Skip to main content
SpringerLink
Log in

Behavioral Health and Performance Support

  • Chapter
  • First Online:
Principles of Clinical Medicine for Space Flight

Abstract

This chapter reviews the stressors and countermeasures that affect crew behavioral health and performance during space flight. This review is based on the experiences of crewed space flight in both the Russian and US programs, including Space Shuttle flights lasting from 1–3 weeks, Salyut and Mir space station flights, International Space Station (ISS) flights, and findings from analog environments that are similar in terms of isolation and other features to the inflight environments on the Space Shuttle, Mir, and ISS. Flight surgeons, aerospace psychiatrists, aerospace psychologists, and crewmembers must be aware of these stressors and the countermeasures that should be implemented to maintain the behavioral health and mission performance of a crew. This chapter offers space medicine and behavioral health clinicians a focused approach to the known risks to behavioral health and performance by focusing primarily on the long duration mission. An overview of both psychiatric and psychological behavioral health and performance issues experienced by long duration crews is also provided, as well as an outline of potentially helpful countermeasures.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Notes

  1. 1.

    “US Operating Segment” denotes crewmembers and activities of non-Russian partners in the ISS program, namely, from the Canadian Space Agency (CSA), European Space Agency (ESA), Japanese Aerospace Exploration Agency (JAXA), and US National Aeronautics and Space Administration

References

  1. Blagov D, Bogdashevskiy R, Myasnikov VI, Kozarenko O, Bronnikov SV. Experts discuss psychological support measures for cosmonauts. Moscow Literaturnaya Gazeta, 4 Jan 1989.

    Google Scholar 

  2. Kanas N. Psychiatric issues affecting long duration space missions. Aviat Space Environ Med. 1998;69(12):1211–6.

    CAS  PubMed  Google Scholar 

  3. DeCortis M. Blaha candid about battling depression during early days aboard Mir. Florida Today Space Online, 3 Mar 1997.

    Google Scholar 

  4. Stuster J. Behavioral issues associated with long duration space expeditions: Review and analysis of astronaut journals experiment 01-E104 (Journals): Final Report. 2010. NASA/TM-2010-216130.

    Google Scholar 

  5. Evans-Flynn E, Gregory K, Arsintescu L, Whitmire A, Leveton LB. Evidence report: risk of performance decrements and adverse health outcomes resulting from sleep loss, circadian desynchronization, and work overload. Houston: NASA; 2015, August 25

    Google Scholar 

  6. Isachenkov V. Psychologist says Mir is sweatshop. Isvestia, 22 Oct 1997.

    Google Scholar 

  7. Bluth BJ. Soviet space stress. Science. 1981;81:30–5.

    Google Scholar 

  8. Oberg JE. Red star in orbit. New York: Random House; 1981.

    Google Scholar 

  9. Bluth BJ. The benefits and dilemmas of an international space station. Acta Astronaut. 1984;11:149–53.

    CAS  PubMed  Google Scholar 

  10. Chaikin A. The loneliness of the long distance astronaut. Discover, 20–31 Feb 1985.

    Google Scholar 

  11. Pogue WR. How do you go to the bathroom in space? New York: Doherty Associates; 1985.

    Google Scholar 

  12. Canby T. A generation after sputnik: are the soviets ahead in space? Natl Geogr. 1986;170(4):420–59.

    Google Scholar 

  13. Kanas N. Psychological and interpersonal issues in space. Am J Psychiatry. 1987;144(11):703–9.

    CAS  PubMed  Google Scholar 

  14. Kozecenko OP, Gushin VI, Sled AD, Efimov AA, Pystinnikova JM. Some problems of group interaction in prolonged space flights. J Hum Perform Extreme Environ. 1999;4:123–7.

    Google Scholar 

  15. Harris PR. Living and working in space: human behavior, culture and organization. New York: Wiley; 1996.

    Google Scholar 

  16. Ball JR, Evans CH Jr, editors. Safe passage: astronaut care for exploration missions. Washington, DC: National Academies Press; 2001.

    Google Scholar 

  17. Slack KJ, Schneiderman JS, Leveton LB, Whitmire AM, Picano JJ. Evidence book: risk of adverse cognitive or behavioral condition and psychiatric disorders. Houston: NASA, 11 Apr 2016. Available at http://ntrs.nasa.gov/archive/nasa/casi.ntrs.nasa.gov/20160004365.pdf

  18. Billica RD, Simmons SC, Mathes KL, et al. Perception of medical risk of space flight. Aviat Space Environ Med. 1996;67:467–73.

    CAS  PubMed  Google Scholar 

  19. Adams RR, Jones DR. The healthy motivation to fly: no psychiatric diagnosis. Aviat Space Environ Med. 1987;58:350–4.

    CAS  PubMed  Google Scholar 

  20. Fine PM, Hartman BO. Psychiatric strengths and weaknesses of typical Air Force pilots. 1968. SAM-TR-68-121.

    Google Scholar 

  21. Flynn CF, Sipes WE, Grosenbach MJ, Ellsworth J. Top performer survey: computerized psychological assessment in aircrew. Aviat Space Environ Med. 1994;65:A39–44.

    CAS  PubMed  Google Scholar 

  22. Jones DR. Flying and danger, joy and fear. Aviat Space Environ Med. 1986;57:131–6.

    CAS  PubMed  Google Scholar 

  23. Bor R, Field G, Scragg P. The mental health of pilots: an overview. Couns Psychol Q. 2002;15(3):239–56.

    Google Scholar 

  24. Young JA. The effects of life-stress on pilot performance NASA/TM-2008-215375.

    Google Scholar 

  25. Santy PA. Choosing the right stuff: the psychological selection of astronauts and cosmonauts. Westport: Praeger; 1994.

    Google Scholar 

  26. Picano JJ. Personality types among experienced military pilots. Aviat Space Environ Med. 1991;62:517–20.

    CAS  PubMed  Google Scholar 

  27. Ashman A, Telfer R. Personality profiles of pilots. Aviat Space Environ Med. 1983;54:940–3.

    CAS  PubMed  Google Scholar 

  28. Kanas N, Manzey D. Space psychology and psychiatry. 2nd ed. El Segundo: Springer Microcosm Press; 2008.

    Google Scholar 

  29. Woolford B, Sipes WE, Fiedler ER. Human space flight. In: Salvendy G, editor. Handbook of human factors and ergonomics. 4th ed. Hoboken: Wiley; 2012. p. 910–30.

    Google Scholar 

  30. Flynn CF, McGlohn S, Miles RE. Occupational outcome in military aviators after psychiatric hospitalization. Aviat Space Environ Med. 1996;67:8–13.

    CAS  PubMed  Google Scholar 

  31. Bailey DA, Gilleran LG, Merchant PG. Waivers for disqualifying medical conditions in US naval aviation personnel. Aviat Space Environ Med. 1995;66:401–7.

    CAS  PubMed  Google Scholar 

  32. Senechal PK, Traweek AC. The aviator psychology program at RAF Upper Heyford. Aviat Space Environ Med. 1988;59:973–5.

    CAS  PubMed  Google Scholar 

  33. Russell JC, Davis AW. Alcohol rehabilitation of airline pilots. Oklahoma City: FAA; 1985. DOT/FAA-AM-85.

    Google Scholar 

  34. Flynn CF, Sturges MS, Swarsen RJ, et al. Alcoholism and treatment in airline aviators: one company’s results. Aviat Space Environ Med. 1993;64:314–8.

    CAS  PubMed  Google Scholar 

  35. Jones DR, Marsh RW. Psychiatric considerations in military aerospace medicine. Aviat Space Environ Med. 2001;72:129–35.

    CAS  PubMed  Google Scholar 

  36. Horowitz MJ. Stress-response syndromes: a review of posttraumatic and adjustment disorders. Hosp Community Psychiatry. 1986;37:241–9.

    CAS  PubMed  Google Scholar 

  37. Klein WB. A survey of the flight surgeon’s rapport with pilots. Aviat Space Environ Med. 1995;66:15–9.

    CAS  PubMed  Google Scholar 

  38. Raymond MW, Moser R. Aviators at risk. Aviat Space Environ Med. 1995;66:35–9.

    CAS  PubMed  Google Scholar 

  39. Pultarova T. It’s all about people: NASA psychiatrist explains why space itself is not detrimental. Space Safety Magazine, 25 Dec 2012.

