Psychological adaptation of Indian expeditioners during prolonged residence in Antarctica.

BACKGROUND: In view of the growing human activities in Antarctica and increasing exposure of humans to prolonged isolation under extreme conditions, such as space travel and deep sea diving, it is necessary to study the psychological adaptation to such an environment. The current study aimed to assess the psychological adaptation of Indian expeditioners to prolonged residence in Antarctica.
MATERIALS AND METHODS: Twenty-four winter team members of 27th Indian Scientific Expedition to Antarctica were administered seven instruments 5 times during the expedition. The instruments measured cognition and memory, general psychological health and tobacco, and alcohol consumption.
RESULTS: Alcohol consumption was maximum during the initial days of arrival on the continent and decreased thereafter, with another spike during the peak of the winter season. Externalized psychological reactions peaked during the midwinter period. Anxiety and insomnia peaked during the coldest period whereas depressive symptoms did not change throughout the expedition. Cognition was at its worst during the final phase of Antarctic residence. No significant change was noted in the third quarter of wintering.
CONCLUSION: Each phase of Antarctic residence could be equated with a particular stage in psychological adaptation. There was no third quarter phenomenon.

INTRODUCTION

Human activities in Antarctica are governed by the Antarctic treaty and are limited to scientific research for peaceful purposes as directed by the Antarctic treaty. Human population predominantly consists of scientists and support staff. Currently, there are 104 Antarctic facilities, temporary and permanent, belonging to various National Antarctic programs.[1] Prolonged residence in Antarctica offers unique challenges to the personnel residing on the continent. In view of the increasing human activities in Antarctica, the health aspect of prolonged residence needs to be examined in greater detail. Scientific literature on the subject has evolved from a collection of anecdotal, unsubstantiated accounts from personal diaries of early explorers to numerous reliable, scientific, and well-documented research articles. Such scientific information is helpful not only for formulating improved screening procedures for Antarctic expeditioners but also for personnel exposed to similar conditions, such as space explorers and deep sea divers.[234] Such studies would also help in ameliorating adverse impact of prolonged isolation in adverse conditions.

The chief stress factors on the continent are psychological, rather than the physical conditions. Prolonged residence in small, isolated communities, prolonged periods of darkness and daylight, lack of outdoor activities, and prolonged periods of underemployment alternating with high workload are the chief stress factors influencing the well-being of the expeditioners.[5] Most of the psychological disorders are mild and do not need clinical intervention. However, they are known to affect group harmony. Salutogenic effects of Antarctic residence are now thought to exceed negative effects as evidenced by the increasing numbers of returning expeditioners.[26]

The psychological symptoms experienced by Antarctic expeditioners can be broadly classified into somatic symptoms, sleep disorders, impaired cognition, negative affect, and interpersonal conflict.[7] The psychological reactions to winter residence in Antarctica represent an adaptive process that occurs in stages. Available literature suggests that the winter expeditioners experience heightened anxiety levels for the first 2 months of arrival on the continent, representing fear of the long winter, and isolation. This is followed by the depression from March to midwinter when the team members settle down to a routine following departure of the summer team. The period just after the midwinter is when the expeditioners tend to become agitated and aggressive. This most critical phase is known as the third quarter phenomenon. During the final phase of Antarctic residence, the anxiety and tension levels are heightened in response to the anxiety of returning home, disruption of station routine due to influx of new personnel, and period of high workload.[3689] The symptoms have also been called the winter over syndrome. The symptoms included depression, irritability and hostility, insomnia, and cognitive impairment, including difficulty in concentration and the occurrence of mild fugue states known Antarctic stare.[21011]

Most of the available literature derives from the experiences of the Western countries. Literature on psychological issues encountered by Indian expeditioners is scarce. The Indian experience is important to understand the effect of cultural variations which might impact the psychological adaption process on the icy continent. In a multinational study, Indians reported decreased anger during the winter.[12] One important study suggested that the Indian expeditioners conformed to the established patterns of psychological adaptation described above.[6]

It was necessary to conduct such studies on the Indian subjects shall also provide a cultural variable to the predominantly Western literature on the subject. In addition, since the Indian wintering team is selected after an exhaustive medical and psychological checkup, it was interesting to explore the psychological aspects of an otherwise psychologically fit individual in response to such an environment. The current study aimed to longitudinally assess the psychological adaption of Indian winter team members in Antarctica. The study assesses the changes in psychological health and cognitive functioning in the expeditioners.

