Joanne McVeigh1,2, Malcolm MacLachlan1,2,3,4, Sam Cromie5,6, Paul Liston5,6, Bill Kavanagh7 and Alison Kay5,6

1. Department of Psychology, Maynooth University, Maynooth, Co. Kildare, Ireland.

2. Assisting Living & Learning (ALL) Institute, Maynooth University, Maynooth, Co. Kildare, Ireland.

3. Health Service Executive, Ireland.

4. Olomouc University Social Health Institute (OUSHI), Palacký University, Olomouc, Czech Republic.

5. Centre for Innovative Human Systems (CIHS), Trinity College Dublin, Dublin, Ireland.

6. School of Psychology, Trinity College Dublin, Dublin, Ireland.

7. National Maritime College of Ireland, Co. Cork, Ireland.


F.4.1 Introduction

A ship is a ‘hole’ in the water that we put people into.  It contains the complex work dynamics of any group of people working on a common task.  A ship is also a ‘whole’ in the water.  It envelops the seafarer’s existence, not just occupationally, but socially and personally.  Living in a series of confined small spaces and moving through huge spaces, the seafarer’s environment is unique and challenging.  However, working in the maritime sector is, in some ways, the same as working in any other sector – you have good days and bad days, some who cope well with the job and others who don’t, colleagues and bosses who are easy to work with and those who aren’t.  Nonetheless, there are also distinctive features of the sector such as isolation from family and friends for long periods, irregular working hours, and the distinctive working culture of seafarers.  This chapter considers how the psychosocial and organisational environment of a ship is related to the health and performance of its crew and seeks to make readers aware of some key features of this relationship, rather than to provide a comprehensive account of the work in this area.  To begin, a case study is described, which illustrates some of the factors to consider.

F.4.2 Case Study

Task-related factors

Dmitri has one major task to carry out, taking his ship from Hong Kong to Rotterdam.  However, this is comprised of a myriad of sub-tasks.  Each sub-task presents distinct challenges to performance.  Some are complex, some are straightforward, and some are boring, while others require intense concentration.  His performance on these sub-tasks is dependent on the nature of the tasks, the equipment he uses such as radar and electronic charts, the procedures he has been given, and the resources available to him.  These are all task-related factors. These also have implications for his psychological wellbeing.  Specific tasks can induce boredom or stress. The overall task necessitates a lengthy period at sea, isolated from family and friends, and responsibility for a ship, its cargo and crew.

Individual-level factors

However, Dmitri himself also brings a lot to the task that determines his performance.  He brings his training and experience.  He has a personality that affects his way of coping with the demands of life at sea.  He has habits that help or hinder both his performance and his own wellbeing.  Quite apart from his individual strengths and weaknesses, Dmitri is vulnerable to the same individual human factors as anyone else, including fatigue, stress and limitations of his perception, memory and concentration.  These are factors at the individual level.  Also at the individual level are Dmitri’s personal challenges: his chronic stomach ulcers, his worry about one of his children who is struggling at school, and his family history of heart problems.  He also has great personal strengths, personal resilience, good humour, a strong loving bond with his wife and children, and relatively few financial worries.  

Team-level factors

Dmitri carries out his work as a member of a team.  He needs to communicate and coordinate with the other seafarers, engineers, port authorities, other ships, and his own company management.  This communication can be clear, concise, and correct or it can be hindered by misunderstandings, language difficulties, and failure of communications equipment.  He needs to play his part as a team member and as a leader.  The team might be an effective one, communicating openly, sharing responsibility, and working to each other’s strengths or weaknesses.  Or it might be dysfunctional, characterised by distrust, cliques, and inequitable work allocation.  Dmitri might be an effective or poor leader of this team.  These are team-level human factors.  They can represent a significant source of human error and of poor psychological health, such as de-motivation, stress, and isolation.

Organisational-level factors

Dmitri carries out his tasks in the context of a shipping company.  His daily work is facilitated and constrained by the company.  They provide Dmitri with the resources that he uses to accomplish his tasks such as the ship, the crew, the equipment, and the procedures.  They provide the direct instructions that he follows including which ports to sail to and the time frame.  They have set an organisational context of explicit policies and procedures on a whole range of topics that establish the context in which he operates, for example policies on discipline, reimbursement, bonuses, health and safety, and promotion.  There is also an implicit set of values and norms that Dmitri has absorbed through his years in the company.  Examples include how to treat your team, the relative importance of efficiency versus safety, what you report and what you don’t.  This is the organisational culture and these are organisational-level human factors.  They have a strong impact on how Dmitri performs his job, how he manages the crew, and how he runs his ship.  This impact can be positive or negative for the various performance metrics and for the wellbeing of Dmitri and the other team members.

Industry-level factors

In turn, Dmitri’s company operates within an international industry, which provides a wider context that has a direct impact on the working lives of Dmitri and his crew.  Regulations are the most tangible influence.  However, commercial pressures are also present, affecting crewing levels and deadlines.  Additionally, there is the professional culture of sea captains, the generally unspoken set of values, norms and attitudes to which Dmitri and his counterparts generally adopt unconsciously.  These are industry-level human factors, increasingly recognised as having a crucial influence on individuals in the operational environment.

This case study illustrates some of the different levels of factors that can affect performance and wellbeing in the sector.  This chapter can only explore some of these at a very general level.  The aim is to raise awareness of the relationship between how work is done and workers’ health and some of the problems that can arise due to psychosocial issues on board ships.  Figure 1 illustrates the general approach to understanding Dmitri’s challenges and to considering the relationship between work, performance, and health, integrating a systems-based approach at different levels of maritime operations.

F.4.3 Health and Performance Factors

Human performance and psychosocial wellbeing have a complex inter-relationship.  At times, they seem in opposition, whereby the drive for efficient and effective performance can increase stress.  However, generally, they are understood to have a positive relationship, so that healthier people perform better and effective performance contributes to psychological health.

This chapter examines the impacts on health and performance that are embedded or nested in different levels of work – the task, individual, team, organisation and industry levels (see Figure 1). 

Health & Performance FactorsLEGEND: Figure 1. A nested model of psychosocial and organisational aspects of maritime work: Synthesising the STAMINA model of human factors1 with the maritime environment2

Figure 1 illustrates how problems or opportunities at any level do not occur in isolation.  Rather, they are nested in other levels of work and life and can therefore influence and be influenced by other factors.  Some factors are more salient to particular levels, but others cut across several levels at once.  It is important to remember that in the ‘systems thinking approach’, factors happening at one level can, and do, affect factors at other levels.  This is not necessarily problematic, as it also means that problems can be solved by addressing them at several levels.

