Studying the Health and Performance of Shipboard Sailors: An Evidence Map
Authors: Schmied Emily A , Martin Robyn M , Harrison Elizabeth M , Perez Vanessa G , Thomsen Cynthia J 
Published: December 2020

ABSTRACT

Introduction
It is estimated that sailors who are assigned to surface ships and submarines are deployed for more than 1 year across their careers and they spend 15% to 23% of their time away from home. Research suggests that shipboard sailors experience rates of behavioral health issues similar to those with ground combat experiences. Despite the rigorous operational tempo and the unique shipboard environment experienced by these service members, little military health research has examined the health outcomes of sailors serving aboard ships. The objectives of this study were to develop an evidence map of the peer-reviewed literature to (1) identify potential threats to the health and readiness of shipboard sailors, (2) identify health and performance issues experienced by this population, and (3) identify gaps in the current peer-reviewed published literature on shipboard health and performance.

Materials and Methods
A systematic review of the existing peer-reviewed literature pertaining to the health, experiences, and performance of shipboard service members was conducted. Comprehensive search terms were used to identify articles published between January 2000 and April 2018. Identified articles were subject to a two-level review process. Study characteristics for all articles selected for final review were extracted, and articles were categorized into 13 content areas that were selected a priori. Findings are presented in an evidence map.

Results
The initial literature search yielded 8,858 unique articles, 90 of which were eligible for full review. Most articles primarily examined active duty sailors from the U.S. or other foreign militaries (88.9%). A total of 60 articles (67.8%) included information about the type of ship studied; the most frequently examined were submarines (29.5%) and aircraft carriers (27.9%). Most of the included studies used cross-sectional (63.3%) or longitudinal (24.4%) designs. Only 7.8% (n = 7) of articles described interventions. The most commonly examined focal areas included physical health issues, such as viral infections and injuries (56.7%), and health behaviors, such as substance use/misuse (40.0%). Other frequently addressed content areas were occupational stress (38.9%), interpersonal issues (32.2%), ship conditions (30.0%), and mental health (28.9%). Most articles (73.3%) addressed more than one content area. There was a high degree of variation in the measurement tools used; self-report surveys were the most common (48.9%), followed by objective physical, biological, or cognitive measures (32.2%) and medical and personnel record reviews (31.1%).

Conclusions
The evidence map identified various gaps in the research pertaining to the health and performance of shipboard sailors. These gaps included a lack of research on the risk factors for common health and performance issues experienced by sailors and on the relationship between stressors of shipboard life and sailors’ health, performance, and readiness. The results of this evidence map should be used to inform the development, implementation, and evaluation of interventions to improve the shipboard environment and/or the preventive health behaviors used by sailors while underway or deployed.