MATERIALS AND METHODS

Study design and setting

This study was carried out as an observational cohort study on 24 members of the winter team of the 27th Indian Scientific Expedition to Antarctica (ISEA) from November–December 2007 to November 2008. The two medical officers of the expedition were excluded from the study since they were involved in data collection. There were 26 members in the winter team of 27th ISEA. The study period covered the duration from the induction of the 1st batch of the team members from India in 1st week of November 2007 by air, till the beginning of deinduction of the expedition team in November 2008. The last batch of the team members was inducted by sea in January 2008. Out of 24 subjects, 17 were inducted by air in November 2007 along with the principal investigator (SKK), the remaining seven were inducted by sea in January 2008 along with one of the coinvestigators (AB). The physical isolation of 27th ISEA started in March 2008, following departure of the expedition vessel and cessation of flights, and ended 8 months later in November 2008 with restarting of flights. The team members were all volunteers selected by an interview followed by detailed medical and psychological examination and comprised scientific and logistics staff. The study was carried out on board the expedition vessel, MV Emerald Sea, and at the Indian Antarctic station, Maitri.

Maitri is located at 70°45'S; 11°44'E on a 17 × 3 km2 area of exposed rock called Schirmacher Oasis about 100 km inland from the Princess Astrid coast of East Antarctica at an altitude of about 100 m above sea level. It lies sandwiched between an ice shelf toward the north and the continental ice cap toward the south. Temperatures range from roughly +5°C in summer to −35°C in winter. Average annual temperature is −11°C. Wind speeds regularly touch 100 km/h, with an increased frequency during the winter season. High-speed winds frequently cause blizzards. The nearest station is Novolazarevskaya located 10 km away. The station is accessible by air and sea only during the limited summer season lasting from November to February. The station is physically cutoff during the remaining 8 months.[13] Polar day (period of 24 h sunlight) and polar night (period of 24 h absence of sunlight) last for 2 months each, from November to January and May to July, respectively. The station can support 25 personnel during the winter and roughly 40 during summer. It is constructed of wood and asbestos and is supported on stilts. Maitri is centrally heated, with facilities for round the clock running hot and cold water and electricity.[14] The toilet complex is within the station complex and consists of dry, electrically operated toilets. Regular Indian meals are served to the team members. Vegetarian as well as nonvegetarian food is served, along with adequate quantity of snack food. Fresh fruits and vegetables, however, are not available due to logistics reasons. Alcohol is also served in controlled amounts. Communication facility during the 27th ISEA consisted of limited talk time through satellite phone and a limited email facility through a common mailbox. Full internet facility was not available. Currently, full web browsing and television telecast are available at Maitri. Recreation facilities consist of a wide range of indoor sports and well-stocked video/audio/book libraries. Outdoor activities are limited to station maintenance activities during the winter.[131415]

Instruments used

A battery of seven instruments was administered to the participants during the study:

PGI memory scale:[1617] This was developed as a short, simple, objective, and valid test of memory and cognitive function. It is administered in Hindi and has been designed for use by the Indian population. The instrument consists of 10 subsets, out of which eight have been used in the current study. These include remote memory, recent memory, mental balance, attention and concentration, delayed recall, immediate recall, verbal retention for similar pair, and verbal retention for the dissimilar pair. Visual retention and recognition were not included in our study because of logistical issues in a remote location

The PGI memory scale has a test retest reliability over a period of 1 week from 0.69 to 0.85 and for the total test about 0.90 (test-retest and split-half)[18]

General health questionnaire (GHQ) (28 item Hindi version):[19] The 28-item version of the GHQ was designed primarily for research purposes and is also useful as a measure of psychological well-being. It consists of four subscales: somatic symptoms (GHQ1), anxiety and insomnia (GHQ2), social dysfunction (GHQ3), and severe depression (GHQ4). Compared to the other versions of GHQ, the 28-item version has the advantage that analysis can be performed within each of the four subscales

Hindi mental scale examination (HMSE):[20] This is the Hindi version of the mini-mental scale examination modified to enable universal administration to literate as well as illiterate individuals. This scale measures cognitive functioning and can be used to screen for dementia. The scale has eleven subscales: Orientation to time, orientation to place, registration, attention, recall, naming, repetition, visual command, three step tasks, sentence, and copying a figure. All the subscales have been included in the current study

Well-being scale (WBS): A 5-point Lichert type WBS was used for self-assessment of motivation, confidence, efficiency, energy level, and mood. The parameters were measured on a scale of 1–10

