The Relationship Between Work-Induced Sexual Abstinence and Psychological Health of Chinese Male Seafarers: The Positive Influence of Job Satisfaction

Abstract

The specific nature of the seafaring occupation keeps seafarers away from partners and shore life for long periods at sea. Therefore, seafarers suffer many challenges in the workplace including frustration of their sexual needs. This study aimed to investigate the relationship between work-induced sexual abstinence, psychological health and job satisfaction among seafarers. A mixed-method approach focusing on cross-sectional survey-based quantitative research was used. The sample included 617 Chinese active seafarers who experienced sexual abstinence on board. Hierarchical cluster analysis was conducted to divide the respondents into different groups corresponding to 14 psychological problems induced by sexual abstinence and experienced in the workplace. Multiple linear regression analysis was applied to identify the relationship between tolerance level of seafarers to sexual abstinence and their job satisfaction. Four distinct groups of seafarers, influenced differently by sexual abstinence, were identified, namely “Saint,” “Adapter,” “Average people,” and “Sufferer” clusters. Multiple linear regression analysis indicated that tolerance level of seafarers to sexual abstinence was positively influenced by overall job satisfaction, perceived working environment, ability utilization for other jobs, own choice for working as a seafarer and perceived friendliness of co-workers, while it was negatively influenced by perceived job responsibility. The study innovates by examining the relationship between sexual abstinence and the psychological health of seafarers. It also extends the function of job satisfaction, which can contribute positively to the tolerance level to sexual abstinence. Management recommendations to address sexual abstinence issues are proposed to better protect the health and psychological well-being of seafarers and enhance operational safety on board.

• What do we already know about this topic?

• This is the first study discussing the psychological/mental health issues of Chinese male seafarers caused by sexual abstinence.

• How does your research contribute to the field?

• Four types of Chinese male seafarers were identified through hierarchical cluster analysis based on their significantly different responses toward 14 psychological issues provoked by sexual abstinence.

• What are your research’s implications toward theory, practice, or policy?

• The relationship between work-induced sexual abstinence and the psychological health of Chinese male seafarers is explored. The correlation between job satisfaction and the tolerance level of seafarers to sexual abstinence is also identified. A management framework is proposed to better protect seafarers’ health and enhance operational safety.

Introduction

Societally constructed and dependent on immediate and wider socio-cultural environments, human sexuality is a physiological need as well as an individual and social behavior. ¹ In his initial works on complexity, Morin ² stressed that sexuality is a human obsession that has led to the massive and ongoing development of rules and practices controlling reproduction and sexual interaction. Further, the World Health Organization (WHO) ³ states that sexual health is “[. . .] fundamental to the physical and emotional health and well-being of individuals, couples and families, and ultimately to the social and economic development of communities and countries.”

Facing such needs, elements or conditions that eventually hinder the fulfilment of the expected sexual life may detrimentally affect individuals’ satisfaction, health, and well-being. Moreover, lack of sexual fulfilment might also diminish workers’ positive feelings and functioning required for the development of healthy workplaces. ⁴ The case of unchosen sexual abstinence associated with living or working environments has been reported as violating the basic physiological needs of human beings. ⁵ Research on sexual abstinence has mainly focused on groups such as prisoners, soldiers and patients with medical conditions including cancer or men with HIV.^5-8 These studies have described psychological suffering, including negative feelings, emotional problems, depression, and detrimental impacts on psychological health and well-being, in each environment that deprive individuals of sexual satisfaction. Additionally, some works have concluded that in situations of extreme sexual restriction, individuals can also be more prone to risky sexual behaviors as a consequence of the negative impact of the psychological symptoms associated with sexual abstinence. ⁸

Health is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” ⁹ Current research and practice on psychological health emphasizes well-being and positive mental health. In line with this, the WHO ¹⁰ has defined positive mental health as “a state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and can make a contribution to his or her community.” This understanding of mental health indicates a shift from a focus on disorders and dysfunction to well-being and positive feelings and functioning. Boosting positive psychological health prevents people from developing mental health issues, anxiety, unhappiness, negative attitude, and poor cognition, which may lead to dysfunctional behaviors. Furthermore, while preventing mental health disorders from occurring and treating them when present is key, the focus of positive psychological health is on improving individuals’ well-being, health and satisfaction, and this is extensible to workplaces. ⁴