F.4.4 Organisational Culture

Organisational culture refers to the beliefs, values and assumptions that characterise organisations or industries.  Similar to ethnic cultures, these include commonly accepted norms, shared attitudes and widespread assumptions.  Bennis and Nanus3 describe a typology of leaders that is salient to the idea of organisational cultures.  Their model refers to collegial, formalistic, and personalistic leaders, whereby a personalistic culture focuses on the person and decision-making powers are afforded to each individual4.  Shea4 empirically explored these theoretical types of leaders using a battery of questionnaires among 700 seafarers from a range of countries and across different types of ships.  He found that collegial and formalistic were the two behaviour types that occurred in the seafarers’ working environment.  The collegial behaviour type describes people who are positive and demonstrably supportive towards subordinate colleagues.  Here the maintenance of cohesion between people is seen as important and is facilitated through team working, discussion, participation and consensus.  Conversely, the formalistic behaviour type describes people who display indifference towards subordinate colleagues and their activities.  Stability, control and coordination are seen as the critical issues here, with the continuity of the organisation seen to be a key objective.

Shea’s research also demonstrates a link between leadership style and safety on ships.  Respondents indicated that the formalistic behaviour type negatively impacted the safety climate of a ship.  More particularly, when seafarers found themselves working in a non-collegial environment, the accident rate increased. As noted by Shea, ‘the existence of a collegial culture on a ship therefore improved the safety culture of the ship’4 (p. 107).  While this is very relevant to the focus of this chapter, it also suggests the possibility that leadership behaviour and organisational culture relate to health behaviours and practices, and indeed to health problems, as well as accidents on board ships.

F.4.5 Organisational Justice

One of the ways in which organisational behaviour and health behaviour may be linked is through the perception of organisational justice, that is how fairly people feel they are being treated in an organisation.  In several spheres, links have been established between feelings of injustice at work, being unfairly treated, and health problems.  Critically, this conception of justice goes well beyond health-related behaviours.  Justice at work significantly influences job satisfaction and dissatisfaction, as well as the intent to leave and broader wellbeing5.  For instance, the amount that seafarers on board ships are paid, at least in part, may be based on where they come from, and in which labour market they have been recruited.  This can mean that similarly qualified crew may have different rates of remuneration.  Different remuneration to different nationalities for the same work causes dissatisfaction amongst seafarers, as it is viewed as an unfair system6.  This sort of discrepancy has been found to relate to worker demotivation in the context of international aid, where more highly paid expatriates work alongside less well paid local workers, who may have the same or more relevant qualifications and experience7.  Such demotivation has been found to relate to people working less hard and the intention to leave one’s present job, as well as being associated with mental health problems8.  Indeed, organisational justice is associated with mental health9.  This suggests that inequities experienced by seafarers from low- and middle-income countries, including the linking of senior positions to nationality, longer tours of duty, and different pay rates for the same job10-14 may significantly affect their mental health.

The idea of developing a just culture has been applied by some in the maritime industry, for example, BP Shipping and Teekay Marine Services.  These programmes have focused on safety and how organisational culture can be changed from the organisationally pathological approach of seeing accidents as inevitable with the people responsible losing their jobs, through a series of steps involving:

  • more positive reactions to accidents
  • developing a systems approach to detect likely accidents
  • developing proactive initiatives to avoid accidents
  • and the ‘generative’ level, where safety is seen as a ’profit centre’.

Here information about accidents, or near accidents, is actively sought as a valuable source of diagnostic information about how the organisation and its components are working15.  In the same way that safety can be seen as a profit centre, so too can health, where healthy and happy workers will perform better. 

F.4.6 Crew Resource Management


Crew Resource Management (CRM) is a system that attempts to minimise errors caused by human behaviour or the human element as it is termed in the maritime environment.  Despite the provision of well-equipped ships and expertly trained crews, accidents still occur, and it is estimated that over 80% of accidents in the shipping sector can be attributed to human error16.  The human element refers to the interaction between humans and the human/machine interface.

CRM in the maritime industry

Crew Resource Management applies to the maritime industry and is derived from Cockpit Resource Management developed within the airline industry.  The introduction of Cockpit Resource Management is considered a factor in reducing air accidents that may be attributed to human factors.  CRM includes elements from separate management systems, such as Bridge Resource Management (BRM) which applies to the navigation crew, Engine Resource Management (ERM) which applies to the engine-room crew, and Maritime Resource Management (MRM) which applies to a combination of navigation and engine-room officers.  CRM includes shipboard personnel that are not part of a ship’s management regime and applies to all ships’ crews.  In essence, all systems execute the same principles with slightly different emphases.  The principles of CRM are delivered in college courses and are designed to change people’s attitudes rather than skill-sets.

CRM encourages the development of good situational awareness and the detection and efficient processing of environmental data.  Good mental and physical health facilitate vigilance, attention, and memory, all key cognitive processes required to achieve the best results.  Team members must be used so that the operation is not controlled by the actions of one person.  A loss of situational awareness can be caused by stress and fatigue, a high workload, or inexperience, and can result in serious adverse consequences for the safe operation of the vessel.

Planning is vital, whether it is routine engine maintenance or navigating a passage from port to port.  All team members are briefed about the plan and changes are made if required.  After the mission is completed, for example, after the ship arrives in port, personnel are de-briefed as part of a learning and developmental process to improve operations. 

Importance of Teamwork in CRM

In the maritime industry, the rank structure within ships’ hierarchies is central, and this frequently leads to communication barriers16,17.  However, teamwork is a central theme of CRM.  Traditionally, the centre of power on a ship lay with the Master.  They were the decision-makers and consultation with other crew was minimal.  Personnel obeyed the Master’s orders, even if the action was considered to be incorrect.  CRM attempts to change the management style and culture on ships.  Seafarers are encouraged to become actively involved in shipboard operations, including the use of advocacy and in particular the right to speak up if they notice problems or errors developing.  Accidents are rarely the results of single point failures, but are rather the end result of error chains.  If a link in the chain is broken, the incident is avoided.  Advocacy, also known as ‘challenge and response’, is a new concept in maritime management.  It requires a change in leadership style and is difficult in practice, particularly in multinational crew environments where power-distances between officers and crew can vary considerably.

The importance of communication

Good communications are essential to foster a teamwork culture.  The use of the Standard Marine Communications Phrases (SMCP) is important.  Ships operate internationally with multi-lingual crews.  Although English is the standard maritime language, many personnel are not fluent English speakers and have difficulty understanding instructions.  This is particularly problematic in crisis management operations.  For port operations, where ships are navigating in confined and high-density traffic waters, safe communications for ship/port interfaces are vital.  The introduction of the maritime pilot can be de-stabilising for a team, as an apparent outsider temporarily joins the team to complete a short-term mission.  CRM principles must be employed in this situation to include teamwork, communications, advocacy and good management.

