Behavioral Health and Performance for Future Space Exploration
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Suzanne Bell↗
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Behavioral Health and Performance Laboratory Research Update
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Suzanne Bell↗
The impact of digital scents on behavioral health in a restorative virtual reality environment
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Renee (Woodruff) Abbott↗
International Space Station Medical Operations
NASA is currently the leader, in conjunction with our Russian counterpart co-leads, of the Multilateral Medical Policy Board (MMPB), the Multilateral Medical Operations Panel (MMOP), which coordinates medical system support for International Space Station (ISS) crews, and the Multilateral Space Medicine Board (MSMB), which medically certifies all crewmembers for space flight on-board the ISS. These three organizations have representatives from NASA, RSA-IMBP (Russian Space Agency- Institute for Biomedical Problems), GCTC (Gagarin Cosmonaut Training Center), ESA (European Space Agency), JAXA (Japanese Space Agency), and CSA (Canadian Space Agency). The policy and strategic coordination of ISS medical operations occurs at this level, and includes interactions with MMOP working groups in Radiation Health, Countermeasures, Extra Vehicular Activity (EVA), Informatics, Environmental Health, Behavioral Health and Performance, Nutrition, Clinical Medicine, Standards, Post-flight Activities and Rehabilitation, and Training. Each ISS Expedition has a lead Crew Surgeon from NASA and a Russian Crew Surgeon from GCTC assigned to the mission. Day-to-day issues are worked real-time by the flight surgeons and biomedical engineers (also called the Integrated Medical Group) on consoles at the MCC (Mission Control Center) in Houston and the TsUP (Center for Flight Control) in Moscow/Korolev. In the future, this may also include mission control centers in Europe and Japan, when their modules are added onto the ISS. Private medical conferences (PMCs) are conducted regularly and upon crew request with the ISS crew via private audio and video communication links from the biomedical MPSR (multipurpose support room) at MCC Houston. When issues arise in the day-to-day medical support of ISS crews, they are discussed and resolved at the SMOT (space medical operations team) meetings, which occur weekly among the International Partners. Any medical or life science issue that is not resolved at the SMOT can be taken to the Mission Management Team meeting, which occurs biweekly from MCC-Houston. This meeting includes the other International Partners and all flight support and console position representatives via teleconference. ISS Crew Surgeons have handled many medical conditions on orbit; including skin rashes, dental abscesses, lacerations, and STT segment EKG changes. Fortunately to date, there have not been any forced medical evacuations from the ISS. This speaks well for the implementation of the primary, secondary and even tertiary prevention strategies invoked by the Integrated Medical Group, as there were several medical evacuations during the previous Russian space stations.
Jones, Jeffrey A.↗
Earth Independent Medical Operations (EIMO) Training Technical Interchange Meeting, 26th October 2023: Background and Summary of Discussion
On 26th October 2023, ExMC convened a panel of Subject Matter Experts (SMEs) from NASA, broadly representing Headquarters, the Human Research Program, Medical Operations, the Human Health and Performance Directorate at JSC, the Health and Medical Technical Authority, the Flight Operations Directorate, and representation from other Centers including: Ames Research Center (ARC), and Glenn Research Center (GRC). Representatives from the Canadian Space Agency also participated in this TIM. In addition, SMEs from industry included representation from the following entities: Axiom Space, Space Exploration Technologies Corporation, Level Ex, Shiny Box Interactive. Additional SMEs from academia included: University of Houston, Touro University, Weill Cornell Medical College and the Translational Research Institute for Space Health at Baylor College of Medicine. This group of stakeholders discussed the training issues related to facilitating EIMO. Sub-topics for this discussion included the following: - Pre-launch medical curriculum development - Ground-based training on medical hardware - Dental health - Behavioral health - Telemedicine - Just-in-time training - Simulation-based training (extended reality)
CMO Training↗
Strategy for Risk Quantification of Spaceflight Crew Health and Performance Using Dynamic Probabilistic Risk Assessment
At NASA, the Crew Health and Performance (CHP) system represents the span of countermeasures, capabilities, interventions, and tested processes and procedures that in combination work to mitigate the human component of spaceflight mission risk. Across the varying NASA mental models of the CHP system, the different functionalities needed to meet human flight systems standards can be broken down into specific categories (i.e. medical capability, environmental health, behavioral health). These categories can be further broken down into specific subgroups generally associated with the CHP functionalities meant to mitigate or buy down individual human system risks. Taking a similar development approach we seek to leverage dynamic probabilistic risk assessment as a means to quantify and relatively assess the human risk state within the crew health and performance domain. By utilizing existing tools as integrators, we propose a rapid development strategy for incorporating research and operational data that represent the influence of the CHP system functionalities, in order to provide order of magnitudes estimates of the influence on most human system risks outcomes. The model system utilizes a modest cumulative risk approach and that limits the scope to primary paths of influence between the CHP functionalities and human system risks, thus enabling quick prototypes of the integrative effects of CHP functional combinations to solicit valuable feedback from stakeholders and customers on the data, relationship, and structure of the integration.
