# Maritime Health Research and Education-NET/Cohort protocols
## 7 Guide for data safety

COPSOQ-network-guidelines-an-questionnaire-COPSOQ-III-131119-signed.pdf

### Background

The seafaring employees often face more difficult working conditions in the sea than the employees working on the land. Their mental health is affected by the environment in which they live, often coupled with long working hours that contribute to stress, anxiety, loneliness, depression, and suicide. The quality of the mental work environment is dependent on a number of well-known indicators which are the object for this study.

### Objectives

To provide systematic and current knowledge about the psychosocial working environment for seafarers in different countries. The survey of the psychosocial working conditions is intended to be part of a joint program MAHRE-NET and the surveys are intended to be repeated every 3-5 years. The aim is to deliver a valid basis for a continuous update of good and safe working environments at sea.

### Methods

A cross-sectional study will be performed by the use of mail-distributed questionnaires to a sample of seafarers originate from the respective countries. The content is demographic information, questions about the psychosocial work environment, ways that work affect seafarers’ private life and family, about the company they work at, and about their own health and well-being. DPQ will be used . This was developed by the National Centre for the Working Environment Copenhagen, Denmark. It has been used in many countries in different languages and validation studies shown to be a valid tool for workplace assessment of the psychosocial work environment.

### Expected results

The results will be used as situation analysis for the industry to make informed decisions. When the employees filled in the questionnaire, the overall results for the workplace and for each of the departments are calculated. If the survey seems to indicate issues with the psychosocial work environment, the work environment committee or other relevant actors at the workplace should discuss how to act on the basis of the results. The results could help initiate prevention strategies on board. In addition, these may fuel the discussions for reforms in the respective working environments.

### Etiological models

The classical etiological model is the Karasek job control and demand model and the model according to Siegrist for chronic psychosocial stress at work, demand-control, and effort-reward imbalance as a modifiable risk factors.

### Prevention

Guidelines for prevention: https://www.copsoq-network.org/assets/Uploads/COPSOQ-network-guidelines-an-questionnaire-COPSOQ-III-131119-signed.pdf

### Keywords

Mental health, psychosocial indicators, monitoring, well-being, seafarers, the Copenhagen Psycho-social Questionnaire.

## Survey of the psycho-social working environment in seafarers

This protocol, under development, is intended to be used as a standard protocol for completion of the CopSQ cross-sectional studies, used for the first time in Thailand 2020. The seafaring employees often face more difficult working conditions in the sea than the employees working on the land. This protocol for CoPSQ surveys as a supplement to the GHQ12 surveys in the maritime schools is part of the diagnostics in a global mental health program at the maritime workplaces Jensen O, Canals M & A Bygvraa D. 2017 and Jensen et al. 2019 Their mental health is affected by the environment in which they live, often coupled with long working hours that contribute to stress, anxiety, loneliness, depression, and suicide. This proposal seeks to improve the seafarers’ mental health by introducing a comprehensive, evidence-based global maritime mental health promotion program that attracts the youngest seafarers to choose and to stay in the job.

## Background

The theories on empowerment, life-long- and problem-oriented learning with the inclusion of all stakeholders form the theoretical background. Our main task is to create responsibility among all stakeholders to help to create a comprehensive occupational- and public health program at sea that includes the whole maritime industry. The specific physical, chemical and psychological working environment factors on board also relate to the seafarer's health conditions (1)(2)(3). The quality of the mental work environment is dependent on a number of factors which have been carefully described in the past approx. 30 years (4) (5) (1). Ships with ongoing replacement of management present great challenges for both the manager and the employees and the culture at the workplace (6). During navigation, the sailors are often moved to very small working groups, where conflict management can be difficult. The requirements are very variable, the nature of the work requires considerable discipline and thus less self-control. Support from superiors and colleagues can be made difficult by the fact that crews come from many different nationalities. These conditions can lead to experienced stress and burnout (7) (1). Fatigue is considered a significant health and safety problem [14]. Jet lag after long flights for joining is described as part of this (8). (12) In the latest research Helen Sampson, director of Cardiff University's Seafarers International Research Centre, said that seafarers working on cargo ships "experience very little happiness on board". (9) She said there was evidence recent-onset psychological disorders were increasing among serving seafarers but 55% of employers said they had not introduced any policies or practices to address mental health for a decade. The report, Seafarers' mental health, and wellbeing found that internet access would make the most significant contribution to improving mental health and wellbeing together with other key recommendations were underscored in the report and the BBC News (Seafarers Mental Health and Well-being Nov. 2019).

