19
1 INTRODUCTION
Seafaring is one of the most physically demanding
professions in one of the most dangerous work
environments (IMHA, January 2012). Difficult
workingconditionsatsea,insufficientqualifications
of subordinate crew members, exposure to danger,
highrequirements forthe seafarers, aswell ashigh
pace at work and long period without family,
extremepsychosocia
lproblems,all
thosefactorslead
toassumptionthatseafarer‘soccupationwashighly
stressful and exhausting (Allen, et al., 2010;
Oldenburg, et al., 2010). Merchant shipping was
knowntobeanoccupationwithahighrateoffatal
Poor Sleep, Anxiety, Depression and Other
Occupational Health Risks in Seafaring Population
J
.Andruskiene
KlaipedaStateUniversityofAppliedSciences,Klaipeda,Lithuania
M
arineScienceandTechnologyCentre,KlaipedaUniversity,Lithuania
S.Barseviciene
KlaipedaStateUniversityofAppliedSciences,Klaipeda,Lithuania
G.Varoneckas
M
arineScienceandTechnologyCentre,KlaipedaUniversity,Lithuania
ABSTRACT: Background: seafaring is an occupation with specific work‐related risks, causing increased
morbidityandmortality.Nevertheless,theresearchintheareaofmarinestudents‘sleepqualityandmental
healthislackinginLithuania,aswellasotherEuropeancountries.Theaimwastooverviewscientificfindings,
relatedwithoccupationalhealthrisks
inaseafaringpopulationandassesthefrequencyofpoorsleepandthe
relations among poor sleep, anxiety and depression in the sample of maritime students. Methods and
contingent.Thescientificliteraturereview,basedonPubMedsourcesanalysis,relatedtooccupationalhealth
risksinseafaringpopula
tion,
wasperformed.Questionnairesurveywasconductedin2014atTheLithuanian
MaritimeAcademy,393(78.9%ofthemmales)studentsparticipated.SleepqualitywasevaluatedbyPittsburg
Sleep Quality Index. Anxiety and depression were assessed by Hospital Anxiety and Depression scale.
Sociodemographicquestionswereused.TheChi‐squaretestrFisherexacttestwasusedtoesti
ma
teassociation
between categorical variables. P‐ Values less than 0.05 were interpreted as statistically significant. Results.
Scientificliteraturereviewindicatethathighlystressfulandexhaustingworkingconditionsonshipscanleadto
depression, insomnia, various types of cancer, cardiovascular, communicable, blood‐born and sexually
tra
nsmi
tteddiseases.Poorsleepwasfoundin45.0%ofthestudents.Milddepressionwasestablishedin6.9%,
moderatein2.3%,Severein0.8%ofthestudents.Mildanxietywasfoundin19.1%,moderatein14.8%and
Severein7.9%ofthestudents.Depression(score≥8)wassignificant
l
ymorefrequentamongthird(fourth)year
students (22.2 %) with poor sleep, as compared to the students demonstrating good sleep (2.7 %). Marine
engineeringprogrammestudentswhosesleepwaspoormoreoftenhaddepression(22.0%),ascomparedto
thestudentswhosesleepwasgood(5.7%).Conclusions.Seafarershavehigherhospit
alizat
ionandmortality
ratesthanage‐matchedpeers,dueto exposuretouniqueoccupationalhealthriskfactors.Maritimestudents
had poor sleep more than anxiety or depression. Anxiety and depression were more common among the
students demonstrating poor sleep rather than good sleep. Key words: Maritime students, Sleep qualit
y,
Anxiety,Depression,Occupational
health.
http://www.transnav.eu
the International Journal
on Marine Navigation
and Safety of Sea Transportation
Volume 10
Number 1
March 2016
DOI:10.12716/1001.10.01.01
20
accidents caused by maritime disasters and
occupational accidents (Hansen et al., 2002). Major
causesofmortalityinshippingdisasterswerevessels
foundering in typhoons, storms and heavy gales,
explosionsincargoholdsandcollisionsduetopoor
visibility. Rough weather, insufficient awareness of
safety, lack of use of personal protective
devices as
well as inexperience were regarded as the main
causesoffatalinjuriesrelatedtowork(Oldenburg,et
al.,2010).
