Given the extended duration of future missions and the isolated, confined and extreme environments, there is a possibility that (a) adverse cognitive or behavioral conditions will occur affecting crew health and performance; and (b) mental disorders could develop should adverse behavioral conditions be undetected and unmitigated.

Acute or chronic conditions during spaceflight may lead to the development of a psychiatric disorder. The Diagnostic and Statistical Manual of Mental Disorders (DSM), defines a mental disorder as: "A syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning."

The risk mitigation strategy of the Human Factors and Behavioral Health (HFBP) Element follows the larger strategy of the HRP “from Evidence to Deliverables” principle, with the involvement of Medical and Mission Operations to help determine the mitigations that are relevant for current and future spaceflight. Specific tasks are defined to address the gaps and provide clear, specific deliverables for long duration spaceflight, ensuring an evidence and operationally-based end item. Based on scientific and operational evidence, HFBP systematically identifies the appropriate platform (e.g., laboratory, ground analog) to address the gaps prior to validating in spaceflight. To ensure relevancy, stakeholders are engaged in the process from the beginning. Evidence gathered from HFBP research characterizes Risk, informs Operations and Standards, and yields countermeasures for performance and behavioral health.

HFBP research addresses the risk of adverse behavioral conditions and psychiatric disorders developing during or following a long duration mission. Early detection of stress or other risk factors during spaceflight is imperative to deter development of behavioral or psychiatric conditions which could seriously harm and negatively impact the individual or the crew, and pose serious consequences for accomplishing mission objectives or jeopardizing the mission altogether. Toward this end, HFBP is developing methods for monitoring behavioral health during a long duration exploration mission, and adapting/refining various tools and technologies for use in the spaceflight environment. These measures and tools will be used to monitor, detect and treat early risk factors. BHP will utilize analogs to test, further refine, and validate these measures for future missions. HFBP also develops countermeasures for maintaining behavioral health and enhancing performance during long duration isolated, confined, and highly autonomous missions; provides recommendations regarding space medicine best practices; and, provides updates for behavioral health and performance standards.

Integrated Research Approach

Spaceflight stressors are experienced simultaneously, thus behavioral changes can be induced by many spaceflight factors. To that end, HFBP developed a fully integrated research plan to address three high-priority risk factors impacting crew health and performance and are believed to be synergistically related: space radiation, isolation and microgravity exposure on long-duration missions. Thus, the following three risks were combined into an integrated approach referred to as the CNS/BMed/Sensorimotor (CBS) Integrated Research Plan:

• Risk of Acute (In-flight) and Late Central Nervous System Effects from Radiation Exposure (CNS);
• Risk of Adverse Cognitive or Behavioral Conditions and Psychiatric Disorders (BMed);
• Risk of Impaired Control of Spacecraft/Associated Systems and Decreased Mobility Due to Vestibular/Sensorimotor Alterations Associated with Spaceflight (SM)

The BMed risk has been designated as the "parent risk" for the CBS Integrated Research Plan. Gaps and supporting research tasks from BMed, CNS and SM that contribute to this plan, are identified by "CBS" in the gap number and task short title.

NASA seeks to accelerate research advances and scientific progress with this integrated research approach to assess and characterize the combined effects of spaceflight hazards related to crew health and performance. Since spaceflight hazards impinge and act upon the human system (the crew), there is an increasing recognition of the importance of characterizing the risks in a completely integrated manner with transdisciplinary expertise. With long-duration crew exposed to multiple risks, NASA is seeking research to understand, analyze and quantify the risk from simultaneous exposure to multiple space flight environmental factors potentially impacting crew health and performance. For example, given that the behavioral medicine (BMed) risk focuses on changes to cognitive functioning, there is a need to characterize the potential interactive or synergistic risk (cf., Greco et al., 1995) to crew health and performance when isolated and confined while simultaneously exposed to space radiation. The potential impact of inflight CNS alterations and sensorimotor (SM) adaptations that may alter brain structure and function must also be understood (Koppelsmans et al., 2017; Mao et al., 2016; Pulga, Porte, Morel, 2016).

Evidence indicates that many spaceflight stressors, including altered gravity, sleep loss, radiation exposure, and isolation and confinement, may all lead to dysregulation of the brain's structure and microenvironment, leading to imbalanced function of neuronal and glial networks and the neurovascular unit (Cassady et al., 2016; Van Ombergen et al., 2017). The magnitude of physical and biological stressors will vary by mission phases but will simultaneously, perhaps synergistically, and cumulatively act on the human system with the potential to adversely impact operationally-relevant crew performance. This suggests the need to identify the types and magnitude of interactions as they affect behavior, especially as it relates to operationally significant performance (e.g., performance that depends on reaction time, and procedural memory).

Complementing behavioral performance measures, this CBS Integrated Research Plan identifies a need to assess brain physiology, neurovascular unit integrity, molecular signaling, and biomarker changes, in order to generate data sets that can be incorporated into computational models (see e.g., Muldoon et al., 2016) to represent and predict changes in operationally-relevant "brain performance pathways". HFBP's conceptualization of Brain Performance Pathways (BPP) is based on how the architecture of brain networks at rest guide the connectivity patterns that emerge during the performance of various tasks (i.e. modularity measured during "resting states" predicts working memory performance and stimulus detection in a perceptual task) (see e.g., Bassett et al., 2011; Cassady et al., 2016; Dosenbach et al., 2007; Fair et al., 2009; Fox et al., 2007; Meunier et al., 2009; van den Heuvel et al., 2009). Relating this finding to operationally-relevant performance is research evidence that demonstrates those scoring higher on IQ tests show smaller functional connectivity changes between "resting state" and "task performance states" (suggesting more efficient adaptation to task demands). Thus, specific impacts on brain focal regions (see e.g., Boes et al., 2015) are important for us to understand since cortical organization reveals a "between-module connectivity" that when disrupted, is associated with widespread cognitive dysfunction (and spaceflight is associated with activating a cortical re-organization, see e.g., Demertzi et al., 2016; and in simulated mic