The use of procedures

Standard Operating Procedures are used to assist the team during operations.  Company and shipboard management develop specific procedures to address routine and emergency tasks.  Personnel may identify unplanned deviations from the procedures and use advocacy to warn the mission co-ordinator.  Procedures in crises are developed by using simulated exercises either on board ship or in college simulation laboratories.  If a planned deviation from the mission is required, managers will discuss the change in mission operation with relevant personnel, assess the advice given and make a decision.  After the decision is made, the team monitors subsequent actions to ensure that they are compliant with the new plan.


In summary, CRM attempts to change the attitude of shipboard and shore side personnel to minimise human error by developing a teamwork culture based on modern management principles.  It is a realm where the interplay between organisational and health behaviour are intimately and sometimes intricately linked.

CRM training will become mandatory under new international shipping requirements for shipping personnel as specified in the international convention, Standards of Training, Certification and Watchkeeping for seafarers (STCW)18.  At present, training courses are varied in their content, delivery and duration

F.4.7 Stress and Fatigue

Stress and fatigue on board

Stress and fatigue are common and difficult problems to deal with on board ships.  A range of factors contribute to fatigue and one of the most obvious is workload.  However, workload is complex.  Should it be considered in terms of external demands placed on someone or in terms of how an individual subjectively experiences their work?  With no good measures of the relationship between external demands, subjective appraisals, and physiological indications of stress19, it is challenging to define objective limits.  Workload can relate to a short intensive peak period of work such as off-loading and taking on cargo, or to the cumulative effects of a monotonous lengthy sea passage.  Thus, having too little to do can be just as fatiguing as having too much to do. 

Seafarers are experiencing increased stress, particularly psychosocial stress20, alongside increased social isolation.  Faster turnaround schedules in ports, increased technology use, decreased personnel, labour intensification, and social isolation have significantly changed on board working and living conditions11,13,21,22As suggested by the ITF Seafarers’ Trust23, fast technological advancement, increased automation, decreased personnel, more diverse crew, lack of shore leave, faster turnaround schedules, and a hierarchical command system may all lead to social isolation on board.  

A range of factors contribute to stress and fatigue at sea including:

  • sleep debt (see below)
  • experience of risk situations
  • degree of interest and engagement in work activities
  • diet
  • fitness and opportunities to move around
  • the time of day that people are working (see below)
  • and the environment.

There is much that can be done to monitor and manage these. 

Reduced Manning and Fatigue

The widespread trend of reduced personnel in the shipping industry has resulted from organisational policies that aim to increase efficiency, often made possible through automation19.  However it has produced some high-profile consequences, such as the Exxon Valdez striking Bligh Reef off Alaska, spilling approximately 11 million gallons of crude oil over 11,000 square miles.  The U.S. National Transportation Safety Bureau’s accident investigators found that the company ‘did not adequately consider the increase in workload caused by reduced manning’19 (p. 47).  However, on a daily basis, seafarers around the world experience the same factors that contributed to the Exxon Valdez accident.  Whether these factors result in accidents or not, it is likely that they take a personal toll on at least some seafarers. 

The Cardiff Fatigue Study impressively indicated the links between fatigue, health and performance, and the association between these and reduced manning practices.  A number of striking findings of the study included:

  • 1 in 4 seafarers reported falling asleep on watch
  • 50% said that they had worked 85 hours per week or more
  • 50% said that their working hours had increased over the last ten years
  • 50% considered their large number of working hours to present a risk to their personal safety and 37% felt that it posed a danger to the safe operation of their ship24.

In a sense then, technological advancements have dictated increased workloads for crews, but these have not been supported by advances in ameliorating fatigue, monitoring health, or indeed promoting the health and wellbeing of crews.  As MacLachlan14 (p. 4) suggests, ‘With larger ships, greater mechanisation and reduced manning levels, more is required from seafarers and there are fewer outlets for the sort of affiliation that sustains both a sense of collective identity and individual worth and support’.

F.4.8 Crew Endurance

One response to managing fatigue has been to consider the factors that promote crew endurance, and the United States Coast Guard have adopted Crew Endurance Management Practices.  Crew endurance is defined as ‘the ability to maintain performance within safety limits while enduring job-related physical, psychological and environmental challenges’25 (p. XV).  Crew Endurance Management (CEM) is defined as ‘a system for managing the risk factors that can lead to human error and performance degradation in maritime work environments’25 (p. XVI).  While CEM considers a range of factors, including temperature extremes, stress, caffeine use, and extended separations from family, one of the mainstays of the approach is sleep management.  This remains a critical factor affecting the health and performance of crews on merchant ships.  Seafarers’ sleep may be adversely affected by continuous exposure to noise, vibration, and movement of the vessel and by the need to work in shifts to ensure the continuous running of the ship26,27. 

F.4.9 Sleep

Extensive research on sleep has demonstrated that brain activity during sleep progresses through distinct stages28.  In stage one, in the first 5-10 minutes, brain activity slows.  If roused during this stage, people often feel that they have not slept at all.  At stage two, after 10-15 minutes, sleep deepens further.  In stage three, also called slow-wave sleep, a person aroused will feel quite sluggish and take several minutes to awaken completely.  However, after 20-30 minutes of slow-wave sleep, the person then returns to a stage two sleep pattern, which is subsequently followed by Rapid Eye Movement (REM) sleep.  This is thought to be the most regenerative stage of sleep and is characterised by rapid eye movements, little muscle tone, and very active brain activity.  This is when you dream.  The full cycle repeats itself several times a night, with the crucial REM periods lengthening as the cycle proceeds.  The first REM episode may only last for 5-10 minutes.  If the cycle is interrupted, it resets from the beginning again. 

Seafarer’s sleep

Seafarers who do not have sufficient sleep periods and/or have their sleep frequently interrupted will develop a sleep debt, which can have the same effects as being drunk on alcohol in terms of ability to work machinery, navigate and so on.  The only effective treatment for a lack of sleep is more sleep!  Individuals keeping sleep logs can be a useful way of monitoring sleep.

A further challenge in the maritime environment is not just the total amount of sleep, or of REM sleep, but also when sleep occurs.  The body’s ability to regulate its hormones, alertness and temperature is mediated by circadian rhythms.  This ebb and flow of energy and alertness is a natural bodily activity that usually occurs in a predictable manner over a 24-hour period and is synchronised by the amount of light that people experience.  Loss of this circadian rhythm results in symptoms similar to jet-lag, when people see natural or artificial light at the wrong time of day, when it should be dark according to their body clock. 