    Google Scholar 

  40. Jarrettt C. New horizons. The Psychologist. 2008;21(December):1018–21.

    Google Scholar 

  41. Rigg RC, Cosgrove MP. Aircrew wives and the intermittent husband syndrome. Aviat Space Environ Med. 1994;65:654–60.

    CAS  PubMed  Google Scholar 

  42. Sloan SJ, Cooper CL. Stress coping strategies in commercial airline pilots. J Occup Med. 1986;28:49–52.

    CAS  PubMed  Google Scholar 

  43. Flinn DE. Psychiatric factors in astronaut selection. In: Flaherty BE, editor. Psychological aspects of space flight. New York: Columbia University Press; 1961.

    Google Scholar 

  44. Alkov RA, Gaynor JA, Borowsky MS. Pilot error as a symptom of inadequate stress coping. Aviat Space Environ Med. 1985;57:244–7.

    Google Scholar 

  45. Johnson P. The roles of NASA, U.S astronauts and their families in long duration missions. In: Vakoch DA, editor. On-orbit and beyond: psychological perspectives on human spaceflight. New York: Springer; 2013.

    Google Scholar 

  46. Luna TD, French J, Mitcha JL. A study of USAF air traffic controller shift work: sleep, fatigue, activity, and mood analyses. Aviat Space Environ Med. 1997;68:18–23.

    CAS  PubMed  Google Scholar 

  47. Luna TD. Air traffic controller shift work: what are the implications for aviation safety? Aviat Space Environ Med. 1997;68:69–79.

    CAS  PubMed  Google Scholar 

  48. Caldwell JA. Fatigue in the aviation environment: an overview of the causes and effects as well as recommended countermeasures. Aviat Space Environ Med. 1997;68:932–8.

    PubMed  Google Scholar 

  49. Rosekind MR, Gander PH, Miller DL, et al. Fatigue in operational settings: examples from the aviation environment. Hum Factors. 1994;36:327–38.

    CAS  PubMed  Google Scholar 

  50. Mitler MM, Carskadon MA, Czeisler CA, et al. Catastrophes, sleep, and public policy: consensus report. Sleep. 1988;11:100–9.

    CAS  PubMed  Google Scholar 

  51. Dinges D, Kribbs N. Performing while sleepy: effects of experimentally induced sleepiness. In: Monk T, editor. Sleep, sleepiness and performance. New York: Wiley; 1991.

    Google Scholar 

  52. Monk T, Buysse D, Reynolds C, et al. Rhythmic vs. homeostatic influences on mood, activation, and performance in young and old men. J Gerontol. 1992;47:P221–7.

    CAS  PubMed  Google Scholar 

  53. Van Dongen HPA, Maislin G, Millington JM, Dinges DF. The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral function and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep. 2003;26(2):117–26.

    PubMed  Google Scholar 

  54. Durmer JS, Dinges DF. Neurocognitive consequences of sleep deprivation. Semin Neurol. 2005;25(1):117–29.

    PubMed  Google Scholar 

  55. Mallis MM, DeRoshia CW. Circadian rhythms, sleep, and performance in space. Aviat Space Environ Med. 2005;76(6):B94–107.

    CAS  PubMed  Google Scholar 

  56. Banks S, Dinges DF. Behavioral and physiological consequences of sleep restriction. J Clin Sleep Med. 2007;3(5):519–28.

    PubMed  PubMed Central  Google Scholar 

  57. Ritsher JB, Kanas NA, Ihle EC, Saylor SA. Psychological adaptation and salutogenesis in space: lessons from a series of studies. Acta Astronaut. 2007;60(4):336–40.

    Google Scholar 

  58. Williams D, Flynn C. Cross-cultural considerations for long duration space flight. Presented at the 50th International Astronautical Congress, Amsterdam, 4–8 Oct 1999. IAF/IAA-99-G.3.01.

    Google Scholar 

  59. Helmreich RL, Merritt AC. Culture at work in aviation and medicine: national, organizational and professional influences. Hants: Ashgate Publishing Ltd; 1999.

    Google Scholar 

  60. Palinkas LA, Johnson JC, Bolster JS, Rakusa-Suszczewski S, Klopov VP, Fu XQ, Scajdeva U. Cross-cultural differences in psychological adaptation to isolated and confined environments. Aviat Space Environ Med. 2004;75:973–80.

    PubMed  Google Scholar 

  61. Kanas N, Weiss DS, Marmar CR. Crew member interactions during a Mir space station simulation. Aviat Space Environ Med. 1996;67:969–75.

    CAS  PubMed  Google Scholar 

  62. Gushin VI, Efimov VA, Smirnova TM, et al. Subjects’ perception of the crew interaction dynamics under prolonged isolation. Aviat Space Environ Med. 1998;69:556–61.

    CAS  PubMed  Google Scholar 

  63. Santy P, Holland AW, Looper L, et al. Multicultural factors in the space environment: results of an international shuttle crew debrief. Aviat Space Environ Med. 1993;64:196–200.

    CAS  PubMed  Google Scholar 

  64. Tomi LM, Rossokha K, Hosein J. The role of cross-cultural factors in long duration international space missions: lessons from the SFINCSS-99 study. Space Technol. 2002;22:137–44.

    PubMed  Google Scholar 

  65. Boyd JE, Kanas NA, Salnitskiy VP, Gushin VI, Saylor SS, Weiss DS, Marmar CR. Cultural differences in crewmembers and mission control personnel during two space station programs. Aviat Space Environ Med. 2009;80:532–40.

    PubMed  Google Scholar 

  66. Sandal G, Vaernes R, Bergan T, et al. Psychological reactions during polar expedition and isolation in hyperbaric chamber. Aviat Space Environ Med. 1996;67:227–34.

    CAS  PubMed  Google Scholar 

  67. Harrison AA, Clearwater YA, McKay CP. The human experience in Antarctica: applications to life in space. Behav Sci. 1989;34:253–71.

    CAS  PubMed  Google Scholar 

  68. Reynolds RD, Styer DJ, Schlichting CL. Decreased vitamin B-6 status of submariners during prolonged patrol. Am J Clin Nutr. 1988;47:463–9.

    CAS  PubMed  Google Scholar 

  69. Gushin VI, Kholin SF, Ivanosvsky YR. Soviet psychophysiological investigations of simulated isolation: some results and prospects. In: Bonting SL, editor. Advances in space biology and medicine, European isolation and confinement study, vol. 3. Greenwich: JAI Press Ltd; 1993.

    Google Scholar 

  70. Miasnikov VI. Mental status and work capacity of crewmen at the Salyut 6 space flight base. Kosm Biol Aviakosm Med. 1983;17:22–5.

    CAS  PubMed  Google Scholar 

  71. Kanas N, Salniskiy V, Grund EM, Weiss DS, Gushin V, Kozerenko O, Sled A, Marmar CR. Human interaction in space: results from Shuttle/Mir. Acta Astronaut. 2001;49:243–60.

    CAS  PubMed  Google Scholar 

  72. Palinkas L, Johnson JC, Boster JS, Houseal M. Longitudinal studies of behavior and performance during a winter at the South Pole. Aviat Space Environ Med. 1998;69:73–7.

    CAS  PubMed  Google Scholar 

  73. Strange RE, Klein WJ. Emotional and social adjustment of recent U.S. winter-over parties in isolated Antarctic stations. In: Edholm OG, EKE G, editors. Polar human biology: proceedings of the SCAR/IUPS/IUBS Symposium on Human Biology and Medicine in the Antarctic. Chicago: Heinemann; 1974. p. 410.

    Google Scholar 

  74. Myasnikov VI, Zamaletdinov IS. Psychological states and group interactions of crew members in flight. Space Biol Med. 1996;3:419–32.

    Google Scholar 

  75. Rivolier J, Bachelard CL. Analogies between living conditions at Antarctic scientific base and on a space station. European Manned Space Infrastructure (EMSI) Program, unnumbered report from the European Space Agency; 1987.

    Google Scholar 

  76. Palinkas LA, Glogower F, Dembert M, Hansen K, Smullen R. Incidence of psychiatric disorders after extended residence in Antarctica. Int J Circumpolar Health. 2004;63:157–68.

    PubMed  Google Scholar 

  77. Kanas N. Psychosocial factors affecting simulated and actual space missions. Aviat Space Environ Med. 1985;56:806–11.

