Liu YQ, Sun JL, Jing M, Liu GX, Shi J, Zhu XW, Wang F, Ye MH. Effects of positive psychological control intervention on sleep and psychology of officers and soldiers working at sea. World J Psychiatry 2024; 14(10): 1538-1546 [PMID: 39474390 DOI: 10.5498/wjp.v14.i10.1538]
Corresponding Author of This Article
Mei-Hua Ye, MBBS, Chief Nurse, Department of Emergency Medicine, Naval Specialty Medical Center, No. 338 West Huaihai Road, Changning District, Shanghai 200052, China. 17721228923@163.com
Research Domain of This Article
Nursing
Article-Type of This Article
Randomized Clinical Trial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Yu-Qing Liu, Jian-Liang Sun, Mei Jing, Xue-Wei Zhu, Fei Wang, Mei-Hua Ye, Department of Emergency Medicine, Naval Specialty Medical Center, Shanghai 200052, China
Guo-Xiang Liu, Department of Nursing, Naval Medical University, Shanghai 200052, China
Jie Shi, Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
Author contributions: Liu YQ and Sun JL contributed equally to this study, they are the co-first authors of the manuscript. Liu YQ contributed to the writing and designing of the article; Liu YQ, Sun JL, Jing M, and Liu GX are responsible for the data analysis of the paper, and the data collection of the article; Shi J and Zhu XW participated in the preliminary idea design and literature search of the article; Wang F and Ye MH are responsible for the technical guidance, review and verification of the article.
Institutional review board statement: The research was reviewed and approved by the Review Committee of Chinese People’s Liberation Army Naval Characteristics Research Center, No. AF-HEC-024.
Clinical trial registration statement: This study has not yet been registered with clinical trials.
Informed consent statement: All research participants or their legal guardians provided written informed consent prior to study registration.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No other data available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mei-Hua Ye, MBBS, Chief Nurse, Department of Emergency Medicine, Naval Specialty Medical Center, No. 338 West Huaihai Road, Changning District, Shanghai 200052, China. 17721228923@163.com
Received: May 31, 2024 Revised: August 7, 2024 Accepted: September 12, 2024 Published online: October 19, 2024 Processing time: 138 Days and 19.9 Hours
Abstract
BACKGROUND
The working environment of submarine crews is also very special. They are in a closed, high-temperature, high-noise, high-vibration and narrow working and living space for a long time, and they suffer from physical discomfort caused by seasickness, which will affect the mental health of officers and soldiers. American psychologists have achieved positive results in psychological resilience training for officers and soldiers from the perspective of positive psychology. At present, there are few reports on the correlation between psychological resilience in the field of domestic research on submarine crew psychology, and it is necessary to conduct further research.
AIM
To explore the impact of active psychological regulation intervention on officers and soldiers operating in confined spaces at sea.
METHODS
A total of 121 soldiers working in a confined space of a large ship were randomly divided into an experimental group and a control group. The 50 soldiers in the experimental group were given a training course intervention, while the 71 soldiers in the control group did not receive any intervention measures. The Pittsburgh Sleep Quality Index, Psychological Resilience Scale, military Psychological Stress Self-Assessment Questionnaire, and General Self-Efficacy Scale scores were compared before and 6 months after the intervention.
RESULTS
Under the positive psychological control intervention, except for sleep efficiency (P = 0.05), the difference between the remaining dimensions of the Pittsburgh Sleep Quality Index scores and the total scores of the experimental group compared with the control group was statistically significant (P < 0.05); the assessment of the psychological condition showed that, in addition to the Psychological Stress Self-assessment Questionnaire for Military Personnel scores (P = 0.05), the scores of the Mental Toughness Scale (Dispositional Resilience Scale Resilience II) in the experimental group, General Self-Efficacy Scale scores were statistically significant (P < 0.05) compared to pre-intervention.
CONCLUSION
Positive psychological intervention and control can improve the sleep state and psychological state of officers and soldiers working in confined space at sea.
Core Tip: This project investigated the characteristics of submarine crew members and carried out positive psychological intervention in the form of training courses for submarine officers and soldiers at sea based on the psychological resilience model from the perspective of positive psychology. The application improved the psychological health level of submarine officers and soldiers and their sleep quality, providing a theoretical basis for military health services and worthy of promotion.