Drayton Munster↗
Explaining Health Risk Behaviors in the U.S. with Social Deprivation at Local and Regional Levels
Health risk behaviors are precursors to many chronic health outcomes, and hence, they pose a challenge to public health. Social deprivation undoubtedly creates circumstances that limit access to healthy habits. Moreover, broad regional effects (weather patterns, political ideology, social norms), and local characteristics (cultural notions and barriers, urban places) also influence lifestyle choices and must be accounted for to truly understand the impact of social deprivation on risky behaviors. This research fills the knowledge gap in epidemiological modeling of health risk behaviors by leveraging machine learning to find associations between social deprivation and health risk behaviors, when adjusted by regional and local effects. Four health risk behaviors, namely, binge drinking, smoking, lack of sleep, and lack of physical activity from the CDC PLACES project are considered in a single framework to understand and compare the interplay between local/regional characteristics and seven measures of social deprivation. Our results indicate that local and/or regional factors rise to the top for three out of four risk behaviors (binge drinking, smoking and lack of sleep) out-competing social deprivation measures. Un-entangling the geographical effects reveals that poverty, educational attainment and non-employment are the three deprivation measures most significantly associated with all four health risk factors. The research thus indicates that public health policies to promote healthy lifestyle behaviors must seek to remedy social deprivation, but using socially and culturally sensitive interventions.
Gokhale, Swapna↗
Risk of Adverse Cognitive or Behavioral Conditions and Psychiatric Disorders: Evidence Report
In April 2010, President Obama declared a space pioneering goal for the United States in general and NASA in particular. "Fifty years after the creation of NASA, our goal is no longer just a destination to reach. Our goal is the capacity for people to work and learn and operate and live safely beyond the Earth for extended periods of time, ultimately in ways that are more sustainable and even indefinite." Thus NASA's Strategic Objective 1.1 emerged as "expand human presence into the solar system and to the surface of Mars to advance exploration, science, innovation, benefits to humanity, and international collaboration" (NASA 2015b). Any space flight, be it of long or short duration, occurs in an extreme environment that has unique stressors. Even with excellent selection methods, the potential for behavioral problems among space flight crews remain a threat to mission success. Assessment of factors that are related to behavioral health can help minimize the chances of distress and, thus, reduce the likelihood of adverse cognitive or behavioral conditions and psychiatric disorders arising within a crew. Similarly, countermeasures that focus on prevention and treatment can mitigate the cognitive or behavioral conditions that, should they arise, would impact mission success. Given the general consensus that longer duration, isolation, and confined missions have a greater risk for behavioral health ensuring crew behavioral health over the long term is essential. Risk, which within the context of this report is assessed with respect to behavioral health and performance, is addressed to deter development of cognitive and behavioral degradations or psychiatric conditions in space flight and analog populations, and to monitor, detect, and treat early risk factors, predictors and other contributing factors. Based on space flight and analog evidence, the average incidence rate of an adverse behavioral health event occurring during a space mission is relatively low for the current conditions. While mood and anxiety disturbances have occurred, no behavioral emergencies have been reported to date in space flight. Anecdotal and empirical evidence indicate that the likelihood of an adverse cognitive or behavioral condition or psychiatric disorder occurring greatly increases with the length of a mission. Further, while cognitive, behavioral, or psychiatric conditions might not immediately and directly threaten mission success, such conditions can, and do, adversely impact individual and crew health, welfare, and performance.