Morbidityofmaritimeemployeesintheperiodof
globalizationwasanimportantissueforoccupational
healthcareandtheshippingindustry(Tomaszunas,
2002). Scientific research results indicated merchant
seafaring
previously a high‐risk occupation for
suicides at work,there hadbeen a sharpfall inthe
suicide rate in the past 40 years, likely reasons for
this included reduction over time in long
intercontinental voyages and changes of seafarers’
lifestyles(Robertset.Al,2010).Riskfactorsofsuicide
still remained
easy access to a mean of suicide
(drowning),long‐termseparationfromfamily,heavy
alcohol consumption and psychoses (Roberts,
Marlow, 2005). On the other hand working in the
isolatedenvironmentcouldhave „salutogenic“effect
because seafarers were isolated from stress and
strainsofdailylife(Sandalet.al,2006).Therewas
an
evidencetosuggestthatseafarerswerewelltrained
andpreparedforthischallenge.Polishseafarershad
demonstrated the highest rates in social
relationships, environment and psychological
functioningqualityoflifedomains,aswellasproper
openness to new experiences, higher than average
conscientiousnessandagreeableness(Jeźewska etal.,
2013).
Maritime students were more vulnerable to
stress at work, as compared with merchant marine
officers,workingminimum15yearsatsea.Stressat
sea,experiencedbystudents,wasrelatedwithsocial
relations, physical onerousness, the lack of control
andthelackofsupport(Jeźewskaetal.,2006).
International maritime
health research field had
largelydevelopedwithinthespheresofoccupational
healthservicesandinternationalhealthproblems.In
theperiodof2000to2010sixthematiccategoriesin
the scientific literature were identified: health care
access, delivery and integration; tele health; non‐
communicable diseases and physical health
problems; communicable diseases; psychological
functioning and health; safety‐related issues
(MacLachlanetal,2012).
Seafarersexperiencedoccupationalriskfactorson
board, such as time pressure and long working
hours, which could be specified as cardiac risk
factors (Oldenburg, et al., 2010). Taking into
considerationthehealthyworker effect,cardiacrisk
factorsoccurredslightlymore
frequentlyinseafarers
than in the general population (Oldenburg, et al.,
2010).Seafarerswereathighriskofdeathincaseof
myocardial infarction on board. The impact of the
workenvironmentandwork‐relatedfactorsreduced
significantlythechanceofsurvivalatseainthecase
of sudden cardiac attack
(Jaremin, Kotulak, 2003).
Occupational factors, such as high work stress, job
demand, and lack of support and physical hazards
were related with severe and long term fatigue
(Wadsworth et al., 2008). Seafarers with
temporary/apprentice employment, as compared
withpermanent,reportedsignificantlymorephysical
fatigue,mentalfatigueandlackofenergy.
Compared
todayshift,thoseworkingonthenightshiftreported
significantlymorementalfatigueandlackofenergy.
Negative organizational safety climate was
associatedwithphysical,mentalfatigueand lackof
energy(Hystadetal.,2013).
Fatigue symptoms were associated with a range
ofoccupationalandenvironmentalfactors,uniqueto
seafaring.Reportingagreaternumberofriskfactors
was associated with greater fatigue: OR=2.53 for
thosewith3‐4 riskfactorsandOR=9.54forthosewith
≥5 riskfactors (Wadsworth etal., 2008).Strong link
between fatigue and poorer cognitive and health
outcomes was assessed. Seafarers‘fatigue could be
related with
long term ill‐health (Wadsworth et al.,
2008).
Long working hours (9‐12), increased eyestrain.
Vibrationandnoisewererelatedwiththeoccurrence
of psychoemotional strain. 87% of the seafarers’
experiencedfatigue‐relatedlackofenergy,42%made
slight mistakes, 29% showed poor judgement.