Seafaring: Health, Sexual Abstinence, and the Workplace

Seafaring is one of the world’s oldest professions and seafarers have consistently been considered an occupational group vulnerable to the development of mental health difficulties and ill-health conditions.^11-16 This vulnerability is related not only to demanding working conditions but also to the life challenges of seafarers while on board ships.^17,18 The ship is the location and space where seafarers work, but unlike most professions, this working space also becomes their living space for prolonged periods when at sea. ¹⁹ While the duration of seafarers’ contracts varies according to nationality and, potentially, trade, seafarers from developing countries such as China usually work between 4 and 6 months on ships, followed by a period of leave. Due to the COVID-19 pandemic, the shifting of seafarers became extremely difficult. As a result, contract periods were notably extended, and a significant number of seafarers (mostly from developing countries) remained working on board for over 10 consecutive months,^20-22 which breaches the principle of regulation 2.5 of the Maritime Labor Convention 2006 (MLC, 2006) concerning the right to be repatriated. Lengthy stays at sea, with or without pandemics, imply that seafarers are separated from their families and significant others for long periods. These particularities of the seafaring profession, characterized by long-distance relationships with family and loneliness on board, have been repeatedly identified as the main factors contributing to the psychological stress of seafarers. ¹¹

Despite the long history of seafaring, no study related to the sexual abstinence of crewmembers has been identified. The existing studies on seafarers’ sexual health discuss risky sex practices or sexually transmitted infections.^23-25 The mental and physical impacts of sexual abstinence on ships seem to be ignored. Considering that crewmembers spend extended periods at sea and are unable to access shore facilities due to short port stays and intensive work,^26-28 seafarers are trapped onboard with no or limited possibility for sexual satisfaction. Furthermore, isolation of seafarers has been exacerbated by the impacts of the COVID-19 crisis, including denial/limitation of shore leave, impossibility to sign on and off, and extended contracts.^29-32

Seafarers must be physically and mentally healthy to be able to work safely and productively. ³³ Involuntary sexual abstinence (ie, induced by medical, working, or living conditions) may affect individuals’ mental and physical health as evidenced in other populations.^5-8 Thus, it is important to study this unexplored aspect in seafarers who, because of the specific nature of the job they do, are separated from their spouses and partners for long periods. Against this background, this unprecedented research, focused on Chinese male seafarers, explores the perceived influence of seafarers’ sexual abstinence on their psychological health.

Seafarers’ Sexual Abstinence and Job Satisfaction

In addition to the impact on psychological health, this research strives to examine the relationship between seafarers’ perceived job satisfaction and their level of tolerance to sexual abstinence. Job satisfaction is a subjective variable indicating the feeling of an employee toward his or her job. It is influenced by the person’s working experience and perception. ³⁴ Job satisfaction has a close relationship with other job-related facets such as quality of work, pay, promotion, supervision, and co-workers.^35-37 In addition, researchers have proved that a strong career identity is essential for achieving career satisfaction, which is closely related to the broader concept of job satisfaction.^38,39 Job satisfaction can highly influence the perceived stress level of employees, thus further influencing their performance and health.^40,41

Job satisfaction has been extensively studied in safety-critical industries, because of its crucial role in safety. In shipping, job satisfaction has been associated with enhanced seafarers’ performance and overall maritime safety.^41-43 An et al ⁴² found that job satisfaction plays a moderating role in the relationships between work-family conflicts (ie, because of separation from family), job stress, and job performance. In addition, low job satisfaction has recently been identified as a significant risk factor related to mental health issues in seafarers. ¹⁵ In the current research, the relationship between job satisfaction and sexual abstinence as a result of distance between couples or isolated life at sea is explored. This relationship has not been previously studied, but it is hypothesized that job satisfaction could help to minimize the anticipated negative impact of sexual abstinence, thereby protecting seafarers’ psychological health.

Based on the description above, the proposed research model is summarized in Figure 1. Using a large sample of Chinese male seafarers as the study subject, the research investigates the influence of sexual abstinence on their psychological health. It also explores the extent to which socio-demographic, job and company characteristics of the seafarers, together with the onboard welfare and facilities that they experience on board, affect such influence. The psychological health dimensions assessed include seafarers’ emotions, cognition, functioning, relationships with others, and psychological problems. ⁴⁴ Furthermore, the relationship between job satisfaction and level of tolerance to sexual abstinence for seafarers is identified.

