10.1016@j.actaastro.2022.09.054 Acta Astron The Psychology and Mental Health of The Spaceflight Environment

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The psychology and mental health of the spaceflight environment: A scoping review
Logan M. Smith
PII: S0094-5765(22)00531-8
DOI: https://doi.org/10.1016/j.actaastro.2022.09.054
Reference: AA 9468
To appear in: Acta Astronautica
Received Date: 16 April 2022

Revised Date: 26 May 2022
Accepted Date: 26 September 2022
Please cite this article as: L.M. Smith, The psychology and mental health of the spaceflight environment:
A scoping review, Acta Astronautica (2022), doi: https://doi.org/10.1016/j.actaastro.2022.09.054.
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Running head: SPACE PSYCHOLOGY SCOPING REVIEW 1
The Psychology and Mental Health of the Spaceflight Environment: A Scoping Review
1 | Introduction
Since before the first spaceflight occurred, mission planners have attempted to anticipate
how a human’s psyche would handle the spaceflight environment [1]. These early views of the
psychological implications of spaceflight varied widely; while some believed that any pilot that
could withstand the stresses of war could withstand the stresses of spaceflight [2], others
recognized that there were likely to be stressors unique to the spaceflight environment, which
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carried unknown implications for the astronaut [3]. As humans began to enter and return from a
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spaceflight environment, the importance of the psychological implications of spaceflight began
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to evolve. Initially, mission planners focused on the psychological resilience and invulnerability
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of astronaut candidates, thinking that these traits would be sufficient for successful missions [4].
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However, as the number of people living and working in space increased, and data were gathered
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on the various negative psychological outcomes that could present in a spaceflight environment,
the focus shifted towards finding appropriate psychological trainings, treatments, and support for
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a person in space.
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In recent decades, various government bodies have devoted an increasing amount of
resources to investigations regarding the psychology of spaceflight, including the American
National Aeronautics and Space Administration (NASA), the Soviet space program, the Russian
Space Agency, and the European Space Agency, among others. Separately and together, these
government bodies have devoted time and resources towards determining the various
psychological risk factors, stressors, and effects associated with a spaceflight environment, as
well as the potential trainings and treatments to cope with these phenomena. For example,
SPACE PSYCHOLOGY SCOPING REVIEW 2
NASA’s Behavioral Health and Performance Operations Group is tasked with supporting the
mental health of astronauts and their families before, during, and after a spaceflight mission [5].
Great strides have been taken to summarize the current knowledge regarding human
psychology in a spaceflight environment in a way that is easily accessible by researchers.
Noteworthy examples include Friedman and Bui’s detailed examination of the psychiatric
formulary and psychological outcomes of current and future long duration space missions [6],
Daniel Collins’ review of the psychological considerations for astronaut selection [7], and the
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plethora of studies published by Dr. Nick Kanas throughout his career. The collective efforts of
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these researchers, as well as dozens of other researchers from around the world, have contributed
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to our understanding of the psychological challenges presented by a spaceflight environment, the
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anticipated challenges of future long duration deep space missions, and the opportunities for
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future research in these areas.

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However, while the collective efforts of researchers in this field have been substantial,
there currently does not exist a methodical, systematic review of the entirety of available
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literature regarding space psychology. The lack of an organized overview of all peer-reviewed
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space psychology literature limits the potential impact of this field; without a clear consensus of
what is known, and what is yet unknown, it can be difficult to address relevant research
questions and build off of previous findings. As such, a detailed, scoping review of the current
state of space psychology literature is warranted.
The objective of this review is to pool together all available space psychology
manuscripts. In doing so, this review will be able to summarize the findings in an accessible
way, present data in a manner that is useful, and identify the questions that are still unanswered
in this field. As will be explained in this manuscript, this review will take the form of a scoping
review that will identify the need for future research in the field of space psychology. For the
purposes of this review, space psychology will be approached as the scientific knowledge
regarding the human mind, human behavior, social behavior, and other related psychological
phenomena in space.
2 | Methods
This scoping review used the methodology outlined by Arksey and O’Malley [8], as well
as the methodology recommended by the Joanna Briggs Institute [9], two widely replicated
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scoping review formats. Additionally, the Tricco et al. [10] PRISMA extension for scoping
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reviews (PRISMA-ScR) informed the procedures of this review. The scoping review approach
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was determined to be the best method of summarizing the current state of space psychology
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literature, as no methodical review had yet been conducted. Using this approach allows for a
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systematic and expansive review of all available peer-reviewed manuscripts regarding space
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psychology, and other related topics, published in the English language. As the focus of this
review was on peer-reviewed manuscripts, grey literature was excluded.

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As outlined by Arksey and O’Malley [8], this scoping review consisted of five stages: (1)
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identifying the research question; (2) identifying the relevant studies; (3) study selection; (4)
charting the data; and (5) collating, summarizing, and reporting the results.
2.1 Stage 1: Identifying the research question
It is standard practice to use intentionally broad research questions when conducting a
scoping review to increase the breadth of studies that are captured by the subsequent search
terms. Thus, the research question guiding this study was: What is known from all published,
peer-reviewed literature regarding the psychology of spaceflight, its associated mental health
implications, and all other related phenomena?

2.2 Stage 2: Identifying relevant literature
The search strategy used in this scoping review was intentionally broad, yielding a high
amount of false positive hits – literature that included several of the key words, but was
irrelevant to the research question. This was determined to be the best strategy to ensure the
depth and breadth of the field of space psychology was represented in this scoping review to the
fullest extent possible. Search terms were developed after reading a number of well-known space
psychology articles and identifying key words and associated synonyms and related phenomena
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to the subject of the article. Identified terms were searched across the PsycINFO, PubMed,
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Embase, and Scopus databases (see Table 1 for the PsycINFO search strategy, which was
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replicated across all databases). Original database searches were performed in May 2021 and
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included all available results from the onset of the database until the search date.
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Table 1 | Search term strategy

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PsycINFO search strategy (original search performed: May 2021.

(Space Search Terms)
1. space*
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2. spaceflight*
3. orbit*
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4. astro*
5. cosmo
6. taiko*
7. rocket*
8. gravit*
AND
(Psychology Search Terms)
9. psych*
10. mental
11. depr*
12. anxi*
13. suicid*
14. stress
15. happ*
16. fear*
Note: Each space search term was combined with each psychology search term; for example:
space* AND psych*. Searches were restricted to the target words found within the titles only.
Results were restricted to English language publications only.
2.3 Stage 3: Literature selection
The application of a broad inclusion criteria allowed for a wide review of literature
related to various aspects of space psychology. To be included, each manuscript had to be peer-
reviewed, published in the English language, and available in these databases. No search
limitations were applied to the date of publication, other than the manuscript had to be published
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prior to the database searches. Occasionally, only the title and abstract of a target paper was
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available; in these instances, either a formal request for the manuscript was made through the
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Oklahoma State University Interlibrary Loan system, or the author of the manuscript was
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contacted directly via email. These methods were able to yield all missing manuscripts, which
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would then be screened per the standard process.

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The entirety of the search results for each search string were downloaded from each
database into a Microsoft Excel file, including the title, authors, date of publication, and abstract
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for each result. All titles were then screened and coded as appearing relevant or irrelevant at this
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stage. For example, a title may be deemed as irrelevant if it included the keyword of “stress,” but
it was obvious that this was in reference to the physical stress exerted on a physical material in
orbit. The abstracts of potentially relevant titles were reviewed to determine if the manuscript
should be selected for full-text review based on the following criteria: (1) related to space
psychology, (2) not a duplicate, (3) not a purely space simulation study that lacks data from
spaceflight environment or personnel that had previously flown in space. The implications of
excluding space simulation studies will be discussed later in this manuscript. Peer-reviewed
manuscripts of any type (e.g., review, original data collection, experiments, opinion papers, etc.)
were included. All manuscripts that were included in this scoping review are reported in Table 2.
2.4 Stage 4: Charting the data
The author(s), year of publication, manuscript type, sample characteristics, and key
findings were charted as described by the Joanna Briggs Institute [9].
2.5 Stage 5: Collating, summarizing, and reporting the results
The thematical analysis techniques and guidelines offered by Braun and Clarke [11] were
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used to identify the relevant information from the selected manuscripts. Manual coding of the
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manuscript type, sample characteristics, and other relevant information was completed, and the
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contents of the manuscript were read and summarized. The results of this coding and
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summarization led to the creation of a manuscript summary table, which is reported in the
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Supplementary Materials section of this manuscript.

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3 | Results
The number of manuscripts included at each step of the screening and evaluation process
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is included in Figure 1. The broad search terms used in this review for all things related to space
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psychology yielded n = 13,450 initial manuscripts. The combination of manuscripts identified
through all databases resulted in n = 12,722 manuscripts after duplicates were removed. Next,
the titles of all remaining manuscripts were reviewed for relevancy; this resulted in n = 235
manuscripts remaining after the exclusion of manuscripts that did not meet the selection criteria.
The abstracts of the remaining manuscripts were reviewed, resulting in the removal of n = 158
manuscripts that did not meet the study criteria. The full text of n = 77 manuscripts was then
reviewed in their entirety, resulting in the removal of n = 9 manuscripts. The final list of
reviewed manuscripts included in this scoping review is n = 68. A summary of the 68

manuscripts reviewed is provided in the Supplementary Materials section, which includes: (1)
author(s); (2) titles; (3) year of publication; (4) manuscript type; (5) sample size and
characteristics, if any; and (6) key findings / manuscript summaries.
Figure 1 | Method Search Strategy
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3.1 | Characteristics of reviewed articles
3.1.1 Years of publication

The final selection of manuscripts ranged in date of publication from 1960 to 2021. This
included three manuscripts from 1960-1970, one manuscript from 1971-1980, thirteen
manuscripts from 1981-1990, seventeen manuscripts from 1991-2000, twenty manuscripts from
2001-2010, thirteen manuscripts from 2011-2020, and one manuscript from 2021.
3.1.2 Sample characteristics
The majority of manuscripts included in this scoping review did not report original data
collected from a sample of study participants. However, of those that did, the samples that were
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in space at the time of data collection (n = 153) included: American astronauts (n = 98), Russian
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cosmonauts (n = 53), a Romanian cosmonaut (n = 1), and an astronaut from an undisclosed
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country (n = 1). Additionally, some manuscripts reported data from samples of astronauts who
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had previously flown to space, but were not in space at the time of data collection (n = 181),
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including: American astronauts (n = 107), Russian cosmonauts (n = 24), a European astronaut (n

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= 1), a Japanese astronaut (n = 1), and astronauts from undisclosed countries (n = 48). There
were also manuscripts that reported data from individuals who were not in space, had never been
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to space, and were not astronauts (n = 187), including: volunteers from Italy (n = 45), volunteers
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from America (n = 14), American ground control personnel (n = 108), and Russian ground
control personnel (n = 20).
3.1.3 Data from astronauts in space
While some countries have different names for their own personnel who travel to space
(e.g., Russian “cosmonauts,” Chinese “taikonauts,” etc.), for the purposes of this manuscript the
term “astronaut” will be used to broadly refer to all individuals who have traveled to space,
except where it is necessary to specify particular groups. Of the 68 manuscripts included in this
review, ten manuscripts discussed data gathered from astronauts in space. The focus of these
manuscripts included general mental health, emotions, crew performance, cognitive factors,
sleep, medication usage, and interpersonal factors.
3.1.4 Data from astronauts no longer in space
Astronauts no longer in space are defined as any person who had previously flown a
mission to space for any length of time. Of the 68 manuscripts included in this review, ten
manuscripts discussed data gathered from astronauts no longer in space. The focus of these
manuscripts included general mental health, cognitive factors, positive aspects of spaceflight,
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crew performance, stress, sleep, medication usage, and interpersonal factors.
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3.1.5 Data from non-astronauts
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Of the 68 manuscripts included in this review, two reported data from individuals not
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involved in spaceflight at all (e.g., laboratory volunteers), and one reported data gathered from
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ground control personnel for space missions. The focus of these manuscripts included general
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mental health, the effects of magnetic fields, cognitive factors, proposed mental health
treatments, and interpersonal factors.