Psychoemotional strain was related to waist
and
spinal pain, insomnia and depression. 70% of
seafarers had poor sleep at sea. Difficulties falling
asleep were reported by 24%, wakefulness 44.6%,
waking up due to fatigue 6.2%, light sleep 43.4%
(Sąlyga,Kušleikaitė,2011).
Maritime workers on 6‐hour shifts reported
significantlymoresleepproblems,ascomparedwith
12‐hourshiftworkers. The6‐hourshiftworkerswere
moreaffectedbynoiseandshiftworkitself(Hansen,
Holmen,2011).
High stress level on board lead to frequent
smoking. Decreased manual workload, a high
cholesterol diet increased prevalence of obesity, so
the main risk factors of cardiovascular disorders
were
common in maritime environment (Hansen et
al., 1994; Kirkutis et al., 2004). Danish seafarers,
especially males, faced an increased overall cancer
risk, in particular risk for lung cancer and other
tobaccoassociatedcancers(Kaerlevetal.,2005).
Seafarers from the Nordic countries had been
reportedto have excess cancer morbiditycompared
with the population on shore. The excess was
attributable to lung cancer and alcohol‐related
cancers.Therelativeriskofpleuralcancerwashigh
inallNordiccountries(Andersenetal.,1999).
Highlyphysicallydemandingworkintheheatof
engine rooms or galleys, exposure to radiant heat
fromgenerators
andovens(Bridger,Bennett,2011).
Exposures to different type of hydrocarbons,
carrying oil products and chemicals, exposure to
carcinogenic substances, asbestos exposure (Hansen
etal.,2005;RobertsandHansen,2002)wereproved
as lung cancer risk factors, polycyclic aromatic
hydrocarbonsandnitroarenes–possibleriskfactors.
For the mesothelioma cases, former
asbestos
exposure was considered a causal factor (Forsell et
al., 2007; Saarni et al., 2002). Long ‐term chemical
exposuresontankersincreasedratesofspecifictypes
ofcancers(Saarnietal.,2002).Onaverage,55.5%of
seafarers were exposed to chemicals, 60% were
alwaysusingpersonalprotectionequipment(Jensen
et
al., 2005). Chemicals used for different cleaning
21
tasksonboardwerethemostfrequentcauseofinjury
(Hansen, Pedersen,2001). Occupationalexposure to
benzenemighthavecontributedtotheincreasedrisk
of chronic myeloid leukemia (age‐standardized
cumulative cancer incidence ratios (SIR) 3.15)
(Jianguang, Hemminki, 2005). Occupational
exposures of deck crews on tankers added to their
risk
of renal cancer, leukemia and possibly
lymphoma(Saarnietal.,2002).ExposuretoUV‐light
from the sun was associated with significantly
increasedriskoflipcancer(SIR2.74)andskincancer
amongseafarers,workingneartheequator(therisk
is 2‐4 times higher, as compared with working in
NorthernEurope)(Jianguang,Hemminki,2005).
Noise levels varied considerably (approximately
102‐110dBintheengineroomand75dBincontrol
rooms) in various areas of vessels and were the
highestintheenginerooms.Engineroompersonnel
experienced significantly higher risk of hearing
impairment (RR=2.39), as compared with other
seafarers (Kaerlev et al., 2008). Deck crew (non‐
officer) seamen had high standardized incidence
ratios for injuries and carpal tunnel ship caused
musculoskeletal strain, noise and vibration
influencedhealth(Hansenetal.,2005). Shipmotion
increasedtask demands and time to complete tasks
and caused loss of balance, sea sickness,
sleep
disturbances,slips,trips,fallsandgeneraltiredness.
Seafarersusedladdersandhatchesdaily,sometimes
inextremesoftemperature(Kaerlevetal.,2008).Life
at sea imposed additional physical demands
(Bridger,Bennett,2011).
Seafarers were exposed to a variety of
occupational hazards making exposure to biologic
agents and the concomitant risk
of communicable
diseases extremely important within this working
group.Seafarerswereatriskofcontractinginfectious
diseases at ports of call in different countries
(Crossland et al., 2007). Many seafarers were, as a
part of the job, international travelers, and were
known to have a risk of hepatitis A and
B, HIV
infection,tuberculosis,chickenpox,meas les(Hansen
et al., 2005; Rachiotis et al., 2010; Buff et al., 2008).
