Studying the Health and Performance of Shipboard Sailors: An Evidence Map

The association of multi-system conditions on mental health trajectories during naval deployment

This study seeks to enhance understanding of mental health trajectories across Navy deployments and the predictors of those trajectories by exploring a range of job design and individual-level factors. Personnel from the Royal Australian Navy were surveyed on pre-deployment, mid-deployment, and post-deployment. At pre-deployment, there were 559 (Mage = 30.19; male = 75.5%) survey responses, N = 112 survey responses could be linked at all time points (retention rate of 20.04% across all time points), and 314 personnel (56.2%) responded at least twice. Latent class growth analyses and growth mixture models were used to determine the trajectories that best fit the data. Separate models were developed for each of the mental health outcomes studied (i.e. psychological distress, perceived resilience, and perceived stress), plus a latent outcome representing a summary measure of psychological ill-health. This latent outcome, estimated as the most comprehensive assessment approach, was used to evaluate all 33 predictors. Consistent with previous work, we identified between two and four trajectories reflecting resilient/low symptom trajectories and heterogeneous symptom trajectories. There were a greater proportion of personnel in the heterogeneous symptom trajectories than identified in previous research. A key contribution of this work is the thorough comparison and ranking of factors that influence the deployment experience. We emphasize the importance of role demands and resources in determining these trajectories when compared directly to self-regulation strategies. Study findings highlight important implications for job design for military personnel during deployment and underscore the importance of adopting a holistic system approach to well-being.

A qualitative investigation of demands, resources and self-regulation during Navy deployment

Creating a sustainable workplace for Navy personnel is vital for their wellbeing and retention. This qualitative study explores the interplay between job and personal demands, resources, and stress self-regulation strategies affecting psychological strain among Navy personnel during deployment. We conducted semi-structured key informant interviews with 25 Navy personnel (68% male) to determine the demands and resources at sea that affect psychological strain. The findings identified that individual differences in coping strategies (e.g., recovery management), abilities (i.e. ability to make social connections), and their mind-set about deployment (e.g., sense of purpose) were perceived to play a role in the experience of strain. Additionally, the presence of supportive peers and leaders was identified as a key resource, whereas external stressors (e.g., family crisis) and social tension onboard, amplified by confined spaces, were commonly reported demands. Our findings also contribute to a growing body of research suggesting a nuanced interaction between individual coping strategies and job design. Formal organizational support was identified as enabling adaptive self-regulation strategies, while the capacity to form and maintain positive relationships helped foster a sense of belonging, countering isolation. Another key contribution was the individual differences in the appraisal of resources offered by the organization and the potential importance of resource appraisal in how effective resources were perceived to be for addressing shipboard demands. We provide recommendations relating to targets for personnel training, interventions, and leadership in terms of communication, supporting day-to-day and equal opportunity for recovery, resource access, maintaining morale, and shaping the evaluation of demands.

Effect of cyclic meditation on anxiety and sleep quality in sailors on merchant ships-A quasi-experimental study

Background

Sailors undergo anxiety and sleep disturbances due to prolonged journeys and the nature of their work on ships. Earlier studies indicate Cyclic Meditation (CM) being beneficial for managing anxiety and improving sleep quality. Thus, the current study was designed to investigate the effect of CM on anxiety and sleep quality among sailors.

Materials and methods

Fifty sailors were assigned to experimental (n = 25) and control (n = 25) groups. The experimental group received 45 min of CM, 7 days a week for 3 weeks. Control group continued with their routine activities and were offered CM practice the following 3 weeks. Hamilton Anxiety Scale for anxiety (HAM-A) and the Pittsburg Sleep Quality Index (PSQI) for sleep along with blood pressure and pulse rate were taken at baseline and by the end of 3 weeks. Data were analyzed using Repeated Measures Analysis of Variance (RM ANOVA) for within and between group effects.

Results

Significant differences were found between the groups following 3 weeks for all the variables. Experimental group demonstrated reduced anxiety (p < 0.001) and improved sleep (p < 0.001) along with improvements in blood pressure and pulse rate. The control group did not show any significant changes following 3 weeks.

