Burnout syndrome in seafarers in the merchant marine service

Fatigue, Work Overload, and Sleepiness in a Sample of Spanish Commercial Airline Pilots

Commercial aviation pilots are an occupational group that work in particular conditions, with frequent schedule changes, shift work, unfavorable environmental conditions, etc. These circumstances can lead to fatigue, work overload (WO), and daytime sleepiness, factors that can affect their health and safety. This study aimed to assess the prevalence and the association between these parameters in a sample of Spanish commercial airline pilots. The Raw TLX, Fatigue Severity Scale, and the Epworth Sleepiness Scale questionnaires were administered in a sample of 283 participants. The relationships of the total scores between all the questionnaires were studied by the chi-square test and the risk scores (odds ratio) were calculated. Different models using multiple linear regression were carried out to evaluate the effects of WO, fatigue, and daytime sleepiness, among the total scores, age, and flight hours. Additionally, the internal consistency of each questionnaire was estimated. A total of 28.2% presented WO above the 75th percentile, with mental and temporal demand the dimensions with the greatest weight. A total of 18% of pilots presented fatigue, 15.8% moderate sleepiness, and 3.9% severe sleepiness. We observed an association among WO, fatigue, and daytime sleepiness, important factors related to pilot health and aviation safety.

A Study of Psychometric Instruments and Constructs of Work-Related Stress among Seafarers: A Qualitative Approach

Due to unpredictable and demanding working circumstances and the significant potential for dangers and accidents, seafaring has been characterised as one of the world's riskiest and stressful vocations that lead to physical and mental health problems. However, very few instruments measure work-related stress, particularly in a seafaring context. None of the instruments are psychometrically sound. Therefore, a valid and reliable instrument to measure seafaring work-related stress is indispensable. This study aims to review work-related stress instruments and to explore the work-related stress construct among seafarers in Malaysia. This study uses a systematic review and semi-structured interviews across two phases. In Phase 1, we conducted a systematic review of several databases: Academic Search Ultimate, Emerald Journal Premier, Journal Storage (JSTOR), ScienceDirect, Springer Link, Taylor and Francis Online, and Wiley Online Library based on Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA). In 8975 articles, only 4 (four) studies used psychological instruments and 5 (five) studies used survey questionnaires to measure work-related stress. In Phase 2, we conducted a semi-structured interview with 25 (twenty-five) seafarers, online due to COVID-19 restrictions. The semi-structured interview indicated 6 (six) themes, namely, physical stress, personal issues, social living onboard, technostress, work factors, and the effect of the COVID-19 pandemic. In conclusion, the present study has identified three psychometric instruments for measuring work-related stress among seafarers: The Psychological General Well-Being Index, Perceived Stress Scale, and Job Content Questionnaire. We also found psychometric elements in some of the instruments are questionable, such as theoretical basis, construct development, and inadequate internal consistency value. In addition, this study also found that work-related stress is a multidimensional construct that needs to be studied based on work contexts. The findings of this study can contribute to the body of knowledge of a work-related stress construct in a seafaring context and could help to inform policy makers in the maritime industry. This study suggests a psychological instrument to measure work-related stress among seafarers in future studies.

Psychosoziales Wohlbefinden und Schlafqualität asiatischer Seeleute

Das psychosoziale Wohlbefinden und die Schlafqualität von Seeleuten wird von vielen verschiedenen Faktoren beeinflusst, z. B. Reisedauer, Wetter, irregulären Arbeitszeiten oder beschränktem Kontakt zur Familie. Häufig arbeiten sie über Monate mit denselben Personen und sind zugleich isoliert. Die Arbeits- und Lebensumstände der Seeleute an Bord haben mehreren Studien zufolge einen signifikanten Einfluss auf die individuelle Gesundheit sowie die Schiffssicherheit 1, 2. Das Ziel der Studie ist die Identifikation der wichtigsten Einflussfaktoren auf das Wohlbefinden und die Schlafqualität von Seeleuten.