Therewas anevidenceto suggestthat international
shipping was associated with an increased risk of
spreading communicable diseases. According to
WHO, most of detected gastrointestinal disease
outbreaks, influenza, legionellosis, varicella and
rubella
were associated with travelling by cruise
ships(Mitrukaetal.,2012).
Crew members with different susceptibility to
infection shared living quarters, common food and
water supplies, as well as sanitation and air‐
conditioningsystems,sotheworkingconditionslead
to spread of communicable diseases, such as
Norovirus (influenza A and
B), influenza A H1N1
(WHO, 2013). Malaria, Dengue Fever and
ChikungunyaFeveroccurredamongseafarersinthe
regions at risk of these diseases (Brotherton et al.,
2003).Blood‐born andsexually transmitted diseases
(hepatitisB,C,HIV)wererelatedwithunsafesexor
tattooing(Nikolicetal.,2000).
From 1999 to
2008, 33 imported malaria cases
wererecordedinKlaipeda,from1to8casesperyear.
Among them, there were 28 infections of seafarers,
whowereprobablyinfectedonWestAfrica,Nigeria,
Cameroon or Angola. Malaria was a work ‐related
healthriskamongseafarers(Oldenburgetal.,2010).
Relationshipsamong
workcharacteristics,fatigue
andill‐healthwerenotclear:fatiguewasacommon
symptomofillnessandcouldresultinmorenegative
interpretation and/or coping with work
characteristics;ornegativeworkcharacteristicscould
leadtofatiguewhichcouldresultinpoorhealthand
well‐being(Wadsworthetal.,2008).
Self‐rated
health decreased by age. The adjusted
oddsratioforfemalescomparedtomaleswithgood
health was 2.65 (Scerbaviciene, Pilipavicius, 2009).
Theseafarerswereexpectedtobeatleastashealthy
asorhealthierthanthegeneral populationduetothe
minimum health conditions required passing the
regularhealthexamination.
93%oftheseafarerswith
verygood orgoodhealth wasonthe samelevel or
higherthanthegeneralpopulationinfourcountries:
Estonia, Finland, Lithuania and Latvia
(Scerbaviciene,Pilipavicius,2009).
Research show that maritime students already
meetsomeoccupationalhealthrisks.Morethan60%
of theUSA students studying
inthe different areas
were categorized as poor sleepers, were using
medications and reported more physical and
psychologicalhealthproblemsascomparedtogood
sleepers (Lund et al., 2010). More than one third
(31%) of the medical students at the University of
Tartu, evaluated the sleep quality as satisfactory,
poor
orverypoor(Veldi etal.,2005).Theprevalence
of insomnia among nursing students in Italy
increased significantly from 10.3% (<20 years) to
45.5% among older students, and was predicted by
theseveredepression,headacheandpoorqualityof
life (Angelone et al., 2011).The social activities
werelessfrequentand
notregularamongthecollege
studentsaged18‐39yearsdemonstratingpoorsleep,
as compared to the students having good sleep
(Carneyetal.,2006).
Poorsleepamongthefirstyearstudentscouldbe
relatedwith changedliving environment,especially
noise and light in residential halls (Sexton‐Radek,
Hartley, 2013).
However alcohol consumption was
the significant predictor of worsened sleep quality
and poorer academic performance in the randomly
selected sample of 236 students (124 women) of an
artscollege(VanDongenetal.,2003).
College students are vulnerable to a variety of
sleepdisorders,whichcanleadtosleepdeprivation
and
impairedindividualcognitiveperformance(Van
Dongenetal.,2003).Howeverthescientificliterature
criticallyreviewedtheefficacyofrelevantbehavioral
sleep medicine interventions and discussed special
considerationsfor usingthem with college students
whohaveuniquesleeppatternsandlifestyles(Kloss
etal.,2011).