Slack, Kelley J.↗
Weaving Together Space Biology and the Human Research Program: Selecting Crops and Manipulating Plant Physiology to Produce High Quality Food for ISS Astronauts
Researchers from the Human Research Program (HRP) have teamed up with plant biologists at KSC to explore the potential for plant growth and food production on the international space station (ISS) and future exploration missions. KSC Space Biology (SB) brings a history of plant and plant-microbial interaction research for station and for future bioregenerative life support systems. JSC HRP brings expertise in Advanced Food Technology (AFT), Advanced Environmental Health (AEH), and Behavioral Health and Performance (BHP). The Veggie plant growth hardware on the ISS is the platform that first drove these interactions. As we prepared for the VEG-01 validation test of Veggie, we engaged with BHP to explore questions that could be asked of the crew that would contribute both to plant and to behavioral health research. AFT, AEH and BHP stakeholders were engaged immediately after the return of the Veggie flight samples of space-grown lettuce, and this team worked with the JSC human medical offices to gain approvals for crew consumption of the lettuce on ISS. As we progressed with Veggie testing we began performing crop selection studies for Veggie that were initiated through AFT. These studies consisted of testing and down selecting leafy greens, dwarf tomatoes, and dwarf pepper crops based on characteristics of plant growth and nutritional levels evaluated at KSC, and organoleptic quality evaluated at JSCs Sensory Analysis lab. This work has led to a successful collaborative proposal to the International Life Sciences Research Announcement for a jointly funded HRP-SB investigation of the impacts of light quality and fertilizer on salad crop productivity, nutrition, and flavor in Veggie on the ISS. With this work, and potentially with other pending joint projects, we will continue the synergistic research that will advance the space biology knowledge base, help close gaps in the human research roadmap, and enable humans to venture out to Mars and beyond.
International Space Station↗
Behavioral Health/Employee Assistance. Interim Program Report FY 2020
The Sandia National Laboratories' (SNL) Corporate Behavioral Health Program is a workplace- based program that: 1) provides Employee Assistance Program (EAP) services including early identification and resolution of personal concerns which may impact job performance, 2) assists managers and the organization in addressing productivity issues, and 3) supports the SNL commitment to provide a safe and healthful work environment. The program is offered to approximately 13,500 employees in New Mexico. The Behavioral Health Program is a corporate program combining services in NM and CA. It is integrated with other occupational health and clinical services including disability, disease management and preventive health programs. In addition, Sandia's Behavioral Health Program provides critical management consultation and psychological assessment services for external organizations including Human Resources, the Department of Energy and Security through the Clinical Evaluation (CE) process, Human Reliability Program (HRP), Protective Force Program, Workplace Violence/Threat Assessment Team (TAT), and Insider Threat Working Group programs. The program supports Sandia National Laboratories' mission to safeguard national security, the environment, and the public; it is a proactive approach to early identification, intervention and assessment. Importantly, it reduces barriers to accessing mental health services and assists with reducing health care costs attributed to illness or injuries related to unhealthy lifestyles and behaviors. The team is comprised of a professional staff including a licensed Clinical Psychologist, a licensed professional clinical counselor (LPCC) and a licensed Marriage and Family counselor (MFT) who is also a Certified Employee Assistance Professional and who holds a doctorate in counseling psychology.