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3.1.6 Methods of data collection

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The methods used to collect data from study samples varied widely depending on the
type of data being collected, the location of the study sample, and the aims of the study. Of the
68 manuscripts included in this study, three collected data via survey/questionnaire, six collected
data through structured assessments (e.g., Spaceflight Cognitive Assessment Tool), and two
collected data via physiological responses (e.g., skin conductance, blood pressure, tooth pain
threshold, etc.). Several manuscripts did not explicitly state the measures used for data
collection, and thus are not summarized in this section. It is important to note that some
manuscripts reported data gathered via multiple pathways (e.g., physiological responses and
surveys/questionnaires).
Table 2 – Manuscripts captured in scoping review
Barger, et al., (2014). Prevalence of sleep deficiency and use of hypnotic drugs in astronauts before, during, and after
spaceflight: an observational study.
Benke, et al., (1993). Space and cognition: the measurement of behavioral functions during a 6-day space mission.
Bishop, et al., (1999). Humans Living and Working in Space–The Interrelated Aspects of Physiology, Psychology,
Human Factors and Life Support.
Bluth, (1980). Social and psychological problems of extended space missions.
Cartreine, et al., (2009). Self-guided Depression Treatment on Long-duration Space Flights: A Continuation Study.
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Ceauşu, et al., (1982). The psychic activity under conditions of space flight.
Chang, et al., (2020). Promoting tech transfer between space and global mental health.
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Christensen, et al., (1986). A review of the psychological aspects of space flight.
Collins, (2003). Psychological issues relevant to astronaut selection for long-duration space flight: a review of the
literature.
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Connors, et al., (1986). Psychology and the resurgent space program.
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Crane, (1962). Psychiatric evaluation of space flight.
Del Seppia, et al., (2006). Simulation of the geomagnetic field experienced by the International Space Station in its
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revolution around the Earth: effects on psychophysiological responses to affective picture viewing.
Flaherty, et al., (1960). Psychiatry and space flight.
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Friedman, et al., (2017). A psychiatric formulary for long-duration spaceflight.

Gabriel, et al., (2012). Future perspectives on space psychology: recommendations on psychosocial and
neurobehavioural aspects of human spaceflight.
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Geuna, et al., (1995). Stressors, stress and stress consequences during long-duration manned space missions: a
descriptive model.
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Goemaere, et al., (2016). Gaining deeper insight into the psychological challenges of human spaceflight: the role of
motivational dynamics.
Gushin, (2002). Psychological countermeasures during space missions: Russian experience.
Helmreich, (1983). Applying psychology in outer space: Unfilled promises revisited.
Hideg, et al., (1982). Psychophysiological performance examination onboard the orbital complex Salyut-Soyuz.
Ihle, et al., (2006). Positive psychological outcomes of spaceflight: an empirical study.
Johannes, et al., (2003). Changes in the autonomic reactivity pattern to psychological load under long-term
microgravity--twelve men during 6-month spaceflights.
Kanas, (1985). Psychosocial factors affecting simulated and actual space missions.
Kanas, (1987). Psychological and interpersonal issues in space.
Kanas, (1988). Psychosocial training for physicians on board the space station.
Kanas, (1990). Psychological, psychiatric, and interpersonal aspects of long-duration space missions.
Kanas, (1990). Psychosocial support for long-duration space crews.
Kanas, (1991). Psychosocial support for cosmonauts.
Kanas, (1998). Psychiatric issues affecting long duration space missions.
Kanas, (1998). Psychosocial issues affecting crews during long-duration international space missions.
Kanas, (2002). Psychological and psychiatric issues in space.
Kanas, (2015). Psychology in deep space.

Kanas, (2016). Psychiatric issues in space.
Kanas, (2020). Spirituality, humanism, and the overview effect during manned space missions.
Kanas, et al., (2006). Do Psychosocial Decrements Occur During the 2nd Half of Space Missions?
Kanas, et al., (2007). Crewmember and mission control personnel interactions during International Space Station
missions.
Kanas, et al., (2007). Psychosocial issues in space: results from Shuttle/Mir.
Kanas, et al., (2009). Psychology and culture during long-duration space missions.
Kass, et al., (1995). Psychological considerations of man in space: Problems & solutions.
Landon, et al., (2018). Teamwork and collaboration in long-duration space missions: Going to extremes.
Manzey, (2000). Monitoring of mental performance during spaceflight.
Manzey, (2000). Psychological aspects of human spaceflight: Effects on human cognitive, psychomotor, and
attentional performance.
Manzey, (2004). Human missions to Mars: new psychological challenges and research issues.
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Manzey, et al., (1998). Mental performance during short-term and long-term spaceflight.
Manzey, et al., (1993). Behavioral aspects of human adaptation to space analyses of cognitive and psychomotor
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performance in space during an 8-day space mission.
Manzey, et al., (1995). Psychological countermeasures for extended manned spaceflights.
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Marsh, et al., (2008). Conceptual approach for stress estimates among astronauts and cosmonauts.
Miasnikov, et al., (1981). Prevention of psychoemotional disorders on a prolonged space flight by psychological
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support means.
Monzani, et al., (2019). Coping in the final frontier: An intervention to reduce spaceflight-induced stress.
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Morphew, (2001). Psychological and human factors in long duration spaceflight.

Myasnikov, et al., (1996). Psychological states and group interactions of crew members in flight.
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Nechaev, et al., (2004). Some aspects of psychophysiological support of crewmember's performance reliability in
space flight.
Oluwafemi, et al., (2021). A review of astronaut mental health in manned missions: Potential interventions for
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cognitive and mental health challenges.

Palinkas, (2007). Psychosocial issues in long-term space flight: overview.
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Ritsher, et al., (2007). Psychological adaptation and salutogenesis in space: lessons from a series of studies.
Ritsher, et al., (2005). Maintaining privacy during psychosocial research on the International Space Station.
Rose, et al., (1994). Psychological predictors of astronaut effectiveness.
Ruff, (1960). Psychiatric problems in space flight.
Salamon, et al., (2018). Application of virtual reality for crew mental health in extended-duration space missions.
Santy, (1983). The journey out and in: psychiatry and space exploration.
Santy, (1987). Psychiatric components of a health maintenance facility (HMF) on space station.
Santy, et al., (1993). Multicultural factors in the space environment: results of an international shuttle crew debrief.
Seguin, (2005). Engaging space: extraterrestrial architecture and the human psyche.
Suedfeld, (2005). Invulnerability, coping, salutogenesis, integration: four phases of space psychology.
Suedfeld, (2012). Personal growth following long-duration spaceflight.
Ursin, et al., (1992). An attempt to determine the ideal psychological profiles for crews of long term space missions.
Vander Ark, et al., (1996). Psychological preparation and support for space station crews.
Yaden, et al., (2016). The overview effect: awe and self-transcendent experience in space flight.
3.2 | Type of publication
This section will categorize the type of manuscript that was captured and summarized in
this review. While no clear guidelines exist for categorizing manuscripts in a scoping review,
these manuscripts can best be thought of as either a review, a report of original data, an
experiment, or a proposal. Many manuscripts contain elements of multiple categories (e.g., a
report of original data containing a review section), and manuscripts were categorized according
to the perceived intent of the author.
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3.2.1 Reviews
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Review manuscripts were any manuscripts that attempted to expand on previous research
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or literature without reporting data gathered directly by the researchers. At times, these Review
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manuscripts would report unpublished data that was from other researchers, or previous research
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that was not publicly available or difficult to find. These were the most numerous manuscript
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type captured in this scoping review, with fifty articles falling within this category. The focus of
these reviews varied widely, from summaries of interpersonal stressor for spaceflight crews, to
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recommendations for psychiatric formularies for deep space missions. Summaries of all review
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manuscripts are provided in the Supplementary Materials section, and information from these
review manuscripts will be included in the Discussion section that focuses on each theme from
this scoping review.
3.2.2 Reports of original data
Fifteen manuscripts captured in this scoping review reported original data gathered from
participants, both on the ground and in space. The reported original data varied from cognitive
factors, to physiological responses, to emotional and behavioral outcomes, and more. Full
summaries of all reports of original data are provided in the Supplementary Materials section,
and information from these reports will be used throughout the Discussion section of this scoping
review.
3.2.3 Experiments
Two manuscripts included in this scoping review featured experiments, which are any
study where the researchers directly manipulated one or more variables while measuring the
effects in participants. One experiment involved simulating the magnetic field present in space at
the altitude that the International Space Station orbits to measure its effects on laboratory
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volunteers [12], and the other experiment tested the outcomes of a computer-based therapeutic
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intervention in a randomized clinical trial [13]. Full summaries of these experiments are provided
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in the Supplementary Materials section, and the findings from these data will be addressed in the
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Discussion section of this manuscript.
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3.2.4 Proposals
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One manuscript included in this scoping review falls within the category of a proposal,
which is a manuscript specifically meant to propose a treatment, research endeavor, or other

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related idea. This sole proposal manuscript was dedicated to explaining, outlining, and
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advocating for the development and use of a Spaceflight-Induced Stress Management Plan, a
group-based psychological training program [14]. A summary of this proposal is proposal is
provided in the Supplementary Materials section, and the specifics of this proposal will be
described in the Discussion section of this review.
3.3 Bibliometric Analyses of Space Psychology Literature
3.3.1 Author Co-Author Analysis (AAA)
To better understand the state of available, peer-reviewed space psychology literature as a
whole, an Author Co-Author Analysis (AAA) was performed. An AAA is a bibliometric

technique borrowed from the Social Network Analysis literature of analyzing the conceptual
structure of a discipline [15]. An AAA works under the assumption that authors who frequently
publish together often perform research on similar concepts. Accordingly, frequently co-authored
authors are expected to “cluster” together in an AAA, allowing for a visual sense of the
relationship between researchers in this field. VOSviewer, a program that allows information
regarding bibliometric networks to be visualized [16], was used to perform this AAA. Figure 2
shows the results of the AAA.
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VOSviewer identified eight distinct clusters:
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1. Cluster 1: Authors in this cluster (e.g., Fassbender, Schiewe, Lorenz) frequently co-
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author with Manzey, who acts as the sole link between this cluster and authors outside of
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this cluster.
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2. Cluster 2: Authors in this cluster (e.g., Salnitski, Kirsch) frequently co-author with
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Johannes, who acts as the sole link between this cluster and authors outside of this
cluster.
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3. Cluster 3: Authors in this cluster (Marmar, Grund, Bostrom, Weiss) frequently co-author
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with each other and have individual and joint connections to authors outside of this
cluster.
4. Cluster 4: Authors in this cluster (e.g., Ferlazzo, Whiteley) frequently co-author with
Kanas, who acts as the sole link between this cluster and authors outside of this cluster.
5. Cluster 5: This is a small cluster, having few total numbers of publications in this
literature. However, authors in this cluster have frequent co-authorship with each other,
and shares connections with Kanas and several other authors.