Insufficient sleep and irregular sleep‐wake
patterns resulting chronic sleep debt and negative
consequences are present at alarming levels among
students.Theresearchintheareaofstudents’sleep
qualityand mooddisorders islacking in Lithuania,
as well as other European countries, especially
amongmarinestudents.
The aim of the survey was to evaluate sleep
quality
and the state of mental health of maritime
22
students in the institution of higher education in
Lithuania and establish relations between sleep
quality and mental health with regard to studying
yearandstudyprogramme.
2 MATERIALANDMETHODS
2.1 Studysample
ThesurveywasconductedinMarchandApril,2014.
The study sample consisted of 393 Lithuanian
Maritime
Academystudents(78.9% males),from18
to 34 years of age. The first (34.9%), the second
(28.0%), the third and fourth (37.1%) year students
wereinvolvedinthestudy(Table1).Meanageofthe
students was 20.71 (SD=1.971).They were grouped
according to the study programmes: Marine
Navigation students’ group
(28.5%), Marine
Engineering (37.4%) and the group of students,
studyingPortandShippingManagementorFinances
of Port and Shipping Companies or Maritime
Transport Logistics Technologies (34.1%). The
groupingwasperformedinordertoensuretheeven
distributionoftherespondentsasmuchaspossible.
The grouping was also performed according
to the
age:18‐19years(22.7%),20(26.7%),21(25.2%)and≥
22 years (24.4%). Frequency of the subjectively
perceivedsleepqualityandanxietywascomparedin
age groups, studying year groups and study
programmegroups.
ThestudywasapprovedbyBioethicsCommittee
ofKlaipedaUniversity.
2.2 Questionnaires
PittsburghSleep
QualityIndex(PSQI) (Buysseetal.,
1989) was used for subjective sleep quality
evaluation.PSQI isaself‐rated questionnairewhich
assessessleepqualityoverone‐monthtimeinterval.
19 individual items generate seven “component”
scores: subjective sleep quality, sleep latency, sleep
duration, habitual sleep efficiency, sleep
disturbances, use of sleeping
medication, and
daytime dysfunction. The sum of scores for these
seven components yielded one global score. Total
PSQIscore<5wasevaluatedasgoodsleepquality;>
5–poorsleep.
Hospital Anxiety and Depression (HAD) scale
(Zigmond,Snaith,1983),aself‐assessmentscalewas
used to identify states
of depression, anxiety and
emotionaldistressamongthestudentsofLithuanian
Maritime Academy. The HAD scale has in total 14
items,withresponsesbeingscoredonascaleof0‐3,
with3indicatinghighersymptomfrequencies.Score
for each subscale (anxiety and depression) ranged
from0‐21withscorescategorized
asfollows:normal
(0‐7), mild (8‐10), moderate (11‐14), severe (15‐21).
Scoresfortheentirescale(emotionaldistress)ranged
from 0‐42, with higher scores indicating more
distress. Prior to completing the scale respondents
wereaskedto“fillitcompleteinordertoreflecthow
they have
been feeling during the past week”
(Zigmond,Snaith,1983).
Additional sociodemographic questions about
respondents’age,gender,studyprogrammeandyear
ofstudyingwereincludedinthequestionnaire.
2.3 StatisticalAnalysis
TheChi‐squaretestorFisherexacttestwasusedto
estimate the association between categorical
variables.P‐values lessthan
0.05wereinterpretedas
statisticallysignificant.
3 RESULTS
3.1 Subjectivesleepqualityandpsycho‐emotionalstatus
ofthestudents
Almost a half (45.0%) of the investigated students
hadpoorsleep,accordingtoPSQI.Thethird(fourth)
yearstudentsmoreoftenhadpoor sleep(40.7%),as
compared to the second‐year
students (23.7%),
p<0.001(Table1).
The students of Marine Engineering programme
had a significantly lower mean score (0.52) in the
subscale of sleep efficiency, as compared to the
studentsofMarineNavigationprogramme(0.85)and
otherprogrammes(0.82),p<0.05(Table2).