The consequences of a lack of sleep

The inevitable consequences of sleep debt and loss of circadian rhythm are that cognitive performance deteriorates and the body is put under greater stress.  More errors in performance occur, including arithmetical errors in navigation, less vigilance when using machinery, being less likely to identify a hazard, slower reaction times etc.  This combination of being more likely to make mistakes, less likely to detect them and less able to correct them, can of course be disastrous in the engine room, on deck, or on the bridge on watch.  Sleep debt, i.e. getting less than 7-8 hours of continuous sleep per day, is also associated with reduced energy, apathy, withdrawal and depression.  Sleep debt will accumulate and the effects spread further into the day from just after waking up to many hours later and possibly even the whole waking period.  While brief planned napping can be helpful on a short-term basis, it will not address the fundamental sleep debt problem of a lack of REM sleep.  The use of medications, either to delay or to bring on sleep, should be avoided except in the most extreme situations and for short periods of time, as they mask and interfere with the body’s ability to regulate itself and may have negative performance, mood and other health-related effects.  They may be particularly problematic if a heavily-sedated person is awoken to deal with an emergency.   

F.4.10 Occupational Hazards

Occupational hazards on board

Oldenburg et al.29 examined occupational risks among seafarers.  The major categories that they highlighted were accidents and disasters at sea such as vessels foundering or colliding, falling into a hold, being swept overboard in rough seas, incorrect or non-use of safety equipment, and piracy.  For example, in 2008, 774 seafarers were reportedly taken hostage.  They note that, apart from accidents and work-related injuries, the main cause of death at sea is acute cardiovascular disease, accounting for 55-70% of all natural causes of death at sea in the 1980s and 1990s in the British and Danish merchant fleets.  Although the incidence of cardiovascular disease is not necessarily greater among seafarers, the treatment options and access to medical expertise are much reduced.  In a related study, Oldenburg et al.30 found that other significant stressors, particularly relevant to the organisational aspect of seafaring, were separation from family and length of shipboard stay, with the latter sometimes being twice as long for non-European personnel compared with Europeans and sometimes exceeding 12 months.  On German-flagged vessels, average sea times ranged from 3-6 months for European crew and 6-9 months for non-Europeans.

While most research on fatigue and performance has focused on deck personnel, Rydstedt and Lundh36 examined the relationship between psychosocial workload and mental strain among Swedish engineering officers.  Importantly, they found that it was not the intrinsic content of their job but rather the work-role conflict that was associated with mental health difficulties.  Specifically, the perception that they were being required to adopt and fulfil many new and sometimes contradictory regulations, which were often felt to be outside the scope of their original training, was associated with more mental health problems.  Rydstedt and Lundh concluded that ‘to fully understand the work pressures of seafarers, a socio-technical perspective is necessary, which allows us to study the work role and the working conditions of the individual’s interaction with the technical and organisational context’36 (p. 174). 

Occupational Hazards and Suicide in the Seafaring Population

Fatigue, isolation and a lack of social contact have all been adversely influenced by shorter turn-around times for ships in port.  Enhanced ship and port security measures also make it more difficult for seafarers to socialise ashore, even if the opportunity is available.  Perhaps the most distressing consequence of these work conditions is an elevated rate of suicide among seafarers.  Other factors that may contribute to this include difficulties at home for which the seafarer feels powerless to influence, stresses on board and prolonged motion sickness31.  Approximately 1.4% of all deaths globally were due to suicide in 201532.  Among seafarers, this figure is considered to be significantly higher33.  The U.K. Protection and Indemnity Club34 reported that 4.4% of all deaths on board were attributable to suicide from 2014-2015, which proliferated to 15.3% for 2015-2016.  Mellbye and Carter35 conducted a review of seafarers’ depression and suicide and found that investigations of depression and suicide amongst seafarers indicate improvement, although numerous recent case series suggest that suicide remains problematic.   

F.4.11 Cultural Differences

Crews of many nationalities

Multinational crewing, limited opportunities for recreation, and significant environmental stressors such as heat, noise, vibration, confinement, and motion are noted as other important occupational hazards by Oldenburg et al.29.  Further information in this area can be found in Ch 4.5.  Multinational crewing, in the context of health, may present particular challenges, as different cultures may have quite different causes of, experiences of, and expressions of both physical and psychological problems.  Equally, the most effective way of addressing these problems may be different across different cultural groups37.  For example, Nielsen et al.38 conducted a cross-sectional study of 541 seafarers from two Norwegian shipping companies and reported differences between European and Filipino participants in relation to aspects of the work environment and well-being.  Specifically, Filipino crew reported experiencing the work environment as more negative with higher degrees of harassment, laissez-faire leadership, and low safety, although they reported experiencing more team cohesion and their captains as more authentic.  While no difference was found between Europeans and Filipinos concerning job satisfaction, Filipinos reported higher levels of intentions to leave their occupation38.

The impact of different personalities

With any crew on board there will be individual personality differences, and knowing something about someone’s personality means being able to better understand how they will respond to a given situation.  For instance, extroverts are people whose thinking and behaviour is outward-focused.  Introverts are people whose thinking and behaviour is inward-focused.  Introverts tend to be quiet and reserved, preferring to spend time on their own.  They can concentrate well on tasks and tend to be contemplative.  Extroverts, on the other hand, are social and gregarious, preferring to spend time with others.  They are energetic and can find it difficult to concentrate, being easily distracted39.  Given that work at sea involves what might be termed ‘close isolation’ from other people, being in close quarters with other seafarers and far away from family and other friends, it is likely that extroverts and introverts will respond differently to different aspects of living and working at sea.  This may present itself as apparently inconsistent behaviour and changes in mood, as individuals try to cope with the inescapable aspects of their work-life that they find least easy to deal with. 

The effect of culture on individual responses

An individual’s cultural background may also influence how that individual responds to a particular set of circumstances.  Hofstede40 identified several dimensions along which cultures vary in their approaches to work.  Power Distance, for instance, refers to the extent to which less powerful people accept that power is shared unequally.  This score reflects how hierarchical a society is.  For example, Finland scores low on Power Distance, whereby the country does not accept uneven distribution of power and resources, whilst the Philippines scores high on Power Distance and is much more accepting of an uneven distribution of power and resources.  Another dimension, Individualism-Collectivism, reflects whether people see their society in terms of ‘I’ or ‘we’.  Individualism reflects a preference for a loosely-knit society, while collectivism is a preference for tightly-knit social frameworks.  For example, the U.S. is a highly individualistic society, while China scores at the collectivism end of the scale.  Uncertainty Avoidance, yet another dimension, relates to the extent to which a society seeks to avoid or is uncomfortable with uncertainty or ambiguity.  For instance, Russia scores high on Uncertainty Avoidance, indicating that they are more uncomfortable in ambiguous situations, while Ireland scores low. 