Seafarers' mental health status and life satisfaction: Structural equation model

Background

A variety of factors influence seafarers' health. Such factors might affect their satisfaction with life.

Aims

To examine the relationships between seafarers' mental health status and satisfaction with life by using a structural equation method.

Methods

In this survey, 470 seafarers were selected via convenience sampling method from two shipping companies. Validated questionnaires including Satisfaction with Life Scale (SWLS), generalized anxiety disorder-7 (GAD-7), Post-traumatic Stress Disorder-8 (PTSD-8), Patient Health Questionnaire-9 (PHQ-9), General Health Questionnaire-12 (GHQ-12), Perceived Health status and Depression-Anxiety-Stress scale-21 (DASS-21) were used to assess different aspects of well-being and life satisfaction. The stratified path analysis method was applied to analyze the data.

Results

439 seafarers (200 officers and 237 non-officers) with a mean age of 34.5 (SD: 8.05) participated in the current study. The GHQ score directly affected satisfaction with life in both officers (β = 0.35) and non-officers (β = 0.40). Also, perceived health status directly and indirectly affected satisfaction with life among officers (β = 0.19) and non-officers (β = 0.06). While officers working days per month indirectly impacted satisfaction with life through the general anxiety disorder, perceived health status, depression, anxiety, stress and current mental health. In non-officers, generalized anxiety disorder had the most potent indirect effects on satisfaction with life through perceived health status and current mental health.

Conclusion

Perceived health status, directly and indirectly, affected seafarers' satisfaction with life. Measures should be taken in order to improve seafarers' perceived health status and its effects on satisfaction with life.

Healthy workplace onboard: Insights gained from the COVID-19 impact on mental health and wellbeing of seafarers

BACKGROUND: Seafarers’ mental health is seriously affected by COVID-19. The pandemic could act as a catalyst for change with respect to seafarers’ mental health protection and promotion. OBJECTIVE: The study explores the main factors contributing to the mental health and wellbeing of seafarers. Moreover, elements to help seafarers lessen the impact of the pandemic on their work and life onboard are analyzed, and their role in developing a positive psychosocial environment and promoting a healthy workplace onboard are discussed. METHODS: The study involved the use of an ad hoc questionnaire and the adoption of both quantitative and qualitative methods. The sample included one hundred and five active seafarers. RESULTS: Ninety-six percent of the sample stated that mental health is a very or extremely important part of their general health. Seafarers perceive that their mental health has been seriously impacted by COVID-19. Major factors contributing to seafarers’ mental health and wellbeing reveal three groups of factors: rest and spare time-related factors, communication/relationship with the external world, and interaction and social life on board factors. CONCLUSIONS: Strategies suggested by seafarers for coping with “inevitable” psychological stress produced by COVID-19 and promoting their wellbeing include managerial, emotional, facilities-related (including communication infrastructure), physical, and social elements to promote wellbeing. Economic, intellectual, and spiritual elements also have to be taken into consideration and require further investigation. Building on seafarers’ insights and experiences, a healthy environment onboard should cultivate holistically the four main spheres of a healthy workplace (physical work environment, psychosocial work environment, personal health resources, and enterprise community involvement) and the five features of a healthy psychosocial environment (social, emotional, physical, intellectual and spiritual) under all circumstances, whether exceptional or ordinary.

Mental health and psychological wellbeing of maritime personnel: a systematic review

Background

Seafaring has frequently been reported to be a ‘risky occupation’ in terms of both physical and mental health. Individuals working in seafaring professions are exposed to various stressors in the workplace, including social isolation, exposure to poor physical conditions and long work hours. This systematic review aimed to update previous reviews by collating recent literature (published between 2012 and 2021) on the factors associated with mental health and wellbeing in seafaring personnel.