GlobalPSQIscorewassignificantlyhigheramong
thestudents of
Marine Navigationprogramme (6.8)
as compared to Marine Engineering (5.09), p<0.05
(Table3).
Mild depression was established for 6.9%,
moderate–2.3%,severe–0.8%ofthestudents.Mild
anxietywasestablishedfor19.1%,moderate–14.8%,
severe–7.9%ofthestudents.
Depression score, established by HADS, was
higher
(4.43)amongrespondentsolderthan22years,
as compared to the respondents aged 18‐19 years
(3.46),p<0.05.Anxietyscorewassignificantlyhigher
among students older than 22 years (8.36), as
compared to 18‐19 years old respondents (6.42),
p<0.05 (Table 3). Anxiety score was higher among
persons studying third or
fourth year (8.5), as
compared to the first year students (6.72), p<0.05
(Table4).
Depression(score≥8)wasmoreprevalentamong
the students with poor sleep studying Marine
Engineering (22.0%), as compared to sleeping well
students(5.7%)studyingthesameprogramme(Table
5).
23
Table1.SleepqualityaccordingtothePSQI,accordingtotheage,yearofstudyingandstudyprogramme
__________________________________________________________________________________________________
VariablesPSQIdiagnosisP
__________________________________________________________________________________________________
Normalsleep(n=216)Poorsleep(n=177)
n(%) 95%CIn(%) 95%CI
__________________________________________________________________________________________________
Agegroups
__________________________________________________________________________________________________
18‐19 50(23.2) 17.5–28.239(22.0) 15.9–28.8 0.7930
20 59(27.3) 21.3–33.346(26.0) 19.5–32.5 0.7677
21 54(25.0) 19.2–30.845(25.4) 19.0–31.9 0.9234
≥2253(24.5) 18.8–30.347(26.6) 20.0–33.10.6482
__________________________________________________________________________________________________
Yearofstudying
__________________________________________________________________________________________________
First74(34.3) 27.9–40.663(35.6) 28.5–42.7 0.7826
Second68(31.4) 25.3–37.742(23.7) 17.4–30.0 0.0893
Third/Fourth74(34.3) 27.9–40.672(40.7)** 33.4–48.00.1909
__________________________________________________________________________________________________
**p<0.001,ascomparedtothesecondyear
__________________________________________________________________________________________________
Studyprogrammes
__________________________________________________________________________________________________
MarineNavigation 50(23.2) 17.5–28.862(35.0) 28.0–42.1 0.0098
MarineEngineering 88(40.7)** 34.2–47.359(33.4) 26.3–40.3 0.1319
Other
1
78(36.1)* 30.0–42.656(31.6) 24.7–38.50.3526
__________________________________________________________________________________________________
*
p<0.05,
**
p<0.001,ascomparedtoMarineNavigation
1
–ProgrammesofPortandShippingManagement,FinancesofPortandShippingCompanies,MaritimeTransportLogistics
Technologies
Table2.MeansofthePSQIsubscales,accordingtothestudyprogrammes.
__________________________________________________________________________________________________
PSQIsubscalesStudyprogrammesP
MarineNavigation MarineEngineeringOther
1
(n=112)Mean(SD)(n=147)Mean(SD)(n=134)Mean(SD)
__________________________________________________________________________________________________
Sleepquality 1.09(0.72) 0.92(0.63) 0.93(0.72) 0.290
Sleeplatency 1.46(0.89) 1.23(0.92) 1.25(0.87) 0.225
Sleepduration 0.39(0.73) 0.27(0.59) 0.34(0.67) 0.819
Sleepefficiency 0.85(1.15) 0.52(0.89) 0.82(1.14) 0.018
Sleepdisturbance1.24(0.56) 1.21(0.55) 1.32(0.61) 0.081
Useofsleepingmedication 0.1(0.49) 0.12(0.45) 0.22(0.68) 0.328
Daytimedy
sfunction 0.99(0.81)0.82(0.90)0.87(0.79)0.092
__________________________________________________________________________________________________
1
–ProgrammesofPortandShippingManagement,FinancesofPortandShippingCompanies,MaritimeTransportLogistics
Technologies
Table3. Global PSQI, depression and anxiety scores,
according to the age, year of studying and study
programme.