Citation: Liu YQ, Sun JL, Jing M, Liu GX, Shi J, Zhu XW, Wang F, Ye MH. Effects of positive psychological control intervention on sleep and psychology of officers and soldiers working at sea. World J Psychiatry 2024; 14(10): 1538-1546
People’s physical and mental health is closely related to sleep status, and sleep quality has become an important index to measure the health level of the population[1]. Sleep deprivation is common in the military environment, and sleep deprivation can lead to physical and mental health problems, affecting the combat readiness and deployment ability of soldiers[2-4]. As a special group in the army, because of the complex working environment, long-distance voyage away from land for a long time, heavy training tasks, irregular working hours and navigation under bad weather conditions[5,6], surface warship officers and soldiers often have tasks at sea, and they are more prone to sleep disorders than other services under various challenges[7]. A study by LaGoy et al[8] on fatigue monitoring of officers in the United States Navy’s surface forces showed that 23% and 54% of officers, respectively, frequently experienced and observed fatigue. Poor sleep will seriously affect social and work performance during the day, but also reduce the quality of life and overall health status[3]. The close relationship between sleep disorders and mental health disorders is a key issue that soldiers need to pay attention to when facing a variety of environmental stresses and challenges[9]. An important research field of positive psychology is psychological resilience[10]. The study of psychological resilience began in the United States in the 1970s and 1980s. Compared with the United States military, the research and application of positive psychology in our army started relatively late. The introduction of the concept of psychological resilience into the military field stems from the needs of military practice[11]. In recent years, resilience has been associated with good adaptability in military diving and submarine operations[12], but few studies have evaluated seafarers’ strategies to improve sleep or mental state during navigation. From the perspective of positive psychology, the purpose of this study is to analyze the effects of positive psychological intervention on the sleep and psychological state of officers and soldiers working in confined space at sea, and expect to explore an intervention scheme to increase positive coping, so as to improve psychological resilience, alleviate the impact of stress events, improve the sleep status of submarine officers and soldiers, improve the mental health level of submarine officers and soldiers, and improve military performance. To provide theoretical basis for military mental health service.
MATERIALS AND METHODS
General information about research objective
Pre-research collection of submarine crew demographic data and psychosocial and other information, the development of the inclusion criteria and exclusion criteria in line with the eventual 121 cases of submarine officers and men of a base ship crew as the selected object, according to the random number table method of division of the experimental group of 50 people to take a positive psychological control interventions, the control group of 71 people do not intervene.
Inclusion and exclusion criteria
Inclusion criteria: (1) Those who have been in the army for more than one year; (2) No history of major diseases such as malignant tumors; (3) No history of taking psychotropic drugs; and (4) Voluntarily participate in and sign informed consent book researchers.
Exclusion criteria: Patients with previous psychiatric symptoms and complicated with family history of psychosis.
Methods: To set up an intervention group, whose members are all experts in the military field engaged in psychological work, and follow the principles of informed consent and willingness: (1) Psychological experts engaged in the study of military officers and soldiers; have rich scientific research experience, and preside over or conduct research in related fields, associate professor or above; (2) Professionals engaged in military officers and soldiers support training include (medical service training center professionals, medical personnel). Have more than 5 years of support training experience; bachelor degree or above; and (3) Engaged in submarine crew health management related experts, more than 10 years of working experience; associate professor or above title.
The positive psychological control intervention program focuses on the psychological resilience (mental toughness) 4C model[13]. The specific discussion components of the psychological resilience 4C model are as follows: (1) Control includes control over life and emotions. Control over life means that when you encounter something difficult in your life, you know what I can do to change it. People with high life control will always look for other solutions. Emotional control means that I can manage the emotions of myself and others without losing my temper casually; (2) Commitment means, on the one hand, that I set goals, don’t give up, try my best to achieve them, but also know how to give up and when to stop. On the other hand, when we achieve our goals and achieve results, we will be proud; (3) Confidence is manifested in being confident in interpersonal communication, feeling comfortable, treating yourself on an equal footing with others, being able to influence others, and believing that you are capable of doing well in terms of personal abilities; and (4) Challenge means taking risks and learning from setbacks.
