Beven, Gary E.

Holland, Albert

Picano, James J.

Vander Ark, Stephen

English

NASA Technical Reports Server

Long Term Behavioral Health Surveillance 
of Former Astronauts at the NASA Johnson Space Center
Aerospace Medicine Association 
90th Annual Scientific Meeting
Las Vegas, NV
May, 2018
Gary Beven, MD
Albert Holland, PhD
James Picano, PhD
Steven Vander Ark, MS
https://ntrs.nasa.gov/search.jsp?R=20200001667 2020-03-28T19:13:29+00:00Z
Disclosure Information
90th Annual Scientific Meeting
I have no financial relationships to disclose.
I will not discuss off-label use and/or investigational use in my 
presentation. 
Long Term Behavioral Health Surveillance 
of Former Astronauts at the NASA Johnson Space Center
 NASA has not previously performed longitudinal assessment 
and surveillance of astronauts’ behavioral health after they 
departed the active Astronaut Corps. 
 This presentation will provide a brief summary of the 
behavioral health implementation plan for long-term 
longitudinal surveillance of former NASA astronauts at the 
Johnson Space Center. 
Long Term Behavioral Health Surveillance 
of Former Astronauts at the NASA Johnson Space Center
 The Behavioral Health and Performance Operations Group 
(BHP) at the NASA Johnson Space Center is comprised of 
aerospace psychiatrists, operational psychologists and 
behavioral health specialists that provide comprehensive 
behavioral health and performance services to astronauts 
throughout the breadth of their active astronaut career. 
 Components of BHP operations include astronaut candidate 
selection, training, mission preparation, and annual, elective, 
preflight, inflight, and postflight behavioral health assessments. 
Long Term Behavioral Health Surveillance 
of Former Astronauts at the NASA Johnson Space Center
JSC’s Behavioral Health and Performance Operations Group (BHP)
 BHP Operations is a component of the JSC Space Medicine Operations Division
 ISS mission psychological/behavioral health support (primary mission)
 Astronaut applicant psychological and psychiatric screening
 Flight analog study crew selection/screening and analog mission support
 Clinical evaluation and care of astronauts and their dependents
 Occupational mental health evaluation of NASA divers, pilots and flight controllers
 Consultants to the NASA Human Research Program
 Consultants to NASA flight surgeons, ISS crew surgeons, the Astronaut Office, and JSC 
management
 Consultants to the JSC Employee Assistance Program Office
Long Term Behavioral Health Surveillance 
of Former Astronauts at the NASA Johnson Space Center
Long Term Behavioral Health Surveillance 
of Former Astronauts at the NASA Johnson Space Center
 Multifaceted, career spanning, behavioral health program for active astronauts 
 Astronaut candidate (ASCAN) selection
 ASCAN training participation
 Annual BHP evaluations
 Preflight BHP training and evaluations
 Inflight BHP evaluations
 Inflight neurocognitive assessments
 Postflight BHP evaluations
 Elective BHP services 
 Historically, BHP has ended its service provision once an active astronaut 
leaves flight status to become a management astronaut or departs the space 
agency. 
 Therefore, a significant knowledge gap has formed over the past 60 years of 
NASA’s existence, as until now there has been no dedicated behavioral health 
evaluation of former astronauts allowing for an analysis of potential 
behavioral health occupational risks, the initial signs of which may occur later 
in life.
Long Term Behavioral Health Surveillance 
of Former Astronauts at the NASA Johnson Space Center
 Initiation of the Johnson Space Center’s behavioral health plan 
for long-term longitudinal surveillance began in late 2018
 This comprised the development of a concept of operations and 
implementation plan including NASA’s hiring of an experienced 
clinical neuropsychologist to implement the behavioral health 
evaluation elements of this plan
 A comprehensive psychological evaluation will be developed 
that will provide clear understanding of the former astronaut’s 
psychological health and wellness
Long Term Behavioral Health Surveillance 
of Former Astronauts at the NASA Johnson Space Center
 Components of this evaluation will include a diagnostic 
interview, neurocognitive assessment, and psychological 
screening measures. 
 Longitudinal surveillance for behavioral health conditions that 
include depression, anxiety, dementia, traumatic stress 
disorders, substance use, and any other behavioral health 
concerns of significance.
 The ultimate goal being the understanding of how a career as 
an astronaut, and spaceflight in particular, affects behavioral 
health and wellness until the end of life. 
Long Term Behavioral Health Surveillance 
of Former Astronauts at the NASA Johnson Space Center
 The psychologist’s responsibilities will also include:
 Provide behavioral health consultation/liaison services to 
Flight Medicine for former astronauts receiving care at JSC 
(outside of annual evaluation), including management 
astronauts
 Deliver behavioral health interventions to former astronauts 
willing to travel to JSC (as time, funding, and clinical 
capabilities may permit)
 Provide care coordination for former astronauts requiring 
behavioral health services in their home communities
Long Term Behavioral Health Surveillance 
of Former Astronauts at the NASA Johnson Space Center
 This process will assess, detect and monitor cognitive and behavioral health conditions 
in former astronauts through comprehensive evaluations at specified intervals:
 Baseline- Comprehensive behavioral health diagnostic interview and 
psychological/neurocognitive assessment upon leaving active Astronaut Corps (likely 
