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 travellers on long-distance shipping voyages; to identify the factors contributing to psychosocial challenges among travellers; 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

We established specific eligibility criteria to inform the inclusion of studies in the review. Our criteria were designed to ensure that the included studies focused on individuals engaged in long-distance shipping voyages and investigated psychosocial factors, experiences, or interventions related to this context. Studies that capture individuals, such as seafarers, crew members, and maritime workers employed in long-distance shipping voyages, are included. For example, studies exploring the impact of isolation, confinement, cultural adaptation, job stress, social support, mental health services, and coping mechanisms among individuals on long-distance shipping voyages were considered eligible.

On the other hand, we will exclude studies that focus solely on populations not directly related to long-distance shipping voyages, such as studies on short-distance maritime workers or land-based occupations. Additionally, studies focusing solely on passengers or tourists rather than crew members or maritime workers were excluded from our review.

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. Additionally, eligible studies should measure the prevalence of psychosocial well-being among shipping voyages and address the aspects of job satisfaction and quality of life related to long-distance voyages. Studies lacking relevant psychosocial well-being outcomes or measures, as well as those focusing solely on organizational factors, technical aspects, or non-psychosocial aspects of maritime work, were excluded from our review.

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). It should encompass an individual’s subjective life experiences, including their physical, mental, social, and emotional well-being.⁸ 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),⁹ Job Descriptive Index (JDI),¹⁰ Job In General (JIG) scale,¹¹ and Minnesota Satisfaction Questionnaire (MSQ)¹² will all be included in this review.

Types of study

Primary studies that used qualitative or quantitative methods will be included in the review. This allowed a broad range of studies to be included. Mixed-methods studies are also eligible for inclusion, as they can provide valuable insights by combining qualitative and quantitative approaches.

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 was applied to both databases from which the search was carried out. The search was limited to countries in the study setting.

The search was 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)¹³ 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 tool¹⁴ 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,¹⁵ 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.

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”.¹¹ 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.¹⁶ Meta-analysis involves pooling data from individual studies, analyzing them collectively, and often calculating a weighted average effect size.¹⁶ 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.¹⁶

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.¹⁷ 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.¹⁷ Tables and graphs are used to support narrative synthesis or qualitative summary.