    CAS  PubMed  Google Scholar 

  78. Sandal GM, Vaernes R, Ursin H. Crew compatibility and interaction. In: Bonting SL, editor. Advances in space biology and medicine, vol. 5. Greenwich: JAI Press Inc; 1996.

    Google Scholar 

  79. Walford RL, Bechtel R, MacCallum T, et al. Biospheric medicine as viewed from the two-year first closure of Biosphere 2. Aviat Space Environ Med. 1996;67:609–17.

    CAS  PubMed  Google Scholar 

  80. Kanas N, Salnitskiy V, Grund EM, Gushin V, Weiss DS, Kozerenko O, Sled A, Marmar CR. Interpersonal and cultural issues involving crews and ground personnel during Shuttle/Mir space missions. Aviat Space Environ Med. 2000;71(9):A11–6.

    CAS  PubMed  Google Scholar 

  81. Palinkas LA. Psychosocial effects of adjustment in Antarctica: lessons for long duration spaceflight. J Spacecr. 1990;27:471–7.

    CAS  Google Scholar 

  82. Gundel A, Polyakov VV, Zulley J. The alteration of human sleep and circadian rhythms during spaceflight. J Sleep Res. 1997;6:1–8.

    CAS  PubMed  Google Scholar 

  83. Monk TH, Buysse DJ, Billy BD, et al. Sleep and circadian rhythms in four orbiting astronauts. J Biol Rhythm. 1998;13:188–201.

    CAS  Google Scholar 

  84. Frost JD, Shumate WH, Salamy JG, et al. Experiment M133. Sleep monitoring on Skylab. In: Johnston RS, Dietlein LF, editors. Biomedical results from Skylab. Washington, DC: NASA Scientific and Technical Information Office; 1977. p. 113–26. NASA SP-377.

    Google Scholar 

  85. Monk TH, Kennedy KS, Rose LR, Leneger JM. Decreased human circadian pacemaker influence after 100 days in space: a case study. Psychosom Med. 2001;63:881–5.

    CAS  PubMed  Google Scholar 

  86. Stampi C. Sleep and circadian rhythms in space. J Clin Pharmacol. 1994;34:518–34.

    CAS  PubMed  Google Scholar 

  87. Tobler I, Borbely AA. 24-hour assessment of rest/activity and sleep/wakefulness: comparison of subjective and objective measures. In: Bonting SL, editor. Advances in space biology and medicine, European isolation and confinement study, vol. 3. Greenwich: JAI Press Ltd; 1993.

    Google Scholar 

  88. Gundel A, Polyakov VV, Zulley J. The alteration of human sleep and circadian rhythms during spaceflight. J Sleep Res. 1997;6:1–8.

    CAS  PubMed  Google Scholar 

  89. Dijk DJ, Neri DF, Wyatt JK, Ronda JM, Riel E, Ritz-DeCecco A, Hughes RJ, Elliott AR, Prisk GK, West JB, Czeisler CA. Sleep, performance, circadian rhythms, and light-dark cycles during two space shuttle flights. Am J Phys Regul Integr Comp Phys. 2001;281:R1647–64.

    CAS  Google Scholar 

  90. Barger LK, Flynn-Evans EE, Kubey A, Walsh L, Ronda JM, Wang W, Wright KP Jr, Czeisler CA. Prevalence of sleep deficiency and hypnotic use among astronauts use of before, during, and after spaceflight: an observational study. Lancet Neurol. 2014;13(9):904–12.

    PubMed  PubMed Central  Google Scholar 

  91. Xu D, Shoemaker JK, Blaber AP, Arbeille A, Fraser K, Hughson RL. Reduced heart rate variability during sleep in long duration spaceflight. Am J Psysiol Regul Integr Comp Physiol. 1993;305:R164–70.

    Google Scholar 

  92. Guo JH, Qu WM, Chen SG, Chen XP, Lv K, Huang ZL, Wu YL. Keeping the right time in space: importance of circadian clock and sleep for physiology and performance of astronauts. Mil Med Res. 2014;1:23.1–7.

    Google Scholar 

  93. Heuer H, Manzey D, Lorenz B, Sangals J. Impairments of manual tracking performance during spaceflight are associated with specific effects of microgravity on visuomotor transformations. Ergonomics. 2003;46:920–34.

    PubMed  Google Scholar 

  94. Kitmacher GH. Design of the Space Station habitable modules. In: 53rd International Astronautical Congress, Oct 2002, p. 10–19. Available at http://www.ninfinger.org/models/vault2006/6.%20ISS%20Module%20Design.pdf. Accessed 21 Feb 2016.

  95. Gushin VI, Efimov VA, Smirnova TM. Work capability during isolation. In: Bonting SL, editor. Advances in space biology and medicine, vol. 5. Greenwich: JAI Press Inc; 1996.

    Google Scholar 

  96. Sauer J, Hockey RJ, Wastell DG. Performance evaluation in analog space environments: adaptation during an 8-month Antarctic wintering-over expedition. Aviat Space Environ Med. 1999;70:230–5.

    CAS  PubMed  Google Scholar 

  97. Sauer J, Hockey RJ, Wastell DG. Maintenance of complex performance during a 135-day spaceflight simulation. Aviat Space Environ Med. 1999;70:236–44.

    CAS  PubMed  Google Scholar 

  98. Jones DG, Endsley MR. Sources of situation awareness errors in aviation. Aviat Space Environ Med. 1996;67:507–12.

    CAS  PubMed  Google Scholar 

  99. Nechaev AP. The relationship between astronauts erroneous actions, their psychophysiological state and work and rest regimen. Aviakosmoskaya Ekologoskaya Medicina. 1999;33:9–12.

    CAS  Google Scholar 

  100. Gushin VI, Zaprisa NS, Kolinitchenko TB, et al. Content analysis of the crew communication with external communicants under prolonged isolation. Aviat Space Environ Med. 1997;68:1093–8.

    CAS  PubMed  Google Scholar 

  101. Hordinsky JR. Skylab crew health—crew surgeons’ reports. In: Johnston RS, Dietlein LR, editors. Biomedical results from Skylab. Washington, DC: NASA Scientific and Technical Information Office; 1977. p. 30–4. NASA SP-377.

    Google Scholar 

  102. Gunderson EKE. Mental health problems in Antarctica. Arch Environ Health. 1968;17:558–64.

    CAS  PubMed  Google Scholar 

  103. Blount BW, Curry A Jr. Family separations in the military. Mil Med. 1992;157:76–80.

    CAS  PubMed  Google Scholar 

  104. Kelley ML. The effects of military-induced separation on family factors and child behavior. Am J Orthopsychiatry. 1994;64:103–11.

    CAS  PubMed  Google Scholar 

  105. Rabb DD, Baumer RJ, Wieseler NA. Counseling army reservists and their families during operation desert shield/storm. Community Ment Health J. 1993;29:441–7.

    CAS  PubMed  Google Scholar 

  106. Black WG Jr. Military-induced family separation: a stress reduction intervention. Soc Work. 1993;38:273–80.

    PubMed  Google Scholar 

  107. McClure P, editor. Pathways to the future: a review of military family research. Scranton: Military Family Institute, Marywood University; 1999. DTIC A364886.

    Google Scholar 

  108. Kanas N. Psychological support for cosmonauts. Aviat Space Environ Med. 1991;62:353–5.

    CAS  PubMed  Google Scholar 

  109. Weybrew BB, Noddin EM. Psychiatric aspects of adaptation to long submarine missions. Aviat Space Environ Med. 1979;50:575–80.

    CAS  PubMed  Google Scholar 

  110. Benke T, Koserenko O, Gerstenbrand F, Watson N. COGIMIR—a study of cognitive functions in microgravity. In: Proceedings of Satellite Symposium 4, Columbus 8 from the International Space Year Conference. Munich, 30 Mar–4 Apr 1992.

    Google Scholar 

  111. Manzey D, Lorenz B, Poljakov V. Mental performance in extreme environments: results from a performance monitoring study during a 438-day spaceflight. Ergonomics. 1998;41:537–59.

    CAS  PubMed  Google Scholar 

  112. Eddy DR, Schiflett SG, Schlegel RE, Shebab RL. Cognitive performance aboard the life and microgravity spacelab. Acta Astronaut. 1998;43:193–210.

    CAS  PubMed  Google Scholar 

  113. Boyd JE, Kanas N, Gushin VI, Saylor S. Cultural differences in patterns of mood states on board the International Space Station. Acta Astronaut. 2007;61(7):668–71.