Methods

Four electronic databases were searched in April 2021 for primary peer-reviewed studies on factors associated with the mental health and psychological wellbeing of seafarers or interventions to improve the wellbeing of seafarers, published in English in or after the year 2012. Thematic analysis was used to synthesise the data and standardised measures of quality appraisal were used to assess risk of bias.

Results

Sixty-three studies were reviewed. Risk factors for poor mental health among seafarers appear to be younger age; being single; poor physical health; exposure to noise/vibration; feeling unsafe; high job demands; long working hours; night/irregular shifts; poor sleep; poor team cohesion; poor perception of management; poor social support; lack of autonomy; scheduling uncertainties; long duration at sea; and over-commitment.

Conclusions

There are numerous steps that maritime managers could take to improve the wellbeing of their personnel, including increased monitoring of the potential for poor mental health in their staff, increasing crew numbers and provision of education and support.

Psychosocial issues and sleep quality among seafarers: a mixed methods study

Background

Seafarers, especially those working for a prolonged period of time, are exposed to a high number of social, psychological and physical stressors including irregular working hours.

Aim

This study aims to identify important aspects of Asian seafarers’ psychosocial wellbeing and quality of sleep that could affect safety and health of the seafarers in long voyage tankers.

Methods

In this mixed method study, psychological health issues were investigated through semi-structured interviews with 17 Asian male seafarers. Participants were selected through purposive sampling. In the quantitative phase, 179 seafarers completed the Pittsburgh Sleep Quality Index (PSQI) on sleep quality.

Results

From the interviews, three categories consisting of six themes emerged, including sleep abnormalities, inevitable stressors, and lack of social communication. The majority of the seafarers believed that their quality of sleep was affected by their physical work environment and by issues raised by their families. As reasons for stress at sea, they mentioned the nature of the occupation and the psychosocial work environment. Most participants pointed out that lack of social communications had adverse effects on both their work lives on board and their private lives at home. In the quantitative phase, the response rate was 81.4%. Mean PSQI index was 5.9 (SD 2.6 and range from 2 to 14). Sleep impairment was higher in academic than non-academic individuals (p < 0.001).

Conclusion

Sleep abnormalities and lack of social communication should be considered as modifiable risk factors for seafarers’ psychosocial well-being at sea.

Bullying behavior and employee well-being: how do different forms of social support buffer against depression, anxiety and exhaustion?

PURPOSE

Workplace bullying has severe negative consequences for the well-being of targeted employees. Previous research suggests that social support may buffer against such adverse effects. However, it remains unclear if different forms of support have equally strong effects and if support buffers equally effectively against different outcomes. Further, little is known about social support as a mitigating factor in remote occupational groups such as seafarers. This study examines the buffering effects of four forms of support (instrumental and emotional peer support, company support, non-work support) on three aspects of employee well-being (depression, anxiety, and exhaustion) among seafarers.

METHODS

Responses to a cross-sectional online survey from a convenience sample of 414 seafarers on international commercial vessels were analyzed using moderated regression analyses with PROCESS.

RESULTS

Exposure to workplace bullying behavior increased seafarers' depression, anxiety and exhaustion. Instrumental peer support and non-work support buffered the negative impact of bullying on depression. The impact of bullying on exhaustion was buffered by company support. The impact of bullying on anxiety was not buffered by any of the four forms of support.

CONCLUSION

Extending previous research, the findings suggest that the interaction between workplace bullying and support depends not only on the source of support, but also on the type of support and the outcome considered. While support from colleagues on board was important for seafarers, company and non-work support must not be overlooked. Interventions should, therefore, encourage the development of peer support and ensure access to shore-based support for workers in remote locations.