99 GENERAL AND MISCELLANEOUS↗
HUMAN FACTORS AND BEHAVIORAL PERFORMANCE EXPLORATION MEASURES: ASSESSING ASTRONAUT RISK
INTRODUCTION: The Human Factors and Behavioral Performance Exploration Measures (HFBP-EM) suite is a set of standardized measures to assess behavioral health and performance risk related to future exploration class missions, and to support reduction of the Human Research Program’s (HRP) Behavioral Medicine (BMed), Team, Sleep, and Human Systems Integration Architecture (HSIA) risks. This presentation will provide an overview of the HFBP-EM program, describe its implementation across spaceflight analogs and the international space station (ISS), and discuss its applicability to audience members. TOPIC: HFBP-EM is a research program designed to develop a standard set of measures that can be used in space and space-analog research to characterize BMed, Team, Sleep, and HSIA risks. It is an ongoing research project that is used examine the validity and reliability of HFBP measures, as well as their shorter forms. It also serves as a test bed for HFBP measures being considered for the spaceflight standard measures. The suite of measures is used to test the efficacy of countermeasures. To date, HFBP-EM has been collected in Human Exploration Research Analogs campaigns 4 and 5, and the SIRIUS 19 mission in the Russian Ground Based Experiment Complex. A subset of the HFBP-EM suite was collected during spaceflight as part of HRP’s Standard Measures in Spaceflight Project. Data was collected from a total of 55 multinational astronaut and astronaut-like crewmembers (mean age: 39.5, SD = 7.6; 31% female; 91% with advanced degrees). Three broad categories of HFBP-EM measures and their relevance to HRP risks will be discussed: 1) surveys that assess team functioning (Teams risk) as well as mood and affect (Bmed risk), 2) performance-based tasks of cognitive functioning and operationally relevant performance (Bmed risk), and 3) physiological biomarkers of sleep (sleep risk) and heart rate (Bmed risk). We will provide an overview of the background of the HFBP-EM program, what the suite currently includes, and next steps in its future development. We will also discuss the application to aerospace practitioners and researchers. APPLICATION: Astronaut teams selected for future space exploration missions will face several challenges that pose significant yet still unknown risks to the behavioral health and performance of astronauts. The HFBP-EM suite provides a comprehensive assessment of behavioral health and performance in space analog and spaceflight settings. This suite can be applied to both operational and research settings to advance risk reduction research for long duration space exploration missions.
S T Bell↗
A Review of the Safety of Selective Serotonin Reuptake Inhibitors for Long Duration Spaceflight
Introduction: As humankind ventures further into the depths of space, planning is already underway for long-duration exploration missions that will test the bounds of human performance. Deep space travel will include added risk related to stressors from the isolated, confined, and extreme (ICE) environment that lies outside the boundaries of low-earth orbit. Currently, selective serotonin reuptake inhibitors (SSRIs) are considered the gold standard treatment for many mental health diagnoses including anxiety and depression; however, SSRIs are also associated with several undesired side effects. The utility of non-pharmacologic therapies for the management of behavioral health conditions has not yet been fully explored. Methods: A comprehensive literature search was performed using PubMed and relevant articles pertaining to the psychological impacts of ICE environments, use of SSRIs in spaceflight, side effects associated with SSRIs, and non-pharmacologic treatments for anxiety and depression were reviewed. Over 100 studies were reviewed in total. Results: Reduced bone mineral density, impaired hemostatic function, significant individual variability resulting from gene polymorphisms, and drug-drug interactions are well described adverse effects of SSRIs that may complicate their operational use in the deep space environment. Many non-pharmacologic therapies have been utilized with success for the management of behavioral health conditions in the terrestrial environment that may show promise for long duration missions. Discussion: Although SSRIs have long been considered standard of care treatment for many behavioral health conditions, we cannot trivialize the risk that prolonged pharmacologic therapy may pose. The need to mitigate these risks by exploring alternative non-pharmacologic therapies has never been more relevant.
Charles H Dukes↗
Self-Guided Multimedia Stress Management and Resilience Training for Flight Controllers
Stress and anxiety-related problems are among the most common and costly behavioral health problems in society, and for those working in operational environments (i.e. astronauts, flight controllers, military) this can seriously impact crew performance, safety, and wellbeing. Technology-based interventions are effective for treating behavioral health problems, and can significantly improve the delivery of evidence-based health care. This study is evaluating the effectiveness, usefulness, and usability of a self-guided multimedia stress management and resilience training program in a randomized controlled trial (RCT) with a sample of flight controllers at Johnson Space Center. The intervention, SMART-OP (Stress Management and Resilience Training for Optimal Performance), is a six-session, cognitive behavioral-based computer program that uses self-guided, interactive activities to teach skills that can help individuals build resilience and manage stress. In a prior RCT with a sample of stressed but otherwise healthy individuals, SMART-OP reduced perceived stress and increased perceived control over stress in comparison to an Attention Control (AC) group. SMART-OP was rated as "highly useful" and "excellent" in usability and acceptability. Based on α-amylase data, individuals in SMART-OP recovered quicker and more completely from a social stress test as compared to the AC group [1]. In the current study, flight controllers are randomized either to receive SMART-OP training, or to a 6-week waitlist control period (WLC) before beginning SMART-OP. Eligible participants include JSC flight controllers and instructors without any medical or psychiatric disorder, but who are stressed based on self-report. Flight controllers provide a valid analog sample to astronauts in that they work in an operational setting, use similar terminology to astronauts, are mission-focused, and work under the same broader work culture. The study began in December 2014, and to date 79 flight controllers and instructors have expressed interest in the study, 49 of those were cleared for participation, we have screened 44 for eligibility, and 23 have met inclusion criteria. Recruitment is ongoing and the study will continue until December 2016. Outcome measures include perceived stress, perceived control over stress, resilience, mood, personality, emotion regulation, sleep, health behaviors, and psychophysiological data such as 24-hour heart rate, alpha amylase, and urinary and salivary cortisol. We are also collecting user feedback such as usability, working alliance, usefulness, and treatment credibility.