    Google Scholar 

  114. Kanas N, Salniskiy V, Gushin V, Weiss DS, Grund EM, Flynn C, Kozeerenko O, Sled A, Marmar CR. Asthenia-does it exist in space? Psychosom Med. 2001;63:874–80.

    CAS  PubMed  Google Scholar 

  115. Grigoriev AI, Egorov AD. Medical monitoring on long-term space missions. In: Bonting SL, editor. Advances in space biology and medicine, vol. 6. Greenwich: JAI Press Inc; 1997.

    Google Scholar 

  116. Sandoval L, Keeton K, Shea C, Otto C, Patterson H, Leveton L. Perspectives on asthenia in astronauts and cosmonauts: review of the international research literature. 2011. NASA/TM-2012-217354.

    Google Scholar 

  117. Kane RL, Short P, Sipes WE, Flynn CF. Development and validation of the Spaceflight Cognitive Assessment Tool for Windows (WinSCAT). Aviat Space Environ Med. 2005;76:183–9.

    Google Scholar 

  118. Miner AC. The effects of confinement, social isolation, and diurnal disruption on crew adjustment and performance in long duration space missions. Washington, DC: NASA; 1989. T-1082K.

    Google Scholar 

  119. Leone G, Lipshits M, Matsakis Y, et al. Influence of weightlessness upon mental rotation and detection of bilateral symmetry. In: Proceedings of the 5th European Symposium on Life Sciences Research in Space, Arcachon, 26 Sept–1 Oct 1993.

    Google Scholar 

  120. Ioseliani KK, Khisambeyev SR. Predicting mental performance of cosmonauts on long-term flights. Presented at the Scientific Council on Space Biology and Physiology, Moscow, 19–21 June 1990.

    Google Scholar 

  121. Manzey D. Monitoring of mental performance during spaceflight. Aviat Space Environ Med. 2000;71(9):A69–75.

    CAS  PubMed  Google Scholar 

  122. Manzey D, Lorenz B, Schiewe A, et al. Dual task performance and space: results from a single case study during a short-term space mission. Hum Factors. 1995;37:667–81.

    CAS  PubMed  Google Scholar 

  123. Kane R, Seaton K, Sipes WE. Cognitive assessment during long duration space flight. Presentation at 82nd annual scientific and human performance meeting of the Aerospace Medical Association, Anchorage, 8–12 May 2011. Available at http://ntrs.nasa.gov/archive/nasa/casi.ntrs.nasa.gov/20110008700_2011008960.pdf. Accessed 15 Mar 2016.

  124. Strangman GE. Human cognition and long duration spaceflight. In: Additional evidence: risk of adverse behavioral conditions and psychiatric disorders, July 2010. Available at https://humanresearchroadmap.nasa.gov/evidence/other/BMed%20Additional%20Evidence.pdf. Accessed 10 Feb 2016.

  125. Strangman GE, Sipes W, Beven G. Human cognitive performance in spaceflight and analogue environments. Aviat Space Environ Med. 2014;85(10):1033–48.

    PubMed  Google Scholar 

  126. Shepard JM, Kossyln SM. The MiniCog Rapid Assessment Battery: developing a “blood pressure cuff for the mind”. Aviat Space Environ Med. 2005;76(6):B192–7.

    Google Scholar 

  127. International Space Exploration Coordination Group. Annual report 2012. Noordwijk, p. 18.

    Google Scholar 

  128. Basner M, Savitt A, Moore TM, Port AM, McGuire S, Nasrini J, Mollicone DJ, Mott CM, McCann T, Dinges DF, Gut RC. Development and validation of the cognition test battery for spaceflight. Aerosp Med Hum Perf. 2015;86(11):942–52.

    Google Scholar 

  129. Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Arch Gen Psychiatry. 2005;62(6):617–27.

    PubMed  PubMed Central  Google Scholar 

  130. Kessler RC, Berglund PA, Demler O, Jin R, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Arch Gen Psychiatry. 2005;62(6):593–602.

    PubMed  Google Scholar 

  131. Kessler RC, Bromet EJ. The epidemiology of depression across cultures. Annu Rev Public Health. 2013;34:119–38.

    PubMed  PubMed Central  Google Scholar 

  132. Flynn CF. An operational approach to long duration mission behavioral health and performance factors. Aviat Space Environ Med. 2005;76(6):B42–51.

    PubMed  Google Scholar 

  133. Harrison AA. Spacefaring: the human dimension. Berkley: University of California Press; 2001.

    Google Scholar 

  134. Harrison AA, Fiedler ER. Behavioral health. In: Vakoch DA, editor. Psychology of space exploration: contemporary research in historical perspective. Washington, DC: Government Printing Office; 2011. p. 17–46.

    Google Scholar 

  135. Gushin V. Psychological countermeasures during space missions: Russian experience. In: Proceedings of “Life in space for life on earth”. 8th European Symposium on Life Sciences Research in Space, 23rd Annual International Gravitational Physiology Meeting, 2–7 June 2002. ESA Publications Division, Noordwijk. ESA SP-501:365–66.

    Google Scholar 

  136. Rose RM, Fogg LF, Helmreich RL, McFadden TJ. Psychological predictors of astronaut effectiveness. Aviat Space Environ Med. 1994;65:910–5.

    CAS  PubMed  Google Scholar 

  137. McFadden TJ, Helmreich RL, Rose RM, et al. Predicting astronaut effectiveness: a multivariate approach. Aviat Space Environ Med. 1994;65:904–9.

    CAS  PubMed  Google Scholar 

  138. Holland AW. NASA investigations of isolated and confined environments. In: Bonting SL, editor. Advances in space biology and medicine, European isolation and confinement study, vol. 3. Greenwich: JAI Press Ltd; 1993.

    Google Scholar 

  139. Clement G. Fundamentals of space medicine. 2nd ed. New York: Springer; 2011.

    Google Scholar 

  140. Garshnek V. Soviet space flight: the human element. Aviat Space Environ Med. 1989;60:695–705.

    CAS  PubMed  Google Scholar 

  141. Fassbender C, Goeters KM. Psychological evaluation of European astronaut applications: results of the 1991 selection campaign. Aviat Space Environ Med. 1994;65:925–9.

    CAS  PubMed  Google Scholar 

  142. Manzey D, Schiewe A, Fassbender C. Psychological countermeasures for extended manned spaceflights. Acta Astronaut. 1995;35:339–61.

    CAS  PubMed  Google Scholar 

  143. Steimle H. Astronaut selection and training. In: Norberg D, editor. Human spaceflight and exploration. Berlin/Heidelberg: Springer; 2013.

    Google Scholar 

  144. Picano JJ, Williams TJ, Roland RR. Assessment and selection of high-risk operational personnel. In: Kenney CH, Zillmer EA, editors. Military psychology: clinical and operational applications. New York: The Guilford Press; 2006. p. 353–70.

    Google Scholar 

  145. Galarza L, Holland A. Critical astronaut proficiencies required for long duration space flight. SAE Technical Paper 1999-01-2096; 1999. https://doi.org/10.4271/1999-01-2096.

  146. Holland AW, Vessey WB, Barrett JD. Conducting an exploration focused astronaut job analysis. 13 May 2014. NASA Technical Reports Server. Available at http://ntrs.nasa.gov/archive/nasa/casi.ntrs.nasa.gov/20140005013.pdf. Accessed 22 Feb 2016.

  147. Barrett J, Holland AW, Vessey WB. Identifying the “Right Stuff”: exploration-focused astronaut job analysis. Conference Paper presented to Annual Conference of the Society for Industrial and Organizational Psychology; 30th, Philadelphia. 23–25 Apr 2015. NASA Technical Reports Server. JSC-CN-31959.

    Google Scholar 

  148. Bluth BJ, Helppie M. Soviet space stations as analogs. 2nd ed. Washington, DC: NASA Headquarters; NASA Grant NAGW-659; 1986.

    Google Scholar 

  149. Manzey D, Hormann HJ, Fassbender C, Schiewe A. Implementing human factors training for space crews. Earth Space Review. 1995;4:24–7.

    CAS  PubMed  Google Scholar 

  150. Bessone L, Coffey E, Filippova N et al. International Space Station Human Behavior & Performance Competency Model, vol. II, 2008. NASA TM-2008-214775.