Fagerstorm test for nicotine dependence (FTND):[21] This is a standard instrument used to assess the degree of tobacco addiction. The instrument consists of six questions, each of which has graded responses. A higher score indicates greater nicotine dependence. The Cronbach's alpha coefficient for FTND is reported as 0.86[22]

Alcohol use disorder identification test (AUDIT):[23] This is an instrument designed by the World Health Organization to identify individuals with harmful and hazardous alcohol consumption pattern. The AUDIT consists of ten standardized questions with graded responses. Higher scores indicate higher alcohol dependence. The reliability of AUDIT questionnaire has been reported to be 0.70 or higher in diverse population settings[24]

CAGE questionnaire:[25] This is a brief, four-item instrument used for screening for alcoholism. A greater number of responses in the affirmative indicate greater alcohol dependence. The sensitivity and specificity for CAGE questionnaire has been documented as 93.8% and 85.5%, respectively.[26]

Data collection procedure

All subjects were assured of complete confidentiality and were explained in detailed about the purpose of the study before consent was taken. The questionnaires were first administered immediately after reaching Antarctica (November 2007) in case of individuals being inducted by air. Participants being inducted by sea were first administered the questionnaires onboard the expedition vessel in December 2007. The questionnaires were subsequently administered in April 2008, June 2008, August 2008 and November 2008 at an interval of 2 months at Maitri. The five spells of data collection coincided with arrival on the continent/baseline reading (November/December 2007), beginning of the winter/initial phase of isolation (April 2008), midwinter (June 2008), peak winter (August 2008), and last phase of Antarctic residence (November 2008). The data for the summer team were thus collected five times, corresponding with the baseline reading, beginning of the winter, peak of the winter, third quarter of the wintering period, and beginning of summer season in Antarctica.

Statistical analysis

The data for the various spells were compared and analyzed for statistical significance using nonparametric Friedman test. The change in each parameter was considered significant if P < 0.05. Each of the subscales for the GHQ was analyzed separately. For the rest of the instruments, the total score was considered for analysis.

RESULTS

A total of 24 winter team members were included in the study. Two subjects were unable to participate in the November 2008 spell. All the subjects were male with the oldest subject being 59 years of age and the youngest 27 years (mean 44.16 ± 9.34 years). All subjects were literate [Figure 1].

Figure 1

(a-d) The error plot for five periods of assessments for general health questionnaire 1 (ghq1); GHQ2 (ghq2), GHQ3 (ghq3), and GHQ4 (ghq4). The period of assessments are November–December 2007 (nd07); April 2008 (ap08); June 2008 (jun08); August 2008 (aug08); and November 2008 (nov08)

The nonparametric Friedman Test revealed that some trend was observed in almost all the scales. Most of the parameters were low initially, then gradually increased and finally recorded a drop [Figure 2]. The mean ranks of total scores of GHQ1, GHQ2, and HMSE were statistically significant across different time points. Those of GHQ3 and AUDIT were marginally significant. The rest of the parameters did not vary significantly during the expedition.

Figure 2

(a-e) The error plot for five period of assessments for Fagerstorm test for nicotine dependence (ftnd), CAGE (cage), alcohol use disorder identification test (audit), Hindi mental scale examination (hmse), PGI memory scale (pgi), and well-being scale (wbs). The period of assessments is November–December 2007 (nd07); April 2008 (ap08); June 2008 (jun08); August 2008 (aug08); and November 2008 (nov08)

DISCUSSION

Wintering over in Antarctica is a challenge of a high order. The study of the psychological adaptive processes to prolonged residence under unique conditions as are prevalent there provides invaluable insights. A multitude of similar studies from Antarctic stations from various countries in a variety of geographical locations can provide invaluable information about the psychological impact of prolonged residence on the continent.

The scores of somatic symptoms and social dysfunction subscales of GHQ peaked during the June 2008 spell followed by a decline. This coincided with the midwinter period. Somatic symptoms score finally reduced to settle above the baseline observation (November/December 2008), whereas social dysfunction score declined to below the baseline level. Insomnia and anxiety peaked during the August 2008 spell, which coincided with the period just after the polar night and is the coldest and windiest at Maitri. Somatic symptoms and social dysfunction are externalized reactions whereas Insomnia and anxiety might be considered as internalized reactions.[5] The above results show that the internalized reactions were maximum in a later spell than the more visible externalized reactions. Severe depression did not change significantly probably because the winter activities were planned well in advance and kept most of the team members reasonably occupied. The team members picked up new skills during this period. A study on French expeditioners reported increased thymic reactions, decreased social reactions and stabilized somatic reactions during the expedition. On the other hand, Rohrer suggested early on that anxiety is the dominant emotion at the start of the expedition, followed by depression along with somatic symptoms. Insomnia dominates during the subsequent part of the expedition, while toward the end of the expedition, the expeditioners may become agitated.[5] Still other researchers have suggested a different sequence of psychological reactions.[627]

