people with depression, or any other illness," the British mental-health charity Mind said in a statement Friday.

"There will be pilots with experience of depression who have flown safely for decades and assessments should be made on a case-by-case basis," it added.

Watching events unfold closely is Dr. James Butcher, a psychologist with 40 years of experience working with major airlines, setting up screening systems and assessing pilot applicants in the United States.

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"Generally the pilots that are being seen as applicants for major carriers, the majority of them are very well adjusted people and are able to manage the stressful situations," he said.

"Most people that go through the screening process that we do, they do fairly well. There's just a small percentage of people that don't meet that criteria," the University of Minnesota professor emeritus added.

Authorities like the FAA in the U.S. require pilots undergo medical exams. But medical exams never really delve into the psychological life of the pilot, Dr. Butcher said. "It's basically a physical. Is the ticker still working?" he added.

The FAA requires that pilots disclose existing physical and psychological conditions – and any drug treatment they are undergoing – or risk a fine of $250,000 (U.S.) for falsifying information.

Rigorous personality assessments are not mandatory under FAA rules – and yet, it's often that kind of assessment that could flag mental-health issues in applicants, Dr. Butcher said.

The Minnesota Multiphasic Personality Inventory-2, or MMPI-2, is a widely used test of adult psychopathology that Dr. Butcher has helped to develop. It can be used by clinicians to diagnose mental disorders and whether an individual is suitable for high risk positions relating to public safety.

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But even when it is used on would-be pilots, there are challenges.

"When people wish to have a job as an airline pilot, they tend to present themselves as almost God-like. They're very defensive in the way they approach interviews. They want to put their best foot forward," Dr. Butcher explained.

"Within the [test] there are ways to determine if a person is being straightforward and honest – and if they aren't …we don't recommend them," he added.

Also, if test answers demonstrate "questionable" personality factors indicating that a would-be pilot might be impulsive, show poor judgment or be experiencing mental-health issues, the person carrying out the assessment looks at outside factors – work history, any arrests or evidence of substance abuse – to reach a decision on whether to recommend a candidate, Dr. Butcher said.

But testing at the beginning of employment does not necessarily predict what could happen years later. Pilots worry about flying conditions and the safety of the aircraft and passengers, working long hours and enduring extended periods away from family.

It all takes its toll: "Over the long haul after they've been flying for a while, you might find substance-abuse issues or life stress situations where a person becomes depressed over their personal life falling apart. Those can be the factors. It's in a minority of pilots, but it does occur," Dr. Butcher said.

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Fellow pilots might notice something is wrong, but right now there is no active means of assessing pilots and their mental health throughout their career, he added.

For Dr. Knipping, aviation medicine has come a long way. Wearing glasses is no longer an obstacle to becoming a pilot and over the past 50 years, he said, there has been a real shift from "search and destroy – which is find a medical condition and ground the pilot – to search and rescue. …

"If you can identify a problem before it causes a performance deficit and you do that successfully, now you have actually supported that person's career. Otherwise, you wouldn't have any experienced pilots out there," he said.

"If you're going to establish a hard standard and never let anyone who's had any mental-health problems of any kind, any time in their life, ever fly again, you know what? You should go have drones fly you around because there's no such thing as a perfect pilot," Dr. Knipping said.

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