Rose, R. D.↗
Communication Bandwidth Considerations for Exploration Medical Care During Space Missions
Destinations beyond low Earth orbit, especially Mars, have several important constraints, including limited resupply, limited to no possibility of medical evacuation, and delayed communication with ground support teams. Therefore, medical care is driven towards greater autonomy and necessitates a medical system that supports this paradigm, including the potential for high medical data transfer rates in order to share medical information and coordinate care with the ground in an intermittent fashion as communication allows. The medical data transfer needs for a Martian exploration mission were estimated by defining two medical scenarios that would require high data rate communications between the spacecraft and Earth. One medical scenario involves a case of hydronephrosis (outflow obstruction of the kidney) that evolves into pyelonephritis (kidney infection), then urosepsis (systemic infection originating from the kidney), due to obstruction by a kidney stone. A second medical scenario involved the death of a crewmember’s child back on Earth that requires behavioral health care. For each of these scenarios, a data communications timeline was created following the medical care described by the scenario. From these timelines, total medical data transfers and burst transmission rates were estimated. Total data transferred from the vehicle-to-ground were estimated to be 94 gigabytes (GB) and 835 GB for the hydronephrosis and behavioral health scenarios, respectively. Data burst rates were estimated to be 7.7 megabytes per second (MB/s) and 15 MB/s for the hydronephrosis and behavioral health scenarios, respectively. Even though any crewed Mars mission should be capable of functioning autonomously, as long as the possibility of communication between Earth and Mars exists, Earth-based subject matter experts will be relied upon to augment mission medical capability. Therefore, setting an upper boundary limit for medical communication rates can help factor medical system needs into total vehicle communication requirements.
Krihak, Michael↗
Predicting Compliance in an Epidemiological Model: Constructs from Psychological Theory and Research
Vaccination and the alternative behavior, vaccine refusal, are a classic example of manifesting behaviors driven by social norms and norm violations. Establishing how norms emerge, and under what circumstances people choose to violate them are key issues to understand in modeling epidemics. Interactions between individuals can lead to large-scale patterning of behavior (emergent phenomena). As norm violations are revealed through human behavior, drawing on psychological theory and principles to predict those violations is a viable approach for more human-constrained epidemiological models. As an example of the implications at scale, vaccine refusal is correlated with the spread of mis/disinformation about vaccine side-effects. Considering the complexities of network dynamics, the downstream effects means that if even a small group within a population are persuaded against vaccination, there is a reservoir from which disease and disease outbreaks can propagate. This work will attempt to identify those psychological indicators, to define circumstances that predict health behaviors, and identify potentially modifiable antecedents of health behavior, and factors that influence changes toward health protective behaviors.
59 BASIC BIOLOGICAL SCIENCES↗
Psychosocial Characteristics of Optimum Performance in Isolated and Confined Environments (ICE)
The Behavioral Health and Performance (BHP) Element addresses human health risks in the NASA Human Research Program (HRP), including the Risk of Adverse Behavioral Conditions and the Risk of Psychiatric Disorders. BHP supports and conducts research to help characteristics and mitigate the Behavioral Medicine risk for exploration missions, and in some instances, current Flight Medical Operations. The Behavioral Health and Performance (BHP) Element identified research gaps within the Behavioral Medicine Risk, including Gap BMed6: What psychosocial characteristics predict success in an isolated, confined environment (ICE)? To address this gap, we conducted an extensive and exhaustive literature review to identify the following: 1) psychosocial characteristics that predict success in ICE environments; 2) characteristics that are most malleable; and 3) specific countermeasures that could enhance malleable characteristics.