    Google Scholar 

  151. Grunsfeld J. NOLS in Space. The Leader. 2002. http://www.nols.edu/alumni/leader/02summer/nolsinspace.shtml. Accessed 24 Feb 2016.

  152. Bishop SL. Analogues to space: learning how to boldly go. In: Vakoch DA, editor. On-orbit and beyond; Springer, Berlin, Heidelberg. 2013. p. 25–50.

    Google Scholar 

  153. Besonne, L. Beblo-Vranesevic K, Cusso QA, De Waele J, Leuko S, Marcia P, Rettberg P, Sanna L, Sauro F, and Taiti S. ESA CAVES: Training astronauts for space exploration. In: Filippi M, Bosak P, editors. Proceedings of the 16th International Congress on Speleology, vol 1, Brno/Praha: Czech Speleological Society, 21–28 July 2013, p. 321–27.

    Google Scholar 

  154. Gazenko OG. Man in space: an overview. Aviat Space Environ Med. 1983;54:S3–5.

    CAS  PubMed  Google Scholar 

  155. Manzey D. Human missions to Mars: new psychological challenges and research issues. Acta Astronaut. 2004;55:781–90.

    PubMed  Google Scholar 

  156. Landon LB, Vessey WB, Barrett JD. Evidence report: risk of performance and behavioral health decrements due to inadequate cooperation, coordination, and psychosocial adaptation within a team, 24 Aug 2015. Houston: NASA. Available at http://ntrs.nasa.gov/archive/nasa/casi.ntrs.nasa.gov/20160003865.pdf

  157. Sipes W, VanderArk S. Operational behavioral health and performance resources for International Space Station crews and families. Aviat Space Environ Med. 2005;76(6.II):B36–41.

    PubMed  Google Scholar 

  158. NASA, Johnson Space Center International Space Station Medical Operations Requirements Documents (ISS MORD) Revision B, SSP 50260. May 2003:paras. 6–7, 6–8.

    Google Scholar 

  159. Lebedev V. Diary of a cosmonaut: 211 days in space. New York: Bantam Books; 1988.

    Google Scholar 

  160. Fiedler E, Harrison A. Psychosocial adaptation to a mars mission. In: Levine J, Schmild R, editors. The human mission to Mars: colonizing the red planet. Cambridge, MA: Cosmology Science; 2010.

    Google Scholar 

  161. Santy P, Bungo M. Pharmacologic considerations for shuttle astronauts. J Clin Pharmacol. 1991;31:931–3.

    CAS  PubMed  Google Scholar 

  162. Nechaev AP, Myasnikov VI, Stepanova SI. Complex analysis of cosmonauts errors. Presented at the 46th International Astronautical Congress, Oslo, Oct 1995. IAF/IAA-95-G.3.06.

    Google Scholar 

  163. Putcha L, Berens KL, Marshburn TH, Otrega HJ, Billica RD. Pharmaceutical use by U.S. astronauts on space shuttle missions. Aviat Space Environ Med. 1999;70(7):705–8.

    CAS  PubMed  Google Scholar 

  164. Wotring VE. Medication use by U.S. crewmembers on the International Space Station. FASEB. 2015;29:4417–23.

    CAS  Google Scholar 

  165. Flynn-Evans EE, Barger LK, Kubey AA, Sullivan JP, Czeisler CA. Circadian misalignment affects sleep and medication use before and during spaceflight. npj Microgravity. 2016;2:15019. Available at www.nautre.com/articles/npjmgrav201519. Accessed 12 Feb 2016.

    PubMed  PubMed Central  Google Scholar 

  166. Kales A, Scharf MB, Kales JD, et al. Rebound insomnia: a potential hazard following withdrawal of certain benzodiazepines. JAMA. 1979;241:1692–5.

    CAS  PubMed  Google Scholar 

  167. Mendelson WB. Efficacy of melatonin as a hypnotic agent. J Biol Rhythm. 1997;12:651–6.

    CAS  Google Scholar 

  168. NASA Space flight human system standard volume 1: revision a: crew health. 2014. Available at https://standards.nasa.gov/standard/nasa/nasa-std-3001-vol-1. Accessed 5 Feb 2016.

  169. NASA Space flight human system standard volume 2: human factors, habitability, and environmental health. 2015. Available at https://standards.nasa.gov/standard/nasa/nasa-std-3001-vol-2. Accessed 4 Feb 2016.

  170. Shappell SA, Wiegmann DA. U.S. Naval aviation mishaps, 1977–92: differences between single- and dual-piloted aircraft. Aviat Space Environ Med. 1996;67:65–9.

    CAS  PubMed  Google Scholar 

  171. Knapp CJ, Johnson R. F-16 Class A mishaps in the U.S. Air Force, 1975 through 1993. Aviat Space Environ Med. 1996;67:777–83.

    CAS  PubMed  Google Scholar 

  172. Erwin SI. Navy aims to curtail aviation mishaps caused by crew error. National Defense, Oct 2000.

    Google Scholar 

  173. Bacon LM. Navy safety boss grapples with ’14 spike in aviation mishaps. Navy Times, 4 Jan 2015.

    Google Scholar 

  174. Suter AH. The effects of noise on performance. Aberdeen Proving Ground: US Army Engineering Laboratory; 1989. TM 3-89.

    Google Scholar 

  175. Gomes LMP, Pimenta AJFM, Castelo BNAA. The effects of occupational exposure to low-frequency noise on cognition. Aviat Space Environ Med. 1999;70:A115–8.

    CAS  PubMed  Google Scholar 

  176. Frost R. How would the International Space Station differ if it were being designed now? Forbes, 28 Oct 2014.

    Google Scholar 

  177. Razmijou S. Mental workload in heat: toward a framework for analyses of stress states. Aviat Space Environ Med. 1996;67:530–8.

    Google Scholar 

  178. Fitts PM. Skill maintenance under adverse conditions. In: Flaherty BE, editor. Psychological aspects of space flight. New York: Columbia University Press; 1961.

    Google Scholar 

  179. Cohen D, Wherry RJ, Glenn F. The analysis of workload predictions generated by multiple resource theory. Aviat Space Environ Med. 1996;67:139–45.

    CAS  PubMed  Google Scholar 

  180. Brenner M, Doherty T, Shipp T. Speech measures indicating workload in demand. Aviat Space Environ Med. 1994;65:21–6.

    CAS  PubMed  Google Scholar 

  181. Jorna PG. Heart rate and workload variations in actual and simulated flight. Ergonomics. 1993;36:1043–54.

    CAS  PubMed  Google Scholar 

  182. Roscoe AH. Heart rate as a psychophysiological measure for in-flight workload assessment. Ergonomics. 1993;36:1055–62.

    CAS  PubMed  Google Scholar 

  183. Hankins TC, Wilson GF. A comparison of heart rate, eye activity, EEG, and subjective measures of pilot mental workload during flight. Aviat Space Environ Med. 1998;69:360–7.

    CAS  PubMed  Google Scholar 

  184. Wilson GF, Fullenkamp P, Davis I. Evoked potential, cardiac, blink and respiration measures of pilot workload in air-to-ground missions. Aviat Space Environ Med. 1994;65:100–5.

    CAS  PubMed  Google Scholar 

  185. Leach C, Cintron NM. Endocrine system and fluid and electrolyte balance. In: Talbot JM, Genin AM, editors. Space medicine and biotechnology, vol. 3. Washington, DC: NASA Scientific and Technical Information Office; 1975.

    Google Scholar 

  186. Leach CS, Cintron NM, Krauhs JM. Metabolic changes observed in astronauts. J Clin Pharmacol. 1991;31:921–7.

    CAS  PubMed  Google Scholar 

  187. Charles JB, Lathers CM. Cardiovascular adaptation to spaceflight. J Clin Pharmacol. 1991;31:1010–23.

    CAS  PubMed  Google Scholar 

  188. Nicogossian AE, Sawin CF, Huntoon CL. Overall physiologic response to space flight. In: Nicogossian AE, Huntoon CL, Pool SL, editors. Space physiology and medicine. 3rd ed. Philadelphia: Lea & Febiger; 1994. p. 213–27.

    Google Scholar 

  189. Dinges DF, Rider RL, Dorrian J, McGlinchey EL, Rogers NL, Cizman A, Goldenstein SK, Volger C, Venkataraman S, Metaxas DN. Optical computer recognition of facial expressions associated with stress induced by performance demands. Aviat Space Environ Med. 2005; 76(6) Section II:B172–182.

