Abstract:
Objective: This study characterizes determinants of depression and anxiety among U.S. Mariners during the COVID-19 pandemic and identifies areas for intervention on these outcomes.
Methods: We developed a cross-sectional online survey assessing mental health, barriers to accessing mental health care, concerns, worries, and experiences when sailing during the pandemic, job satisfaction, and safety climate for U.S. Mariners. We measured depression using the Patient Health Questionnaire-2 (PHQ-2) and anxiety using the Generalized Anxiety Disorder-2 (GAD-2) scale. A score of 3 or greater indicated a diagnosis was likely for both scales. Differences in GAD-2 and PHQ-2 scores were investigated between groups defined by gender, race/ethnicity, age, industry, and credential, and logistic regression models were developed to investigate factors related to depression and anxiety. Barriers to access mental health care were also collated.
Results: The survey was completed by n=1,384 U.S. Coast Guard-credentialed mariners who had sailed during the COVID-19 pandemic. Of the respondents who choose to identify, 89% identified as male, 82% identified as white, and 87% were between the ages of 25 - 65. The prevalence of likely depression and anxiety were 20.7% and 22.7%, respectively, among survey respondents. Mariners with depression symptoms were more likely to experience adverse events on the vessel (OR 1.64, [CI: 1.25, 2.15]), report lower well-being (OR 0.30, [CI: 0.22, 0.40]), and had more concerns about COVID-19 (OR 1.47, [CI: 1.11, 1.96]). While mariners with anxiety symptoms were more likely to be young (OR 0.84, [CI: 0.74, 0.96]), hold concerns about COVID-19 (OR 2.01, [CI: 1.52, 2.67]), experience less support on the vessel (OR 0.66, [CI: 0.45, 0.97]), and reported lower well-being (OR 0.28, [CI: 0.20, 0.37]). Mariners reported many barriers to accessing mental health care when on a vessel, mariners with the depressed and anxiety symptoms groups identifying more barriers.
Conclusions: Pandemic impacts faced by U.S. Mariners led to an increased mental health burden (increased prevalence of depression and anxiety symptoms) coupled with decreased mental healthcare access on the vessel. Going forward, steps must be taken to decrease barriers to accessing mental health care for mariners.