Palinkas, Lawrence A.↗
Human Behavior and Performance Support for ISS Operations and Astronaut Selections: NASA Operational Psychology for Six-Crew Operations
The Behavioral Health and Performance group at NASA Johnson Space Center provides psychological support services and behavioral health monitoring for ISS astronauts and their families. The ISS began as an austere outpost with minimal comforts of home and minimal communication capabilities with family, friends, and colleagues outside of the Mission Control Center. Since 1998, the work of international partners involved in the Space Flight Human Behavior and Performance Working Group has prepared high-level requirements for behavioral monitoring and support. The "buffet" of services from which crewmembers can choose has increased substantially. Through the process of development, implementation, reviewing effectiveness and modifying as needed, the NASA and Wyle team have proven successful in managing the psychological health and well being of the crews and families with which they work. Increasing the crew size from three to six brought additional challenges. For the first time, all partners had to collaborate at the planning and implementation level, and the U.S. served as mentor to extrapolate their experiences to the others. Parity in available resources, upmass, and stowage had to be worked out. Steady progress was made in improving off-hours living and making provisions for new technologies within a system that has difficulty moving quickly on certifications. In some respect, the BHP support team fell victim to its previous successes. With increasing numbers of crewmembers in training, requests to engage our services spiraled upward. With finite people and funds, a cap had to placed on many services to ensure that parity could be maintained. The evolution of NASA BHP services as the ISS progressed from three- to six-crew composition will be reviewed, and future challenges that may be encountered as the ISS matures in its assembly-complete state will be discussed.
VanderArk, Steve↗
Pick-and-Eat Salad-Crop Productivity, Nutritional Value, and Acceptability to Supplement the ISS Food System
The capability to grow nutritious, palatable food for crew consumption during spaceflight has the potential to provide health-promoting, bioavailable nutrients, enhance the dietary experience, and reduce launch mass as we move toward longer-duration missions. However, studies of edible produce during spaceflight have been limited, leaving a significant knowledge gap in the methods required to grow safe, acceptable, nutritious crops for consumption in space. Researchers from Kennedy Space Center, Johnson Space Center, Purdue University and ORBITEC have teamed up to explore the potential for plant growth and food production on the International Space Station (ISS) and future exploration missions. KSC, Purdue, and ORBITEC bring a history of plant and plant-microbial interaction research for ISS and for future bioregenerative life support systems. JSC brings expertise in Advanced Food Technology (AFT), Behavioral Health and Performance (BHP), and statistics. The Veggie vegetable-production system on the ISS offers an opportunity to develop a pick-and-eat fresh vegetable component to the ISS food system as a first step to bioregenerative supplemental food production. We propose growing salad plants in the Veggie unit during spaceflight, focusing on the impact of light quality and fertilizer formulation on crop morphology, edible biomass yield, microbial food safety, organoleptic acceptability, nutritional value, and behavioral health benefits of the fresh produce. The first phase of the project will involve flight tests using leafy greens, with a small Chinese cabbage variety, Tokyo bekana, previously down selected through a series of research tests as a suitable candidate. The second phase will focus on dwarf tomato. Down selection of candidate varieties have been performed, and the dwarf cultivar Red Robin has been selected as the test crop. Four light treatments and three fertilizer treatments will be tested for each crop on the ground, to down select to two light treatments and one fertilizer treatment to test on ISS. Our work will help define light colors, levels, and horticultural best practices to achieve high yields of safe, nutritious leafy greens and tomatoes to supplement a space diet of prepackaged food. Our final deliverable will be the development of growth protocols for these crops in a spaceflight vegetable production system. With this work, and potentially with other pending joint projects, we will continue the synergistic research to help close gaps in the human research roadmap, and enable humans to venture to Mars and beyond. This research was co-funded by the Human Research Program and Space Biology (MTL1075) in the ILSRA 2015 NRA call.
Behavioral Health↗