Oldenburg et al.14 examined occupational risks among seafarers. The major categories which they highlighted were accidents and disasters at sea (e.g. vessels foundering or colliding, falling into a hold, being swept overboard in rough seas, incorrect or non-use of safety equipment) and piracy (in 2008, 774 crew members were reportedly taken hostage, with most instances currently in the South China Sea, the Indian Ocean and the coasts of East and West Africa). Oldenburg et al. 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 between the 1980s and 1990s in the British and Danish merchant fleets. Although the incidence of CVD is not necessarily greater among seafarers, the treatment options and access to medical expertise are much reduced and Oldenburg et al. recommend telemedical advice from a radiomedical physician ashore and transmissions of radiomedical ECG to assist accurate diagnosis.In a related study Oldenburg et al.15 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.

 Fatigue, isolation and a lack of social contact have all been negatively influenced by shorter turn-around times for ships in port, as well as enhanced ship and port security measures making it more difficult for crew 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, which may also have contributory factors of troubles at home which the seafarer feels powerless to influence, stresses onboard and prolonged motion sickness16.  While most research on fatigue and performance has focused on deck personnel, Rydstedt and Lundh17 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 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 organizational context’17 (p 174).