    Google Scholar 

  190. Dinges DF, Venkataraman S, McGlinchey EL, Metaxas DN. Monitoring of facial stress during spaceflight: optical computer recognition combining discriminative and generative methods. Acta Astronaut. 2007;60:341–50.

    Google Scholar 

  191. Tafforin C. The Mars-500 crew in daily life activities: an ethological study. Acta Astronaut. 2013;91:69–76.

    Google Scholar 

  192. Handcock P, Caird JK. Predicting effects of interactive stresses on human performance during long duration space operations. Presented at the AIAA Space Programs and Technologies Conference, Huntsville, 25–28 Sept 1990.

    Google Scholar 

  193. Vaernes R, Bergan T, Warncke M, et al. Chapter 8: Workload and stress: effects on psychosomatic and psychobiological reaction patterns. In: Bonting SL, editor. Advances in space biology and medicine, European isolation and confinement study, vol. 3. Greenwich: JAI Press Ltd; 1993.

    Google Scholar 

  194. Vaernes RJ. Chapter 22: Lessons learned from ISEMSI and EXEMSI. In: Bonting SL, editor. Advances in space biology and medicine, vol. 5. Greenwich: JAI Press Inc; 1996.

    Google Scholar 

  195. Basner M, Dinges DF, Mollicone D, Ecker A, Jones CW, Hyder EC, Di Antonio A, Savelev I, Kan K, Goel N, Morukov BV, Sutton JP. Mars 520-d mission simulation reveals protracted crew hypokinesis and alterations of sleep duration and timing. Proc Natl Acad Sci. 2013;110(7):2635–40.

    CAS  PubMed  PubMed Central  Google Scholar 

  196. Takla NK, Koffman R, Bailey DA. Combat stress, combat fatigue, and psychiatric disability in aircrew. Aviat Space Environ Med. 1994;65:858–65.

    CAS  PubMed  Google Scholar 

  197. Gould D, Udry E. Psychological skills for enhancing performance: arousal regulation strategies. Med Sci Sports Exerc. 1994;26:478–85.

    CAS  PubMed  Google Scholar 

  198. Hysong SJ, Galarza L, Holland AW. A review of training methods and instructional techniques: Implications for behavioral skills training in U.S. Astronauts. 2007. NASA/TP-2007-213726.

    Google Scholar 

  199. Zorrilla EP, Redei E, DeRubeis RJ. Reduced cytokine levels and T-cell function in healthy males: relation to individual differences in subclinical anxiety. Brain Behav Immunol. 1994;8:293–312.

    CAS  Google Scholar 

  200. Schiepers OJG, Wichers MC, Maes M. Cytokines and major depression. Prog Neuro-Psychopharmacol Biol Psychiatry. 2005;29(2):201–17.

    CAS  Google Scholar 

  201. Noponen M, Sanfilip M, Samanich K, et al. Elevated PLA2 activity in schizophrenics and other psychiatric patients. Biol Psychiatry. 1993;34:641–9.

    CAS  PubMed  Google Scholar 

  202. Ribeiro SC, Tandon R, Grunhaus L, et al. The DST as a predictor of outcome in depression: a meta-analysis. Am J Psychiatr. 1993;150:1618–29.

    CAS  PubMed  Google Scholar 

  203. Nelson JC, Davis JM. DST studies in psychotic depression: a meta-analysis. Am J Psychiatry. 1997;154:1497–503.

    CAS  PubMed  Google Scholar 

  204. Sadock BJ, Sadock VA, Ruiz P. Medical assessment and laboratory testing in psychiatry. In: Kaplan HI, Sadock BJ, editors. Synopsis of psychiatry: behavioral sciences/clinical psychiatry. 11th ed. Baltimore: Williams & Wilkins; 2015. p. 266–74.

    Google Scholar 

  205. Gushin V. Psychological countermeasures during space missions: Russian experience. J Gravit Physiol. 2002;9:P311–2.

    PubMed  Google Scholar 

  206. Wolverton M. Sleeping by starlight: David Dinges studies how humans rest and work in space. Penn Med. 2012;Fall:12–5.

    Google Scholar 

  207. Engel GL. The clinical application of the biopsychosocial model. Am J Psychiatr. 1980;137:535–44.

    CAS  PubMed  Google Scholar 

  208. Holmes T. Life situations, emotions, and disease. Psychosomatics. 1978;19:747–54.

    CAS  PubMed  Google Scholar 

  209. Nardini JE, Herrmann RS, Rasmussen JE. Navy psychiatric assessment program in the Antarctic. Am J Psychiatr. 1962;119:97–105.

    CAS  PubMed  Google Scholar 

  210. Palinkas LA, Suedfeld P, Glogower F, et al. Some historical and scientific considerations of the psychological issues about living in the Antarctic environment. Travel Med Int. 1995;3:99–106.

    Google Scholar 

  211. Palinkas LA. Psychosocial issues in long-term space flight: overview. Gravit Space Biol Bull. 2001;14(2):25–33.

    CAS  PubMed  Google Scholar 

  212. Santy PA, Holland A, Faulk DM. Psychiatric diagnoses in a group of astronaut applicants. Aviat Space Environ Med. 1991;62:969–73.

    CAS  PubMed  Google Scholar 

  213. Berry CA. Medical care of space crews (medical care, equipment, and prophylaxis). In: Talbot JM, Genin AM, editors. Space medicine and biotechnology, vol. 3. Washington, DC: NASA Scientific and Technical Information Office; 1975.

    Google Scholar 

  214. Endo T, Ohbayashi S, Yumikura S, et al. Astronaut psychiatric selection procedures: a Japanese experience. Aviat Space Environ Med. 1994;65:916–9.

    CAS  PubMed  Google Scholar 

  215. Santy PA, Endicott J, Jones DR, et al. Results of a structured psychiatric interview to evaluate NASA astronaut candidates. Mil Med. 1993;158:5–9.

    CAS  PubMed  Google Scholar 

  216. Flinn DE, Hartman BO, Powell DH, et al. Psychiatric and psychological evaluation. In: Lamb LE, editor. Aeromedical evaluation for space pilots. Brooks Air Force Base: USAF School of Aerospace Medicine; 1963.

    Google Scholar 

  217. Maschke P, Oubaid V, Pecena Y. How do astronaut candidate profiles differ from airline pilot profiles? Aviat Psychol Appl Hum Factors. 2011;1(1):38–44.

    Google Scholar 

  218. Christen BR, Moore JL. A descriptive analysis of “not aeronautically adaptable” dispositions in the US navy. Aviat Space Environ Med. 1998;69:1071–5.

    CAS  PubMed  Google Scholar 

  219. Aleksandrovskiy YA, Novikov MA. Psychological prophylaxis and treatments for space crews. In: Leach Huntoon CS, Antipov AA, Grigoriev AI, editors. Humans in spaceflight. Vol. 3, Book 2. Reston: American Institute of Aeronautics and Astronautics; 1996. p. 433–43.

    Google Scholar 

  220. Palinkas LA, Gunderson EK, Johnson JC, et al. Behavior and performance on long duration spaceflight: evidence from analog environments. Aviat Space Environ Med. 2002;71:A29–36.

    Google Scholar 

  221. Horwath E, Johnson J, Klerman GL, et al. Depressive symptoms as relative and attributable risk factors for first-onset major depression. Arch Gen Psychiatry. 1992;49:817–23.

    CAS  PubMed  Google Scholar 

  222. Artal M, Sherman C. Exercise against depression. Physician Sports Med. 1998;26:55–60.

    CAS  Google Scholar 

  223. Byrne A, Byrne DG. The effect of exercise on depression, anxiety and other mood states: a review. J Psychosom Res. 1993;37:565–74.

    CAS  PubMed  Google Scholar 

  224. Santy PA. Psychiatric components of a health maintenance facility (HMF) on space station. Aviat Space Environ Med. 1987;58:1219–24.

    CAS  PubMed  Google Scholar 

  225. Palinkas LA, Johnson JC, Boster JS. Social support and depressed mood in isolated and confined environments. Acta Astronaut. 2004;54:639–47.

    PubMed  Google Scholar 

  226. Billica R. In-flight medical events for astronauts during the Space Shuttle program: STS-1 through STS-89 April 1981–January 1998. Inst Med Rev Space Med; 2000.