6. Cluster 6: This is a small cluster, consisting of one researcher (Eckart) who has only co-
authored with Bishop, who has co-authored with numerous other authors.
7. Cluster 7: This is a small cluster that consists of several co-authorships with Suedfeld,
who has numerous co-authorships with other clusters.
8. Cluster 8: This is a large, distributed cluster consisting of authors (e.g., Fiedler, Musson,
Wang, Gushin, etc.) who have co-authored with numerous other authors and clusters of
authors throughout this literature.
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Figure 2 | Author Co-Author Analysis
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Identifying co-authorship clusters in the space psychology literature provides a deeper
understanding of the relationships between these authors. As can be seen, while some authors
share very few co-author connections with other researchers, some authors have a high level of
co-author connections (e.g., Kanas, Johannes, Manzey, Suedfeld, Bishop, etc.). Additionally, by
viewing this Author Co-Author Analysis as a density map, we can view the relative productivity
of the researchers in this field (Figure 3). In this density map, areas that are highlighted in a
brighter color have a higher density, indicating more publications from this author. As can be
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seen here, Kanas and Manzey stand out as particularly productive authors in this field, as
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measured by number of publications and co-authorships.
Figure 3 | Author Co-Author Density Map

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Additional bibliometric analyses of these results, including an Author-Co-Citation
Analysis and a Text Analysis of Relevant Terms, are provided in the Supplementary Materials
section of this manuscript.
4 | Discussion
This manuscript builds on decades of previous research by creating a broad, accessible,
and scoping overview of what is known and still unknown regarding space psychology. Previous
reviews of space psychology literature, though not conducted systematically and according to
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specific guidelines, have already proved to be helpful for this field. For example, the recent 2021
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review by Oluwafemi and colleagues has already been cited several times within a year of
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publication [17]. Longer standing reviews, such as those completed by Nick Kanas [18-20],
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Dietrich Manzey [21-23], and Patricia Santy [24-26] have already been cited dozens to hundreds
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of times by other researchers across the fields of psychology, sociology, medicine, biology, and
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other disciplines. It is clear that information regarding human psychology in a spaceflight

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environment is useful to the broader scientific community, and this usefulness will likely grow as
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the number of humans living and working in space continues to grow.
The summaries of previous work presented in the Supplementary Materials section of this
manuscript can serve as a helpful reference to other researchers in this field. Numerous themes
were identified when analyzing the texts of the manuscripts included in this scoping review.
These themes varied from stressors associated with spaceflight, to medication usage in space, to
space station habitability and design, among others. A detailed summary of what is known about
each of these themes and has been captured by this review follows.
4.1 General findings on space psychology as a field of study

The way that mission planners, policy makers, astronauts, and researchers have thought
about space psychology has changed over time. Initially, the psychological selection criteria for
astronaut candidates focused on “the right stuff” – an idea similar to psychological
invulnerability [4]. In summary, it was proposed that an ideal astronaut candidate would simply
be unaffected by the psychological stressors of a spaceflight environment. As a growing number
of astronauts began to exhibit symptoms of psychological stressors during and after spaceflight,
the focus began to shift towards fostering psychological resilience within astronaut candidates, or
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the ability to cope with and rebound from stress [4]. Most recently, the field of space psychology
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has significantly widened, and now includes cognitive processes, group dynamics,
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psychopathology, stress and wellbeing, sleep, exercise, nutrition, radiation effects, ergonomics,
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habitability, and more. This integrated, complex view of space psychology is likely to dominate
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the approach to this field in the foreseeable future, and offers a broader, scoping view of mental
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health that is more in line with how terrestrial psychology is currently being conducted.
4.2 Low earth orbit versus deep space

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Several published manuscripts have attempted to make predictions regarding the

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psychological differences between deep space missions and missions to low earth orbit. Kanas
and colleagues’ work posits that increased feelings of monotony, boredom, and isolation,
especially as it relates to reduced social contact, reduced workload, hypo-stimulation, and
intragroup tension, may be exacerbated above what is seen in low earth orbit missions [19].
Additionally, commonly used coping strategies for these stressors, such as private family
conferences in real-time, may not be feasible in deep space. Manzey’s work has highlighted
similar stressors, while also emphasizing the potential detriments to crew skill, mood, morale,
and motivation that long transfer times to deep space destinations may bring [21]. Additionally,
Manzey highlighted the difficulties in remotely monitoring crew mental health, while
spotlighting the challenges in gathering quality psychological data in sufficient quantities to
detect and prevent mental health deterioration.
Data published in 2008 by Marsh and Rygalov focused on the experiences of five
astronauts and cosmonauts no longer in space [27]. Specifically, these researchers found that, the
longer an individual spent in space, the higher their likelihood was of experiencing a stressor.
These researchers posit that the significantly higher stress levels predicted for long duration
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missions may be too high for a mission to Mars to remain safe unless ways are found to lower
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these stress levels [27]. As future mission targets shift towards deep space destinations, care must
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be taken to ensure the issues posited by these researchers do not impact the success of said
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missions. As will be highlighted further in this manuscript, the stressors, psychiatric disorders,
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and proposed treatments anticipated for deep space missions differ in key ways from current low
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earth orbit missions. Thus, more research is needed before the start of these missions to minimize
risk to crew and mission success.

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4.3.1 Known stressors in a spaceflight environment

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While the majority of manuscripts related to space psychology mention some form of
stressor associated with spaceflight, several manuscripts are worthy of being highlighted in this
section due to the emphasis they place on discussing stressors. A list of all stressors mentioned in
these manuscripts is provided in Table 3. Where appropriate, and in line with the intentions of
the authors being cited, similar stressors were combined into a singular stressor (e.g., “anxiety”
and “depression” being categorized as “psychological disorders”). Additionally, stressors were
separated into one of five categories to allow for easier organization and future reference.
Table 3. Known Spaceflight Stressors
Physiological / Psychological Psychosocial Human Factor Habitability Stressors

Physical Stressors Stressors Stressors Stressors
Radiation 31, 33 Isolation 27, 31, 32, 33, High team Variations in work / Limited hygiene 31
34, 36, 40
coordination rest levels 27, 31, 32, 34,
demands 31 35, 36, 37, 38, 39, 40
Altered sense of time Confinement 27, 31, 32, Interpersonal tension Limited external Chronic exposure to
27, 31, 32, 33, 34, 38 33, 36
with ground crew 31, exchange of vibration / noise 31, 32, 33,
33, 38, 39
information 31 34
Altered circadian Limited possibility Family life Limited equipment, Limited sleep facilities
rhythms 27, 31, 33, 38 for rescue 27, 31, 33 disruptions 31, 36, 38 facilities, and 31
supplies 31, 37
Decreased sunlight Potential for loss of Enforced Risk associated with Lighting / illumination
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exposure 31 life 31, 33 interpersonal contact equipment failure 31, 31, 33, 34
31, 33, 40 35, 37
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Microgravity 31, 32, 33 System / mission Crew factors / Adaptation to the Lack of privacy 31, 32, 33,
complexity 31, 32 demographic factors artificial environment 34, 38, 39
Environmental sensory Hostile external -p

31, 32, 33, 34, 35, 37, 38, 39
Multicultural issues
31
Technology-interface Isolation from support

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deprivation 31, 39 environment 31, 32, 33 31, 34, 36
challenges 31, 33, 34, 37 systems 31
Sleep disturbance 31 Altered sensory “Host-Guest” Use of equipment in Reliance on artificial
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stimuli 31, 33, 35 phenomenon 31 microgravity 31 life support 32

Space Adaptation Disruptions in sleep Social conflict 27, 31, Shift changes 32, 40 Colors of the
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Syndrome (SAS) 31, 32 27, 31, 33, 35, 38, 40 35, 36, 37, 38, 39, 40
environment 33, 39
Limits of performance Limited comforts 31, Leadership stressors Desynchronization 32 Shapes of the
32 32, 37 32, 33, 34, 39, 40
environment 33, 39
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Cognitive decrements 32 Decision-making Social skills 32, 37, 39 Autonomy 32, 35 Instrument displays 33
stresses 32
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32, 33
Physical fatigue Motivation changes Personality Competency / skill Overall habitat
27, 32
differences 32, 33, 34, 39, demands 32 aesthetics 33
40
Spatial illusions 32 Productivity Human reliability / Mission duration 35, Habitat odors 33
pressures 32, 33, 40 errors 32, 39 36, 37
Prolonged deviations Emotion / mood Organization / chain Work underload 36 Sudden accelerations /
from normal body changes 32 of command issues decelerations 33
posture 33 32
Magnetic fields 33 Mental fatigue 32

Communication Poor air ventilation 33
demands 32
Pain / sickness 33, 36 Cumulative effect of Sexuality 33 Toxic agents 33
multiple stressors 32
Decreased motor Boredom 32, 34, 38, 39 Decreased crew Food restrictions /
coordination 33 cohesiveness over limitations 31, 33, 35
time 33, 34, 39
Information Decreased
overload 32 communication
capabilities 35, 39
Career motivations Space-specific
33, 38
language constraints
39
Homesickness 33, 35, Scientific language

