Rationale for Adapting Group Interpersonal Therapy for the Treatment of Psychological Distress Among Seafarers

Few interventional resources are available to treat this hard-to-reach, internationally dispersed workforce (2, 6). Not every ship has general medical staff on board, and fewer still have personnel trained to provide mental health services (2). Although helplines and telecounseling services are available through labor unions, employers, and third parties, the communication infrastructure at sea is inconsistent, curtailing seafarers’ ability to engage in telehealth (5). In addition, ship designs offer limited private space (3).

Although mental health clinics may be available at port, seafarers spend little time docked, making use of land-based services impractical (2). Furthermore, many seafarers function as migrant workers under temporary contracts, operating within a complex, decentralized system that leaves them vulnerable to gaps in both general medical and mental health care (2). These barriers and systemic loopholes may, in part, explain why existing resources and measures to safeguard seafarers’ mental health are insufficient.

Seafarers approach employer-sponsored services cautiously (3) but have been reported to be more receptive to peer support (7). On a ship, this preference lends itself to community-driven, group interventions. One such evidence-based intervention is group IPT, a time-limited, manualized treatment for depression that is delivered in a group format to alleviate psychological distress by clarifying links between an individual’s depressive symptoms and four core categories of interpersonal stressors: loneliness, role transition, grief, and interpersonal conflict (9). Of note, these four themes frequently underlie psychological distress in seafarers.

Group IPT begins with a facilitator meeting separately with each prospective group member to better understand their unique symptoms and circumstances. During this meeting, the facilitator encourages commitment to the therapeutic process, provides psychoeducation, and sets treatment goals. This individual session is followed by three phases of group therapy. During the initial phase, group members become acquainted with one another and learn about each member’s depressive symptoms. In the middle phase, group members explore problem areas contributing to their depression while practicing interpersonal skills and supporting one another. In the final phase, group members review their progress, strategize how to handle future challenges, and say their goodbyes (9).

Since group IPT’s development in the 1990s, researchers have adapted the manual for various contexts. For example, group IPT has been modified to treat occupational distress. The effectiveness of this modification was evaluated in two separate pilot studies that assessed clinical and occupational outcomes (10, 11). In both studies, group IPT outperformed treatment as usual, significantly decreasing workers’ depression while improving their occupational self-efficacy and work attitude (10, 11).

Group IPT has also been implemented in settings with limited health care infrastructure. For example, a culturally specific adaptation of the group IPT manual was developed for nonclinician group facilitators as part of a clinical trial in rural Uganda (12). Participants treated with group IPT experienced a nearly fivefold improvement in their depressive symptoms compared with participants assigned to receive treatment as usual (12). The modality’s broad adaptability and successful delivery by nonclinicians make group IPT especially promising for treating psychological distress among seafarers.

In an adaptation of group IPT for seafarers, the basic structure of the intervention would stay intact, but screening, group formation, and delivery would depend on crew size and vessel type. For example, cruise ships have crews that are large enough to include a health care worker on staff who could be trained in group IPT before departure. This crew member could periodically distribute a screening tool, such as the PHQ-9, and facilitate groups as needed (9). Cargo ships and tankers, however, have smaller crews and are unlikely to have a health care worker aboard (2). In these cases, screening could be conducted while docked at port, and a trained third-party facilitator could be brought aboard for the duration of treatment. Alternatively, one or two crew members could be proactively identified and trained as group IPT facilitators. However, when cases that are inappropriate for group IPT arise, such as severe substance use, psychosis, or active suicidality, emergency resources should be activated.

Adapting group IPT for seafarers is not without limitations. For instance, small crew sizes and workplace hierarchies may interfere with open therapeutic discourse. In addition, delivering group therapy in every participant’s native tongue may not be possible for multinational crews. Depending on the circumstances, individual delivery of IPT may be more appropriate.

Seafarers make up an essential workforce that experiences high rates of psychological distress, and their occupational environment makes treatment of their mental health conditions difficult. Group IPT is an evidence-based mental health intervention that has been successfully adapted for occupational contexts as well as low-resource settings and therefore has the potential to meet the needs of this vulnerable population.