While Hofstede’s dimensions have been highly influential in academic psychology, they have also been criticised on theoretical and practical grounds and in terms of the original research methodology used to derive these dimensions41.  There is more support for some dimensions than for others.  There is also the danger that people can over-read culture and see an individual’s behaviour to be overly culturally-determined, rather than being a background factor to which the individual responds37.  Notwithstanding these caveats, some of Hofstede’s dimensions appear to have relevance to the maritime sector too.  Bao and Yip42 examined the relationship between culture and vessel detention, using Hofstede’s dimensions.  They found that high individualism and high uncertainty avoidance correlated with low detention rates.  


F.4.12 Psychosocial Maritime Health


MacLachlan et al.43 reviewed 192 publications in International Maritime Health from 2000 to 2010 to establish the coverage of the journal and the scope of research in maritime health.  They identified six broad thematic categories:

  • healthcare access, delivery, and integration
  • telemedicine
  • non-communicable diseases and physical health problems
  • communicable diseases
  • psychological functioning and health
  • safety-related issues.

Within these themes, ‘psychological functioning and health’ and ‘telemedicine’ had the fewest publications. 

However, psychological functioning incorporates many health problems long recognised in the industry, including suicide, depression, anxiety, and alcohol or drug dependence, to name a few.  Psychological health also relates very strongly to many lifestyle-associated health problems found in the other thematic categories such as cardiovascular disease, diabetes, and sexually transmitted diseases.  Finally, MacLachlan et al. noted a trend for more papers on telehealth, stress, fatigue and other psychological issues. 


Mental Health Initiatives

The significance of psychosocial aspects is increasingly acknowledged in the maritime sphere by seafarers, employers, unions, insurance companies and international regulatory bodies44.  The growing awareness of mental health problems at sea is encouraging and there have recently been some very practical initiatives in this area.  On ships and in docks, leaflets are increasingly becoming available in an attempt to give access to mental health information and address the strong stigma around mental health in many cultures.  For instance, the booklet by the International Committee on Seafarers’ Welfare (ICSW), entitled ‘Mental care – you are part of it!’, provides a very good and user-friendly information leaflet that covers monotony, stress, anxiety, depression, harassment and bullying, fatigue, psychosis, drugs and alcohol, and job satisfaction.  Importantly, it highlights that ‘having a useful job as a member of a mutually supportive team can be one of the best protections against mental health problems’.  It further emphasises that ‘sensitivity to the mental problems of your fellow crew members remains at the heart of good management and efficient ship operations’45.  These messages resonate strongly with the ethos of this chapter, that organisational aspects of work and personal health, welfare and performance are intrinsically braided, at each layer of activity in the ship and the maritime industry.  This implies that, in the maritime sector, a work environment that is perceived as supportive and just is pivotal to providing a good platform upon which individually-focused psychosocial interventions can be optimally applied46-48.

Complementary to the ICSW work is an Australian initiative, partnering Melbourne Port Welfare Association, Beyond Blue (the national depression initiative), The Rotary Club, Stella Maris Seafarers’ Centre, and the Mission to Seafarers Victoria49, on a project that has also produced an accessible leaflet on ‘The Mental Health of Seafarers’.  The leaflet focuses on depression, including a nine-point checklist to help people identify the core symptoms of depression.  In addition, it mentions aspects of anxiety and stress, including some explanation of treatment options.  The leaflet states that ‘the purpose of this booklet is to provide masters and other ships’ officers with basic information about the mental illness of depression so seafarers who are depressed may be identified and helped’.  The leaflet may also be useful to seafarer ratings, if provided in accessible formats.  This is important as having your boss identify your mental health problems may be felt by some to simply add to such problems and is also potentially open to abuse.  Some may be concerned that such a label could constitute reason for a company to terminate their employment.  This project, however, is very well-motivated and has been based on a concern to address the very serious problems of depression and suicide at sea50.  It is also one of the few projects that recognises the problem of workplace bullying.

Detection of Psychosocial Health Problems

Before identifying the extent or nature of a mental health problem, it is often necessary to identify when such problems might exist, and some indications of this may come from aspects of work and social behaviour.  According to the U.K. Health and Safety Executive51, behavioural signs of stress may include rushing around, skipping or rushing meals, swings in mood, worsening work relationships, irritability, becoming more indecisive, confused thinking and forgetfulness.  Increases in smoking or drinking and drug abuse may all be associated with poor attempts to cope with stress.  Increased complaints about health and feeling tired all of the time may also occur.  Physical symptoms may include headaches, problems with the digestive system (such as indigestion, stomach pains, and ulcers), as well as increased blood pressure and its natural consequence, an increase in cardiovascular disease including stroke.

Usually at sea, treatment options for mental health problems are limited.  Furthermore, some forms of psychopharmacology may promote dependence and affect attention and performance at sea.  It is generally accepted that the long-term prescription of psychoactive medication is not desirable for the majority of mental health problems.  Evidence-based clinical guidelines developed through centres of excellence, such as the U.K.’s National Institute for Clinical Excellence (NICE), recommend psychological interventions as the first line of response for common mental health problems such as depression.

Assessing Psychosocial Health across Cultural Groups

The evaluation of psychosocial health, particularly across different cultural groups, is fraught with complexities.  Many mental health problems may present differently in different cultures.  For instance, a perennial debate with regard to major depression is whether the high levels of somatisation (expressing distress through physical symptoms) that are common among South-East Asians and the high levels of psychologisation, that isexpressing distress through psychological symptoms among North Americans, constitute variations within the broad syndrome of depression or quite distinct disorders37.

The most common way of identifying or diagnosing mental health syndromes is through a clinical interview or standardised psychometric questionnaire.  The former often takes considerable training but can be guided by structured interview schedules, and these could be used by another seafarer or through telemedical practitioners.  However, individuals’ responses to such interviews and the use of established questionnaires may also be problematic.  A psychometric assessment instrument is never valid and reliable in itself.  These attributes always exist relative to the population samples it has been used on.  A psychometric assessment for anxiety may have excellent specificity and sensitivity in a French sample, but the translated versions, even if perfectly and accurately translated, may not work in the same way for a different linguistic or cultural group who construe and express their mental health problems differently.  Very few psychometric instruments that assess mental health problems have been extensively used across cultural groups and therefore allow us to have confidence in their validity and reliability, while at the same time being short and simple to administer. 

