Abstract
Seafarers spend more time at sea than on land, which makes them a hard-to-reach community. Since their mental health and well-being is usually addressed from a land-based perspective, dedicated and validated methods incorporating maritime specificities are lacking. During the COVID-19 pandemic, research into seafarers’ mental health and well-being flourished. However, a systematic review of the literature to assess the type and appropriateness of assessment methods pertaining to the mental health and well-being of seafarers has yet to be undertaken. This study reviews 5 databases (ERIC, Scopus, PubMed, Google Scholar and EBSCO) to assess the methods used to examine seafarers’ mental health and well-being during the pandemic. Peer-reviewed literature alongside grey literature that applied quantitative or qualitative instruments to measure seafarers’ mental health and/or well-being, published in English between March 2020 and February 2023, was eligible for the review. Studies from all geographic regions and regardless of nationality, rank and ship type of the subjects were explored. Database searches produced 272 records. Five additional records were identified via other methods. We identified 27 studies suitable for review, including 24 published in peer-reviewed scientific journals and 3 reports and surveys produced by the industry or welfare organizations. Assessment methods used to measure seafarers’ mental health and well-being vary significantly in the literature. The frequent use of ad hoc questionnaires limits the possibility to replicate and compare the studies due to various inconsistencies. Furthermore, several validation and reliability measures needed more solidity when applied to the seafaring population. Such inadequate measuring and a mix of assessment methods impacted the comparison of results and might inflate the risks of underreporting or overstating mental complaints.
Seafarers have consistently been considered an occupational group vulnerable to developing mental health difficulties. This vulnerability is mainly related to their exposure to a harsh working environment and living conditions at sea. However, no attention has been given to the research methods and psychological instruments commonly used to measure seafarers’ mental health and well-being.
Although quantitative and qualitative measurements have been used in different studies, a systematic review has yet to be conducted to analyse the type and appropriateness of methods used to assess the mental health and well-being of seafarers.
We synthesize the measurement tools used to assess the mental health and well-being of seafarers during the COVID-19 pandemic, which has been a prolific period for interest and research into seafarers’ mental health and well-being. Moreover, we make recommendations for selecting and using appropriate scales and propose suggestions for further studies on seafarers’ mental health and the development of validated psychological instruments.
From our systematic review, researchers, maritime health practitioners, policymakers, and other maritime stakeholders can obtain valuable and practical evidence for the selection of instruments to assess mental health problems, development of management strategies for mental health, and design of new studies concerning the mental health and well-being of seafarers.
Introduction
In its 2022 World Mental Health Report, the World Health Organization (WHO) stressed the detrimental impacts of the COVID-19 crisis on the mental health of the general population. 1 Disruption and distress generated by the COVID-19 pandemic affected the health and well-being of workers, particularly key workers and those on the frontline. United Nations agencies urged employers to protect workers 2 and “not dismiss workers’ fears, worries, and concerns surrounding pandemics” but consider “a cumulative occupational health psychology of pandemics” and their impacts. 3 Remote work arrangements were recommended whenever possible, leading to significant work environment changes, including management practices. 4 However, remote work is largely unavailable for key workers, who remain indispensable to the functioning (Seafarers, although essential to society by moving 90% of trade on board ships (e.g., goods, medicines), have not been designated critical (key) workers during the pandemic by all countries, despite the efforts of governments and industry.6,95) of societies and economies, including seafarers and fishers, who facilitate world trade and food security. While land-based key workers were able to return home at the end of the workday seafarers and fishers were “locked out of land” and remained on board ships 5 beyond the expiration of their contractual agreements.6,7
It was not uncommon for seafarers to spend periods of over 11-months onboard (ILO’s 2006 Maritime Labour Convention (MLC) states that the maximum continuous period a seafarer should serve on board a vessel without leave is 11 months. In some instances, seafarers have not been able to go home for 18 months. The Neptune Declaration Change Indicator keeps track of the extent to which seafarers have been on board beyond the expiration of their contracts. This indicator shows that the number of seafarers onboard vessels for over 11 months has remained relatively stable over the pandemic crisis at 0.3-0.4% (reaching highest peaks of 1 and 1.3% between June and December 2021) and has decreased slightly to 0.2% just recently in January 2023. 96 ),8,9 with an exhausting 24/7 workload,10,11 limited or no access to medical care 12 and without enjoyment of their repatriation rights. 13
The impact of the crisis on seafarers’ mental health has been researched and documented.10,14 -23 The pandemic exposed structural deficiencies in occupational health and safety at sea24 -26 and brought crew welfare issues to the fore of discussions.