Figure 1.

Research model: Sexual abstinence, psychological health, and job satisfaction.

Methods

This cross-sectional descriptive-analytical study adopted methodological triangulation based on two-step research. The first step was a qualitative exploration via interviews with 5 Chinese male seafarers. Conducted in Chinese, the one-on-one interviews focused on identifying the challenges on board and the attitude toward sexual abstinence. This initial dataset supported the development of an initial questionnaire validated by a limited number of participants before deploying the final survey (second step). Additionally, the enriched information obtained through the interviews was used to support the quantitative results. The research was conducted following the research ethics requirements of Dongbei University of Finance and Economics (China). Research ethics approval, involving human participation, was obtained (approval number: 2021-0067).

Questionnaire Design

The questionnaire was designed using the Sojump (www.wjx.cn) online survey tool. The questionnaire was divided into 5 main sections, most of which contained 5-point Likert-scale questions. In the socio-demographic section, the respondents were invited to provide general information as well as answer specific questions related to their employment at sea. Considering the impact of the COVID-19 crisis, the respondents were requested to exclude the pandemic period. The second section, which examined perceived job satisfaction, was adapted from the widely-used Job Descriptive Index developed by Smith et al. ³⁷ The index includes questions related to the quality of work (ie, difficulty, responsibility, the stress of the work, and working environment), pay (ie, salary level, personal ability and choice, and recognition from society and family), promotion (ie, opportunities for promotion), supervision (ie, the effectiveness of supervision), and co-workers (ie, friendliness of co-workers). As ships are working and living spaces, additional ad-hoc questions related to the living environment on board were added. The third section assessed the tolerance level to sexual abstinence by inviting the respondents to indicate their level of adaptation to sexual abstinence while working on board. The fourth section focused on the psychological impact of abstinence using 8 common factors extracted from the Psychological Health Index of Chinese Adults, ⁴⁴ namely anxiety, hostility, depression, poor mental endurance, sensitive interpersonal relationship, inadaptability, bad emotion, and somatization. Perceived fairness and bigotry dimensions were excluded from the analysis. These two dimensions are rooted in social comparison, are highly influenced by cultural norms and standards and have been less validated as core aspects of the psychological and emotional health of individuals. ⁴⁴ Finally, the fifth section invited the participants to assess the availability of onboard welfare and recreational facilities.

Pilot Testing

Pilot testing with 43 respondents clarified the wording and content of the questionnaire, which was initially composed in English by the researchers, and then translated into Chinese by the lead researcher, who is fluent in both languages and understands the social-cultural context of China. ⁴⁵ Basic analysis such as descriptive statistics and comparison of means was conducted to test whether the questionnaire was effective. A Cronbach’s alpha test (.833) was conducted to examine the reliability of the questionnaire, while KMO (0.815) and Bartlett’s test of sphericity (0.036) were conducted to examine its validity. After this initial validation, the questionnaire was distributed.

Questionnaire Distribution

The questionnaire was distributed from 6 May 2021 to 20 May 2021. During the pandemic period, seafarers could not take shore leave, which restricted the possibility of sexual contact. The survey link was advertised on WeChat (a popular social network among Chinese seafarers). The lead researcher widely disseminated the survey through his maritime networks and public maritime accounts on WeChat. Participants signed the consent form online before completing the questionnaire.

Data Analysis

To analyze how Chinese male seafarers are influenced by sexual abstinence, a hierarchical cluster analysis, which is effective in identifying the segments of respondents, was deployed. ⁴⁶ In our case, the respondents could be clustered based on their psychological health conditions after experiencing sexual abstinence, thus achieving the research objective. Ward’s agglomeration method with squared Euclidean distance was used to segment the sample. This multivariate segmentation technique reveals the latent diversity in a sampled population by maximizing in-group similarities and between-group differences, as framed by strategically selected variables. ⁴⁷ Decisions on an optimal cluster solution resulted from assessments of multiple objective and subjective criteria. These included the statistical significance of differences between clusters, cluster differences on cognate survey items, dendrogram structures, cluster size, and interpretability. ⁴⁸ Cluster differences in job and socio-demographic characteristics, the tolerance level to sexual abstinence, perceived psychological health issues, and availability of onboard welfare facilities were identified using chi-squared or ANOVA test, with eta-squared effect sizes calculated for the latter to explore the magnitude of statistically significant differences.

