Although several studies in different study groups (e.g., general population, health care providers, patients) have assessed the mental health outcomes during the COVID-19 pandemic [24,25,26,27,28,29,30,31,32], to the best of our knowledge, this is the first study that assesses mental health outcomes of seafarers during the COVID-19 pandemic. Therefore, this study provides a snapshot of the psychological status of seafarers under the shadow of the COVID-19 pandemic.
According to our study, the prevalence of anxiety symptoms, depressive symptoms, and PTSD was 12.4, 14.1, and 37.3%, respectively. A recently published meta-analysis on the impact of coronavirus syndrome (MERS vs. SARS vs. COVID-19) on the mental and physical health of health care workers (HCW) revealed that the prevalence of anxiety symptom features, depressive symptoms, and PTSD was 29.0, 26.3, and 20.7%, respectively [33]. The lower observed prevalence of psychological outcomes among seafarers compared to HCW may be related to the unsimilar workplace setting. HCW are working in the frontline of the health care system, and they are in close contact with COVID-19 infected people. So, the extent and type of the stressors or mental health issues in such an occupation are entirely different with seafarers working in the isolated workplace.
A cross-sectional study conducted on the young Chinese population during COVID-19 showed that 40.4% of the studied population was prone to psychological problems; the prevalence of PTSD was 14.4% [34]. Although a similar questionnaire has been used in our study and Chinese youth study, but the prevalence rate of PTSD among seafarers was much higher than Chinese people. This discordant finding may be justified by different study groups and time of PTSD measurement. Our study was conducted 4 months after the COVID-19, while the Chinese youth study was performed just 2 weeks after the emergency.
A comparison study among people affected and unaffected by quarantine during the COVID-19 pandemic showed a higher prevalence of depressive symptoms and anxiety symptoms among the affected group, which might be related to long-term social isolation. Also, the overall prevalence of anxiety symptoms and depressive symptoms in the studied population was 8.3 and 14.6%, respectively [35]. The findings of our study are in line with mentioned study, although the settings are different. We think the isolated nature of the workplace at sea might be the possible reason for such similarity of the prevalence rate of the two studies.
Our study revealed that the prevalence of depressive symptoms among married officers who had been on board for a more extended period during the COVID-19 pandemic was higher than the other crew members. Long periods of separation from loved ones, especially kids, might be a reason for such finding among married officers. A recently published study about COVID-19 in maritime setting revealed that apart from long term isolation, additional factors related to current health emergency including pressure to get home from family members, concern about family members’ health in vulnerable cities, limited medical facilities, lack of awareness, and less access to medical care ashore- because of COVID-19 port restrictions- might also have adverse effects on the psychological status of people at sea [36]. Although this study fails to provide seafarers’ perspectives regarding the current extra-ordinary situation at se, we think that in our study, such kinds of factors might also affect seafarers’ mental health status.
In our study, the general anxiety score was higher among officers compared to non-officers. We know that seafarers have a high potential to be infected with COVID-19 when traveling from home to ship, ship to home, or visiting port facilities [36]. Officers are in contact with the port during load and discharge. Also, they are responsible for the safety of the crew members on board. We think such close contact with port authorities, together with the responsibility for providing the safety of people on board, might cause more stress and fear of being infected by COVID-19. Consequently, such pressure may induce higher anxiety symptoms level.
Another study also suggests that the mental health of people, especially vulnerable ones, can be affected by several psychological factors such as fear, stigma, and lack of awareness [29]. We assume that ship-specific stress situations, together with lack of awareness about the COVID-19 situation and less access to medical care ashore, might cause fear and uncertainty among seafarers. So, these factors might be the main reasons for such prevalence of anxiety symptoms and depressive symptoms among seafarers, especially in married officers. They, therefore, require particular attention with regard to psychosocial health issues during the recent global health emergency.
The current study also revealed that the odds of intrusion and depressive symptoms significantly was higher among seafarers with a more extended stay at sea during COVID-19, which supports the assumption that the symptoms are actually caused by the difficult situation on sea. This might be connected to working hard, dealing with a problematic situation, and uncertainty about the current situation and getting back home. Further studies are suggested to explore the main reasons for such findings.
We found that the odds of hyper-vigilance and avoidance decreased by increasing working hours per week. A possible reason would be that seafarers may blunt or neglect their emotions through work or sometimes by overworking. Although the study’s cross-sectional nature hampered the evaluation of causal relationships, further studies are needed to evaluate the causal relationship of mental health issues.
We found that officers experienced more anxiety symptoms, depressive symptoms, hyper-vigilance, and avoidance. Because officers are the ones who should provide a safe workplace for all crew members in such dangerous situations, also, they are physically more in touch with port authorities. Nonetheless, further studies on seafarers are needed since the data regarding seafarers, even prior to the pandemic, is controversial. Some studies have reported a low level of depression and mental issues among seafarers compared to the normal population [37, 38]. Whereas others have found a prevalence of suicidal thoughts among seafarers, as high as 35% [39].
Limitations and strengths of the study
The cross-sectional nature of the study is the main limitation of the current work. Also, due to a lack of studies on the prevalence of the psychological issues reported here before the pandemic situation, it was challenging to determine whether the extent of psychological issues among seafarers has increased during the COVID-19 outbreak. Furthermore, the lack of data regarding prior psychiatric illness in participants was one of our limitations.
Besides, all limitations connected with self-report measures might affect the results of our study. The strength of the study is that this is the first study with a large sample size in seafarers to address the psychological status of this study group during the COVID-19 outbreak by using validated instruments.