_______________________________________________
VariablesGlobalPSQIDepression Anxiety
scorescorescore
Mean(SD) Mean(SD) Mean(SD)
_______________________________________________
Agegroups
18‐19 5.24(2.28) 3.46(2.28) 6.42(3.92)
20 5.57(2.62) 3.75(2.68) 7.02(4.13)
21 5.87(2.82) 4.06(2.67) 7.93(4.69)
*
≥225.65(2.89) 4.43(3.07)
*
8.36(5.19)
*
_______________________________________________
Yearofstudying
_______________________________________________
First5.55(2.72) 3.84(2.81) 6.72(4.682)
Second5.22(2.44) 3.67(2.31) 6.97(3.62)
Third/Fourth 5.91(2.77) 4.23(2.89) 8.5(4.91)
*
_______________________________________________
Studyprogramme
_______________________________________________
MarineNavigation 6.8(2.54)4.26(2.8)7.54(4.33)
MarineEngineering5.09(2.51)
*
3.91(2.83) 7.16(4.85)
Other
1
5.73(2.86) 3.69(2.5) 7.7(4.44)
_______________________________________________
*p<0.05,ascomparedtothereferencegroup(italic)
1
–ProgrammesofPortandShippingManagement,
FinancesofPortandShippingCompanies, Maritime
TransportLogisticsTechnologies
D–Depression
A–Anxiety
1
–ProgrammesofPortandShippingManagement,
FinancesofPortandShippingCompanies, Maritime
TransportLogisticsTechnologies
Table4.Relationshipamongsleepquality,depressionand
anxietyaccordingtotheyearofstudying.
_______________________________________________
HADS Firstyear Secondyear Thirdand
fourthyear
(n=137)(n=110)(n=146)
_________________________________________
Good Poor Good Poor Good Poor
n=74 n=63 n=68 n=42 n=74 n=72
_______________________________________________
D 5 8 5 4 2 16
Score≥86.8% 12.7% 7.4% 9.5% 2.7% 22.2%**
A 16 32 20 22 22 52
score≥821.6% 50.8%**29.4% 52.3%* 29.7% 72.2%**
_______________________________________________
*p<0.05,ascomparedtogoodsleep
**p<0.001,ascomparedtogoodsleep
D–Depression
A–Anxiety
Table5.Relationshipamongsleepquality,depressionand
anxietyaccordingtothestudyprogramme.
_______________________________________________
HADS Marine MarineOther
1
Navigation Engineering
(n=112)(n=147)(n=147)
_________________________________________
Good Poor Good Poor Good Poor
n=50 n=62 n=88 n=59 n=78 n=56
_______________________________________________
D 5 9 5 13 2 6
score≥810.0% 14.5% 5.7% 22.0%* 2.6% 10.7%
A 4 35 22 34 22 37
score≥828.0% 56.5%* 25.0% 57.6%**28.2% 66.1%**
_______________________________________________
*p<0.05,ascomparedtogoodsleep
**p<0.001,ascomparedtogoodsleep
24
Firstyear,secondandthird(fourth)yearstudents
whohadpoorsleep,demonstratedanxiety(score≥8)
more often, as compared to the students who had
good sleep, respectively 50.8% vs 21.6%, 52.3% vs
29.4%, 72.2% vs 29.7% (Table 4). Anxiety (score≥8)
was more prevalent among Marine Navigation
students having
poor sleep (56.5%) as compared to
thestudentswhosesleepwasgood(28.0%)(Table5).
StudentsoftheMarineEngineeringprogrammewho
had poor sleep, demonstrated anxiety more often
(57.6%)ascomparedtosleeping wellstudentsofthe
same study programme (25.0%). Persons studying
Portand ShippingManagementor Finances
of Port
and Shipping Companies or Maritime Transport
LogisticsTechnologieswhohadpoorsleep,reported
anxiety (66.1%) more often, as compared to the
studentsofthesameprogrammewhohadgoodsleep
(28.2%),p<0.001(Table5).