The impact of the COVID-19 pandemic on seafarers' mental health and chronic fatigue: Beneficial effects of onboard peer support, external support and Internet access

While commercial shipping remained vital for maintaining global supply chains during the COVID-19 pandemic, measures imposed to control the spread of infection have disrupted crew changes and impacted interactions with port personnel and among crew members on board. Initial reports indicate that this affected work and life on board, the length of seafarers' time on board as well as seafarers' employment and family concerns. However, the consequences for seafarers' well-being are not well understood. The purpose of this study was to examine the effects of the COVID-19 pandemic on seafarers' mental health and chronic fatigue, and to analyze the role of potential mitigating factors, notably onboard peer support, external support and Internet quality. Survey responses from 622 seafarers on international commercial vessels were analyzed using structural equation modeling. Findings suggested that the impact of the pandemic increased seafarers' fatigue and mental health problems. However, they also indicated ways of mitigating the negative impact of the pandemic and increasing resilience by enhancing support from fellow crew members on board, ensuring the availability of external support and providing fast and reliable Internet access.

Mental health problems and their related factors among seafarers: a scoping review

BACKGROUND

Seafarers are often reported to be engaged in a dangerous physical and psychosocial work environment. However, mental health status among seafarers has not been focused on compared with physical health issues. Systematic, comprehensive reviews of mental health problems and their relevant factors are lacking. This review aimed to clarify beneficial approaches to the mental health problems faced among seafarers using a scoping review to systematically map the evidence regarding mental health issues and their related factors.

METHODS

Studies were searched on MEDLINE/PubMed, Science Direct, Academic search complete using EBSCOhost databases, SCOPUS, EMBASE, and Web of science on 20, August 2020. This scoping review was conducted based on the framework of Arksey and O'Malley and Preferred Reporting items for Scoping Reviews flow diagram. The inclusion criteria were studies which determined the relationship between factors relevant to working conditions or working environment, and mental health in seafarers, and etc. Data were narratively summarized and reported.

RESULTS

Twenty-four were included in this review while two major findings were clarified. Firstly, the prevalence of stress, depressive symptoms, and burnout have been mentioned for decades. Secondly, factors related to mental health and psychological issues can be categorized as individual and work environmental factors. The individual factors include experience, age, health status (high BMI, poor sleep, and diabetics), and resilience. The work environmental factors consist of two parts. Job demands comprise pressure from contractors/customers/time, working hours, ship department, job title, voyage episodes, period of seafaring, noise, and vibration. The job resources included instrumental support, team cohesion, shipboard caring and effort-reward imbalance.

CONCLUSIONS

A beneficial approach to mental health problems faced among seafarers is necessary to understand comprehensively at individual and organization levels. Promoting health behaviors, training resilience, and managing obesity and chronic diseases comprise individual level strategies. Providing seafarers with adequate instrumental support, and practical support to communicate with customers, managing their distinct work-rest hours and adequate effort-reward balance comprise organization level methods.

Post-traumatic stress disorder and mental health assessment of seafarers working on ocean-going vessels during the COVID-19 pandemic

Background

There are increasing concerns about mental health consequences of the COVID-19 pandemic among seafarers. This study aims to assess the effects of the current global health pandemic on life satisfaction and adverse psychological outcomes among seafarers.

Methods

In this cross-sectional study, 470 multinational seafarers working on board ships of two international shipping companies were assessed. Mental health outcomes were assessed by the general anxiety disorder (GAD-7) questionnaire, post-traumatic stress disorder (PTSD-8) questionnaire, and patient health questionnaire (PHQ-9) depressive severity score. Multivariate logistic regression was used to determine the association of demographic and work-related variables with mental health outcomes.

Results

Overall, 439 out of 470 invited seafarers with a mean age of 34.5 (SD: 8.05) years participated in this study (participation rate: 93.4%). The prevalence of anxiety, depressive, and post-traumatic stress symptoms was 12.4, 14.1, and 37.3%, respectively. In the multivariate model, the current vessel’s signing duration was directly associated with the odds of depressive and intrusion symptoms. Moreover, the duration of work per week was inversely associated with hyper-vigilance and avoidance. Also, non-officers, compared to officers, experienced significantly lower anxiety and depressive symptoms, hyper-vigilance, and avoidance.