One of the few mental health measures that has been used across many cultural groups, and shown to be valid, is the General Health Questionnaire (GHQ), which comes in various versions.  Its short form, the GHQ-12, is as good a measure as is available.  However, the trade-off with its validity is its lack of ability to diagnose the exact nature of the mental health problem.  Rather, it can detect the extent of a mental health difficulty along a continuum.  It also suggests levels of scoring along this continuum that may be of a clinical severity to warrant intervention of some type, but does not automatically place people into a category of ‘you have a problem’ or ‘you don’t have a problem’.  This of course reflects more of a psychological and a medical, categorical approach to diagnosis, but also allows reported measures to determine how an individual varies along a continuum over time.  The GHQ-12 can be downloaded and is available in a number of different languages.  It can be self-administered or used by any seafarer who would like to help another to establish how severe their distress is.  However, as noted, the consequences of using it may be problematic.  If a seafarer is labelled as having a psychiatric problem, they may be discharged by their company at the earliest opportunity.  This may be far from home, potentially turning a problem into a crisis.  Thus, the identification of significant mental health problems at sea will require sensitivity, confidentiality, and support from people who have a real likelihood of being able to intervene effectively.

Integrated Occupational Health Systems for Promoting, Protecting and Responding to Psychosocial Maritime Health

Jensen et al.52  have called for a better integrated approach to maritime health, and the advent of telemedicine presents the prospect for health monitoring to move beyond pre-employment medical screening to incorporate ongoing psychological and biological monitoring of seafarers on board.  This may be through regular checks and individually-tailored advice, ranging from personal healthcare and fitness to continual professional and self-development modules.  Such a holistic approach can seek to combine each of the elements described in Figure 1, although obviously this requires high-level buy-in in terms of attitude and resources and funding.  

The relationship between health and work is changing and becoming more complex.  Not only is how much they are interlinked being increasingly recognised, but in high-income economies, more people in aging populations want to continue to work for longer, even when they have significant health problems53.  The concepts of the right to work and of managing health problems at work may also permeate the maritime industry in time.  Mental health in the workplace was the topic of World Mental Health Day 2017, whereby the World Health Organization stated that ‘employers and managers who put in place workplace initiatives to promote mental health and to support employees who have mental disorders see gains not only in the health of their employees but also in their productivity at work’54.  As indicated, mental health and performance are bedfellows.  So too are the many behavioural factors, from diet, to exercise, to relaxation, which are strongly implicated in serious physical illnesses such as cardiovascular disease.  

The containment of life on board a ship is often seen as problematic, and indeed this text has highlighted some of the psychosocial challenges associated with it.  However, this encapsulation also offers unique opportunities for the development of occupational health and performance programmes that more comprehensively integrate work and leisure.  One area that may hold particular promise in this regard is positive psychology55, where the focus is on facilitating positive health, positive attitudes, and positive work behaviour, rather than correcting or addressing a ‘lack of”, ‘failures’, ‘errors’ or ‘dysfunctions’.  Whilst beyond the scope of this chapter, moving forward, it would be beneficial for health and occupational practitioners in the maritime industry to more effectively utilise the characteristics of maritime work to develop intervention programmes that stimulate strengths, health and good work at sea, whilst also being responsive to the sort of health challenges and their multiple levels of contributing factors that we have discussed here.


Joanne McVeigh and Mac MacLachlan are grateful to Shell International B.V. for funding some of their research in this area.  Mac is also grateful to the Masters and crew of Arklow Shipping’s Arklow Meadow and the Irish Lights vessel Granuaile for kindly affording him the opportunity to spend sea time with them.    


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F.4.13 Bullying and harrassment


Harassment and bullying can be of concern given the shipboard living and working environment, isolation, size and proximity of cabins and the necessity to remain at the workplace during rest periods or free time.
Bullying and harassment in any shape or form is totally unacceptable.

Harassment and bullying on board ships can have serious consequences:
    -for the physical and emotional health of seafarers,
    -lead to decreased motivation and increased sickness, 
    -can compromise effective teamwork, and
    -have negative effects for companies, resulting in a deterioration of working conditions and potential organisational, economic and legal consequences. 


There is no legal definition of bullying but is defined here as: ‘A threatening or intimidating work environment in which a group of people or an individual may become fearful or intimidated because of the negative or hostile behaviour of another group of people or individual’[1]

Harassment, on the other hand, has the following legal definition:

 ‘A form of discrimination when unwanted conduct takes place which has the purpose or effect of violating the dignity of a person and of creating an intimidating, hostile, degrading, humiliating or offensive environment’[2]

How to address bullying and harassment

In order to ensure a ship culture that is resilient to bullying and harassment, it is important for seafarers to consider and discuss with others onboard, how to:

-Respect other cultures,
-Tolerate the personalities and styles of others,
-Recognise boundaries,
-Be curious to get to know others,
-Challenge unacceptable standards.

Many issues can be resolved informally, however, if the person is persistent:
-Tell the person to stop,
-Consider writing down what it is you are subjected to,
-Keep a diary/log of all incidents,
-Lodge a formal complaint or grievance.

The ECSA and ETF guidelines offer further ideas on how to safeguard employees onboard.




F.4.14 Gender Issues


For a long time the maritime industry has been recognised as a workplace for men. However, in recent years, the awareness of women as an important human resource has been increasingly raised within the industry. This section covers key elements of gender issues in maritime professions and how they are relevant to maritime health. 

Women as a minority group in the maritime industry

Traditionally in many parts of the world, the maritime industry has been dominated by men. For example, the percentage of women seafarers was reported as 1% of the participants of a large work force survey by BIMCO and the ICS in 2015 (1). In fact, the majority of women seafarers are found in the hotel and catering sections of cruise ships and passenger ferries. Hence, those women in ship operation sections, such as deck and engine officers/ratings, are much fewer and Drewry, ILO, & ITF (2) report their population as 0.12% of the total seafarers. On the other hand, women in shore-based maritime professions are estimated between 3% and 30% (3).

It is worth noting that women’s representation in maritime organisations vary by country’s policies. For example, in the Philippines where the government sets up a gender and development budget, approximately 40% of employees in the Philippine Port Authority (PPA) are women and some occupy senior positions (4). In Saudi Arabia, without policies, it is reported that women represent only 1% in the maritime business (5).

What is gender?