38
constraints 39
Separation from
earth 33
Transcendental
experiences 27, 33, 38,
39, 40
Monotony 33, 34, 35, 38,
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39, 40
Psychiatric disorders
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27, 33, 38, 40
Loneliness 34, 38
Loss of control 34
Irritability 34 -p
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Psychological
disorders 33, 38, 40
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Asthenia 40
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Note: Superscript numbers indicate the associated reference that mentions this specific stressor.
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Stressors have long been associated with negative outcomes during missions to low earth
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orbit. Though the effects of stressors have not been directly linked to tragic outcomes, there have
been numerous deviations from mission protocols, interpersonal conflicts, and reduced
effectiveness attributed to the impact of stressors while in space. For example, the crew of
Apollo 13 was reported to have experienced such a high degree of interpersonal tension that
mission planners nearly ordered the mission be cut short [7]. Similarly, crew members of Skylab
4 experienced irritability and interpersonal animosity to the point that the crew demanded an
entire day without work in order to resolve their tension [7]. Negative outcomes associated with
stressors have been reported from Soviet-era spaceflights as well. During a 1985 Salyut mission,
cosmonauts developed such a high degree of interpersonal tension with ground personnel that
they ceased all communication with mission control for two days [7].
As was noted by Christensen and Talbot, the cumulative effect of multiple stressors may
itself be a stressor [32]. This is a widely recognized psychological phenomenon; laboratory tests
have revealed that simultaneous stressors are associated with diminished task performance,
perceptions of greater workload demands, and physiological stress responses [41]. Other studies
have found a synergistic effect of multiple stressors, where the total negative effect of multiple
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stressors may be greater than the sum of each stressor individually [42]. This has important
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implications for the spaceflight environment. While a singular stressor – such as space habitat
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odors – may not by itself be sufficient to cause a negative outcome for astronauts, this stressor
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combined with other stressors – such as physical fatigue, interpersonal tension, confinement, and
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family life disruptions – may significantly increase the likelihood of a negative outcome during a
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spaceflight mission.
4.3.2 Anticipated stressors in a deep space environment

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Nearly all stressors listed in Table 3 and common to missions to low earth orbit are
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expected to be factors in a long duration, deep space mission. However, the very nature of a deep
space mission may exacerbate some of these stressors. For example, knowledge of the limited
possibility for rescue and the dangers of the mission may be especially pronounced during a deep
space mission [43]. Astronauts may also experience an increase in feelings of isolation,
confinement, and loneliness as the distance between their spacecraft and earth grows.
Additionally, there are certain stressors that only become noticeable during deep space missions.
As an example, while a communication delay is technically present on earth, these effects
become more noticeable the further that two communicating parties get from each other. During
missions to Mars and other deep space destinations, communication delays will become
especially impactful [44].
Little is known about how humans will cope with long duration missions to deep space
destinations. Crews living and working together for years on end, with minimal external social
interactions and minimal changes in environment, may be at an increased risk of negative
outcomes [44]. While a rapid return to earth is possible during emergencies in low earth orbit,
this is not the case for missions to Mars and beyond.
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4.4 Supportive measures
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Key to the health and safety of the crew, and the overall success of the mission, are
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supportive measures. These can be thought of as any intervention, accommodation, or
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modification that is made in order to better support the overall wellbeing of the crew members of
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a spaceflight mission. Ideas for supportive measures are usually mentioned in the majority space
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psychology literature, as outlined in Table 4. Where appropriate, similar supportive measures
were combined into a singular supportive measure (e.g., “deep breathing” and “meditation”
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being categorized as “training in relaxation techniques”). Additionally, supportive measures were

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separated into one of five categories to allow for easier organization and future reference.
Unfortunately, little data is known regarding the effectiveness of these supportive measures.
However, supportive measures that are known to have already been used in a spaceflight
environment will be denoted as such.

Table 4. Supportive measures for spaceflight
Lifestyle Social Psychological Habitat-related Mission Structure

Interventions Interventions Interventions Interventions Interventions
Personal meal Private Use of virtual- Nature / plants Adjustable schedules
preparation* 17 communication with reality 17, 34, 45, 51 included on station 17, 17, 19, 32, 40, 45, 49, 50
46
family and friends*
17, 19, 21, 32, 45, 49
17,
Nutrient-rich foods* Development of a Access to Artificial gravity 17, Careful crew selection
19, 34
core-periphery group entertainment* 17, 19, 35, 46
criteria* 17, 19, 32, 40, 47, 48,
structure* 17 45, 49 49
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Dietary supplements* Numerous and Periodic positive Allowing the Pre-launch training* 19,
17, 35
varied potential surprises* 17 passage of sunlight* 32, 40, 47, 48, 49
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social contacts* 46 17, 46
32, 33, 34, 40, 49
Exercise* Regular crew Psychotropic Improved colors of Job rotation 32
Recreation* 32, 33, 34, 40,

meetings* 40, 49
Social sensitivity -p
medicine* 6, 19, 45, 47
Gifts from earth* 19,
environment 45, 46
Improved Job enrichment 32
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50 32 21, 45
training* environmental
lighting 34, 45, 46
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Group dynamics Training in More observation Cross-training 32

training* 32, 34 relaxation windows* 45, 46
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techniques* 45, 49
Psychological Private quarters 45, 46, Recognitions, awards,
therapy 19, 21, 32, 40, 50 50
and benefits* 32, 40
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Self-control Reduced noise levels Radiation protection 35

training* 32 45, 46
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Clinical hypnosis 33 Variations in habitat

environmental factors
46
Mindfulness Views of the habitat

training 50 from the windows* 46
Reminding crew Comfortable air
members of the temperature /
purpose of the humidity 35, 46
mission 40
Limiting Habitat directional
emotionally cues 46
stimulating
information* 40
Habitat day / night
cycles 46
Direct views of
earth* 21
Note: Superscript numbers indicate the associated reference that mentions this specific
supportive measure. An * indicates a supportive measure that is known to have been used during
spaceflight.
It is worth noting that there are more potential stressors listed in Table 3 than there are
supportive measures provided in Table 4. This discrepancy may be interpreted in several
different ways. First, it is obvious that the spaceflight environment can produce a high degree of
stress through various means; nearly all aspects of spaceflight, from the habitat an astronaut is in,
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to the changes in their body, to the workload of the mission, can be detrimental to their overall
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wellbeing. While the spaceflight environment is taxing, it is also limiting; the supportive
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measures for these stressors are greatly limited by the size of the habitat, the technology
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available, the scope of the mission, and other related factors. Thus, while the stressors are many,
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the supportive measures are few.

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Additionally, it is important to note that many supportive measures are effective at
reducing the effects of multiple stressors. For example, exercise is believed to be capable of
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reducing the physiological effects of the spaceflight environment, the psychological effects of
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isolation and loneliness, the interpersonal effects of stress and boredom, and more. The multi-
faceted nature of these supportive measures makes it possible to address multiple concerns at
once, greatly expanding the options that mission planners have when devising strategies for
supporting crews.
The supportive measures necessary for future deep space missions may change when
compared to low earth orbit missions. For example, the necessity of artificial gravity will grow
as mission lengths grow [17, 35, 46]; longer times spent in space may lead to physiological
effects that cannot be adequately managed through diet and exercise alone, such as bone density
loss, muscle loss, vision impairment, and other negative outcomes. Similarly, as astronauts
venture further from earth, simply having a view of earth outside of a window may no longer be
possible, and the need for virtual reality depictions of earth environments may be needed [17, 34,
45, 51]. Private communication with family and friends, sometimes referred to as "family
conferences,” while highly beneficial for astronauts in low-earth orbit, may become increasingly
difficult during deep space missions due to the communication delay presented by the distance of
the crew from earth. It is difficult to predict how astronauts will react to future deep space
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missions. As will be explained in the next sections, some negative outcomes that may result from
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stressors are psychiatric disorders, for which specific types of supportive measures will be
needed.
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4.5.1 Psychiatric disorders in a spaceflight environment
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Psychiatric disorders can be conceptualized as any condition that can significantly

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negatively affect mood, thinking, emotions, or behavior, or cause distress or impairment in
social, occupational, or personal functioning. Currently, most psychiatric disorders are evaluated
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using criteria provided by the American Psychiatric Association’s Diagnostic and Statistical
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Manual of Mental Disorders, Fifth Edition (DSM-5). However, there are no publicly known
reports of the occurrence of actual DSM-5 disorders during spaceflight [6]. Importantly, it is
worth noting that the lack of accounts of DSM-5 disorders that the public is aware of does not
necessarily indicate that these have not occurred in space. For medical confidentiality reasons,
we may not know if astronauts – whose identities are quite public – have experienced DSM-5
disorders in space. In fact, reported experiences of depression and adjustment problems, as will
be highlighted below, may very well have been categorized by NASA flight surgeons as a DSM-
5 disorder but not made public. Thus, in this section, the occurrence of known psychological
symptoms that have been encountered in missions to low earth orbit will be cataloged in Table 5,
in lieu of psychiatric disorders. Predictions regarding the actual psychiatric disorders that could
be encountered during long duration / deep space missions will also be cataloged in Table 5.
Although each psychological symptom encountered in low earth orbit is thought to be likely to
present in deep space, the attention in this section for deep space missions will primarily focus
on the possible psychiatric disorders that could be present, rather than just the symptoms.
Table 5. Psychiatric symptoms and disorders in a spaceflight environment
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Psychological symptoms previously reported in Psychiatric disorders anticipated for long duration
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missions to low earth orbit / deep space missions
Anxiety symptoms 4, 6, 20, 52, 53, 54, 56 Anxiety disorders
Depressive symptoms 4, 19, 20, 48, 52, 53, 54, 55, 56
Serious psychiatric symptoms 6 -p
Panic disorders 6
Generalized anxiety disorder 26
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Psychological emergency 6 Depressive disorders
Aberrant / irrational behaviors 4, 7 Major depressive disorder 6, 26
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Belligerence / hostility 4, 7, 52 Substance-induced depressive disorder 6

Impaired judgement 7 Psychotic Conditions
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Irritability 6, 7 Brief psychotic disorder 6, 19, 26

Asthenia 4, 7, 19, 52, 55, 56 Substance-induced psychotic disorder 6, 26
Psychological trauma 4 Sleep-wake disorders
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Psychosomatic symptoms 4, 19, 20, 33, 53, 54, 55, 56 Circadian rhythm disorders 6
Fatigue 4, 53 Insomnia 6, 31
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Euphoria 48, 54 Trauma and stressor-related disorders

Sleep problems 20, 54, 57 Adjustment disorder 6, 26
Adjustment problems 19, 55, 56 Acute stress disorder 6
Posttraumatic stress disorder 6
Psychiatric emergencies
Agitation 6, 26
Delirium 6, 26
Neuroleptic malignant syndrome 6
Serotonin syndrome 6
Substance intoxication and withdrawal 6
Euphoria 31
Cognitive performance detriments 31
Dissociative disorders 26
Asthenia 19
Effects of being unable to view earth 21
Note: Superscript numbers indicate the associated reference that mentions this specific disorder.
Some of the most reported psychological symptoms encountered on orbit include
depression symptoms (e.g., depressed mood, sadness, low energy), anxiety symptoms (e.g.,
anxiousness, nervousness, restlessness), and psychosomatic symptoms (e.g., tension headaches,
diarrhea, stomach pains, tooth pain). The reasons for these psychological symptoms differ
widely. For example, one astronaut beginning a long duration space mission to low earth orbit
reported feelings of depression due to feeling isolated from his family [56]. It is important to
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note that the overall incidence rate of on-orbit psychological symptoms is quite low. Data from
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89 Space Shuttle missions found that 34 symptoms were reported among 208 crew members [6].
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These findings are equal to 0.11 symptoms reported every 14 person-days, or 2.87 every person-
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year [6]. Other psychological symptoms, such as irritability [7], fatigue [4], and euphoria [48],
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have been reported while in space. While these individual symptoms do not meet the threshold
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for a psychiatric disorder according to the DSM-5, they can detract from an astronaut’s overall
mental wellbeing and mission effectiveness.