Conclusion

The present study revealed a high prevalence of mental health problems among seafarers during the COVID-19 pandemic. We recommend that more evidence is generated regarding psychosocial health issues for this vulnerable occupation.

Effects of the COVID-19 pandemic on the mental health of seafarers: A comparison using matched samples

The COVID-19 pandemic and the measures implemented to curb its transmission have altered workplaces and challenged occupational health and safety in unprecedented ways, with high levels of mental distress reported across several industries. In the maritime industry, occupational health and safety risks, including psychosocial risks, were a concern already before the COVID-19 pandemic. However, knowledge about the prevalence of mental health problems and the factors associated with them is still limited. The purpose of this study was to investigate the impact of the COVID-19 pandemic as well as the effects of respondent and work-related characteristics on seafarers' self-reported symptoms of depression and anxiety. Data came from two cross-sectional convenience samples of seafarers on international commercial vessels, surveyed before (N_pre-pandemic = 793) and during the pandemic (N_pandemic = 504). Matching the two samples on respondent and work-related characteristics using propensity scores, we found that the pandemic contributed to significantly higher levels of depression and anxiety. Further analyses showed that seafarers with longer work periods, those who had been on board longer than expected, and those working on vessels registered with "Flags of Convenience" reported significantly higher levels of both depression and anxiety during the pandemic, but not prior to the pandemic. Taken together, these findings suggest that the impact of the COVID-19 pandemic led to a deterioration of working conditions and increased mental health risks for seafarers. Practical implications for safe-guarding occupational health and safety during this and future crises are discussed.

Stress research during the COVID-19 pandemic and beyond

The COVID-19 pandemic confronts stress researchers in psychology and neuroscience with unique challenges. Widely used experimental paradigms such as the Trier Social Stress Test feature physical social encounters to induce stress by means of social-evaluative threat. As lockdowns and contact restrictions currently prevent in-person meetings, established stress induction paradigms are often difficult to use. Despite these challenges, stress research is of pivotal importance as the pandemic will likely increase the prevalence of stress-related mental disorders. Therefore, we review recent research trends like virtual reality, pre-recordings and online adaptations regarding their usefulness for established stress induction paradigms. Such approaches are not only crucial for stress research during COVID-19 but will likely stimulate the field far beyond the pandemic. They may facilitate research in new contexts and in homebound or movement-restricted participant groups. Moreover, they allow for new experimental variations that may advance procedures as well as the conceptualization of stress itself. While posing challenges for stress researchers undeniably, the COVID-19 pandemic may evolve into a driving force for progress eventually.

The Predictive Factors of New Technology Adoption, Workers' Well-Being and Absenteeism: The Case of a Public Maritime Company in Venice

The main goal of this research was to investigate the psychosocial aspects that influence the acceptance of innovative technology in maritime transport and its impact on employees’ work-related wellbeing and absenteeism. In particular, this study focused on a device that had been introduced to sailors working in water public transportation in Venice. The theoretical framework included two integrated models: the TAM model, concerning acceptance of the technology, and the JD-R model, related to workers’ well-being. A two-wave study was conducted; at T1, a self-report questionnaire was administered to 122 sailors. Four months after its first administration (T2), objective data related to days of absenteeism were collected. The study showed that the perceived ease of use and the usefulness of the device influenced the workers’ intentions to use the technology and their motivational processes of work engagement, which was also related to social support. Work engagement impacted on work satisfaction and predicted the level of absenteeism (measured at Time 2). The implementation of a new technology may fail if transportation companies do not consider psychosocial factors that assist in the acceptance of such technology and promote the involvement of workers in the technological system.