The intervention is carried out in the form of a training course, which embodies positive cognitive style, ABC emotional rules, stress coping style, hope goal and interpersonal interaction for group counseling and development training. the design of the course has been demonstrated by experts and meets the actual needs of submariners. The content, form, method, time and interval of each course are described and presented in detail. The course should be carried out with simulation exercises and self-proficiency. Questionnaires and interviews were issued after each class, and the researchers instructed them to fill in the relevant questionnaires and feedback on the intervention courses, and conducted one-to-one face-to-face interviews to understand their satisfaction with the intervention methods and their personal feelings after teaching. It was maintained for 6 months during the intervention period, during which we paid attention to the development and changes of the psychological resilience level of the submariners. At the beginning of the study, the demographic data and social psychology of the submariners were collected at the same time. The Pittsburgh Sleep Quality Index (PSQI) scale, Psychological Resilience Scale, military Psychological Stress Self-rating Questionnaire (PSET) and General Self-Efficacy Scale (GSES) were distributed to evaluate the initial sleep status and psychological status of the two groups. And fill in again after a period of 6 months of intervention.
Observation indicator
Sleep status: Sleep status was evaluated by PSQI. To evaluate the sleep status of warship officers and soldiers, the scale included 19 self-evaluation items and 5 other evaluation items. A total of 7 dimensions are subjective sleep quality, falling asleep time, actual sleep time, sleep efficiency, subjective sleep disorder, hypnotic use and daytime dysfunction. Each dimension was scored according to 0-3, the cumulative score of 7 components was divided into PSQI total score, and the total score was 0-21. The higher the total score, the worse the sleep quality: ≤ 4 as good sleep quality, 5-10 as average sleep quality, ≥ 11 as poor sleep quality.
Mentality: The mental state assessment of officers and soldiers working in confined space at sea is divided into three parts: Psychological resilience, psychological stress level and sense of self-efficacy.
Psychological Resilience Scale: The level of psychological resilience was measured by the Dispositional Resilience Scale Resilience II (DRS-II). The scale, Delaney et al[14] believe that DRS-II is a reliable and effective self-report tool for assessing psychological resilience. The DRS-II scale independently measures resilience from both positive and negative dimensions. The “positive” aspects (control, commitment, challenge) indicate that more resources can be used to combat stress, and high scores in the positive dimension are related to higher levels of resilience. The “negative” aspects (powerlessness, alienation, rigidity) indicate that they are more vulnerable to stress. The lower the negative score, the higher the level of resilience. In this study, the Cronbach coefficient of the DRS-II scale was 0.6991.
Military PSET (8) the scale consists of 10 questions, and the items reflect all kinds of psychological stress symptoms of the subjects. According to the feelings of nearly half a month, the subjects were asked to make a three-grade rating of “none, sometimes and often”, with a score of 1-3 respectively, and the sum of the scores of each item was the original score, which was then converted to a T score with an average of 50 and a standard deviation of 10. In the SD formula, x is the original score. X is the average score and SD is the standard deviation. T < 70 is normal, T ≥ 70 indicates a higher degree of psychological stress. The internal consistency Cronbach’s coefficient of the scale is 0.841 and the test-retest reliability is 0.461. It has good reliability and validity and is an effective tool to measure the psychological stress level of soldiers.
The GSES consists of 10 items, which is a one-dimensional scale. The sum of the scores of the 10 items is divided by 10 as the total score of the scale. The psychometric characteristics of the scale are ideal, the internal consistency coefficient is 0.87 and the test-retest reliability is 0.83.
Statistical analysis
SPSS26.0 software package was used for statistical analysis, the measurement data were expressed by mean ± SD, paired sample t-test was used for intra-group comparison, independent sample t-test was used for inter-group comparison, and χ2 test was used for counting data adoption rate and inter-group comparison. If the data do not conform to the normal distribution or the homogeneity of variance, Wilcoxon rank sum test and Kruskal WallisH test are used. P < 0.05 indicates that the difference is statistically significant.
RESULTS
Results of general clinical information
The general information of the selected research subjects is shown in Table 1, and the results show that the differences between the two groups of submarine officers and soldiers in terms of age, military age, ethnicity, level of education, rank, and marital status are not statistically significant (P < 0.05), and are comparable.