4+ hours of initial patient contact)
 Annual – Updated behavioral health diagnostic interview and screening measures 
and neurocognitive screening exam, depending on age or complaints, with follow-up 
as needed (likely 1.5 to 2.0 hours of patient contact)
 Periodic – Extended neuropsychological assessment (frequency based upon age and 
clinical status; likely 4+ hours of patient contact)
Long Term Behavioral Health Surveillance 
of Former Astronauts at the NASA Johnson Space Center
 Upon leaving the active astronaut corps and until age 60:
 Initial Baseline Comprehensive Evaluation: Extensive behavioral health diagnostic interview and 
psychological/neurocognitive assessment (likely 4+ hours of face to face patient contact)
 Annual Evaluation: Behavioral health diagnostic interview and screening measures (e.g., anxiety, mood, 
substance use, quality of life, sleep, psycho-social factors (e.g., marriage/family), neurocognitive screening 
exam--depending on complaints) with follow-up as needed (likely 1.5 hours of face to face patient contact)
 Age 60 to Age 75:
 Annual Evaluation
 Comprehensive evaluation every FIVE years
 Over age 75:
 Annual Evaluation 
 Comprehensive evaluation every THREE years
Long Term Behavioral Health Surveillance 
of Former Astronauts at the NASA Johnson Space Center
 Potential Behavioral Health Screening Measures (depending on age) include:
 Center for Epidemiologic Studies Depression (CES-D) 
 Symptom Checklist 90 (SCL-90R)
 Beck Anxiety Scale
 AUDIT (Alcohol Use Disorders Identification Test)
 Dementia Rating Scale-2
 Geriatric Depression Scale
Long Term Behavioral Health Surveillance 
of Former Astronauts at the NASA Johnson Space Center
 Potential Neuropsychological Baseline Battery:
 Boston Naming Test
 NAB Naming
 California Verbal Learning Test
 WAIS IV Vocabulary Test
 WAIS IV Similarities Test 
 WAIS IV Block Design Test
 WAIS IV Matrix Reasoning Test
 WAIS IV Digit Symbol Test
 NAB Digit Span Test
 WMS IV Logical Memory
 WMS IV Visual Reproduction
 Benton Visual Retention Test
 Grooved Pegboard
 Delis-Kaplan Executive Function Scales:
 Trail-Making Test
 Verbal Fluency: Category and letter naming
Long Term Behavioral Health Surveillance 
of Former Astronauts at the NASA Johnson Space Center
Long Term Behavioral Health Surveillance 
of Former Astronauts at the NASA Johnson Space Center
15
 Hypothetical case example #1 (Initial Comprehensive Evaluation)
 A  recently retired female astronaut is seen by BHP for her initial 
evaluation as part of her annual medical evaluation in the JSC Flight 
Medicine Clinic. 
 She is veteran of two Space Shuttle flights and one ISS long duration 
expedition for a total of 212 days in space including 5 EVAs. She 
currently works for a NASA contractor in the commercial space 
industry. She is happily married with children in college. She recently 
turned 60, has no major health problems and no significant medical or 
behavioral health complaints. 
Long Term Behavioral Health Surveillance 
of Former Astronauts at the NASA Johnson Space Center
16
 An initial BHP Comprehensive Evaluation is performed: 
 Neuropsychological assessment including 1.5 hour clinical 
interview and approximately 2.5 hours of neuropsychological tests. 
This serves as a baseline for all future evaluations.
 Neuropsychological Assessment: Core evaluation comprising 
measures of executive functioning (e.g., attention, working 
memory, abstract reasoning), verbal and non-verbal memory, 
spatial analytic processing, naming and verbal fluency. 
 Baseline clinical interview – comprehensive psychosocial interview 
with additional screening measures for anxiety, depression, 
substance use, quality of life, and sleep.
Long Term Behavioral Health Surveillance 
of Former Astronauts at the NASA Johnson Space Center
17
 Hypothetical case #2 (annual behavioral health assessment)
 A 73-year-old male former astronaut is seen by BHP for his third 
annual behavioral health assessment. He flew on four Space Shuttle 
flights for a total of 38 days in space with 6 EVAs before leaving NASA 
to return to his alma mater to teach aerospace engineering. He retired 
from that academic position three years ago. He has mild 
hypertension and hyperlipidemia which is controlled with medication, 
but is otherwise healthy and fit. 
 BHP Annual Evaluation: An update to his existing comprehensive 
psychosocial interview occurs to track changes in his life over the 
period since his last evaluation, with additional screening measures for 
anxiety, depression developed for older adults (e.g., Geriatric 
Depression Scale), and a brief screening of cognitive functioning due 
to age.
Long Term Behavioral Health Surveillance 
of Former Astronauts at the NASA Johnson Space Center
18
 The evaluation reveals he has been depressed since the death of his 
wife 11 months ago. His family physician placed him on an anti-
depressant medication approximately 3 months ago, with only partial 
benefit. He continues to experience significant symptoms of depression  
(including positive result on GDS) but denies suicidal ideation or intent. 
 The psychologist provided him with education about grief and 
depression, assisted him in finding a behavioral health provider in his 
home community for more intensive treatment, later conferred with that 
local provider, and provided details of the evaluation performed in 
Houston. 
 The former astronaut continues to be seen annually for behavioral 
health evaluation in Houston. 


Long Term Behavioral Health Surveillance of Former Astronauts at the NASA Johnson Space Center

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