## Occupational stress and depression etiological models

Due to the high prevalence and severe consequences, stress and depressive disorders provide an important challenge to occupational and public health. For occupational stress and depression, the classical etiological model is the Karasek job control and demand model According to Siegrist chronic psychosocial stress at work, demand-control, and effort-reward imbalance, is a modifiable risk factor. Findings from 12 reports indicate a rather consistently elevated odds ratio of about 1.8 of depression among men and women who were exposed to high demand and low control at work or who spent high efforts in combination with low rewards received in turn. Occupational stress and depression have also been described in terms of an interaction between the predisposing, precipitating, and perpetuating factors.Danasekaran, Raja, and Ravivarman Govindasamy have given a list of suspected etiological risk factors for anxiety and depression

## Objectives

To provide systematic and current knowledge about the psychosocial working environment for seafarers on ships from different countries. To use scientific methods that are well tested on land and which are supposed to be useful on the ships and thus can ensure relevant and valid results.

## Scientific aims

The aim is to help to create Health Promotion Program. The goal is for everyone to benefit from the project, both for the seafarers and for the company. The project focuses on good psycho-social wellbeing on board and in the company with the benefits for all parties the workers, owners, and the community. The scientific aim is to produce data and publications that convey new knowledge of high validity based on the newest scientific principles for the conduct of studies in peer-reviewed publications.

## Hypotheses

It is the aims to test the hypothesis that the physical and psychosocial working environment of the ships differs by ship type and size, area of work, job type of the ship, and other industries onshore. Further that there is a connection between the working environment, lifestyle onboard and home, and the health and welfare of the crews.

## Methods

An epidemiological, cross-sectional-based study will be performed by the use of mail distributed questionnaires about the subjective environment including self-assessment of health are used. The content of the questionnaires is demographic information about the person for the students and about the ship for the seafarers. So we have two versions of the questionnaire one for the students and one for them when they are in practice as seafarers and later employed seafarers. We include screening for smoking, height, and weight for BMI related to the prevention of the Chronic disease in order to stay in line with the DiMoPEx (CA 15129) The plan is to offer the Maritime students to carry out this study to be used for their Graduation Thesis. Based on our experience with the supervision of our students over the last three years we believe that the students are able to produce scientific valuable new knowledge for the benefit of the maritime workers and the companies. The CoPSoQ has been developed in 30 years and we consider to use the latest version "Danish ......

## Questionnaires

The new Danish Psychosocial Questionnaire has 87 questions developed from the CoPSOQ schemes. This might be too long for our target groups. Maybe it can be divided so that each cohort only answers one part specific themes.
Dansk psykosocialt sporgeskema
COPSOQ-II/short-version Danish
CoPsOQ Spanish short version - Article
COPSOQ-English short version
COPSOQ-short version supplemental information

## Data collection

This questionnaire CoPSQ was developed by the National Centre for the Working Environment (NRCWE, previously AMI), Copenhagen, Denmark. It was developed as a tool for workplace assessment of the psychosocial work environment. When the employees have filled in the questionnaire, the overall results for the workplace and for each of the departments are calculated. If the survey seems to indicate problems with the psychosocial work environment, the work environment committee or other relevant actors at the workplace should discuss how to act on the basis of the results. If help from the outside is needed, the workplace may contact consultants, the Labour Inspection, or relevant organisations. The NRCWE has developed a users’ guide for understanding and interpretation of the results. This guide should be used in connection with the questionnaire. The guide also includes a short overview on the issue of “going from survey to action” in connection with the psychosocial work environment. Data in Thailand was collected by personal interview by the maritime students.

## Long-term perspectives

After a successful study with the Maritime company in Thailand, the idea is to repeat the questionnaire again in 2-3 years after agreement with the companies. Studies with other themes like Safety Culture can be done with the Maritime Companies in Thailand.
Further the aim is to collaborate with other countries. The identical questionnaire will be used with possibility to compare between the countries. Our target group of maritime workers include seafarers, fishermen, port workers, off-shore workers and seafarers’ wives. That means we will try to do similar studies with the other target groups over time.
We propose a program with methodological training support and supervision of the students’ research projects, their graduation Thesis.
This initiative will contribute to important parts of the UN Sustainable goals, especially Goal 3: Good Health and Wellbeing especially for the maritime workers and Goal 14: Life below water with observations on compliance to keep the garbage on board and visible pollutions at sea in the monitoring.

## Data processing

Data is transferred to electronic processing during the investigation. Standardized statistical methods will be used using the latest data processing SPSS program. Data will be handled under strict confidentiality in anonymous form on CMSS. All data will be stored in a special database to use data up following studies later. The Data Inspectorate is informed and current legislation is complied with.