Cognition, including memory was assessed by the PGI memory scale and HMSE. The PGI memory scale scores did not change significantly during the course of the expedition whereas the HMSE scores changed significantly. However, it was observed that the HMSE score fell sharply only during the November 2008 spell. Thus, the changes in cognition cannot be deemed to be conclusive. The previous studies have shown variable results. Some reported impairment in various variables of cognition, others reported no change, and still, others reported improvements in cognition following wintering over in Antarctica. Fatigue of prolonged isolation under extreme conditions and deprivation of environmental stimuli might be responsible for such behavioral changes.[579] Cognitive impairment, memory impairment, and depression have been observed to be interrelated.[11]

Out of the two instruments used for measuring alcohol dependence, CAGE scores did not change significantly, whereas the AUDIT score was highest on arrival on the continent and then decreased with a lesser peak during the Aug 2008 spell. Alcohol consumption decreased during the expedition because although alcohol is made available in ISEA in adequate quantities, its distribution is restricted by the expedition leader and is served in limited amounts. Some team members do carry a limited personal stock of liquor. The previous team may have had some left over liquor from its allocated quota. It is also possible that as this extra stock got depleted, the consumption might have decreased. These aspects might have possibly played some role, but are difficult to control in such studies. Alcohol is served as a leisure activity and to promote social interaction in ISEA. However, irresponsible drinking, which might be precipitated under stressful conditions on the continent coupled with underemployment, might impede team performance, and well-being.[728] Findings also differ across countries due to varying environmental, cultural and demographic factors. The previous studies have reported variable patterns of alcohol consumption.[629]

Tobacco consumption did not show any significant seasonal variation during the study as measured by FTND. In 27th ISEA, tobacco consumption was in the form of smoking (cigarettes and beedis) and chewing. Smoking is not encouraged in ISEA and is permitted only in designated areas of the station because of the fire hazard. Tobacco is not available in ISEA, and subjects may have some personal stocks. The Indian study by Bhargava et al. reported a gradual decrease in smoking, with a sudden spike toward the end of the expedition. They attributed this observation to increased anxiety levels toward beginning and end of the wintering period.[6] However, in the current study, though anxiety levels showed significant variation (GHQ2), tobacco consumption did not. Excessive smoking and alcohol consumption represent manifestations of underlying psychological reactions. However, these were not found to manifest in 27th ISEA, perhaps partly due to limited availability.

It can be surmised from the above discussion that alcohol consumption was maximum during the initial days of arrival on the continent and decreased thereafter, with another spike during the peak of the winter season. Externalized psychological reactions (somatic symptoms and social dysfunction) peaked during the midwinter period. Internalized psychological reactions showed variable results: anxiety and insomnia peaked during the coldest period, whereas depressive symptoms did not change throughout the expedition. Cognition was at its worst during the final phase of Antarctic residence. Thus, each phase of Antarctic residence had its own set of psychological reactions. The predominance of psychological reactions during the third quarter of the isolation period (coinciding with the peak of the winter in the months of July and August) as observed by earlier authors was not validated by this study findings. There are now an increasing number of studies disputing the third quarter phenomenon.[2]

The study provides information on psychological health of a unique sample of individuals, who were otherwise rigoursly screened but stayed for prolonged periods in difficult, isolated terrian. Studies of this kind have significant implications for future expeditions to farther areas on earth and beyond, including space flights.[30] The study included multiple, serial assessments for psychological ill-health, including screening for both psychological ill health and substance use using well accepted and standard tools. The study suffers from some limitations such as relatively small sample and the possible influence of environmental issues (limited availability) on alcohol and tobacco consumption. Further, while the current study focused on negative consequences, the effects can also be in the form of salutogenesis, that is, a sense of positive growth and meaning in one's life which need to be studied too.

With increasing number of Antarctic stations, multicentric studies are now possible. Long-term study at the same station can also be carried out though may not be on the same set of subjects. The data thus generated is more likely to present a true representation of the enigma of prolonged isolation in extreme conditions. With the operationalization of its third Antarctic station, Bharti, researchers from India are also in a position to conduct multicentric and longer term studies on psychological and psychiatric aspects of prolonged stay at Antarctica and similar environs. It will also be important to accordingly develop and test strategies which may maximize the performance in the extreme environments.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.