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Psychosomatic symptoms are commonly reported by space crews. A 1976 Soyuz-21

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mission was terminated early after cosmonauts began to report a foul odor in their spacecraft,
which was not detected by subsequent crews [6]. Additionally, a 1985 Soyuz mission was also
ended early due to a cosmonaut experiencing genitourinary symptoms that were believed to be
psychosomatic in nature [6].
Sleep problems are also widely reported among crews to low earth orbit. For example,
during the Gemini 7 mission, the two astronauts on board reported frequent tiredness throughout
the mission, and only slept an average of 5.3 hours per night [54]. Reports of sleep problems
while in space may be a sign of an underlying psychological issue [20], but may also be a sign of
difficulty adjusting to the spaceflight environment [57]. Regardless of the cause, sleep issues can
lead to an increased risk of a host of psychiatric disorders [58].
There is great debate among space psychology researchers regarding the presence of
asthenia, a type of adjustment difficulty involving fatigue, irritability, emotional lability,
attentional difficulties, restlessness, sleep difficulties, appetite changes, and heart/blood pressure
changes [56]. However, while asthenia has been reported by Russian space crews numerous
times, follow-up studies by American researchers – on both astronauts and cosmonauts – have
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failed to detect this condition [52]. Future research is needed to determine if asthenia is a
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detectable condition, a cultural phenomenon, or an amalgamation of several different
psychological symptoms.
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4.5.2 Anticipated psychiatric disorders in a deep space environment
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It is worth noting the rarity of serious psychiatric disorders during missions to low earth
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orbit. This rarity is likely due to the highly specific psychological selection criteria employed
while searching for astronaut candidates [53, 56]. For contrast, symptoms of major mood and
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thought disorders, such as bipolar disorder or schizophrenia, have been reported in 5% of

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individuals working in space analog environments who have not had as stringent of a selection
criterion (e.g., submarine crews, Antarctic crews) [56].
As mission durations increase in length, and mission distances from earth also increase,
the probability of encountering a serious psychiatric disorder is thought to also increase,
regardless of stringent selection criteria [33]. For example, it is predicted that long duration
missions may have a stress level of 70.1%, compared to the 43.42% for short duration missions
[27]. While stress itself is not a serious psychiatric condition, its net effects can increase the risk
of developing various psychopathologies. As is outlined in Table 5, the possible psychiatric

disorders anticipated for long duration or deep space missions are varied. Whether it be an
anxiety or depressive disorder, psychotic disorders, trauma-related disorders, or a psychiatric
emergency, the possible negative outcomes during these types of missions are numerous.
4.6.1 Current and previously used treatments for psychiatric disorders in a spaceflight
environment
Psychiatric conditions that warrant direct intervention – whether through medication or
an empirically-supported therapy – are rare in a spaceflight environment. Despite this rarity,
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treatment options have existed for the majority of missions to space. Table 6 includes all known
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psychotropic medications and psychological interventions that are publicly known to have been
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used in space or are known to exist as treatment options on the International Space Station.
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Table 6. Current psychological treatment options during spaceflight
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Psychotropic Medications Psychological Interventions

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Antidepressants Crisis intervention 59

Sertraline 6 Unspecified brief individual psychotherapy 59
Venlafaxine 6 Self-hypnosis 45
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Antipsychotics Muscle relaxation techniques 45

Aripiprazole 6 Emergency return to earth 6
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Ziprasidone 6
Anxiolytics and Anticholinergics
Diazepam 6
Diphenhydramine 6
Lorazepam 6
Sleep agents
Melatonin 6
Zaleplon 6
Zolpidem 6
Temazepam 6
Triazolam 6
Flurazepam 6
Wake agents
Caffeine 6
Modafinil 6
Note: Superscript numbers indicate the associated reference that mentions this specific treatment.
The most commonly used psychotropic medications in space have been sleep agents and
wake agents [6]. Though astronauts have access to other sorts of medications while in space,
such as antipsychotics, there has not been a known need for these so far. Generally, should an
astronaut develop a severe enough psychopathology to warrant the prolonged use of
antipsychotics, mission planners would likely opt for an emergency return to earth for this
astronaut [6]. Still, the presence of these medications on board spacecraft and space stations
indicate that mission planners understand the need for a wide variety of medication options for
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addressing the effects of stressors and psychopathologies while in space.
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It is important to note that the psychological interventions outlined in Table 6 differ from
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the supportive measures listed in Table 4. Although supportive measures can be helpful for
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indirectly treating psychiatric disorders (for example, exercising to reduce some of the symptoms
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associated with depression), the psychological interventions listed here are more seen to be direct
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treatments for a psychiatric disorder. For instance, self-guided interventions, such as muscular
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relaxation techniques and self-hypnosis, can be quite helpful for the management of anxiety [45].
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Similarly, crisis interventions can be used to intervene when an astronaut is experiencing intense
emotional distress, psychotic symptoms, or even suicidality [59].
Unspecified brief individual psychotherapy has been noted as an option for treating
psychiatric disorders while in space [59]. However, there are no accounts of this being used thus
far in the history of space missions, likely due to there not being a history of psychopathology
exhibited in space. This lack of psychopathology experienced in space is perhaps due to the
thorough psychological screening methods used when selecting astronaut candidates [6]. Thus, if
more people begin to live and work in space in the coming years, or the psychological selection
criteria is ever modified, there could be an increase in psychiatric disorders in space and a
subsequent increase in the need for specific, tailored psychotherapy options.
4.6.2 Proposed treatments for psychiatric disorders in a deep space environment
As missions to space shift towards destinations further from earth, and for periods of time
significantly longer than what most astronauts experience during missions to low earth orbit, the
risk of developing a psychiatric disorder may increase. Not only will a sense isolation,
confinement, and loneliness possibly increase, but physical distance from earth may become a
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significant stressor [33]. The unpredictability of the deep space environment, combined with the
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clear increase in stressors, warrants a wider variety of psychological treatment options, which are
presented in Table 7.
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Table 7. Proposed psychological treatment options for deep space missions
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Psychotropic Medications Psychological Interventions

Antidepressants Periodic psychological assessments 6
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Bupropion 6 Traditional psychotherapy

Ketamine 6 Supportive therapy 6
Mirtazapine 6 Cognitive behavioral therapy 6
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Paroxetine 6 Interpersonal therapy 6

Venlafaxine 6 Physical restraints 6
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Antipsychotics Predesignated seclusion / observation areas 6

Aripiprazole 6 Spaceflight-Induced Stress Management Plan (SIS-MAP) 60
Haloperidol 6 Virtual reality
Olanzapine 6 Virtual nature 51
Ziprasidone 6 Virtual environments for exercise 51
Anxiolytics and Anticholinergics Virtual windows 51
Benztropine 6 Simulated social interactions 51
Buspirone 6 Virtual games and entertainment 51
Clonidine 6 Simulated larger habitat volume 51
Diazepam 6 Self-guided depression treatments 13
Diphenhydramine 6
Hydroxyzine 6
Lorazepam 6
Prazosin 6
Propranolol 6
Mood Stabilizers
Divalproex 6
Sleep Agents
Melatonin 6
Trazodone 6
Zolpidem 6
Wake-promoting Agents
Caffeine 6
Modafinil 6
Note: Superscript numbers indicate the associated reference that mentions this specific treatment.
It is recommended that psychotropic medications for deep space missions be a part of a
broader comprehensive behavioral health regimen [6]. Similar to the combined effects of
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multiple stressors being greater than the effect of an individual stressor [32], the cumulative
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effect of multiple treatment modalities can often be more powerful than any single treatment
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option [6]. The psychotropic formulary proposed in Table 7 offers a variety of possible
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medications to be used that, when combined with other treatment modalities, is capable of
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addressing a host of different acute and chronic psychiatric conditions.

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The effects of the spaceflight environment on medications are worth noting.

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Microgravity, radiation, magnetic fields, and other orbital phenomena all have the potential to
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change the potency of medications while in space [6]; findings on this have been mixed. For
example, a comparison of medications stored on earth versus medications stored in space for 28
months found that the rate of medication degradation appeared to be faster for medications stored
in space [61]. However, a different examination of medications stored in space for 550 days
found no noticeable degradation below accepted standards [62]. With these differing findings,
NASA’s Human Research Program has called for more research into this field [63].
Periodic psychological assessments should be a central part of every astronaut’s
psychological health program [6]. Identifying early signs of psychiatric disorders, and initiating a
treatment early, is a strong predictor of improve outcomes [64]. Once a psychiatric disorder has
been identified, traditional psychotherapy may be a powerful tool for reducing symptoms and
achieving emotional and behavioral stability. Options such as supportive therapy, cognitive
behavioral therapy, and interpersonal theory, among others, are widely supported by years of
empirical evidence and should be an option in a spaceflight environment [6].
Although psychological therapy is recommended for the treatment of psychiatric
disorders while in space [6], and physicians serving on the mission to space have been thought of
as a good candidate for delivering therapy to fellow astronauts [59], this method of delivering
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therapy poses significant concerns. For example, a crew member entering a therapeutic
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relationship with another astronaut would instantly create a dual relationship, a potentially
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dangerous state for a therapist and client that represents real hazards to both individuals [65].
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Teletherapy, while a viable options for low earth orbit missions, may be impossible to effectively
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carry out during a deep space mission. Delayed communications are thought to be an
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increasingly stressful part of a deep space mission [66], and this delay in communication times
may reduce the efficacy of therapy. As such, there is a distinct need for automated psychotherapy
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for deep space missions, which provides a way for therapy to be conducted that does not require
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individuals to enter dual relationships [67]. Virtual reality also offers a new treatment modality
that can reduce stress, tension, loneliness, isolation, and even the sense of confinement.
Providing virtual landscapes to explore can increase exercise uptake, which can have benefits to
the physical and mental health of the astronaut [51].
However, automated psychotherapy and virtual reality may not be suitable treatments for
severe psychopathologies. Treatment options such as medication use, restraints, and observation
may be an appropriate immediate treatment for an astronaut that is experiencing severe
psychopathology far from earth [6]. While these are not sustainable treatments, and do not often
lead to psychological stability in and of themselves, these options are helpful for ensuring the
safety of all crew members until other types of psychological treatments can be used.
4.7 Cognitive and neurobiological factors in a spaceflight environment
In addition to the psychological factors related to spaceflight, there are numerous
cognitive and neurobiological factors that have been identified. Though smaller than the amount
of data reported regarding general mental health, what has been reported has indicated that there
are several changes to cognitive and neurobiological functioning for astronauts in space. It is
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important to note that the cognitive and neurobiological factors featured in this section do not
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represent the entirety of research conducted in these fields. Work by researchers such as Jennifer
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Boyd and Matthias Basner, although not captured by the scoping review search strategy, are
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worth considering in addition to what is outlined below. The cognitive and neurobiological
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changes captured in this scoping review are provided in Table 8 and are separated into three
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groups: factors that decreased while in space, factors that increased while in space, and factors
that changed in varied ways while in space.