    Google Scholar 

  227. Shepanek M. Human behavior research in space: quandaries for research subjects and researchers. Aviat Space Environ Med. 2005;76(Supp1):B25–30.

    PubMed  Google Scholar 

  228. Bezchlibnyk-Butler K, Jeffries JJ, Procyshyn RM, Virani A, editors. Clinical handbook of psychotropic drugs. 20th ed. revised. Ashland: Hogrefe Publishing; 2014.

    Google Scholar 

  229. Rothchild E. Telepsychiatry: why do it? Psychiatr Ann. 1999;29:394–401.

    Google Scholar 

  230. Hilty DM, Servis ME, Nesbitt TS, et al. The use of telemedicine to provide consultation-liaison service to the primary care setting. Psychiatr Ann. 1999;29:421–7.

    Google Scholar 

  231. Hyler SE, Gamgure DP, Batchelder ST. Can telepsychiatry replace in-person psychiatric assessments? A review and meta-analysis of comparison studies. CNS Spectr. 2005;10(5):403–12.

    PubMed  Google Scholar 

  232. O’Reilly R, Bishop J, Maddox K, Hutchinson L, Fisman M, Takhar J. Is telepsychiatry equivalent to face-to-face psychiatry? Results from a randomized controlled equivalence trial. Psychiatr Serv. 2007;58(6):836–43.

    PubMed  Google Scholar 

  233. Christensen JM, Talbot JM. A review of the psychological aspects of space flight. Aviat Space Environ Med. 1986;57:203–12.

    CAS  PubMed  Google Scholar 

  234. Connors MM, Harrison AA, Akins FR. Living aloft: human requirements for extended spaceflight. Washington, DC: NASA Scientific and Technical Information Branch; 1985.

    Google Scholar 

  235. Lin TY. Neurasthenia revisited: its place in modern psychiatry. Psychiatr Ann. 1992;22:173–87.

    Google Scholar 

  236. Gouliaev AH, Senning A. Piracetam and other structurally related nootropics. Brain Res Rev. 1994;19:180–222.

    CAS  PubMed  Google Scholar 

  237. Neznamov GG, Morozov IS, Barchukov VG, et al. The therapeutic efficacy and the effect of gidazepam and fenazepam on the psychophysiological status and on the performance of operators with mental disorders at a neurotic level. Eksp Klin Farmakol. 1997;60:17–21.

    CAS  PubMed  Google Scholar 

  238. Winnicka K, Tomasiak M, Bielawska A. Piracetam—an old drug with novel properties? Acta Pol Pharm. 2005;62(5):405–9.

    CAS  PubMed  Google Scholar 

  239. Müller WE, Eckert GP, Eckert A. Piracetam: novelty in a unique mode of action. Pharmacopsychiatry. 1999;32(1):2–9. https://doi.org/10.1055/s-2007-979230.

    Article  PubMed  Google Scholar 

  240. Suedfeld P. Homo invictus: the indomitable species. Can Psychol. 1997;38(3):164.

    Google Scholar 

  241. Suedfeld P. Invulnerability, coping, salutogenesis, integration: four phases of space psychology. Aviat Space Environ Med. 2005;76(1):B61–6.

    PubMed  Google Scholar 

  242. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. (DSM-5). Washington, DC: American Psychiatric Association; 2013.

    Google Scholar 

  243. Judd LL, Akiskal HS. The prevalence and disability of bipolar spectrum disorders in the US population: re-analysis of the ECA database taking into account subthreshold cases. J Affect Disord. 2003;73(1):123–31.

    PubMed  Google Scholar 

  244. Sadock BJ, Sadock VA, Ruiz P. Mood disorders. In: Kaplan HI, Sadock BJ, editors. Synopsis of psychiatry: behavioral sciences/clinical psychiatry. 11th ed. Baltimore: Williams & Wilkins; 2015. p. 347–87.

    Google Scholar 

  245. Müller-Oerlinghausen B, Berghöfer A, Bauer M. Bipolar disorder. Lancet. 2002;359(9302):241–7.

    PubMed  Google Scholar 

  246. Horst WD, Preskorn SH. The role of benzodiazepines in the treatment of psychotic disorders. Psychiatr Ann. 1993;23:317–24.

    Google Scholar 

  247. Janicak PG, Levy NA. Rational copharmacy for acute mania. Psychiatr Ann. 1998;28:204–12.

    Google Scholar 

  248. Sadock BJ, Sadock VA, Ruiz P. Psychopharmacological treatment. In: Kaplan HI, Sadock BJ, editors. Synopsis of psychiatry: behavioral sciences/clinical psychiatry. 11th ed. Baltimore: Williams & Wilkins; 2015. p. 948–53.

    Google Scholar 

  249. Centers for Disease Control and Prevention. Mental illness surveillance among adults in the United States. Suppl 2. Atlanta, GA. 2011;60(3):11–32.

    Google Scholar 

  250. Weissman MM, Bland RC, Canino GJ, et al. Cross-national epidemiology of major depression and bipolar disorder. JAMA. 1996;76:293–9.

    Google Scholar 

  251. Keller MB, Lavori PW, Mueller TI, et al. Time to recovery, chronicity, and levels of psychopathology in major depression. A 5-year prospective follow-up of 431 subjects. Arch Gen Psychiatr. 1992;49:809–16.

    CAS  PubMed  Google Scholar 

  252. Pies RW. Medical “mimics” of depression. Psychiatr Ann. 1994;24:519–20.

    Google Scholar 

  253. Gueorguieva R, Mallinckrodt C, Krystal JH. Trajectories of depression severity in clinical trials of duloxetine: insights into antidepressant and placebo responses. Arch Gen Psychiatry. 2011;68(12):1227–37.

    CAS  PubMed  PubMed Central  Google Scholar 

  254. Busch KA, Clark DC, Fawcett J, et al. Clinical features of inpatient suicide. Psychiatr Ann. 1993;23:256–62.

    Google Scholar 

  255. Gibbons RD, Hur K, Bhaumik DK, Mann JJ. The relationship between antidepressant medication use and rate of suicide. Arch Gen Psychiatry. 2005;62(2):165–72.

    CAS  PubMed  Google Scholar 

  256. Robins E, Murphy GE, Wilkinson RH Jr, et al. Some clinical considerations in the prevention of suicide based on a study of 134 successful suicides. Am J Public Health. 1959;49:888–99.

    CAS  Google Scholar 

  257. Barraclough B, Bunch J, Nelson B, et al. A hundred cases of suicide: clinical aspects. Br J Psychiatry. 1974;125:355–73.

    CAS  PubMed  Google Scholar 

  258. Rich CL, Young D, Fowler RC. San Diego suicide study, I: young vs. old subjects. Arch Gen Psychiatr. 1986;43:577–82.

    CAS  PubMed  Google Scholar 

  259. Isometsä ET. Psychological autopsy studies–a review. Eur Psychiatry. 2001;16(7):379–85.

    PubMed  Google Scholar 

  260. Sadock BJ, Sadock VA, Ruiz P. Brief psychotic disorder, other psychotic disorders and catatonia. In: Kaplan HI, Sadock BJ, editors. Synopsis of psychiatry: behavioral sciences/clinical psychiatry. 11th ed. Baltimore: Williams & Wilkins; 2015. p. 339–46.

    Google Scholar 

  261. Sadock BJ, Sadock VA, Ruiz P. Delirium. In: Kaplan HI, Sadock BJ, editors. Synopsis of psychiatry: behavioral sciences/clinical psychiatry. 11th ed. Baltimore: Williams & Wilkins; 2015. p. 697–703.

    Google Scholar 

  262. Andreasen N. Symptoms, signs, and diagnosis of schizophrenia. Lancet. 1995;346(8973):477–81.

    CAS  PubMed  Google Scholar 

  263. Sadock BJ, Sadock VA, Ruiz P. Schizophrenia. In: Kaplan HI, Sadock BJ, editors. Synopsis of psychiatry: behavioral sciences/clinical psychiatry. 11th ed. Baltimore: Williams & Wilkins; 2015. p. 313–322.

    Google Scholar 

  264. World Health Organization. The ICD-10 classification of diseases and health problems: diagnostic criteria for research. Geneva: World Health Organization; 1993.

    Google Scholar 

  265. Sadock BJ, Sadock VA, Ruiz P. Neurocognitive and other disorders due to a general medical condition. In: Kaplan HI, Sadock BJ, editors. Synopsis of psychiatry: behavioral sciences/clinical psychiatry. 11th ed. Baltimore: Williams & Wilkins; 2015. p. 723–37.