The initial explorations revealed adverse impacts on financial security for many seafarers,23,27 -29 lack of shore leave, increased workload and fatigue-related accidents.24,30 -32 Specifically, the International Mobile Satellite Organization (Inmarsat) 31 reported an abrupt spike in distress calls in 2020. Inmarsat established a link between the global health crisis and a “drastic rise in distress calls in the last 3 years” related to “issues with crew change, rapid turnaround in ports and fatigue on board.” Markedly, the intensification of stress, anxiety and depression complaints of seafarers 29 has the potential to become a catalyst for individuals choosing to leave the seafaring industry33 -35 or to damage the reputation of the industry and discourage newcomers to seafaring careers. 36
Seafarers’ mental health and well-being gained special attention with the COVID-19 pandemic, and 5 literature reviews have been published since March 2019.37 -41 These reviews exhaustively analyzed the factors affecting seafarers’ mental health and well-being during the period. The literature mainly focused on describing the factors that contribute to either improving seafarers’ mental health or preventing seafarers from becoming mentally ill. 42 The study of seafarers’ mental health and its screening and monitoring has been the subject of significant attention during the COVID-19 period and post-pandemic. However, we lack specific, standard and validated mental health assessment methods and options for maritime use. Former studies and reviews did not examine research methods to assess seafarers’ mental health nor did they evaluate the quality of studies (utility, reliability and representativeness). A single review (Li et al) 37 described data collection employed in research pre-2021 and drew attention to the need to evaluate data sources and methods related to seafarers’ health research. The current article aims to address that need.
Methods
Design and Search Strategy
The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. 43 The review explored the literature to extract assessment methods deployed to assess seafarers’ mental health and well-being assessment during the COVID-19 pandemic. Studies published in the period between March 2020 and February 2023 were included.
The systematic review steps included:
identification of studies via keywords and manual searches;
categorization of studies according to the assessment methods (ie, the type of measurement tool(s) used to assess mental health and well-being); and
analysis of mental health methods and instruments before concluding.
The review was conducted in March 2023. Five databases were searched. Article abstracts and full-text articles from 3 academic databases were initially screened: ERIC, Scopus, and PubMed. In addition, Google Scholar and EBSCO were also examined via searches of titles and abstracts to include additional studies (especially from grey literature) not identified in PubMed and Scopus.
A 2-step keyword search strategy was adopted. First, the search terms COVID-19 and seafarer(s) were combined with the mental health and well-being/well-being terms. The specific search string used was: (COVID-19 or covid) AND (seafarer/s) AND (mental health or well-being or wellbeing). A second, more generic, search strategy included a combination of the terms COVID-19 and seafarer with maritime and shipping resulting in additional studies (in Scopus) with relevance to seafarers’ mental health assessment. The search string used was: (COVID-19 or covid) AND (seafarer/s) AND (maritime or shipping).
Other terms such as pandemic, coronavirus or sars-cov-2 were not used because they did not produce additional results or included non-COVID-19 pandemics not in the scope of this review. The terms “questionnaire,” “survey,” or “assessment method” were not processed to avoid excluding relevant studies.
Grey literature was included in the review. Studies identified through sources other than databases involved manual searches through reference lists of articles and websites of organizations publishing reports concerning seafarer’s mental health and well-being.
Eligibility Criteria
The inclusion criteria to select studies for the review were the following:
in the English language or other languages but including an English abstract;
in peer-reviewed journals or grey literature; and
include either quantitative or qualitative instruments to measure seafarers’ mental health or well-being.
Studies discussing other studies, conducting documentary research or systematic reviews, not directly measuring the mental health or well-being of seafarers, or not describing any objective or subjective instrument used for the psychological assessment were excluded.
Studies from all geographic regions and meeting the inclusion criteria were eligible for review regardless of age, gender, nationality, rank, and ship type of the subjects.
Data Extraction
All selected abstracts were downloaded and checked. Duplicates were removed manually. Full articles that met the inclusion criteria were retrieved, and the following characteristics were extracted: author/s, year of publication, geographic region, type of publication, sample size, maritime trade, mental health outcome assessed, data collection method, assessment method, mental health measurement tool, and reliability and validity analysis. The reference lists of studies were checked to find additional relevant publications not identified by the electronic search.
Quality of the Studies
The included studies were assessed using 2 critical appraisal tools. The Critical Appraisal Skills Program (CASP) Qualitative Checklist 44 was used for qualitative research and is composed of 10 appraisal criteria. The Joanna Briggs Institute Critical Assessment Tools (JBI) for cross-sectional studies 45 were applied to quantitative studies and comprised 8 criteria. For the application of both checklists, the authors assigned each criterion a value: 0 if “Not meeting the appraisal criterion,” 0.5 if “Partially meeting the appraisal criterion/uncertain,” or 1 if “Meeting the appraisal criterion.” The total score of each study was converted to a percentage, with a higher score reflecting a higher quality of the paper.
Results
Figure 1 presents the PRISMA diagram of the study selection process. Database searches produced 272 records. Five additional records were identified via other methods. Of the final 52 full studies, one record could not be retrieved, and 4 were systematic reviews. Seventeen were excluded because, although discussing mental health in seafarers, the studies were not original research and did not include any mental health outcomes. Four more reports were excluded because they were documentary research/letters to the editor, one because it developed a new mental health questionnaire and one more because the data presented overlapped with another study included. Finally, an industry report was removed because the findings were included in a peer-reviewed study selected. Consequently, 27 original studies formed the core of the review.
The PRISMA 2020 flow diagram.
Included Studies Characteristics
Table 1 summarizes the characteristics of the 27 included studies. The authors read the papers included in the review and extracted the information from each, as presented in Table 1.
Characteristics of the Studies Included in the Review and the Mental Health Measurement Used.
GAD = generalized anxiety disorder; SAS = self-rating anxiety scale; PHQ = patient health questionnaire; PTSD = post-traumatic stress disorder; DASS = depression, anxiety & stress scale; GHQ = general health questionnaire; CAS = coronavirus anxiety scale; PSS = perceived stress scale; SWLS = satisfaction with life scale; WHO = World Health Organization; MHC-SF = mental health continuum short form; SDS = self-rating depression scale; NR = not reported; NA = not applicable.
This study was included in the review instead of another study published by the same authors with overlapping data. 60 While the two studies used the same set of participants and the same outcome measures, the study that was finally included in the review contained an additional questionnaire (i.e., SWLS) to the ones used in the study excluded.
This study used the same set of participants as the other study published by Baygi et al 47 and included in the study. However, the review also had it because it contained an additional questionnaire (i.e., SAS). The other two questionnaires (GHQ-12 and DASS-21) are just described as part of Baygi et al 47 because they are used in the same sample of seafarers, thus avoiding duplicate information.
This report used the same set of participants as a peer-reviewed article published by the same authors. 18 However, the original research report was chosen for the review because it contained more complete data on the sample and the questionnaire utilized.
The 24 scientific studies were published in various journal types, as shown in Table 1. Journals that concern health-related issues, either in public health, healthcare/medical or psychiatry/psychology fields, published most of the studies (n=8), followed by journals about maritime and ocean matters (n = 6) and journals on labor issues, including workplace and occupational health (n = 5). Moreover, 4 studies (n = 4) were published in maritime health-related journals and one final study (n = 1) in a research journal.
Most studies were published by Asian (n = 9) and European countries (n = 8), which have a long history of maritime trade or represent “developed economies.” Collaborations between European countries and Asia (n = 2) and Oceania (n = 2) also contributed to the seafarers’ mental health literature.
Almost all studies, except 2, indicate the sample size, which ranges from 9 (qualitative analysis) to42 000 seafarers (quantitative analysis). Complete sociodemographic data are not included in all studies, and those studies that provide demographic details report a varied range of nationalities, seafarers’ ranks and types of vessels. Concerning the country of the participating samples, these were mainly multinational, which reflects the globalized labor market for seafarers. However, there was a significant representation of Indian, Filipino and Chinese nationalities. European nationalities, mainly British, French and Croatian seafarers, also contributed to the reviewed studies.
Mental Health and Well-Being Assessment Methods
Six studies used qualitative research methodology, and 21 relied on quantitative research. Given the nature of the seafaring occupation, which makes seafarers a hard-to-reach group, data collection was done online in most of the studies.
Qualitative Tools
Six studies that used qualitative tools15,17,21 -24 to explore the psychological effects of the COVID-19 pandemic on seafarers either stranded at sea or waiting to join a vessel. These studies collected the experiences of seafarers during the COVID-19 period to identify the impacts on health. Seafarers were asked about the effects of aspects such as difficulties in repatriation, crew changes, shore leave, contract extension or medical care access in relation to their mental health. Seafarers’ narratives and, in some cases, those of maritime stakeholders were analyzed via interviews or other qualitative tools, including open-ended questions, focus groups, netnography or online forum conversations with seafarers. However, no direct mental health outcomes (eg, symptoms of depression or anxiety or any other mental health issue) were included in these studies. One study 22 used psychological phone consultations to diagnose mental health disorders among seafarers at sea and ashore.
Quantitate Tools
Quantitative research during this period included 2 types of mental health measurements: study-specific questionnaires and validated psychological scales. Eleven used ad hoc questions and indexes designed for the study, and 10 employed validated mental health and psychological well-being scales. One study used both: validated questionnaires and ad hoc questions.
Specific-study questionnaires
Almost half of the reviewed studies16,19,28,46,49 -52,57 -59 employed study-specific questionnaires designed for the research to indicate the prevalence of the problem/s asked for. Most of these study-specific questionnaires include either “Yes/No” or “Likert-type” response format to questions such as “Your level of happiness/level of stress,” 51 “How much your mental health and well-being has been affected,” 19 “Do you suffer from anxiety or sad mood?,” 49 “How is your mental health during these periods?”, 46 or “Negative impact of COVID-19 on your mental health.” 28 Moreover, one study 20 assessed seafarers’ mental distress by asking ship officers to observe colleagues and rate their anxiety symptoms and impacts on performance.
Two studies that employ ad hoc questions produced seafarers’ well-being Indexes, which do not offer a health outcome per se (e.g., anxiety, depression or stress) but a longitudinal measure of the impact of several factors (eg, family contact, shore leave etc.) on seafarers’ mental health and well-being. One well-known Index, the “Happiness Index,” 59 has monitored seafarers’ satisfaction since 2018 and regular reports integrate factors such as working life and family contact. The other Index is the “SEAFiT Index” 57 , which regularly reports on issues such as participation in social life onboard, physical health, and work satisfaction.
Validated screening questionnaires
Table 2 describes the types of validated and well-established questionnaires used to screen mental health, including issues such as anxiety, depression, trauma and stress. The questionnaires are of two types, those that assess one mental health construct (eg, anxiety) or those considering more than one construct (eg, anxiety, depression and stress). Notably, the questionnaires used have yet to be validated for the seafarer population. Just 6 reviewed studies (see Table 1) included a reliability measure (Cronbach’s Alpha and Cohen’s Kappa) of the instrument utilized in the sample of seafarers studied.
Characteristics of Established Instruments Used in Studies (Studies Include One or More Questionnaires).
Unidimensional tools
To assess anxiety, depression or trauma and stressor-related disorders, researchers used established, reliable and validated instruments in the general population. Two studies applied GAD-7 61 (General Anxiety Disorder) questions47,53,54 for assessing anxiety in seafarers during the COVID-19 pandemic. One study 55 administered an “adapted” version of the GAD-2 questionnaire. 62 The GAD-2 consists of GAD-7 first items, which represent the core anxiety symptoms and present good sensitivity and specificity in identifying GAD. 63
One study 48 used the Self-rating Anxiety Scale (SAS), another widespread tool for screening for anxiety disorders. 64 It assesses psychological and physiological anxiety symptoms and shows satisfactory psychometric properties and good discrimination between clinical and non-clinical samples and anxiety and other psychiatric disorders. 65
The dysfunctional anxiety produced by the pandemic and its effect on work was also measured in one study 33 utilizing the Coronavirus Anxiety Scale (CAS), which shows good internal consistency in predicting depression, anxiety and death anxiety.66,67
Concerning depression, 2 studies used the PHQ-9 (Patient Health Questionnaire)47,53,54 commonly used for screening depression and its severity. 68 Evidence supports its use in clinical settings and community and research samples, 69 and the tool has sound psychometric properties. 70
A “modified” version of the PHQ-2 was also used in one study. 55 Despite being a short version of PHQ-9, it presents a good sensitivity and specificity to identify cases of major depression. 71 The modified version positively rephrased the anhedonia measurement. The questionnaire is the short version of PHQ-9. It comprises only the first 2 items, which inquire about the frequency of depressed mood and anhedonia. The tool presents a good sensitivity and specificity to identify cases of major depression. 71
One study 56 used another widespread questionnaire for screening for depression: the Self-rating Depression Scale (SDS). 72 The SDS assesses psychological and physiological depression symptoms and shows satisfactory psychometric properties. 73
In addition to anxiety and depression, a study assessed trauma and stressor-related disorders 47 by using the (Post-traumatic Stress Disorder) PTSD-8 screening assessing 3 domains: intrusion, avoidance and hypervigilance. 74 PTSD-8 has good psychometric properties in samples exposed to different traumatic events and clinical conditions,74,75 but it has to be validated in community and research samples. Another study 52 assessed post-pandemic trauma and its relationship with job re-attachment. The study used the screening scale for PTSD developed by Breslau et al (1999), which evaluates trauma according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and whose items were slightly modified to adapt to the context of COVID-19. Remarkably, the 2 previous screening scales for PTSD cover symptoms of the DSM-IV diagnosis, which is more than a decade outdated and reflects an obsolete understanding of trauma-related issues. 76
Additionally, one industry study that assessed seafarers’ mental health during 2 different moments of the pandemic53,54 also measured stress employing the Perceived Stress Scale (PSS). 77 The PSS is deemed appropriate for non-clinical use, and cross-cultural validations have shown satisfactory psychometric results. 78
Multidimensional tools
Some studies opted for multidimensional mental health assessments, including symptoms of anxiety and depression together or any other psychiatric issues. In this regard, 2 studies utilized the Depression, Anxiety and Stress Scale DASS-21.29,47 The DASS-21 is a self-report scale focusing on dimensions rather than a categorical conception of psychological disorders and measures the negative emotional states of depression, anxiety and stress. 79 Extensively used, the DASS-21 revealed good psychometric properties in clinical and non-clinical samples and across cultures.80,81
Two studies used another popular multidimensional tool, the General Health Questionnaire GHQ-12.11,48 The questionnaire measures psychological distress such as anxiety and depression, social dysfunction and loss of confidence. 82 Evidence has shown its satisfactory psychometric properties, with internal reliability ranging between moderate to excellent in different clinical samples, general population or work-related contexts. 83
The PHQ-4 was used by Pauksztat et al 30 in whose study the 4 items from the scale were “adapted” (eg, the item measuring anhedonia was rephrased positively). The PHQ-4 is a brief screening tool for depression and anxiety disorders, 84 which results from the combination of 2 validated tools: the PHQ–2 and the GAD–2. The questionnaire has shown good psychometric properties for detecting probable cases of anxiety and depressive disorders in clinical samples, has also been validated in the general population and offers normative data.84,85
Seafarers’ well-being was assessed during the pandemic using 2 scales in 2 separate studies. On one hand, Baygi et al 47 administered the SWLS (Satisfaction With Life Scale). 86 This brief scale presents favorable psychometric properties for use in non-clinical and general populations and has been translated into many languages. 87 On the other hand, Mejia et al 53,54 administered the WHO-5 (World Health Organization– 5 Well-being Index). A self-reporting measurement of current mental well-being, 88 the index has been translated into 30 languages to avoid language misunderstanding and has adequate validity in screening for depression. 89
Discussion
The review analyzed the methods deployed by research to study seafarers’ mental health and well-being during the COVID-19 pandemic. The contributory factors to the deterioration of seafarers’ mental health and well-being during the pandemic have been sufficiently explored. These include fears of COVID-19 infection, extended contracts and working hours beyond reasonable limits, increased workload and fatigue, limited access to health care and essential supplies, denial of shore leave and repatriation, concerns about finances and employment uncertainties; concerns about family members’ health, loneliness and isolation; and feeling disrespected and unsupported by management.37 -39,41,42 However, no study, either considering the pandemic time or before, has been conducted to overview the mental health assessment methods and choices utilized in seafaring populations.
Firstly, researchers tend to favor questionnaires over qualitative analysis. Concerning qualitative exploration of seafarers’ mental health, the studies’ sample sizes ranged between nine and 32.15,17,22,24 One study 21 did not report its sample size. Studies need to include rigor for justifying sample size, 90 and just one work, 23 that surveyed 752 seafarers applied saturation point and theoretical validity to the data collected. No qualitative study combines with quantitative datasets to cross-check evidence and enhance the credibility and validity of data. Among questionnaire-based studies, more than half opt for ad hoc researcher-generated questionnaires. Unsurprisingly, the questionnaires present a large variability in questions and vocabulary used. Some questionnaires introduced generic questions to measure the impacts of COVID-19 on mental health,19,28 while others provided specific questions on stress, anxiety or happiness levels.46,49,51 Terms describing mental health were inconsistent (eg, stress, sad mood, happiness, anxiety, well-being, depression), undermining the validity of the constructs the studies intend to measure. While ad hoc questionnaires planning to respond to specific events with a population focus remain relevant, inconsistencies in questions and terms compromise replicability and comparison of results with other studies. The 2 industry-related surveys57,59 offer a longitudinal measure of the seafarer’s mental health and the factors impacting it. The regularity of these surveys (several times a year before and during COVID-19) increases the representativeness of the results and allows the identification of trends.57,59 However, ad hoc questionnaires fail to include well-establish instruments assessing mental health. Therefore, the need for psychometric rigor of standardized tools for validity and replicability purposes 91 would require the insertion of validated questions. Using adequate vocabulary would enhance the robustness of ad hoc questionnaires.
The review also identified studies using validated screening instruments (eg, GAD-7, PHQ-9, GHQ-12, DASS-21).11,29,30,33,47,48,53 -56 A study based on a large sample (42 000 seafarers) also surveyed well-being using an established WHO standard.53,54 However, just a few reviewed studies include any reliability and validity measures of the instruments utilized among seafarers.19,30,33,46,52 Notably, the review shows that authoritative and validated tools incorporating maritime specificities (operational needs and dedicated to maritime populations) to assess seafarers’ mental health are not currently available. Developing and validating such instruments in a seafaring context is necessary and mirrors the same issues the aviation environment encounters for aviation professionals’ mental health assessment. 92 A recent attempt might be emerging. Zhen et al 93 have developed a mental health test scale for seafarers (SMHT) measuring 13 mental health dimensions, including life on-board-related. The scale presents good initial reliability and validity.
Finally, the reviewed articles neglected to measure the functional impacts of mental health problems on work performance, spare time or relationships. Just one study included a single question about the effects of anxiety symptoms on work performance as assessed by supervisors but not by those struggling with issues. 20
In short, several elements require consideration for future works on seafarers’ mental health:
(1) enriching dataset by crossing survey with qualitative research;
(3) inserting questions from authoritative questionnaires in ad hoc surveys whenever possible;
(4) ensuring vocabulary consistency;
(5) conducting studies/reviews on the psychometric properties of the questionnaires assessing seafarers’ mental health, not limited to the COVID-19 pandemic period;
(6) developing sector-specificity questions/questionnaires to validate and for future use; and
(7) the impact on functioning should be thoughtfully considered for future assessment of seafarers’ mental health because it is essential to understand individuals’ mental health. 94
The review has 3 limitations. It only includes the assessment of seafarers’ mental health and well-being during COVID-19; thus, it should be expanded to include this assessment before and after the pandemic. There is also a possible selection bias resulting from excluding articles not published in English. Furthermore, despite including grey literature, other relevant studies from non-indexed journals might not have been detected.
Conclusions
The first 21st-century pandemic (ie, COVID-19) has disturbed work environments with consequences on workers’ health and safety. Seafarers allowed world trade to continue during the crisis but at the expense of their health, particularly their mental health.
The exceptional opportunity to analyze the impacts of the pandemic on the occupational group of seafarers was weakened by the need for surveys using authoritative questionnaires and questions validated for this particular population.
While studies employing ad hoc questionnaires may explore new areas, the incorporation of validated mental health assessment questionnaires is necessary to ensure consistency and comparability. Such inclusion might address the methodological weaknesses by imposing further validation.
Consequently, validated and reliable instruments for seafarers must be developed. Indeed, rigorous assessment of seafarers’ mental with authoritative tools is necessary to ensure targeted and quality interventions.
Supplemental Material
sj-doc-1-inq-10.1177_00469580231212218 – Supplemental material for A Systematic Review of Assessment Methods for Seafarers’ Mental Health and Well-Being During the COVID-19 Pandemic
Supplemental material, sj-doc-1-inq-10.1177_00469580231212218 for A Systematic Review of Assessment Methods for Seafarers’ Mental Health and Well-Being During the COVID-19 Pandemic by Maria Carrera-Arce, Raphael Baumler and Johan Hollander in INQUIRY: The Journal of Health Care Organization, Provision, and Financing
Footnotes
Acknowledgements
The authors would like to thank the authors who performed all studies included in the systematic review. Prof. Johan Hollander would like to acknowledge the generous support by The Nippon Foundation of Japan.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by a Grant from the Ministry of Rural Affairs and Infrastructure of the Government of Sweden (project no. I2021/02298). The authors received no financial support for publication of this article.
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References
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