Prevalence and risk factors of depression symptoms among Chinese seafarers during the COVID-19 pandemic: a cross-sectional study

BACKGROUND

To curb the spread of COVID-19, most countries have adopted measures such as banning shore leave at ports and placed restrictions on crew change. Seafarers may bear an excess pressure during the COVID-19 pandemic. This study aimed to investigate the prevalence and risk factors associated with depression symptoms among Chinese seafarers during the COVID-19 pandemic.

DESIGN

Cross-sectional study.

METHODS

This field survey-based study was conducted at Rongcheng Port, Shandong Province, China, from 10 June 2020 to 25 July 2020. Sociodemographic and occupational characteristics and health-related behaviours were collected through a face-to-face questionnaire. The Self-Rating Depression Scale was used to evaluate depression status during the preceding week. Logistic regression models were used to explore factors related to depression.

RESULTS

441 male Chinese seafarers were enrolled. Overall, the proportions of seafarers with low, moderate and severe depression symptoms were 23.35%, 9.30% and 9.07%, respectively. Compared with those with good self-rated health (SRH), seafarers with poor SRH had higher odds of depression (OR, 2.24, 95% CI 1.22 to 4.11). Less leisure time or physical exercise was associated with more severe self-reported depression symptoms (1-3 per week vs ≥4 per week: OR, 1.72, 95% CI 0.71 to 4.14; none vs ≥4 per week: OR, 3.93, 95% CI 1.67 to 9.26). Poor sleep quality was associated with higher likelihood of reporting severe depression (fair vs good: OR, 2.78, 95% CI 1.54 to 5.01; poor vs good: OR, 4.30, 95% CI 1.65 to 11.24). The more frequent seafarers worked overtime a week, the higher the likelihood of reporting severe depression symptoms (1-2 per week vs none: OR, 1.82, 95% CI 1.04 to 3.18; ≥3 per week vs none: OR, 2.49, 95% CI 1.05 to 5.92). Also, high perceived work stress was linked to higher odds of being depressed (intermediate vs low: OR, 2.06, 95% CI 0.78 to 5.46; high vs low: OR, 3.83, 95% CI 1.35 to 10.90).

CONCLUSIONS

There is a high burden of depression associated with COVID-19 among seafarers. Special interventions that protect the mental health of seafarers are more critical than ever in the context of the pandemic.

Causes of and Preventive Measures for Complacency as Viewed by Officers in Charge of the Engineering Watch

Complacency has been recognised as a cause of maritime accidents, and there is a need to develop and execute relevant preventive measures. The effectiveness of preventive actions depends on the contribution of the seafarers. Therefore, the purpose of this study was to identify causes and elicit proposals for preventing complacency by officers in charge of the engineering watch. A total of 63 Croatian engineering officers participated in four deliberative workshops, facilitated by an expert in the teaching of leadership and management. As causes of complacency, intensive workload, poor knowledge/understanding of the equipment, steep authority gradient, lack of collaboration, poor communication, efficiency-thoroughness trade-off, crewing strategies, and lack of organisational justice were identified. Efficient training on workload management, adequate familiarisation, reporting issues with technology, producing one’s own manuals, more effective leadership courses, more emphasis on non-technical skills as criteria for a promotion, joint workshops on teamwork for land-based managers and seafarers, open and objective performance evaluation, and direct communication between land-based managers and seafarers were proposed as feasible preventive measures. Human-centred design and standardisation of the equipment were evaluated as unlikely to be feasible. Some practical implications from the findings were discussed.