Additionally, multiple linear regression analysis was conducted to identify the relationship between the job satisfaction of Chinese male seafarers and their level of tolerance to sexual abstinence. The stepwise method was selected, which can eliminate the unqualified independent variables based on significance standards and is thus more reliable for “predicting” the influential relationship. ⁴⁹

Results

Sample Size and Socio-Demographic Characteristics

Eight hundred thirty responses were received in total, of which 617 were fully completed and valid. All respondents were Chinese male seafarers, mostly married (73.3%). Consistent with the average age of Chinese seafarers (36), ⁵⁰ the sample consisted of the age cohorts 31 to 40 (59%), 18 to 30 (23.5%), 41 to 50 (13.6%), and 51 to 60 (3.9%). Around half of the sample held a diploma as the highest level of educational achievement (52.5%) and had worked as a seafarer for more than 9 years (54.9%) (see Table 1).

Table 1.

Socio-demographic, Job and Company Characteristics of the Sample.

	Count (N = 617)	Percentage (%)	Items	Count (N = 617)	Percentage (%)
Marital status			Age
Single	150	24.3	18-30	145	23.5
Married	452	73.3	31-40	364	59.0
Divorced or widowed	15	2.4	41-50	84	13.6
			51-60	14	3.9
Education			Years of working as a seafarer
High school, technical education, or below	114	18.5	Less than 3	86	13.9
			3-9	192	31.2
			9 or more	339	54.9
Diploma	324	52.5
Undergraduate degree or above	179	29.0
Ship type			Company nature
Bulk ship	315	51.1	State-owned company in China	227	36.8
Oil tanker	182	29.5
Container ship	60	10.0	Private-owned company in China	118	19.1
LNG or LPG	28	4.5
Ocean cruise	30	4.9	Foreign company	65	10.5
			Freelance seafarers	207	33.5
Current rank			Working places on board
Low level	175	28.4	Deck	309	50.1
Middle level	250	40.5	Engine room	293	47.5
High level	192	31.1	Other areas	15	2.4
Co-workers’ nationality			Working experience with female seafarers
All Chinese	442	71.6	Yes	28	4.5
Foreigners	175	28.4	No	589	95.5
Contract period (months)			Holiday duration (months)
3 or below	39	6.3	2 or less	44	7.1
At least 6	403	65.3	3 or more	276	44.7
At least 9	144	23.3	No requirement	297	48.2
No requirement	31	5.1
Shore leave opportunity			Monthly salary onboard (USD)
Hardly any	194	31.4	Below 1500	120	19.4
1-2 times/contract period	276	44.7	1500-3,000	230	37.3
1-2 times/month	111	18.0	3000-4,500	113	18.3
3 or more times/month	36	5.9	4500 or above	154	25.0

Job and Company Characteristics

Half of the participants worked on bulk ships (51.1%), and more than one-third worked for state-owned companies in China (36.8%). The majority of respondents were middle and high-level officers on board (71.6%). The respondents were evenly distributed with respect to their workplaces on the ship (47.5% on the deck, and 50.1% in the engine room), with only a few respondents working in the kitchen or in other supporting areas (2.4%). Most participants only worked with the Chinese crew (71.6%). Finally, very few respondents (4.5%) have ever worked with female seafarers (see Table 1).

Nearly two-thirds of the respondents (65.3%) reported that their companies request them to work on board for at least 6 months at a time, while 23.3% had 9-month contracts. Only a very small proportion of the respondents claimed that their single contract period was 3 months or less (6.3%), or that their companies had no requirement for their single work period on board (5.1%). Around half of the respondents (48.2%) were able to decide their holiday duration themselves, while 44.7% of respondents had the possibility of taking at least 3 months’ holiday before they boarded the ship again. However, the holiday duration for the remaining respondents (7.1%) was no longer than 2 months (see Table 1).

Around one-third of the respondents (31.4%) rarely had access to shore leave while working on the ship. Only 5.9% claimed that they could take shore leave frequently, while 18.0% had 1 or 2 shore leave opportunities every month. The remaining 44.7% of respondents had one or 2 random shore leave opportunities throughout their whole working period on the ship (see Table 1).

