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Signs of Depression

Depression Onboard

Seafaring is indisputably a strenuous and stressful job ; seafarers in general experience higher work stress than the general population ( Agterberg G., & Passchier, J. 1998) and are exposed to several stressful job factors that includes high job demands , increased workload, long working hours, shift work and stressful environmental conditions, rough weather, noise, vibration and temperature changes. Unlike their counterparts at shore, seafarers experience additional psycholosocial factors that contribute to poor mental health. Some of the key challenges include lengthy periods away from home, limited opportunities to interact with new people, fatigue, abuse, loneliness, isolation, limited recreational activity, short turnaround time, short shore leave, a multinational environment etc., ( Irversen R., 2012)

Numerous studies confirm that psychological job demands constitute a risk for major depression and generalized anxiety disorder ( Lelliot, Tulloch et al, 2008). Work stress is consistently associated with the onset of depression and anxiety even among subjects without prior history of these disorders. According to Dr. Melchior of the Institute of Psychiatry at Kings College, people working in high stressful jobs have twice the risk of developing depression and anxiety compared to people in less stressful jobs. (www.theguardian.com/science/2007/aug/02/mentalhealth.workplacestress)

Research consistently confirms that job demands, lack of job control and effort and reward imbalances constitute some of the psychosocial factors increase the risk of mental illnesses while reducing well being; while, high quality social support can act as a buffer against the negative effects of depression and other mental health problems (Belkic & Landsbergis et al , 2004). High risk jobs may be linked to greater psychological distress leading to mental illness ( Collins & long, 2003, Gerberich et al, 2004) and workplace pressure is so prevalent that the World Health Organization considers job stress an important risk factor to public health

Stress at work has been the focus of attention among many mental health and human resource professionals. According to a 2015 Work-Life Survey by the American Psychological Association 37 percent of Americans experience significant stress related to their job that can lead to health problems such as fatigue, headaches, elevated blood pressure, gastrointestinal distress while decrease stress tolerance and increase anxiety and depression ( Meyers, L., 2016) .

Depression is the most prevalent illness reported impacting over 350 million worldwide and currently the second cause of disability . Depression accounts for 10 percent of missed days at work and is associated with lost productivity , absenteeism, significant economic cost and mortality ( European Agency for Safety and Health at Work – EU-OSHA,2014). Depression is a serious mental disorder associated with high mortality accounted for by suicide. In fact, suicide among seafarers is reported to be higher than the general population accounting for 5.9 percent of total deaths ( Irvensen, 2012). According to Robert & Marlow (2005) if disappearances at sea are also added then suicide is a critical issue that needs to be addressed.

According to the World Health Organization an estimated 804 000 suicide deaths occurred worldwide in 2012, representing an annual global age-standardized suicide rate of 11.4 per 100 000 population (15.0 for males and 8.0 for females). Suicide is a sensitive issue and likely underreported due to the stigma it carries and the fact that it is illegal in some countries it may be misclassified as an accident or another cause of death. Frequently, several risk factors act cumulatively to increase a person’s vulnerability to suicidal behavior.

Risk factors associated with suicide at the community level include war and disaster, stresses of acculturation (such as among indigenous peoples or displaced persons), discrimination, a sense of isolation, abuse, violence and conflictual relationships. While at the individual level previous suicide attempts, mental disorders, harmful use of alcohol, financial loss, chronic pain and a family history of suicide comprise risk factors . Unequivocally, depression has been significantly linked to suicidal ideation and the risk of suicidal behavior is prevalent at all times during major depressive episodes.( DSM-5) In light of the stigma associated with mental illness seafarers may withhold and conceal mental health issues that would otherwise be treatable if appropriately assessed and diagnosed.

According to reports from the Center for Disease Control and Prevention, one in four adults will develop a mental disorder in a given year; men have a 7 percent prevalence rate between the ages of 40 to 59 while for women that is increased to 12 percent. Unfortunately, clinical depression often goes unrecognized and may lead to significant impairments in personal, work and interpersonal relations.

Diagnostic features of depression include depressed mood for most of the day for at least during a two week period, indicated by feelings of sadness, emptiness and hopelessness. A decreased interest or pleasure in almost all or all activities , sleep disturbances that may manifest as insomnia or prolonged sleep episodes, appetite or weight changes, psycho-motor changes that may include agitation or retardation , decreased energy , tiredness and fatigue . Some individuals may complain of aches and pains rather than sadness and many show irritability or persistent angry outbursts. Feelings of worthlessness or guilt that includes unrealistic negative attributions of one’s self worth and diminished ability to think, concentrate or indecisiveness nearly every day. Finally, thoughts about death and suicidal ideation are common. In many cultures somatic symptoms may constitute the presenting complaints along with insomnia and loss of energy.

Onset of depression increases during puberty and peaks around the twenties. The course varies among individuals and recovery in 2 out of 5 cases begins within three months of onset. Recovery is contingent on severity of episode, chronicity, and comorbidity with anxiety or personality disorders.

Risk factors for the onset of depression may be temperamental such as neuroticism, environmental such as adverse childhood experiences or stressful life events, genetic with heritability accounting for 40 percent. Comorbidity with others disorders is common and includes substance disorders, anxiety panic disorder, obsessive compulsive disorder, anorexia nervosa and borderline personality disorder (DSM-5).

Impairments vary from mild to severe, and with great decreases in physical, social and role functioning. Depression may manifest differently at work versus other settings since individuals try to mask the symptoms of depression. It may be manifested with passive, withdrawn and aimless attitude and behavior, impaired judgment, and cloudy decision making. Irritability, angry outbursts or exaggerated frustration over minor incidences are also very common. Depression is associated with increased risk of smoking, alcohol consumption , poor sleep and health issues.

Cross cultural studies indicate that depression often goes unrecognized in primary care settings since many present somatic symptoms, insomnia, loss of energy and pain .

Depression, anxiety and other mental illnesses among seafarers is of increased concern, and associated with other physical ailments they experience. In light of the fact that stressful life experiences can act as precipitants to depression , care needs to be taken in properly assessing individual’s mental health status prior to boarding since work stress can lead to onset of depression . Depression is a highly treatable condition and recency constitutes an important determinant of near term recovery. On the other hand, chronicity of depressive symptomatology decreases the likelihood of full symptom resolution (DSM-5).

Depression is a common mood disorder in the general population, can be triggered by stressful life events and varies in symptoms and course specifics. It is important to note that in most countries and cultures depression can go unnoticed in primary care settings, and that in many cultures somatic complaints constitute the primary presenting symptom. Recovery usually begins within 3 months and can extend to one year for the majority of individuals.

Depression is burdensome for the individual with serious stigma attached at work hence reducing the chances of asking for help. There is a growing need to address depression at work given that disability claims are growing by 10 percent annually and mental disorders are at the heart of more than 9 percent of long term disability claims. Depression is the leading cause of lost productivity in the US with an annual cost of $44 billion to employers; a bear of a burden that is hard to ignore given the implications of depression for both employees and employers.

Mental illness among seafarers is of growing concern and it’s believed that mental health problems may contribute to many other physical health conditions that seafarers experience. Early diagnosis is essential to the course and treatment of depression and other mental health issues facing seafarers . Psychoeducational interventions can increase awareness, reduce the stigma , and decrease risks.

At IMEQ CENTER our standard diagnostic instruments tests includes self reported measures of high reliability and validity across different populations and cultures to prevent via proper diagnosis and interventions.