Table 1 General information of submarine officers and soldiers, n (%).
Index
Research group (n = 50)
Control group (n = 71)
t/χ2
P value
Age (years), mean ± SD
26.56 ± 4.00
26.73 ± 3.66
-0.245
0.807
Military age (years)
≤ 3
6 (12.00)
9 (12.68)
0.023
0.999
4-6
17 (34.00)
24 (33.80)
7-9
11 (22.00)
15 (21.13)
≥ 10
16 (32.00)
23 (32.39)
Nationality
Han nationality
48 (96.00)
68 (95.77)
0.004
0.951
Minority
2 (4.00)
3 (4.23)
Education level
Bachelor degree and above
8 (16.00)
12 (16.90)
0.065
0.968
Junior college
24 (48.00)
35 (49.30)
Senior high school and below
18 (36.00)
24 (33.80)
Job classification
Cadre
5 (10.00)
7 (9.86)
0.001
0.980
Warrior
45 (90.00)
64 (90.14)
Marital status (yes/no)
20/30
29/42
0.009
0.926
Results of sleep status
According to the sleep quality assessment carried out according to the PSQI scale, there was no significant difference between the two groups before intervention; after intervention, the sleep status scores of all dimensions in the study group were improved, and the difference was statistically significant, while there was no significant change in the control group; the same is true of the total score of PSQI, as shown in Tables 2 and 3.
Table 2 Scores of Pittsburgh Sleep Quality Index dimensions of submarine officers and soldiers, n (%).
Index
Group
Before intervention
After intervention
χ2
P value
0 point
1 point
2 points
3 points
0 point
1 point
2 points
3 points
Subjective sleep quality
Research group (n = 50)
6 (12.00)
23 (46.00)
17 (34.00)
4 (8.00)
13 (26.00)
28 (56.00)
8 (16.00)
1 (2.00)
8.109
0.044
Control group (n = 71)
9 (12.68)
34 (47.89)
23 (32.39)
5 (7.04)
8 (11.27)
34 (47.89)
24 (33.80)
5 (7.04)
0.080
0.994
χ2
0.092
9.066
P value
0.993
0.028
Time to fall asleep
Research group (n = 50)
14 (28.00)
18 (36.00)
12 (24.00)
6 (12.00)
27 (54.00)
14 (28.00)
7 (14.00)
2 (4.00)
7.938
0.047
Control group (n = 71)
20 (28.17)
25 (35.21)
17 (23.94)
9 (12.68)
20 (28.17)
23 (32.40)
18 (25.35)
10 (14.08)
0.165
0.983
χ2
0.016
10.064
P value
0.999
0.018
Actual sleep time
Research group (n = 50)
26 (52.00)
15 (30.00)
6 (12.00)
3 (6.00)
38 (76.00)
10 (20.00)
1 (2.00)
1 (2.00)
7.821
0.050
Control group (n = 71)
37 (52.11)
21 (29.58)
9 (12.68)
4 (5.63)
35 (49.30)
21 (29.58)
10 (14.08)
5 (7.04)
0.219
0.974
χ2
0.019
10.736
P value
0.999
0.013
Sleep efficiency
Research group (n = 50)
1 (2.00)
48 (96.00)
1 (2.00)
0 (0.00)
10 (20.00)
39 (78.00)
1 (2.00)
0 (0.00)
8.295
0.016
Control group (n = 71)
2 (2.82)
66 (92.96)
2 (2.82)
1 (1.40)
2 (2.82)
64 (90.14)
3 (4.23)
2 (2.81)
0.564
0.905
χ2
0.891
11.091
P value
0.828
0.011
Sleep disorder
Research group (n = 50)
12 (24.00)
28 (56.00)
9 (18.00)
1 (2.00)
25 (50.00)
20 (40.00)
4 (8.00)
1 (2.00)
7.824
0.050
Control group (n = 71)
17 (23.94)
40 (56.34)
13 (18.31)
1 (1.41)
17 (23.94)
38 (53.52)
15 (21.13)
1 (1.41)
0.194
0.979
χ2
0.064
10.139
P value
0.996
0.017
Hypnotic drug
Research group (n = 50)
43 (86.00)
4 (8.00)
2 (4.00)
1 (2.00)
49 (98.00)
1 (2.00)
0 (0.00)
0 (0.00)
5.191
0.158
Control group (n = 71)
66 (92.96)
3 (4.22)
2 (2.82)
0 (0.00)
64 (90.14)
3 (4.23)
3 (4.22)
1 (1.41)
1.231
0.746
χ2
2.424
3.450
P value
0.489
0.327
Daytime dysfunction
Research group (n = 50)
9 (18.00)
16 (32.00)
18 (36.00)
7 (14.00)
20 (40.00)
17 (34.00)
9 (18.00)
4 (8.00)
8.021
0.046
Control group (n = 71)
13 (18.31)
22 (30.99)
25 (35.21)
11 (15.49)
12 (16.90)
23 (32.39)
26 (36.62)
10 (14.09)
0.129
0.988
χ2
0.060
10.397
P value
0.996
0.015
Table 3 Total Pittsburgh Sleep Quality Index scores of submarine officers and men.