A large proportion of the respondents (37.3%) claimed that their average monthly salary when working on board was between 1500 and 3000 USD; 18.3% of respondents indicated a monthly income of 3000 to 4500 USD, and a quarter of respondents reported a higher monthly income of 4500 USD or above. However, 19.4% of respondents had an average monthly salary of less than 1500 USD (see Table 1).

Psychological Health and Sexual Abstinence Cluster Solution

One of the main purposes of the research was to explore the influence of sexual abstinence on the psychological health of seafarers. To that end, the 14 items, extracted from the Psychological Health Index of Chinese Adults and used to examine the psychological influence of sexual abstinence on the respondents, were selected for clustering. A 4-cluster solution divided the sample into 4 highly distinct (P < .001) and logically differentiated segments with large size effects (η2) in the cluster mean differences (see Table 2). The 3-cluster option was rejected because it contained one segment with a very high level of internal heterogeneity, while 2 of the segments in the 5-cluster solution (resulting from the splitting of a cluster in the 4-cluster solution) were not substantively distinct.

Table 2.

Overall and Cluster Outcomes on the 14 Clustering Items and Other Cluster Analysis Result. ^*

Item	Overall mean (N = 617)	Cluster 1: Average (n = 189, 30.6%)	Cluster 2: Adapter (n = 235, 38.1%)	Cluster 3: Sufferer (n = 78, 12.7%)	Cluster 4: Saint (n = 115, 18.6%)
I feel anxious (η2 = 0.652)	3.57	4.08	3.35	4.92	2.23
I cannot control my temper (η2 = 0.691)	3.30	3.86	2.98	4.92	1.93
I feel depressed (η2 = 0.729)	3.37	4.04	3.02	4.91	1.92
I feel homesick (η2 = 0.520)	3.78	4.28	3.58	4.95	2.56
I feel lonely (η2 = 0.680)	3.48	4.06	3.20	4.96	2.07
I feel that there is no hope for the future (η2 = 0.636)	3.07	3.57	2.63	4.85	1.94
I feel sad (η2 = 0.693)	3.36	3.96	3.03	4.96	1.96
I cannot sleep well (η2 = 0.746)	3.41	4.05	3.10	4.96	1.96
I feel physical pain (η2 = 0.717)	2.98	3.44	2.54	4.97	1.78
I feel agitated (η2 = 0.757)	3.31	3.98	2.94	5.00	1.82
I become suspicious (η2 = 0.723)	3.73	3.73	2.64	4.99	1.81
I become pessimistic (η2 = 0.719)	3.06	3.70	2.53	4.92	1.83
I start to have the thought of suicide (η2 = 0.290)	2.24	2.44	1.95	3.54	1.61
Overall, I notice that I start to have psychological health issues (η2 = 0.494)	3.24	3.97	2.83	4.54	2.01
I get used to sexual abstinence when I am working on the ship (η2 = 0.172)	2.64	2.41	2.75	1.71	3.43
Item	Overall (N = 617)	Cluster 1: Average People (n = 189, 30.6%)	Cluster 2: Adapter (n = 235, 38.1%)	Cluster 3: Sufferer (n = 78, 12.7%)	Cluster 4: Saint (n = 115, 18.6%)
Education ** (χ2 = 21.436, ρ < 0.002)
High school or below/technical education	18.5	19.6	20.9	17.9	12.2
Diploma	52.5	56.1	52.8	59	41.7
Undergraduate or above	29	24.3	26.4	23.1	46.1
Working experience with female seafarers ** (χ2 = 11.555, ρ < 0.009)
Yes	4.5	3.7	3	2.6	10.4
No	95.5	96.3	97	97.4	89.6
Single contract period ** (χ2 = 28.206, ρ < 0.001)
3 months or below	6.3	6.9	5.1	9	6.1
At least 6 months	65.3	60.8	70.2	48.7	73.9
At least 9 months	23.3	26.5	22.1	37.2	11.3
No requirement	5.1	5.8	2.6	5.1	8.7
Holiday duration ** (χ2 = 30.055, ρ < 0.003)
Maximum 2 months or less	7.1	6.9	4.3	20.5	4.3
Maximum 3 months	14.9	13.8	15.7	11.5	17.4
Maximum 4 months	16	15.9	16.6	17.9	13.9
Maximum 5 months or above	13.8	16.9	11.9	10.3	14.8
No requirement	48.1	46.6	51.5	39.7	49.6
Item	Overall (N = 617)	Cluster 1: Average People (n = 189, 30.6%)	Cluster 2: Adapter (n = 235, 38.1%)	Cluster 3: Sufferer (n = 78, 12.7%)	Cluster 4: Saint (n = 115, 18.6%)
Shore leave frequency ** (χ2 = 40.854, ρ < 0.001)
3 or more opportunities per month	5.8	5.8	3	5.1	12.2
1 or 2 opportunities per month	18	13.2	23	10.3	20.9
1 or 2 opportunities every 3 months	28	29.1	33.2	17.9	22.6
1 or 2 opportunities every 6 months	16.7	18	15.3	15.4	18.3
Hardly any opportunity	31.4	33.9	25.5	51.3	26.1
Sex-related education ** (χ2 = 14.289, ρ < 0.003)
Yesw	9.7	5.3	11.1	5.1	17.4
No	90.3	94.7	88.9	94.9	82.6
Item	Overall (N = 617)	Cluster 1: Average People (n = 189, 30.6%)	Cluster 2: Adapter (n = 235, 38.1%)	Cluster 3: Sufferer (n = 78, 12.7%)	Cluster 4: Saint (n = 115, 18.6%)
Various entertainment facilities ** (χ2 = 32.244, ρ < 0.001)
Yes	53.3	46	53.6	38.5	74.8
No	46.7	54	46.4	61.5	25.2
High-quality internet ** (χ2 = 25.188, ρ < 0.001)
Yes	24.5	19	23.4	15.4	41.7
No	75.5	81	76.6	84.6	58.3
Item	Overall (N = 617)	Cluster 1: Average People (n = 189, 30.6%)	Cluster 2: Adapter (n = 235, 38.1%)	Cluster 3: Sufferer (n = 78, 12.7%)	Cluster 4: Saint (n = 115, 18.6%)
Psychological consultation ** (χ2 = 19.809, ρ < 0.001)
Yes	19.8	13.8	23	9	30.4
No	80.2	86.2	77	91	69.6
High-quality meals ** (χ2 = 44.202, ρ < 0.001)
Yes	32.9	27	34	11.5	54.8
No	67.1	73	66	88.5	45.2
Comfortable living environment ** (χ2 = 38.632, ρ < 0.001)
Yes	48.9	43.9	48.1	29.5	72.2
No	51.1	56.1	51.9	70.5	27.8