## Ethical requirements

Since the study does not involve blood sampling, and since participation in the study is completely voluntary after informed consent, the study does not involve ethical problems. All data are treated according to the Act on the duty of confidentiality, and the guidelines for good epidemiological practice will be followed. The participants' anonymity will be ensured in all ways and this will be apparent from the project description and the form. It will be ensured that the electronic form is locked so that the information cannot be seen by anyone other than the researchers. More detailed information

## Dissemination of results

The students finishes his/her Thesis which will also be handed over to the Maritime company. The results will also be presented in the Maritime Company News and at conferences and be available on relevant websites from e.g….. In case the student wants to go further a scientific article will be published in an international scientific journal.

## Prevention

Jensen and Oldenburg in their latest study conclude that in view of many stressors on board, and the lacking respective education, there is a need to integrate stress management in the maritime educations for officers Guidelines for prevention https://www.copsoq-network.org/assets/Uploads/COPSOQ-network-guidelines-an-questionnaire-COPSOQ-III-131119-signed.pdf Authors "soft guidelines" page 7, start with: "Never start a psychosocial risk assessment unless there is a clear intention of taking action if indicated"
According to Siegrist chronic psychosocial stress at work, demand-control, and effort-reward imbalance, is a modifiable risk factor. Findings from 12 reports indicate a rather consistently elevated odds ratio of about 1.8 of depression among men and women who were exposed to high demand and low control at work or who spent high efforts in combination with low rewards received in turn.

## Pilot study

A pilot study is carried out in a class of maritime university students

## Work plan

* Agreement with maritime company and the students
* Questionnaire and data collection program ready
* Pilot test of the form on health education
* Agreement with Maritime company in Thailand
* Mail lists are established
* Mail with link to the questionnaire in English
* Reminder send twice with 2 weeks between
* Data analysed and tables prepared
* Thesis prepared (article)
* Prevention plan

## REFERENCES

* Oldenburg M, Jensen H-J, Latza U, Baur X. Seafaring stressors aboard merchant and passenger ships. Int J Public Health. 2009;54(2):96–105.
* Oldenburg M, Baur X, Schlaich C. Cardiovascular diseases in modern maritime industry. Int Marit Health. 2010;62(3):101–6.
* MacLachlan M, Kavanagh B, Kay A. Maritime health: a review with suggestions for research. Int Marit Health. 2012;63(1):1–6.
* Levi L. Occupational stressors, biological stress and workers’ health. J UOEH. 1989 Jun 1;11(2):229–45.
* Leka S. Psychosocial hazards and seafarer health: priorities for research and practice. Int Marit Health. 2004;55(1–4):137–53.
* Lodde B, Jegaden D, Lucas D, Feraud M, Eusen Y, Dewitte J-D. Stress in seamen and non seamen employed by the same company. Int Marit Health. 2008;59(1–4):53–60.
* Elo AL. Health and stress of seafarers. Scand J Work Environ Health. 1985 Dec;11(6):427–32.
* Wadsworth EJK, Allen PH, McNamara RL, Smith AP. Fatigue and health in a seafaring population. Occup Med. 2008 May 1;58(3):198–204.
* Seafarers’ mental health and wellbeing [Internet]. IOSH. [cited 2019 Nov 14]. Available from: https://www.iosh.com/resources-and-research/resources/seafarers-mental-health/
* ↑ Hatami, Ali, Shahram Vosoughi, Agha F. Hosseini, and Hossein Ebrahimi. ‘Effect of Co-Driver on Job Content and Depression of Truck Drivers’. Safety and Health at Work 10, no. 1 (March 2019): 75–79 https://doi.org/10.1016/j.shaw.2018.06.001
* ↑ Johannes Siegrist European archives of psychiatry and clinical neuroscience 258 (5), 115-119, 2008
* ↑ Kumar, Shailesh, Simon Hatcher, and Peter Huggard. ‘Burnout in Psychiatrists: An Etiological Model’. International Journal of Psychiatry in Medicine 35, no. 4 (2005): 405–16. https://doi.org/10.2190/8XWB-AJF4-KPRR-LWMF
* ↑ Danasekaran, Raja, and Ravivarman Govindasamy. ‘Better Psychosocial Work Environment: For Well-Being of the Worker and the Organization’. Indian Journal of Occupational and Environmental Medicine 23, no. 1 (2019): 57–58. https://doi.org/10.4103/ijoem.IJOEM_183_18
* ↑ Jensen H-J, Oldenburg M. Training seafarers to deal with multicultural crew members and stress on board. International maritime health. 2020;71(3):174–180.
* ↑ Johannes Siegrist European archives of psychiatry and clinical neuroscience 258 (5), 115-119, 2008