    Google Scholar 

  266. Casey DE. Neuroleptic drug-induced extrapyramidal syndromes and retardive dyskinesia. Schizophrenia Res. 1991;4:109–20.

    CAS  Google Scholar 

  267. Fuller MA, Sojatovic M. Psychotropic drug information handbook. Cleveland: Lexi Comp Inc; 2002.

    Google Scholar 

  268. Bezchlib-Butler K, Jeffries JJ, Virani A, editors. Clinical handbook of psychotropic drugs. 17th ed. revised. Ashland: Hogrefe Publishers; 2007.

    Google Scholar 

  269. Yates WR. Phenomenology and epidemiology of panic disorder. Ann Clin Psychiatry. 2009;21(2):95–102.

    PubMed  Google Scholar 

  270. Sadock BJ, Sadock VA, Ruiz P. Panic disorder. In: Kaplan HI, Sadock BJ, editors. Synopsis of psychiatry: behavioral sciences/clinical psychiatry. 11th ed. Baltimore: Williams & Wilkins; 2015. p. 392–397.

    Google Scholar 

  271. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593–602.

    PubMed  Google Scholar 

  272. Sadock BJ, Sadock VA, Ruiz P. Obsessive-compulsive and related disorders. In: Kaplan HI, Sadock BJ, editors. Synopsis of psychiatry: behavioral sciences/clinical psychiatry. 11th ed. Baltimore: Williams & Wilkins; 2015. p. 418–26.

    Google Scholar 

  273. American Psychiatric Association. Practice guideline for the treatment of patients with panic disorder. Am J Psychiatr. 1998;155(5):1–34.

    Google Scholar 

  274. Leach J. Psychological first aid: a practical aide-memoire. Aviat Space Environ Med. 1995;66:668–74.

    CAS  PubMed  Google Scholar 

  275. Sadock BJ, Sadock VA, Ruiz P. Adjustment disorders. In: Kaplan HI, Sadock BJ, editors. Synopsis of psychiatry: behavioral sciences/clinical psychiatry. 11th ed. Baltimore: Williams & Wilkins; 2015. p. 446–50.

    Google Scholar 

  276. Sadock BJ, Sadock VA, Ruiz P. Examination and diagnosis of the psychiatric patient. In: Kaplan HI, Sadock BJ, editors. Synopsis of psychiatry: behavioral sciences/clinical psychiatry. 11th ed. Baltimore: Williams & Wilkins; 2015. p. 192–210.

    Google Scholar 

  277. Jenkins SC, Hansen MR. A pocket reference for psychiatrists. 2nd ed. Washington, DC: American Psychiatric Press, Inc; 1995.

    Google Scholar 

  278. Ormel J, VonKorff M, Ustun G, et al. Common mental disorders and disability across cultures: results from the WHO collaborative study on psychological problems in general health care. JAMA. 1994;272:1741–8.

    CAS  PubMed  Google Scholar 

  279. Simon GE, Revicki D, Heiligenstein J, Grothaus L, VonKorff M, Katon WJ, Hylan TR. Recovery from depression, work productivity, and health care costs among primary care patients. Gen Hosp Psychiatry. 2000;22(3):153–62.

    CAS  PubMed  Google Scholar 

  280. Gingerich WJ, Eisengart S. Solution-focused brief therapy: a review of the outcome research. Fam Process. 2000;39(4):477–98.

    CAS  PubMed  Google Scholar 

  281. McKeon JF, Persson JL, McGhee J, Quattlebaum M. A review of the US army experience using selective serotonin reuptake inhibitors in aircrew. Fort Rucker: Army Aeromedical Research Laboratory; 2009.

    Google Scholar 

  282. Gingerich WJ, Peterson LT. Effectiveness of solution-focused brief therapy: a systematic qualitative review of controlled outcome studies. Res Soc Work Pract. 2013;23(3):266–83.

    Google Scholar 

  283. Germer CK, Siegel RD, Fulton PR, editors. Mindfulness and psychotherapy. New York: Guilford Press; 2013.

    Google Scholar 

  284. Angus L, Watson JC, Elliott R, Schneider K, Timulak L. Humanistic psychotherapy research 1990–2015: from methodological innovation to evidence-supported treatment outcomes and beyond. Psychother Res. 2015;25(3):330–47.

    PubMed  Google Scholar 

  285. Palinkas LA. The psychology of isolated and confined environments. Understanding human behavior in Antarctica. Am Psychol. 2003;58:353–63.

    PubMed  Google Scholar 

  286. Ihle EC, Ritsher JB, Kanas N. Positive psychological outcomes of spaceflight: an empirical study. Aviat Space Environ Med. 2006;77(2):93–101.

    PubMed  Google Scholar 

  287. Suedfeld P, Legkaia LK, Brcic J. Changes in the hierarchy of value references associated with flying in space. J Pers. 2010;78(5):1411–36.

    PubMed  Google Scholar 

  288. Suedfeld P, Brcic J, Johnson PJ, Gushin V. Personal growth following long duration spaceflight. Acta Astronaut. 2012;79:118–23.

    Google Scholar 

  289. Procyshyn RM, Bezchlibnyk-Butler KZ, Jeffries JJ, eds. Clinical handbook of psychotropic drugs. 22nd ed. revised. Boston: Hogrefe Publishing Corp.; 2017; pages 75–77, 176–179, 218–221, 237.

    Google Scholar 

Suggested Readings

  • Evans-Flynn E, Gregory K, Arsintescu L, Whitmire A, Leveton LB. Evidence report: risk of performance decrements and adverse health outcomes resulting from sleep loss, circadian desynchronization, and work overload. National Aeronautics and Space Administration Lyndon B. Johnson Space Center Houston, 25 Aug 2015.

    Google Scholar 

  • Kanas N. Human in space: the psychological hurdles. Chichester: Springer Praxis Books; 2015.

    Google Scholar 

  • Landon LB, Vessey WB, Barrett JD. Evidence report: risk of performance and behavioral health decrements due to inadequate cooperation, coordination, and psychosocial adaptation within a team. Human Research Program, Behavioral Health and Performance, 24 Aug 2015. NASA, Lyndon B. Houston: Johnson Space Center.

    Google Scholar 

  • Sadock BJ, Sadock VA, Ruiz P. Kaplan and Sadock’s synopsis of psychiatry: behavioral sciences/clinical psychiatry. 11th ed. Baltimore: Williams & Wilkins; 2015.

    Google Scholar 

  • Sandoval L, Keeton K, Shea C, Otto C, Patterson H, Leveton L. Perspectives on asthenia in astronauts and cosmonauts: review of the international research literature. 2011. NASA/TM-2012-217354.

    Google Scholar 

  • Slack KJ, Schneiderman JS, Leveton LB, Whitmire AM, Picano JJ. Evidence book: risk of adverse cognitive or behavioral condition and psychiatric disorders. Human Research Program, Behavioral and Performance. National Aeronautics and Space Administration Lyndon B. Johnson Space Center Houston, 11 Apr 2016.

    Google Scholar 

  • Vakoch DA, editor. On-orbit and beyond: psychological perspectives on human spaceflight. New York: Springer; 2013.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Aerospace Psychology Consultants, Tucson, AZ, USA

    Walter E. Sipes

  2. The Office of Aerospace Medicine, Federal Aviation Administration, Washington, DC, USA

    Christopher F. Flynn

  3. Space Medicine Operations Division, Johnson Space Center, Houston, TX, USA

    Gary E. Beven

Authors
  1. Walter E. Sipes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher F. Flynn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gary E. Beven
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. NASA Johnson Space Center, Houston, TX, USA

    Michael R. Barratt

  2. Gynecologic Oncology and Reproductive Medicine, University of Texas, MD Anderson Cancer Center, Houston, TX, USA

    Ellen S. Baker

  3. Deceased, Formerly Chief, Medical Sciences Division, NASA Johnson Space Center, Houston, TX, USA

    Sam L. Pool

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Science+Business Media, LLC, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Sipes, W.E., Flynn, C.F., Beven, G.E. (2019). Behavioral Health and Performance Support. In: Barratt, M., Baker, E., Pool, S. (eds) Principles of Clinical Medicine for Space Flight. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-9889-0_25

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-9889-0_25

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-9887-6

  • Online ISBN: 978-1-4939-9889-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation