Psychological well-being of travellers on long-distance shipping voyages: A systematic review protocol

Objective

This review seeks to achieve the following objectives: to assess the prevalence of psychosocial issues among seafarers on long-distance shipping voyages; to identify the factors contributing to psychosocial challenges among seafarers; and to examine the impact of psychosocial issues on the well-being and performance of travellers to evaluate existing interventions and support systems for promoting psychosocial well-being among travellers. We intended to answer the following research questions:

Q1: What are the subjective experiences of seafarers during long-distance voyages and how do they perceive and cope with the challenges they encounter?

Q2: What role do social support networks play in mitigating psychosocial challenges among seafarers and how do these networks operate within the maritime environment?

Q3: What are the key factors influencing psychosocial well-being among seafarers, including work-related stressors, voyage duration, and interpersonal relationships?

Eligibility criteria

This review will include studies focusing specifically on the psychosocial well-being of seafarers engaged in long-distance shipping voyages. Eligible studies will involve quantitative, qualitative, or mixed-methods research that examines factors such as mental health, social relationships, or coping mechanisms among seafarers. The review will be restricted to studies that address the challenges faced by deck officers, engineers, and catering personnel, as these roles represent a cross-section of responsibilities and stressors encountered during long voyages. Studies on land-based maritime workers or seafarers involved in short-haul routes will be excluded to maintain a focus on the unique context of extended, long-distance sea travel.

Furthermore, to ensure that the selected studies align with the objectives of our review, we included studies that measured various aspects of psychosocial well-being, including but not limited to mental health, emotional well-being, job satisfaction, social connectedness, quality of life, stress, burnout, resilience, and coping strategies among individuals engaged in long-distance shipping voyages. This encompasses the exploration or measurement of factors such as depression, stress, anxiety, social support, and coping mechanisms, aligning with the objectives of this review. Eligible studies focused specifically on roles such as deck officers, engineers, and catering personnel, who represent a range of responsibilities and unique stressors associated with extended voyages.

Exclusion criteria

Studies focusing on organizational factors, defined as elements related to company policies, administrative structures, or employment practices without a direct psychosocial focus, were excluded. Similarly, studies centered on technical aspects such as operational mechanics, ship design, or equipment functionality will not be included unless they assessed their psychosocial impact. Lastly, non-psychosocial aspects of maritime work, like physical safety protocols or environmental factors (e.g., noise or temperature control) that do not address mental, emotional, or social well-being, were also excluded.

Definition of outcomes

The outcomes of this review will include measures of depression, anxiety, social support, job satisfaction, and QoL. Studies that provide acceptable standard definitions for these concepts were considered. Definitions for depression and anxiety should not deviate widely from those given by Beck,⁷ as this definition is considered the most acceptable. Quality of life should be defined by the World Health Organization (WHO). For this review, Quality of Life (QoL) will be assessed with a focus on the psychosocial dimensions of well-being, following the World Health Organization’s (WHO) broad definition, which considers an individual’s mental, emotional, and social health within the context of their life experiences and environment.⁸

It should encompass an individual’s subjective life experiences, including their physical, mental, social, and emotional well-being.⁹ Studies that have operationalized these constructs with standardized scales, including but not limited to the HAM-A and HAM-D for anxiety and depression, respectively, the Patient Health Questionnaire (PHQ),¹⁰ Job Descriptive Index (JDI),¹¹ Job In General (JIG) scale,¹² and Minnesota Satisfaction Questionnaire (MSQ)¹³ will all be included in this review.

Types of study

This review will include primary studies using qualitative, quantitative, or mixed-methods approaches. Qualitative studies will explore the personal experiences and feelings of seafarers regarding their mental well-being during long voyages. Quantitative studies will provide measurable data, allowing for statistical analysis of psychosocial factors. Mixed-methods studies, which combine both qualitative and quantitative data, will also be included to offer a comprehensive view of the issues faced. These multiple study designs, will enable us to capture the complexity of psychosocial challenges that seafarers encounter. This approach is crucial for understanding their experiences and aligns with established guidelines for systematic reviews, ensuring the research is thorough and meaningful.^14,15 This diverse methodology will help us gain deeper insights into the psychosocial well-being of seafarers and the real-world implications of our findings.

Participants

This review will include all studies that used participants who have had long-distance shipping voyages, regardless of gender or geographical orientation. However, it will exclude children below the age of 15, as they may not be able to corroborate their experience well enough to inform generalization.

Study setting

This review includes studies conducted in India, Denmark, the United Kingdom, Sweden, Ireland, Germany, South Africa, Norway, and the Czech Republic. These countries were selected because of their high shipping voyage rate. Particular attention of the reviewers is paid to India because we intend to leverage the results of this review to conduct primary research within the Indian shipping voyage space.

Sources of data

The researchers intended to develop search strategies for eligible literature using keywords related to maritime activities and mental health. Databases, such as Scopus and Web of Science, will be searched using keywords. These databases were selected as they are considered to hold large volumes of data worldwide, so the potential of covering most of the studies is very high. Advanced Google search engines will also be searched to capture other data that otherwise might not have been indexed in these two major databases (Scopus and Web of Science). Dissertations and theses were excluded because the researchers intended to work with only published records.

This systematic review focuses exclusively on published records and peer-reviewed journal articles. Unpublished theses and dissertations will be excluded from the review owing to potential limitations in access, quality control, or potential bias in unpublished work. All searches will be limited to studies published in English and will involve only human subjects. It is anticipated that this review will be completed in September 2024. That is, the expected end-year search for the data will end in 2024.

Search strategy and process

The literature search will employ Boolean Operators (AND and OR) along with side keywords for each of the databases to be searched. For instance, psychosocial OR “well-being” OR “mental-health” OR “Shipping Voyages” OR Seafarers; for the first phase of the search; the other phase will combine keywords such as psychological AND “shipping voyages” AND Seafarers. This formula will be applied to both databases from which the search will be carried out. The search will be limited to countries in the study setting.

The search will be conducted in two phases. The initial phase will focus on identifying studies conducted within India, given the specific context and relevance of the topic to this geographic region, as well as the fact that the researcher intends to rely on the findings of this review to carry out an original study. Subsequently, a broader search will be carried out to capture relevant literature from other named countries, as indicated in the study setting, to ensure comprehensive coverage of the available evidence.

The statement for Reporting Literature Searches in Systematic Reviews (PRISMA-S)¹⁶ will be relied upon as a guide for reporting our search results. The two authors (AK and TR) will carry out the search independently, and AK and PD will compile the search results and remove duplicates.

Data selection process

At this stage of the review, three authors, AK, TR, and PD, will independently screen the titles and abstracts of the identified records using eligibility criteria. Subsequently, they will independently screen the full text of other records for which decisions could not be reached after their titles and abstracts were screened. On one hand, through a one-on-one interaction between PD, AK and TR, a discussion will be held to resolve any discrepancies that would arise during the screening process. After reaching an agreement on the records to be included by these three authors, NKS and SS will give a final validation to these records owing to their expertise in maritime and Psychological research respectively.

Risk of bias assessment in studies extracted

To ensure that the findings of all the records extracted are free from the risk of bias, based on reliable and unbiased evidence, two of the reviewers, NKS and PKS, will use the Cochrane Collaborations’ Risk of Bias tool¹⁷ to systematically evaluate the risk of bias in the extracted records. This must be performed to meet the standard set for the systematic review protocol. In a systematic review, minimizing bias is a core component of the review,¹⁸ and one of the most preferred means to achieve this is by employing the most appropriate tools. Many tools exist for the execution of this process. However, the Cochrane Collaboration Risk of Bias tool is the most preferred and widely used tool. This affords researchers the opportunity to consider plausible limitations of the studies to be included in the review in order to obtain reliable conclusions.

One important limitation to address is potential demographic discrepancies, particularly in age and gender. Studies that do not control for these factors might yield skewed results, as psychological impacts and health outcomes can vary widely across different demographics. For instance, Oldenburg, Baur, and Schlaich (2010)² discuss the varied occupational challenges that seafarers face, noting that demographic factors can influence the severity of these challenges.² In light of this, the control group should be carefully edited to align with the study group, especially regarding the female-to-male ratio, to ensure balanced comparison and to strengthen the validity of conclusions.

Additionally, treatment and management strategies aimed at reducing death anxiety should be expanded to include frequent psychological consultations both onboard and via telemedicine. Jensen and Oldenburg (2019)¹ highlight the traumatic experiences that seafarers endure, emphasizing the need for comprehensive psychological support.¹ During periods of restricted in-person access, such as the COVID-19 pandemic, telemedicine has proven essential for delivering psychological care to isolated populations, making it a critical component of ongoing mental health support.

Quality assessment

To determine the reliability and credibility of the individual documents, a quality assessment was performed by two authors with several years of experience in the field of psychiatry. One performed the initial assessment, and the other crosschecked. The quality rating was premised on the following criteria: “Selection bias,” “random sequence generation,” “allocation concealment,” “reporting bias,” “other bias,” “performance bias,” “detection bias,” “data collection methods” and “attrition bias”.¹² Each of the articles included in the study was assessed for bias using the Cochrane Collaboration Risk of Bias tool.

Data synthesis

Our choice of approach for data synthesis is informed by the degree of heterogeneity observed. We will use meta-analysis, narrative synthesis, or both. Meta-analysis, a statistical method employed when combining results of large samples of data (records) to be included in a study, provides, to a larger extent, the reliability or precision of the estimates on any treatment effects.¹⁹ Meta-analysis involves pooling data from individual studies, analyzing them collectively, and often calculating a weighted average effect size.¹⁹ On the other hand, narrative synthesis involves a qualitative approach to synthesize evidence from multiple studies. Here, rather than pooling data and collecting statistical analyses, narrative synthesis focuses on summarizing and interpreting findings from individual studies in a narrative format. It includes the description of patterns, themes, and discrepancies across studies, providing a qualitative understanding of the topic under investigation.¹⁹

The researchers’ choice of any or both of these methods is contingent on the outcome of the selected records. However, in the event where heterogeneity will be observed among studies, it will be incumbent to use narrative synthesis, since the application of meta-analysis in this situation will be challenging as the studies will be too different to be combined. In the same instance of heterogeneity prevalence, the researcher will follow the three-step approach to narrative synthesis to synthesize the results included in the study.²⁰ These steps include organizing the description of the studies into logical categories, analyzing the findings within each of the categories, and synthesizing the findings across all included studies.²⁰ Tables and graphs are used to support narrative synthesis or qualitative summary.