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Table 8. Cognitive and neurobiological factors in a spaceflight environment
Decreased Increased Misc. Changes

Manual dexterity 17, 34, 69 Autonomic response to emotional Changed autonomic system reactivity
stimuli 12 68
Dual-task performance 17, 23, 34 Emotional tension 71 Changes in cerebral blood flow 70
Motion perception 17 Sensory-motor reaction time 71, 72 Spaceflight-associated neuro-ocular
syndrome 72
Tracking performance 23, 69 Four-choice reaction time 71
Information processing speed 71 Total ventricular volume 72
Psychic work capacity 71
Central postural functions 34, 72
Internal timekeeping 34
Attentional processes 34
Limb position sense 34
Note: Superscript numbers indicate the associated reference that mentions this specific factor.
A common factor that was found to be impacted by spaceflight was general bodily
coordination, as seen by reduced manual dexterity [17, 34, 69], decreased central postural
functions [34, 72], and decreased limb position sense [34]. Much of these decrements have been
attributed to adaptations to the microgravity environment of space. For example, autonomic
response to emotional stimuli was found to increase during spaceflight [12], as was emotional
tension [71], sensory motor reaction time [71, 72], and four-choice reaction time [71]. It is worth
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noting that these increases are cognitive in nature and may not be a result of a physical change to
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the structure of the brain, but rather could reflect a cognitive overload for the astronaut [17]. The
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novelty of the spaceflight experience, combined with the increased emotional tension [71] and
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decreased psychic work capacity [71] may lead to a host of decrements more globally. As such,
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it can be hard to determine the causal factor in these changes.

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Previous work has indicated that many of the cognitive performance decrements seen in
astronauts can recover after the astronaut has adapted to the spaceflight environment [23]. This
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recovery likely represents the extensive plasticity of the human brain and its ability to
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accommodate for changes over time. However, the very real neurobiological and brain structure
changes still present potential hazards for long duration, deep space missions. Astronauts
engaged in missions to Mars or other deep space destinations may exhibit changes to their
tracking performance, attentional processes, sensory motor reaction time, manual dexterity, dual-
task performance, and vision, among others, that are exacerbated by extensive time in space.
Until the mechanisms of these changes are determined, and interventions to mitigate their effects
are implemented, there will remain unknown risks for future missions.
4.8 Interpersonal factors in a spaceflight environment

Interpersonal factors can be thought of as specific social, personality, personal, cultural,
or mission-related factors that can impact the mission in differing ways. These factors are
provided in Table 9 and are separated into three categories: factors that are thought to be
potentially beneficial for the mission / crew, factors that are thought to be potentially detrimental
to the mission / crew, and factors that can influence the mission / crew in complex ways. Though
several of these interpersonal factors are also listed in other sections of this manuscript (e.g.,
autonomy is also discussed in the section on stressors), factors that are included here are thought
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to have particularly salient interpersonal effects.
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Table 9. Interpersonal factors in a spaceflight environment
Potentially beneficial factors -p

Potentially detrimental factors Misc. factors
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High group cohesiveness 7, 40, 54, 77 Interpersonal tension 19, 20, 34, 38, 39, 52, 54, 75 Group homogeneity 7, 43, 78
High cooperativeness 7, 40 Mixed-sex crews 20, 34, 38, 39, 43, 54, 75, 76, 77, 78 Group heterogeneity 7, 19, 20, 38, 43, 54,
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76, 78
Low irritability 34, 74 Differences in career orientation 19, 32, 38, Crew size 7, 19, 21, 32, 20, 43, 77
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75, 76
Low impatience 74 Cultural differences 19, 34, 39, 54, 75, 76, 78 Need-achievement 7, 32
High agreeableness 34, 40, 74 Language differences 19, 39, 75, 76, 78 Masculine and feminine personality
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traits 7
High emotional stability 34, 40, 43 High psychological dominance 43, 54, 75 Leadership traits 7, 19, 20, 32, 34, 38, 40, 44,
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54, 75, 76, 77
High conscientiousness 44 Differing organizational structures 19, 32, 75 Ground-Crew interactions 20, 21, 38, 44,
52, 54, 75, 79
Appropriate affiliative humor 44 Differences in career experience 40, 54, 76 Crew autonomy 19, 21, 34, 43, 44
Subgrouping 19, 20
Scapegoating 38
Territorial behavior 38
Social monotony 21
Groupthink 21
Note: Superscript numbers indicate the associated reference that mentions this specific factor.
Interpersonal factors are believed to have a strong impact on the overall success of space
missions [75]. Generally, the nature of a space mission, especially with increasing levels of
isolation and confinement, can lead to interpersonal tension, which then may lead to a host of
other phenomena [75]. Differences in career orientation [19, 32, 38], need-achievement [7, 32],
and personality [75] can all be exacerbated by an increased perception of social tension.
Factors that are believed to be potentially beneficial for the success of missions to space
include high group cohesiveness [7, 40, 54, 77], high cooperativeness [7, 40], high agreeableness
[34, 40, 74], high emotional stability [34, 40, 43], and high conscientiousness [44]. Qualities
such as low irritability [34, 74] and low impatience [74] are also critical for the success of a
mission. These personality traits cannot generally be created in an individual who does not
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already possess them, which may require careful selection procedures to ensure that only crew
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members who possess these traits be included in a mission [44]. Appropriate affiliative humor is
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believed to be a helpful, if understudied, personality trait that can greatly contribute to the
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success of a mission [44]. Interestingly, humor may be able to be trained and cultivated [80],
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which may help widen the selection pool of potential astronaut candidates.
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Caution should be exercised when interpreting Table 9’s section on potentially
detrimental interpersonal factors. While mixed-sex crews, cultural differences, and language
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differences have all been widely reported as potentially detrimental on the cohesiveness of a
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crew, the solution to this is not necessarily to select a purely homogenous crew. Although
homogeneity may lead to increased cohesiveness, that may not translate into increased chances
for mission success [43, 78]. Rather, care should be taken to ensure that psychological
countermeasures, psychological training, and selection criteria are used to ensure that the
heterogeneity of the crew is an enhancement, rather than a detriment.
Tension between ground crews and astronauts has been widely reported [20, 21, 38, 44,
52, 54, 75, 79], and the solution for this phenomenon is not always obvious. Though many crews
report a desire for increased autonomy, this also presents risks to the mission [19, 21, 34, 43, 44].
Similarly, many astronauts have reported interpersonal tension stemming from leadership
conflicts, especially when the leader selected for the mission is relatively inexperienced
compared to the rest of the crew or lacks social skills [20, 32, 34, 38]. As such, an increased
emphasis should be placed on the selection and cultivation of a leader for a mission.
Crew size is a complex interpersonal factor. While larger crews can lead to decreased
social monotony [21], they also present the risk of crew members developing groupthink [21],
scapegoating [38], territorial behavior [38], and subgrouping [19, 20]. However, small crews
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may not be practical for future long duration, deep space missions
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4.9 Crew autonomy and delayed communications
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A wealth of data gathered from previous space simulation studies indicate that delayed
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communications – the result of physical distance between crews and ground personnel – can
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result in confusion, wasted time, decreased verbal encoding efficacy, increased stress and
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frustration, and general task and communication errors [66, 82, 83, 84]. It appears that humans
are highly sensitive to any delay in communication, with delays as short as fractions of a second
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[82] up to 5 minutes [66] during space simulation studies being reported as noticeable and
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distressing. A study conducted on the International Space Station found that a 50-second time
delay during audio communications was stressful and frustrating for astronauts, leading to
lowered communication and work quality [44].
Delayed communications can lead to increased crew autonomy, which can drastically
change the nature of a space mission. Generally, increased autonomy represents increased risks
for astronauts [43]. Crew members will have to account for a reduced ability to consult with
ground personnel for the management of external crises, such as environmental hazards or
spacecraft / space habitat failures [21]. Additionally, crew members will have reduced input from
ground personnel for the management of internal crises, such as severe interpersonal conflicts,
medical emergencies, mental or behavioral illnesses, interpersonal violence, physical illnesses,
accidents, suicidal behavior, or the death of a fellow crew member [21].
However, autonomy also presents key opportunities for crews to thrive in a deep space
environment. As distance from earth increases, crew members will need to plan most of their
daily activities without external input [19]. Generally, crew members have reported positive
reactions to increased autonomy, especially with regards to decision making [34]. The freedom
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to plan activities has been found to enhance mood and creativity for crew members [34]. While
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communications with ground personnel may present delayed communications, experiments have
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revealed that certain communication protocols can improve outcomes under these circumstances
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[44].
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4.10 Postflight changes and support

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Data gathered from long duration spaceflights has indicated that some astronauts show
significantly different autonomic system reactivity after spaceflight in ways that are similar to
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that of a hypertensive individual [68]. Similarly, researchers have found a significant increase in
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total ventricular volume following spaceflight, which may correlate with poor postural control
and increased complex motor task completion times [72]. While the majority of cognitive
processes are believed to eventually return to baseline after readaptation to earth [19], some
psychomotor detriments may persist. The chronically high stress levels associated with
spaceflight may also lead to a weakened immune system, which could place astronauts at an
increased risk for developing tumors – especially as a result of the increased cumulative radiation
exposure of spaceflight – or of contracting an infectious disease [33]. Fortunately, sleep levels

have been found to improve after spaceflight, especially when compared to before and during the
mission [57].
These cognitive, neurological, and health challenges that present after spaceflight exist
alongside psychological and interpersonal challenges. For example, personality changes have
been observed in astronauts after spaceflight, especially as it relates to spirituality, views of the
earth, and increased interpersonal sensitivity [38, 54]. Similarly, the fanfare that accompanies
becoming an astronaut can lead to personality effects, interpersonal tension, and anxiety [38].
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Additionally, astronauts returning to earth may have unresolved interpersonal conflicts from their
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time in space, and difficulty re-adjusting to family life on earth [19]. Studies of space analog
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environments, such as submarines on deployment, have led to the recognizing of a specific
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phenomenon known as “submariners’ wives’ syndrome,” which can lead to marital strife as a
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spouse tries to reintegrate themselves into family matters [19]. This syndrome could be present
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in astronauts as well.
Post-mission readaptation briefings and supportive strategies can help astronauts and
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families reintegrate into each other’s lives [85]. Similarly, debriefings at the individual and crew
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level can help resolve conflicts, process complicated emotions and experiences, and identify
problematic thinking patterns; this is especially true when a crew member encountered a
troubling or traumatic experience while in space [19]. Periodic follow-up assessments and
debriefings can help identify new problems as they occur, prevent the development of
psychopathologies, and support families as they attempt to recreate a new life on earth [38]. In
some cases, psychiatric interventions, counseling sessions, and support groups may be required
[38].
4.11 Positive outcomes during and after spaceflight

The positive outcomes of spaceflight can be found as early as the first moments in space.
The novel environment of space, especially its microgravity and changes to sensory experiences
combined with the impressive views it provides can lead to remarkable feelings of awe and
euphoria. This is often referred to as the “overview effect” [86], an experience reported by high-
altitude pilots and astronauts often associated with transcendent experiences, a feeling of
separation from earth, and an expansive mood. Experiencing the overview effect may be one of
the most positive aspects of spaceflight for an astronaut, which may explain why astronauts are
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so willing to undergo what they know to be an intensely stressful experience [87].
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The spaceflight experience can lead to positive outcomes beyond the transcendent
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experiences associated with the overview effect. The highly stressful nature of spaceflight,
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combined with the hard work and planning it took to be selected for the mission, can have a
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salutogenic effect, leading to positive personal changes [88]. Salutogenesis refers to the process
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by which powerful experiences, and even personal crises, can lead to positive growth [89].
Though it is apparent that spaceflight can be a salutogenic experience, little is known regarding
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whether this may act as a protective factor against the more pathogenic outcomes of stress [90],
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or what may help enhance this phenomenon for future long duration missions [91].
Astronauts who have returned to earth have reported remarkable changes in their view of
religion, nationality, and spiritual aspects of life. However, it is important to note that the term
“spiritual,” though commonly used to summarize the changes reported by astronauts, is not often
the term that astronauts use when summarizing their own personal changes [88]; this is perhaps
due to the fact that “spiritual” is a loaded word that carries different connotations than what is
being expressed, though some astronauts do experience distinctly spiritual or religious effects
from being in space [54]. Data collected directly from astronauts indicate that viewing earth from
space most often results in astronauts changing their worldview regarding the fragility of our
planet and the unity of mankind [28].
4.12 Space station habitability and design
A lack of constant, earth-level gravity can lead to deleterious effects on a human’s
muscles, bone density, eye shape, gastrointestinal system, and other bodily functions [35, 46].
Accordingly, when possible, the creation of artificial gravity, likely through the use of a spin
habitat, is recommended [46]. However, when this is not feasible, the use of specialized exercise
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equipment and dietary supplementation can mitigate the effects of the microgravity environment
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to an extent [35].
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Radiation effects can be classified as either acute or delayed. Acute radiation effects are
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often a result of a sudden solar event and can be found by changes in the gastrointestinal system,
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central nervous system, and blood-forming organs [35]. Delayed radiation effects are
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underexplored and may not be noticeable until later after a mission has concluded [35].
Additionally, radiation effects can also impact the growth of plants and the properties of
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electrical devices [35]. As such, care should be taken to implement radiation protection shielding
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for the spaceflight environment, which may take the form of passive bulk shielding,
electromagnetic shielding, electrostatic shielding, or chemical radioprotection [35].
Noise levels, vibrations, atmospheric pressure, humidity, and light levels can all
contribute or inhibit an astronaut’s overall mental wellbeing and physical health [46]. Specific
recommendations are provided by Angel Seguin [46] and are beyond the scope of this review.
However, while some of the recommendations provided would require the construction of
entirely new forms of space habitat (e.g., spin habitats to produce artificial gravity), other
recommendations are entirely feasible for current and near-future spacecraft and habitats (e.g.,
lighting types, air temperature, etc.) [46].
4.13 Psychological selection criteria
The emphasis that space agencies place on psychological selection criteria for astronaut
candidates, the way that selection occurs, and the traits being selected for have changed over
time. Previously, NASA and other space agencies attempted to predict astronaut effectiveness
based on the personality traits that were exhibited pre-flight [75]. Characteristics such as
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interpersonal warmth and sensitivity, low verbal aggressiveness, positive expressivity, and goal-
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orientation, among others, were seen as clear indicators of suitability for astronaut candidacy
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[75]. However, as has been outlined in person-environment fit models of psychology, pre-flight
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reactions may not be indicative of performance during flight due to the drastic differences in the
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actual environments that the individual is being assessed in [75].

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The gender, ethnic, age, and career makeup of a crew can have compounding effects on
crew functionality; importantly, these selection criteria are interwoven with each other. For
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example, while different crew nationalities may represent an opportunity for misunderstandings
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and stressors, what is likely much more impactful is whether all crew members share a common
language [19, 43]. While mixed-sex crews present an opportunity for sexual activity, so too do
same-sex crews. Importantly, there is not yet data regarding what impact sexual activity may
have on the success of a mission, or with what psychological batteries could personnel be
selected for low sexual activity or tolerance for sexual abstinence [43]. Similarly, though little is
known about the effectiveness of astronauts at different ages, it should be recognized that the
radiation hazards of a spaceflight environment may pose especially pronounced reproductive
risks to young astronauts [43].

Select-in criteria should be highly specific to the nature of the mission that astronauts are
being recruited for; the crew composition, mission duties, length of mission, and mission
destination can and should influence the selection of individual crew members [19]. Relevant
select-in procedures should extend beyond the personality traits of the astronaut but also their
interpersonal skills, tolerance of differences, suitability for the complex job of being an
astronaut, and ability to function as part of a team in an extreme environment [19, 44]. Currently,
NASA does not appear to use a scientifically based method of composing teams [44]. However,
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as mission targets shift towards deep space destination, increased care and attention should be
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given to this facet of mission design. Predicting possible points of conflict, identifying skills that
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need to be trained, and understanding how the collective efforts of a team can be more
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substantial than the sum of its individual parts can all help individual and crew selection to be
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much more meaningful and scientific [44]. As such, there exist substantial room for
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improvement in the psychological selection procedures for astronaut candidacy and crew
composition.
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4.14 Psychological training and preparation for spaceflight

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In much the same way that astronauts must have the necessary technical skills to succeed
in their specific role for the mission (e.g., mission physicians should have medical training,
mission pilots should have flight training, etc.), all astronauts would benefit from general
psychological and interpersonal training. This type of training is designed to develop the
necessary skills for coping with the stressors of spaceflight, interacting with fellow crew
members and ground personnel, working under differing leadership styles, working in isolated
and confined environments, communicating with team members, and encountering multi-cultural
and diverse crews [31]. Training crew members together in these various psychological and
interpersonal skills can greatly enhance their ability to respond to different mission scenarios and
increase the likelihood of mission success [38].
There exist numerous opportunities for improving how psychological training and
preparation is done ahead of a spaceflight, especially for long duration, deep space missions.
Future psychological training should include psychoeducation regarding the various psychiatric
problems that could be encountered in space, how to recognize them, and how to intervene [47].
Additionally, training in social competence, especially as it relates to human communication
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styles, interpersonal attitudes, tolerance, and conflict management, would be especially helpful
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[38, 49]. Psychological trainings should ensure that astronauts understand what types of
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performance decrements are likely to be encountered in space, what cross-cultural aspects are
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relevant for their mission, and how best to cope with life as part of a diverse crew encountering
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new stressors [19]. Though NASA and other space agencies have been criticized in the past for
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not devoting enough time and resources to the psychological preparation of astronauts [48], it is
apparent that space agencies are beginning to place a greater emphasis on this part of an
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astronaut’s preparation for spaceflight.

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4.15 Common research methods and concerns
The methods used for conducting psychological research on astronauts differ widely
depending on whether the research is being performed before, during, or after the mission.
Research done before or after a mission can be quite similar to standard psychological and
medical research, in that the participants are usually in a controlled research environment and the
research is being carried out by the researchers themselves. However, research conducted during
a space mission requires that astronauts conduct experiments on each other or themselves, live in
the research environment, and be responsible for their own data collection [23]. Psychological
research on astronauts has traditionally involved examinations of mood and thinking through
surveys, direct report, and speech analysis [23]. Additionally, psychological research involving
astronauts has also used performance tasks (e.g., simple-reaction time tasks, choice-reaction time
tasks, Stroop-like interference tasks, spatial memory tasks, etc.), as well as general performance
monitoring of the astronaut’s duties [23].
However, the spaceflight environment presents significant difficulties for accurate
psychophysiological research. For example, the small sample sizes of astronaut crews result in
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small effect sizes; though repeated measurements, and complex statistical analyses, can
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counteract these issues [23]. Additionally, the highly complex nature of the spaceflight
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environment has made determining the exact mechanisms by which changes are occurring quite
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difficult. As an example, although sensory-motor processes are altered in the spaceflight
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environment [71, 72], it is difficult to determine if this is a result of microgravity, sensory

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overload, general stress response, or something different [23].
Psychological research with astronauts involves privacy concerns that are not always
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present during terrestrial research. Although the use of subject identification codes, encrypted
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data, and informed consent can protect the rights and privacy of a psychological research subject,
astronauts are part of a small, publicly recognized group of people, which creates an opportunity
for someone to guess the identity of a research subject based on relatively few data points [92].
Given that astronauts are aware of this and are also aware that certain findings may impact their
ability to serve in future space missions, they may feel pressure to conceal their thinking and
emotions, or answer questionnaires differently than they otherwise would [92]. These privacy
concerns will likely be compounded by future high-profile missions to the Moon, Mars, and
beyond.
Future psychological research should make use of unobtrusive measures wherever
possible. Not only do astronauts report a preference for unobtrusive measures, but these methods
of data collection can increase the likelihood that the validity of the data is not being threatened
by an astronaut deliberately altering their responses [44]. Additionally, while future space
missions will continue to face the complicating factor of small sample sizes reducing the privacy
of the participants, every opportunity to protect the identity of the research subject, especially as
it relates to identifying information (such as age, gender, nationality, career status, mission
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timing, length of time in space, crew details, etc.), should be taken [92].
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4.16 Limitations and utility of space simulation studies
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Space simulation studies are a hallmark of space psychology research. When gathering
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data from individuals in space has proven to be too costly, impractical, or impossible, space
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simulation studies offer a pathway for researchers to study different phenomena in a way that
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could potentially be applicable for a spaceflight environment. Space simulation studies can
usually be divided into two categories: space analog environments (e.g., submarines, Antarctic
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research stations, etc.), or artificial simulation environments (e.g., Douglas and McDonnell
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Douglas Capsules, Russian Mir Simulator, Human Exploration and Research Analog, etc.) [24,
44, 93]. Each of these types of simulation environments offer benefits and drawbacks for space
psychology research.
Space analog environments have been some of the most commonly used research
modalities in this field. Decades of experience operating missions aboard submarines or to
isolated Antarctic research stations has created numerous opportunities to both passively and
actively gather data on a variety of psychological, psychiatric, and interpersonal phenomena. For
example, space analog environments have found reports of sleep issues, depression, anxiety,
interpersonal difficulties, psychosomatic symptoms, decreased group cohesion over time,
homesickness, personality changes, and stress related to isolation and confinement [2-, 93, 94,
95]. Reports of depression and anxiety, among other psychiatric conditions, have been seen in
numerous space analog missions, but have yet to be reported in space [93]. Similarly, though
performance decrements in the second half of a mission have been reported in space analog
environments, direct measures of this in astronauts and cosmonauts aboard the International
Space Station does not support this finding [95].
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Despite these differences in findings between space analog environments and actual
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spaceflight environments, space analog studies do offer substantial opportunity for data
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collection. Additionally, individuals who have both been to a space analog environment and
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flown in space have attested to the fidelity of these environments. For example, one astronaut
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who flew to space twice thereafter went to Antarctica for research, of which he said that the
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“physics” of Antarctica were “wrong,” but the psychological “mindset” was correct [44]. This
difference between the “physics” of an environment and the “mindset” of an environment is an

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important note. Although Antarctica does not offer a microgravity environment, and although it
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is physically on the earth’s surface, the sense of isolation that an individual feels in Antarctica,
and the harshness of the environment, can contribute to a similar mindset that is experienced in
space [64].
A spaceflight environment can also be recreated, to an extent, by using artificial
simulation environments. These often take the form of an artificial habitat, designed to be
functionally and aesthetically similar to what will be experienced in space or at a deep space
destination, in which research subjects spend a prolonged period of time – even over a year in
this setting. Artificial simulation environments, though unable to simulate microgravity and other
key environmental aspects of space, can use delayed communications, virtual reality, and special
landscapes to simulate target environments as much as possible. Although artificial simulation
environments allow for carefully controlled research, there still exists drawbacks. For example,
research participants engaged in artificial simulation environment studies know that there is no
real danger posed to them [44]. Additionally, it is costly to have multiple studies happening at
once, and the total number of participants for these studies is often lower than that which is
offered by space analog environments.
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It is important to note that missions to Mars and other deep space destinations will
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present psychological challenges that have never been seen before. Extreme distance from earth,
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a profound sense of isolation, an inability to see earth itself, knowledge of a lack of rescue
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options, and sheer time spent away from home can contribute to substantial psychological and
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interpersonal stress in a way that cannot be simulated in any other environment. As such,
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although space simulation studies will be crucial for preparations for deep space missions, their
predictive utility is limited.

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4.17 Grey literature

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Occasionally mentioned during systematic reviews is the concept of “grey literature.”
Grey literature, as defined by the Grey Literature Network Service, is “a field in library and
information science that deals with the production, distribution, and access to multiple document
types produced on all levels of government, academics, business, and organization in electronic
and print formats not controlled by commercial publishing i.e., where publishing is not the
primary activity of the producing body” [96]. Functionally, grey literature is a document that is
not included in an academic database, is not likely peer-reviewed, and is substantially harder to
access during a literature review.

Detailed, methodical steps were followed while conducting this scoping review in line
with guidelines provided by PRISMA [10]. Currently, there exist no such guidelines or
instructions regarding the search for, and inclusion of, grey literature during a scoping review.
The inclusion of grey literature during any sort of systematic review is a contentious issue in the
psychological sciences, with different benefits and drawbacks being mentioned and debated [97].
While including grey literature can help reduce the likelihood of publication bias influencing
results, the lack of peer-review, the inaccessibility of the findings, and the substantial length of
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the documents make using grey literature in a scoping review often untenable.
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A cursory examination of NASA’s Open Data Portal revealed three space psychology
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documents that could have been included in this review [98-100]. A brief review of these
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documents found that the findings reported within them do not contradict any of the other
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findings reported throughout this document. Accordingly, although including grey literature in
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this scoping review may have added additional support to different findings, they likely would
not have changed the conclusions or summaries in a meaningful way. While including grey
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literature is beyond the scope of this review, future researchers should consider reviewing these
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types of documents for their own work.
4.18 Scoping review limitations
This scoping review was limited to peer-reviewed, English language literature published
in the identified databases. As such, these limitations may have resulted in the omission of
important non-English language literature. Additionally, important literature may have been
published in non-indexed databases, though steps were taken to ensure that the databases chosen
resulted in a wide range of journals and collections being reviewed. The exclusion of grey
literature in this review may have also resulted in missed findings that could have been reported.
It is also important to note the relatively small number of manuscripts reporting original data
compared to manuscripts reviewing previously gathered data. While review manuscripts serve a
very important purpose, there is a clear need to increase the amount of publicly available data
being reported in original manuscripts. Similarly, with a small number of authors publishing a
large number of manuscripts, it is imperative that steps be taken to have new perspectives in the
space psychology field from new researchers. Additionally, because this scoping review was
limited to published manuscripts, there is a risk of these findings being skewed by a publication
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bias of only significant results. However, it is important to note that many of the published
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manuscripts included in this review reported non-significant results.
4.19 Future research goals

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What follows is a brief list, but not all-inclusive, of the key areas of opportunity for future
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researchers who are interested in filling the gaps in our understanding of space psychology and
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addressing under-investigated questions.
• The development of a standardized battery of questionnaires and assessments that can be

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used for tracking mood, emotions, thinking patterns, and other psychological phenomena
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during spaceflight, especially as it relates to potential DSM-5 disorders.
• The development of passive, unobtrusive measures of psychological and interpersonal
functioning in space.
• Investigations into the presence and correlates of asthenia in space.
• Investigations into the effects of sexual tension, sexual activity, and sexual deprivation on
crew cohesiveness and individual emotional functioning in a spaceflight environment.
• Investigations into the effects of delayed communication on crew health and happiness,
especially as it relates to autonomous decision making.

• The development of psychological treatments for crews far from earth, especially as it
relates to automated psychotherapy.
• Investigations into what psychological phenomena might be expected when crews are at
extreme distances from earth.
• The development of methods to help ensure and maintain the privacy of psychological
research participants while in space.
• Further research into the use of virtual reality, especially as it relates to psychological
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treatments, recreation, connectedness, and other use cases.
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• Further investigations into the effectiveness of various supportive measures.
•
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Further investigations into what environmental conditions and habitat designs are best
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suited for long duration, deep space missions.
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• Further investigations into the psychological “select-in” criteria that can be used when
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choosing personnel and crews for long duration, deep space missions.
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5 | Conclusions
This scoping review identified a range of psychiatric disorders, stressors, interventions,
and factors associated with spaceflight. This review found that there is still a number of
unanswered questions regarding space psychology that have important implications for current
and future missions to low earth orbit and deep space destinations. As such, there are substantial
areas of opportunity for current and upcoming researchers to leave their mark on this field by
expanding the current knowledgebase of space psychology.
While the findings of this scoping review are too numerous to summarize in this section,
the use of the tables provided in this manuscript can give a cursory overview to the casual reader.
Researchers are encouraged to use this review as a basis for future research. Key findings of this
review will be summarized in bullet points below.
• Key findings
o Known stressors associated with vary from physiological, psychological,
psychosocial, human factor, and habitability stressors (Table 3).
o Supportive measures for spaceflight vary from lifestyle, social, psychological,
habitat-related, and mission structure interventions (Table 4).
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o Though no psychiatric disorders have been reported in space to date, the
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psychological symptoms that have been reported vary widely (Table 5).
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o Numerous psychiatric disorders are predicted to be possible during long duration,
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deep space missions (Table 5).
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o Current psychological treatment options during spaceflight include psychotropic

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medications, crisis interventions, unspecified brief individual psychotherapy,
relaxation techniques, and an emergency return to earth (Table 6).

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o Numerous cognitive and neurobiological factors are found to change during

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spaceflight (Table 8).
o Numerous interpersonal factors can impact the health, happiness, and success of
the crew (Table 9).

References
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Highlights
• To date, no known psychiatric disorders have been reported in space, though symptoms
have
• Many psychiatric disorders are anticipated in deep space, including serious
psychopathology
• Psychological treatment options in space are currently limited
• Deep space missions will require new psychotherapy options be created
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Conflict of Interest
Logan M. Smith is the Program Manager of the Space Health Division of Shuttle, an outer space
travel company.
Author Contribution
Logan M. Smith designed the review, gathered the included articles, performed the analyses of
all articles, interpreted the data, and wrote the manuscript.
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To appear in: Acta Astronautica

Received Date: 16 April 2022

© 2022 Published by Elsevier Ltd on behalf of IAA.

In recent decades, various government bodies have devoted an increasing amount of

resources to investigations regarding the psychology of spaceflight, including the American

psychology in a spaceflight environment in a way that is easily accessible by researchers.

future research in these areas.

state of space psychology literature is warranted.

review was on peer-reviewed manuscripts, grey literature was excluded.

2.1 Stage 1: Identifying the research question

It is standard practice to use intentionally broad research questions when conducting a

implications, and all other related phenomena?

2.2 Stage 2: Identifying relevant literature

Table 1 | Search term strategy

PsycINFO search strategy (original search performed: May 2021.

2.3 Stage 3: Literature selection

would then be screened per the standard process.

2.4 Stage 4: Charting the data

findings were charted as described by the Joanna Briggs Institute [9].

2.5 Stage 5: Collating, summarizing, and reporting the results

Supplementary Materials section of this manuscript.

psychology yielded n = 13,450 initial manuscripts. The combination of manuscripts identified

reviewed manuscripts included in this scoping review is n = 68. A summary of the 68

characteristics, if any; and (6) key findings / manuscript summaries.

Figure 1 | Method Search Strategy

3.1 | Characteristics of reviewed articles

3.1.1 Years of publication

3.1.2 Sample characteristics

including: American astronauts (n = 107), Russian cosmonauts (n = 24), a European astronaut (n

control personnel (n = 20).

3.1.3 Data from astronauts in space

sleep, medication usage, and interpersonal factors.

3.1.4 Data from astronauts no longer in space

treatments, and interpersonal factors.

3.1.6 Methods of data collection

Table 2 – Manuscripts captured in scoping review

Friedman, et al., (2017). A psychiatric formulary for long-duration spaceflight.

Kanas, (2015). Psychology in deep space.

Morphew, (2001). Psychological and human factors in long duration spaceflight.

cognitive and mental health challenges.

3.2 | Type of publication

experiment, or a proposal. Many manuscripts contain elements of multiple categories (e.g., a

to the perceived intent of the author.

this scoping review.

3.2.2 Reports of original data

which is a manuscript specifically meant to propose a treatment, research endeavor, or other

group-based psychological training program [14]. A summary of this proposal is proposal is

described in the Discussion section of this review.

3.3 Bibliometric Analyses of Space Psychology Literature

3.3.1 Author Co-Author Analysis (AAA)

To better understand the state of available, peer-reviewed space psychology literature as a

whole, an Author Co-Author Analysis (AAA) was performed. An AAA is a bibliometric

shows the results of the AAA.

and shares connections with Kanas and several other authors.

who has numerous co-authorships with other clusters.

authors throughout this literature.

Identifying co-authorship clusters in the space psychology literature provides a deeper

Figure 3 | Author Co-Author Density Map

Additional bibliometric analyses of these results, including an Author-Co-Citation

section of this manuscript.

This manuscript builds on decades of previous research by creating a broad, accessible,

other disciplines. It is clear that information regarding human psychology in a spaceflight