4 DISCUSSION
The study results demonstrate that poor sleep and
anxiety are common among maritime
students,
especially among the third (fourth) year students,
whoexperienceincreasedworkloadduringthelast
yearofthestudiesandfullyrealizethespecificityof
their future work, stressors at the workplace and
possible outcomes. The results of our study are in
line with other surveys, which demonstrated that
students regarded their future profession as highly
burdening and stressing already during the study
process and at the beginning of the career. They
realizedthatbeingaseamanrequiredtocollaborate
with others, perform complex mental tasks and
support co‐workers. They also felt that their future
job would involve elements
of competition and
problems related to interpersonal conflicts, and
expectedthattheirworkwouldhavetobeperformed
under hard psychophysical conditions (Jezewska et
al., 2006). Working on board was confirmed as a
stressful workplace when the group of 1,578 Polish
seafarerswasexaminedandthelevelofexperienced
stress
among seafarers was stated as an average
(Jeżewska et al., 2012). On the other hand our
findingsdonotsupportthe resultsofother studies,
because in this study there are no significant sleep
quality and anxiety prevalence differences between
the first and second‐year students. This difference
could be
due to the differences of the samples and
othermethodologicalissues.
Psychological problems which affected people
working at sea were pointed out during the 12th
InternationalSymposiumonMaritimeHealthheldin
France, June 6, 2013. The following psychological
disorders were listed: suicides (auto‐aggression),
post‐traumatic stress disorder, psychosis
and
depression, neurosis, personality disorders,
addictions and behavioural disorders (Jezewska et
al.,2013).
The study results indicate close relations among
sleep quality, anxiety and depression, especially
amongthird(fourth) yearstudents andstudying in
theprogrammes,wherepracticeswereheldonships.
Ourfindingsareinlinewiththestudy,carried
outin
the UK and Germany, during which the seafarers
demonstrated poorer psychosocial health, as
comparedtogeneralpopulationofGermany(Hinzet
al., 2010).As for physical health, seafarers reported
betterhealth,ascomparedtothegeneralpopulation
of Germany. This can be related with the “healthy
workereffect”,
whichisrelatedwiththerequirement
for seafarers to have medical check‐ups before
joiningaship,asaconsequenceillpersonsmaynot
beallowedtoworkon‐board.
Theresultsofourstudydemonstratethenecessity
to monitor the level of stress experienced while
workingatseaandteach
seafarershowtocopewith
stressful situations in order to avoid psychological
consequences.
5 CONCLUSIONS
1 Seafaring is related to physical, emotional,
chemical and biological factors, which are
modifiable, if the primary and secondary
preventive measures for the control of work‐
relatedhazardsareused.
2 Poor sleep was more
(45%) prevalent among
maritimestudentsthandepressionofanyseverity
(10%)oranxiety(41.8%).
3 Sleep efficiency was significantly lower among
students of Marine Engineering programme, as
comparedwithotherstudyprogrammes
4 The third and fourth‐year students more often
had poor sleep and had higher depression and
anxietyscores
ascomparedtothesecondorfirst‐
yearstudents
5 Anxiety was moreprevalent among thestudents
whohadpoorsleep,ascomparedtothestudents
reporting good sleep, independentlyof studying
yearorstudyprogramme
6 Prevalenceofdepressionwassignificantlyhigher
among the third and fourth‐ year students
or
studyingMarineEngineeringwhohadpoorsleep,
ascomparedtothosehavinggoodsleep.
ACKNOWLEDGEMENTS
We thank Inga Bartuseviciene, Deputy Director for
Academic Affairs at Lithuanian Maritime Academy
forhelpinorganizingthequestioningofstudents.
Presented research was carried out in Klaipeda
University and funded by a European Social
Fund
Agency grant for national project “Lithuanian
Maritime Sectorsʹ Technologies and Environmental
Research Development” (Nb.VP1‐3.1‐ŠMM‐08‐K‐01‐
019).
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