The terms, “gender” and “sex” are used commonly, sometimes in a similar context. However, in the early 1970s, the differentiation of terms “gender” and “sex” was first attempted. Money and Ehrhardt (6) define that the term “sex” should be used as a classification of biological differences between males and females while the term “gender” should be used as a socially constructed norm of what are appropriate behaviours as men or women. This claim is widely acknowledged today and the discussions on gender equality often focus on social aspects of women or men’s experiences. Nevertheless, gender discourses do not overlook the significance of the male or female body.

Body and gender

Under the culture of macho or masculinity, as may be seen in the maritime industry, the male body is already emphasized in its expectations of work. Both physical and emotional toughness were, and to some extent still are, regarded as a virtue of ideal mariners (7). This idea is probably less significant with technological development that has transformed part of seafarers’ work from physically demanding tasks to more monitoring and documenting of ship operations. Having said that, such mentalities may still exist.

Kitada and Langåker (8) argue how a woman’s “body” can become a reminder of heterosexuality on board vessels where men are dominant. Without any intentions of emphasizing women’s sexuality, women seafarers may receive unwanted attention by their male colleagues. In order to avoid further problems on board, for instance, some women try to hide their bodylines as much as possible by wearing baggy clothes (9). 

Gender stereotypes

Stereotypes are often used when describing the typical idea about a particular social group (10).  It is also a cognitive process of making a judgement about someone before knowing him/her based on a certain assumption that one already has. It is a risky behaviour as stereotypes can mislead or sometimes stop further communications, and it can be difficult to modify an already fixed idea or be too late by the time one realises that the idea was wrong or inaccurate.

Pilcher and Whelehan (11) define gender stereotypes as “a standardised and often pejorative idea or image held about an individual on the basis of their gender” (p. 167). Certain attributes to men or women are given as socially constructed gender norms. For example, men are rational and instrumental while women emotional and unpredictable. Hence, men are good at leading people and making decisions; women are suitable for caring and assisting men.

In the maritime industry, stereotypes towards men and women are generally strong. Women are often seen as unsuitable for working on board ships due to the stereotypes towards maritime women professionals (12).

Gender identity and sexual orientation

Gender identity is considered one of many identities that one has in terms of race, class, gender, nationality, ethnicity, religion and any other particular communities to which they may belong (13). The sense of belongingness to the community can become extremely important if one is a minority in the community. For example, women seafarers often find themselves as the only woman on board a ship. The occupational culture of seafaring tends to mirror masculine norms and values. In order to become a part of the male crew, women’s gender identity can be in constant negotiation by its capacity of being changed, reshaped and redefined (14). This research reveals that women seafarers tended to use various gender identity management strategies both on board and ashore. Through gender identity management, women try to fit into the male work environment and avoid possible gender-related problems, including sexual harassment as discussed in Chapter 7.3.13 and 7.4.15.

In recent years, so-called sexual orientations, including gay, lesbian, bisexual, and transgender (LGBT) have been highlighted, in addition to gender issues in general. There is very little research on LGBT in the maritime sector, however they exist (15). Queer theory was developed in the mid-1980s through the work of Michel Foucault, by denying the privileges of heterosexuality and questioning dominant ideas of what is normal and appropriate in people’s behaviours. Since the maritime sector tends to be old-fashioned in its way of thinking, it seems to be almost a taboo subject to talk about. Nevertheless, considering the fact that rapid digital transformations are changing the traditional patterns of maritime jobs, it is possible to assume that the industry may be forced to adopt changes by accepting new ideas and approaches in the coming years.

Practical issues 

Gender equality should be achieved not only by quantity but also by quality in the maritime sector. The needs of a minority group, such as women seafarers, may not always be seen as a priority, but there are on board female specific needs. Access to a sanitary bin is known as one of the common challenges faced by women seafarers. According to the 2015 survey(16), approximately 40% of women seafarers responded that they did not have access to sanitary bins. Under the Maritime Labour Convention (MLC) 2006 (17), Standard A3.1, Accommodation and recreational facilities of the Maritime Labour Convention, as Amended, 4(d) sanitary facilities shall be implemented by the competent authority. A similar standard was originally stated in the ILO Convention No. 92 (C092) (18), Accommodation of Crews Convention (Revised), 1949, which applies to those States that ratified C092 regardless of their ratification of MLC, 2006. The problem is that sanitary bins are not specifically mentioned in the description of sanitary facilities in the above two conventions.

To ensure occupational safety and health (OSH) on board ships, Personal Protective Equipment (PPE) is important to protect workers from occupational hazards, accidents, and physical injuries. PPE includes safety helmets, boots, cloves, and coveralls. Several studies claim that PPE in the maritime sector often fails to be tailored to women. For example, female coastguard officers found that their overall or boiler suit with a double zip at the front design was very inconvenient and impractical to go to the bathroom (19). Immersion suits for the maritime operation are also designed based on the assumption of male bodies (20). The ergonomic problem of PPE needs to be addressed in order that workers, including women, feel safe and comfortable to do their job.

Notably, the design of facilities and equipment on ships often fails to address gender perspectives and considerations in terms of crew’s OSH. The effective regulations and guidelines are clearly lacking. The problem should not burden individual seafarers nor affect the attraction of the job. A women-friendly, safe work environment is an important area for further discussions and improvements in the industry.


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  • Drewry, ILO, ITF. Manning 2009. London: Drewry; 2009.
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  • Kitada M. Advancing “good practices” that promote gender equality in the maritime sector. In: Papanicolopulu I, editor. Gender and the Law of the Sea. Leiden: Brill; forthcoming in 2019.
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  • Personal protective equipment and women: Guidance for workplace representatives on ensuring it is a safe fit. ; Trades Union Congress; 2017.
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F.4.15 Sexual harassment


In 2014, the International Maritime Health Association (IMHA), International Seafarers’ Welfare and Assistance Network (ISWAN), International Transport Workers’ Federation (ITF) and Seafarers Hospital Society (SHS) conducted a survey of women’s health and welfare (1). According to this survey report, 17% of women seafarers answered that sexual harassment is an issue. It is also noted that in their pilot survey nearly a half of the participants mentioned that they experienced sexual harassment on board. This gap is explained because the majority of respondents in the pilot survey were rather junior while women in supervisory roles answered the main survey. It is therefore concluded that women with less power in the workplace are more vulnerable to sexual harassment (1).

The definitions of sexual harassment

The International Labour Organization (ILO) provides useful explanations about sexual harassment. It is defined as ‘a sex-based behaviour that is unwelcome and offensive to its recipient’ (2). The following two conditions were identified where sexual harassment exists:

  • ‘Quid Pro Quo’, when a job benefit, such as a pay rise, a promotion, or even continued employment, is made conditional on the victim acceding to demands to engage in some form of sexual behaviour; or;
  • Hostile working environment in which the conduct creates conditions that are intimidating or humiliating for the victim” (2). 