Group
Total PSQI score
t
P value
Before intervention
After intervention
Research group (n = 50)
6.96 ± 2.67
4.32 ± 2.62
7.265
< 0.001
Control group (n = 71)
6.85 ± 2.68
7.13 ± 2.50
-0.854
0.396
t
0.232
-5.958
P value
0.817
< 0.001
Results of psychological resilience
The trait Psychological Resilience Scale II (DRS resilience II) was used to evaluate the patients in the two groups. Before intervention, there was no significant difference in positive and negative scores between the two groups; after intervention, the positive scores in the study group increased and the negative scores decreased, and the difference was statistically significant, while there was no significant change in the control group, see Table 4 for details.
Table 4 Trait Mental Toughness Scale-II scores of submarine officers and soldiers.
Index
Group
Before intervention
After intervention
t
P value
Positive score
Research group (n = 50)
34.70 ± 0.46
36.94 ± 0.47
-28.514
< 0.001
Control group (n = 71)
34.66 ± 0.51
34.65 ± 0.48
0.159
0.874
t
0.422
26.056
P value
0.674
< 0.001
Negative score
Research group (n = 50)
20.48 ± 0.50
17.82 ± 0.44
25.236
< 0.001
Control group (n = 71)
20.38 ± 0.49
20.46 ± 0.50
-0.973
0.334
t
1.090
-30.052
P value
0.278
< 0.001
Results of military PSET
The military PSET score was used to evaluate the psychological stress level of the patients in the two groups. The results showed that there was no significant difference between the two groups before intervention, but the proportion of normal psychological stress level in the study group increased after intervention, and the difference was statistically significant, see Table 5 for details.
Table 5 Military Psychological Stress Self-Assessment Questionnaire Scores of submarine officers and soldiers, n (%).
Group
Before intervention
After intervention
χ2
P value
Normal (T < 70)
Relatively high (T ≥ 70)
Normal (T < 70)
Relatively high (T ≥ 70)
Research group (n = 50)
44 (88.00)
6 (12.00)
49 (98.00)
1 (2.00)
3.840
0.050
Control group (n = 71)
61 (85.92)
10 (14.08)
58 (81.69)
13 (18.31)
0.467
0.494
χ2
0.111
7.628
P value
0.739
0.006
Results of the GSES
The evaluation results of GSES showed that there was no significant difference between the two groups before intervention, but the score of GSES scale increased after intervention, and the difference was statistically significant, see Table 6 for details.
Table 6 General Self-Efficacy Scale Scores of submarine officers and soldiers.