Conclusion

CM could be incorporated as a routine for sailors to manage their anxiety and improve sleep quality during the period on board ships.

Health Conditions Among Navy Submariners at the End of Active Duty; A Retrospective Cohort Study

INTRODUCTION

Maintaining healthy, well-trained, and highly qualified armed forces is critical for ensuring military readiness. The purpose of this article is to contribute to the body of research focused on the health of U.S. Navy submariners and to identify the health conditions of U.S. Navy submariners during their final year of active duty service.

MATERIALS AND METHODS

In this retrospective cohort study, we examined medical records and personnel files of separating U.S. Navy sailors who were: (1) active duty between 2009 and 2018; (2) separated before 2019; and (3) were assigned to a submarine for at least 30 days. Both officers and enlisted service members were included. We linked, described, and analyzed data from the Defense Health Agency, Military Health System Data Repository (MDR), and the Bureau of Naval Personnel (BUPERS). International Classification of Diseases (ICD) diagnoses codes were obtained from MDR. Data collected from BUPERS include age, sex, and rank. We determined the number of individuals who had at least one diagnosed condition (identified as a three-digit ICD code). We report the number of diagnoses and calculate prevalence rates and confidence intervals per condition, as well as prevalence rates per year, using standard formulas. The study was approved by the Naval Submarine Medical Research Laboratory Institutional Review Board.

RESULTS

During the study period, 26,014 submariners separated from the Navy. The average number of separations per year was 2,601. About a third of the separating submariners were in the 25 to 29 age group and over 50% were under 30 years of age. Of the three-digit individual ICD codes, some of the highest operationally relevant rates over the 10-year study period (2009-2018) were for joint disorders (prevalence rate [PR] = 180 per 1,000 submariners), back disorders (PR = 128), and sleep disorders (PR = 134). Three mental-health-related conditions were also among the 20 conditions with the highest rates.

CONCLUSIONS

High rates of specific diagnoses such as joint disorders indicate the need for additional study to examine causal relationships, to determine which conditions may contribute to lost work time, early separations, or low rates of reenlistment and which conditions might be a result of specific military occupations or duties. Study strengths are the large number of subjects and the long period of observations. A study weakness was the inability to identify submariners who separated because of health conditions. The overall impact of the study is that it identifies urgent health risks and establishes a way to prioritize future research. Future research should include a focus on medically separated personnel; compare rates for submariners to other military groups including all-Navy and all-Department of Defense; and determine specific and relative risks as a necessary precursor to developing, implementing, and testing risk reduction and health improvement interventions.

The Development, Implementation, and Feasibility of a Circadian, Light, and Sleep Skills Program for Shipboard Military Personnel (CLASS-SM)

Service members face unique barriers to sufficient and high quality sleep. In the present study, a circadian, light, and sleep skills program for shipboard military personnel (CLASS-SM) was designed to encourage and inform strategies that support optimal sleep and circadian health in the context of those barriers. Phase 1 included program development and refinement via an iterative formative evaluation, including structured interviews with service members and feedback from veterans and experts, resulting in further tailoring to the population. In Phase 2, the highly tailored program was administered to shipboard personnel (n = 55), and acceptability indicators were measured. Sleep- and circadian-related knowledge (pre- and post-program) and the perceived relevance of, and satisfaction with, program content (post-program) were assessed. Before the intervention, most individuals were unaware that 7−9 h of sleep is recommended (72%) and had little understanding of the physiological effects of light; however, knowledge scores increased significantly post-program, from 51% to 88% correct (p < 0.0001). Reception was positive, with high reported satisfaction and relevance. Most individuals reported that they learned something new (89%), planned to use one or more learned strategies (100%), and intended to share learned information with others (85%); the physiological effects of light and circadian rhythms were the content areas most frequently reported as new and useful. The results demonstrate the need for, and feasibility of, the delivery of this program in operational environments.