Behaviours considered sexual harassment include three elements:

  • Physical behaviours, for example, physical violence, touching and unnecessary close proximity. Verbal behaviours such as comments and questions about appearance, life-style and sexual orientation, offensive phone calls and so on.
  • Non-verbal behaviours including whistling, sexually suggestive gestures, display of sexual materials and other covert signals (2).

Sexual harassment can happen between members of the opposite or same sex. Women tend to be victims in male-dominated occupations; however, men can be victims of sexual harassment by either females or males (3). Many cases, regardless of the level of sexual harassment, are unreported (see below); so it is difficult to understand the actual number of cases and their character.

Examples of sexual harassment in the maritime sector

There are a limited number of surveys and research on sexual harassment in the maritime sector. Sea-based female professionals are more vulnerable to sexual harassment in the form of physical behaviour, compared to shore-based women. This may be because of the confined space on board, presenting opportunities for a higher risk of sexual harassment (4) and examples include:

  • A male colleague visited a woman seafarer’s cabin or forced her to enter his cabin (4, 5),
  • A couple of holes were created in the female toilet room (4),
  • Constant telephone calls and love letters to a female seafarer’s cabin (5, 6).

During the field study, Kitada also heard that some women experienced a male colleague’s attempt to kiss and/or hug as well as touching her shoulders or lap on duty (6). Verbal and non-verbal sexual harassment are also common on board, for example, male seafarers comment about a female seafarer’s appearance and a calendar with pictures of naked women displayed in the workplace (6).

Shore-based maritime female professionals tend to experience gender-based discriminations. In the Caribbean, although some progress has been made in the past decades, women are still recipients of lower-paying professions, lesser opportunities for education and training as well as for leadership positions (5). In the UK, a gender pay gap was reported in several major shipping companies. The NYK Group (Europe) Ltd is one of the top three Japanese shipping companies and their women employees earn 60.5 pence for every pound their male colleagues make. Within Carnival Plc, the world’s largest cruise operator, women receive 61.6 pence in comparison with their male counterparts, making every pound.  In the case of V.Ships UK Ltd, women are earning 51.6 pence for every pound a male colleague earns, which shows the worst rate of all (6). Such structural gender-discriminations can lead to Quid Pro Quo type of harassment as well as verbal and non-verbal sexual harassment in their workplace where men are dominant and privileged.

Reporting sexual harassment

The Amendment of the Maritime Labour Conventions (MLC), 2006, regarding harassment and bullying for seafarers, became effective in January 2019. Although it is a guideline, meaning it offers recommendations only, the Amendment emphasizes the responsibility of ship owners to ensure a safe and healthy work environment on board for crew. Without such an emphasis, seafarers tend to feel the pressure of losing their job if they report any incidents to the company. This applies to women seafarers as well, who do not want to project themselves as a trouble-maker or feel helpless about finding effective solutions when the incident happened (4, 6). Inappropriate male behaviours towards women seafarers often remain unchallenged anyway (4). The lack of reporting mechanisms as well as seafarers’ fear of losing their jobs can be a major factor resulting in many cases of sexual harassment going unreported.

In the wake of social media campaigns, such as ‘#metoo’, sexual harassment has become more visible and women’s voices are collectively being raised inside and outside the cyber space. In the maritime sector, Swedish maritime women show a good example of active social media campaigns about sexual harassment. More than 1,150 Swedish maritime women joined a Facebook group under the hashtag #lättaankar, Swedish for anchors away. It is a closed group in which women share their experiences of sexual harassment and bullying.  Some women have never told their stories until this opportunity (7). More information on ISWAN and the helpline is available in Ch. 4.6.

Preventative measures against sexual harassment

Reporting is very important in terms of understanding what is happening on board, applying laws and policies, and providing appropriate support to victims. However, such reactive measures should be combined with more proactive measures to prevent seafarers from sexual harassment and bullying. Because they are away from family and friends for long periods, seafarers tend to be vulnerable to feelings of isolation. This mental aspect of seafarers’ health should not be under-estimated and if sexual harassment or bullying occurs, one can feel even more isolated and find it difficult to cope with life on board. In the Nautilus survey on bullying, discrimination, and harassment, 79% of respondents felt that their experience of being bullied, discriminated, or harassed affected their morale at work and their performance (8).

By recognising the importance of seafarers’ mental and physical health, preventative measures are important tools to enhance on board occupational health and safety (OHS). In addition to MLC, 2006, the IMO’s instrument – International Safety Management (ISM) Code should be used for preventing sexual harassment under the section of OHS. The International Chamber of Shipping (ICS) and the International Transport Workers’ Federation (ITF) co-published a Guidance on Eliminating Shipboard Harassment and Bullying (9) and the Ship Operations Cooperative Program, Inc. in United States made the best practices guide available (10).


  • Stannard S, Vaughan C, Swift O, Robinson G, Altaf SA, McGarry A. Women seafarers’ health and welfare survey: A joint initiative of the International Maritime Health Association (IMHA), International Seafarers’ Welfare and Assistance Network (ISWAN), International Transport Workers’ Federation (ITF) and Seafarers Hospital Society (SHS). International Maritime Health. 2015;66(3):123–38.
  • Sexual Harassment at Work Fact Sheet. Geneva: International Labour Organization; n.d.
  • Johnson PA, Widnall SE, Benya FF, editors. Sexual Harassment of Women: Climate, Culture, and Consequences in Academic Sciences, Engineering, and Medicine. Washington D.C.: The National Academies Press; 2018.
  • Belcher P, Sampson H, Thomas M, Veiga J, Zhao M. Women Seafarers: Global employment policies and practices. Geneva: International Labour Organization; 2003.
  • Stevenson CJ. Sustainable Development Issues in Shipping: Women, the Under-Represented Human Resource. In: Kitada M, Williams E, Froholdt LL, editors. Maritime Women: Global Leadership. Heidelberg: Springer; 2015.
  • Kitada M. Women Seafarers and their Identities. Cardiff: Cardiff University; 2010.
  • Raun KG. Over 1000 women seafarers share sexual harassment experiences ShippingWatch. 2018 19 January.
  • Report: Bullying, Discrimination & Harassment survey 2010. London: Nautilus; 2010.
  • ICS, ITF. Guidance on Eliminating Shipboard Harassment and Bullying. London: International Chamber of Shipping, International Transport Workers’ Federation; 2016.
  • The Best Practices Guide on Prevention of Sexual Assault & Sexual Harassment in the US Merchant Marine. Woodinville: Ship Operations Cooperative Program, Inc.; 2017.