Group
GSES scores
t
P value
Before intervention
After intervention
Research group (n = 50)
2.70 ± 0.27
3.20 ± 0.25
-8.861
< 0.001
Control group (n = 71)
2.70 ± 0.25
2.70 ± 0.24
-0.110
0.912
t
-0.041
10.844
P value
0.967
< 0.001
DISCUSSION
Mental health plays an important role in all aspects of military operations and makes a positive contribution to the operational readiness of deployable troops[15]. In 2006, China’s Ministry of National Defense announced that psychological testing would be included in the formal conscription examination. Therefore, more and more attention has been paid to the mental health of Chinese soldiers. American military psychologists have found that the key to mental health is psychological resilience, which makes soldiers’ response to adversity more mature, obtains psychological growth, and improves the combat effectiveness of the whole army. Researchers define psychological resilience as the combined action of internal and external protective factors on the body, so that it can actively use a variety of resources to adjust in the face of stress difficulties, so as to adapt well and even obtain the results of self-improvement[16]. Nind et al[17] further clarified the connotation of military psychological resilience and interpreted it as the ability to overcome the negative effects of setbacks and related pressures on combat performance. For submarine officers and soldiers, they are confined to small living spaces, exposed to artificial air and artificial light[18]. In addition, the submarine environment requires a long period of isolation, which may involve 60-90 days of underwater cruising[15] some studies have shown that isolation in an isolated and continuous closed environment can easily lead to psychosocial problems[19,20]. In addition to the psychological and physical stress caused by daily military exercises, low-quality sleep can also be used as a source of stress. after all, sleep may not be a priority in military culture[21]. And in the face of mechanical noise, continuous airtight cabins, irregular working hours, etc[22-24], submarine officers and soldiers face many challenges in getting enough sleep. Sleep disorders can easily lead to memory loss, inability to concentrate, distraction, anxiety, irritability and other emotional changes, interpersonal tension, etc., leading to the decline of work efficiency, the weakening of military combat effectiveness and so on[25-27]. Individuals will have cognitive coping and emotional coping when they have different sources of stress. when they can bear it, their physical and mental stress will be enhanced; when they cannot bear it, it will cause further physical and mental damage and inhibit their tenacity, strength and optimism to a certain extent affect psychological recovery and anti-stress ability. Therefore, it is very necessary to carry out psychological education and sleep management among submarine officers and soldiers. Nowadays, more and more studies have shown that psychological resilience is an ability that can be developed through training and learning. Psychological resilience is not innate, but can be cultivated through nurturance[28,29]. From the perspective of positive psychology, this subject carried out a six-month positive psychological intervention centered on psychological resilience for officers and soldiers working in marine confined space. the results showed that the sleep condition of submarine officers and soldiers was improved and their psychological resilience was enhanced. the level of psychological stress is normal, and the sense of self-efficacy has been improved. The reason for the analysis is that during the training intervention, the teaching group guided the officers and soldiers to learn to treat setbacks and stress with a positive and optimistic attitude, change their beliefs and ways of thinking, and enhance their psychological resilience and multi-angle thinking ability and innovation ability stimulate the personal potential and positive energy of submarine officers and soldiers, and improve the stress coping ability of officers and soldiers in real experience. Guide the officers and soldiers to learn a better way of communication and interpersonal skills, improve the problem-solving ability of members, and cultivate efficient work efficiency. Under the long-term intervention, the individual’s positive emotional experience and positive thinking are strengthened, and the sense of self-efficacy increases in the process of teaching. As Bandura, the proposer of self-efficacy, said: “one must have a sense of self-efficacy”. In order to deal with the inevitable obstacles and injustices in life, to success. The higher the self-efficacy, that is, the more likely individuals think they are to do a good job, the more they will try to do it actively[30,31]. Submarine officers and soldiers make more active efforts to deal with the difficulties and pressure of maritime operations, and the psychological stress is no longer too high, which is conducive to the improvement of sleep and psychological status of marine confined space operations.
CONCLUSION
To sum up, active psychological control intervention has a good effect on the sleep status and psychological status of officers and soldiers working in confined space at sea. However, our study considered the submarine crew members of a single large warship in the South China sea, and the data was limited. Further research should include submarine crew samples from all over China. Nevertheless, our research results are still of great significance. The results of this study can provide a reference for military medical departments to improve the mental health level of submariners, and the intervention path is worth popularizing by military doctors at sea. In addition, some officers and soldiers with severe sleep disorders should be paid more attention to. In the follow-up study, the author will also conduct in-depth research on this part of the population.
Footnotes
Provenance and peer review: Unsolicited article; Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Psychiatry
Country of origin: China
Peer-review report’s classification
Scientific Quality: Grade C
Novelty: Grade C
Creativity or Innovation: Grade B
Scientific Significance: Grade B
P-Reviewer: Kumar V S-Editor: Wang JJ L-Editor: A P-Editor: Zheng XM
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