Stress and Strain among Seafarers Related to the Occupational Groups

The present study analyses whether the stress and strain experienced by seafarers differ between the various occupational groups on board container ships. In a maritime field study, 323 sailors on 22 container ships were asked to complete a questionnaire and were biometrically surveyed. In addition, a survey of energy expenditure and heart rate (variability) was carried out with the SenseWear^® armband monitor and the Polar RS800 watch, respectively. The activity data objectively collected by the armband monitor showed an average sleep duration of 5.0 h per day, with particularly short sleep episodes amongst nautical officers. This occupational group also significantly more frequently reported sleep deficits (67%). The highest work-related energy expenditure per day was among the deck ratings (801 kcal), followed by the engine room personnel (777 kcal), and finally the nautical officers (568 kcal). The last-mentioned group, who were also the most likely to experience mental stress in the workplace, had the lowest heart rate variability compared to the other occupational groups. The average working time was the only stress parameter that correlated significantly negatively with the heart rate variability (r = −0.387; p = 0.002). Overall, job-related stressors of seafarers on board should be objectified in further studies and occupational group-specific health promotion programmes should be developed.

Healthy offshore workforce? A qualitative study on offshore wind employees' occupational strain, health, and coping

BACKGROUND

Offshore work has been described as demanding and stressful. Despite this, evidence regarding the occupational strain, health, and coping behaviors of workers in the growing offshore wind industry in Germany is still limited. The purpose of our study was to explore offshore wind employees' perceptions of occupational strain and health, and to investigate their strategies for dealing with the demands of offshore work.

METHODS

We conducted 21 semi-structured telephone interviews with employees in the German offshore wind industry. The interviews were transcribed and analyzed in a deductive-inductive approach following Mayring's qualitative content analysis.

RESULTS

Workers generally reported good mental and physical health. However, they also stated perceptions of stress at work, fatigue, difficulties detaching from work, and sleeping problems, all to varying extents. In addition, physical health impairment in relation to offshore work, e.g. musculoskeletal and gastrointestinal complaints, was documented. Employees described different strategies for coping with their job demands. The strategies comprised of both problem and emotion-focused approaches, and were classified as either work-related, health-related, or related to seeking social support.

CONCLUSIONS

Our study is the first to investigate the occupational strain, health, and coping of workers in the expanding German offshore wind industry. The results offer new insights that can be utilized for future research in this field. In terms of practical implications, the findings suggest that measures should be carried out aimed at reducing occupational strain and health impairment among offshore wind workers. In addition, interventions should be initiated that foster offshore wind workers' health and empower them to further expand on effective coping strategies at their workplace.

Association between social support and health-related quality of life among Chinese seafarers: A cross-sectional study

BACKGROUND

Seafarers have reported impaired health and health-related quality of life (HRQOL). Social support might increase HRQOL, but little is known about this association among Chinese seafarers. The aim of this study was to describe social support and explore its association with HRQOL among Chinese seafarers.

METHODS

A cross-sectional survey was conducted in the ports of Nantong and Rugao, China, from April to December 2013. A total of 917 Chinese seafarers were interviewed on social support, mental distress, perceived occupational stress, and HRQOL using the following self-administered questionnaires: The Social Support Rating Scale, Self-rating Depression Scale, Occupational Stress Questionnaire, and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire. Hierarchical linear regression modelling was used to analyze the association between seafarers' subjective level of social support and their HRQOL.

RESULTS

Of the 917 male Chinese seafarers included in the study, 40.7% perceived high levels of social support, and 39.1% were highly satisfied with their overall quality of life (QOL). Hierarchical regression analysis showed significant associations between level of social support and all health dimensions in the WHOQOL-BREF, even after adjusting for depressive symptoms, occupational stress, occupational activities, sleep duration, and other relevant covariates. Compared with the medium or low level social support group, seafarers with a high level of social support had better QOL scores in the general facet health and QOL (β = 2.43, p<0.05), and the physical health (β = 3.23, p<0.001), psychological health (β = 5.56, p<0.001), social relation (β = 6.07, p<0.001), and environment domains (β = 4.27, p<0.001). In addition, depression, occupational stress, occupational activities, and sleep duration were found to be determinants of seafarers' HRQOL.

CONCLUSIONS

Chinese seafarers have poorer HRQOL than the general population, but social support has a significant positive effect on their HRQOL. Efforts to improve social support should be undertaken.