^*The significance level for all items is P < .001. Bolded and underlined means, respectively, are significantly higher and lower than all other clusters.

^**ANOVA test.

• Cluster 1—the “Average”—accounts for 30.6% of the sample. This group develops mild psychological health issues but their reactions remain similar to most people experiencing sexual abstinence.

• Cluster 2—the “Adapter”—accounts for 38.1%. This group did not express highly negative feelings or emotions except for homesickness (mean: 3.58), anxiety (mean: 3.35) and loneliness (mean: 3.20). The group members do not seem to be heavily affected by sexual abstinence and adapt to the conditions.

• Cluster 3—the “Sufferer” represented 12.7% of the respondents. This group expressed suffering from sexual abstinence and reported serious psychological health issues. Some members in this cluster even claimed that they had suicidal thoughts (mean: 3.54).

On the contrary, Cluster 4—the “Saint”—represents 18.6% of the sample. This group did not seem to develop psychological distress associated with sexual abstinence.

Among these 4 clusters, 3 psychological dimensions obtained the highest overall mean value (see Table 2), which were homesickness (mean: 3.78), suspicion (mean: 3.73), and anxiety (mean: 3.57).

Even though most of the respondents did not become accustomed to sexual abstinence on board, significant differences still existed between clusters with respect to their tolerance levels (see Table 2). Tolerance levels to sexual abstinence for the 4 clusters were consistent with the psychological reactions of the groups. The “Saint” cluster demonstrated the highest tolerance level, while the “Sufferer” cluster indicated the lowest. This confirmed the reliability of the cluster solution.

Socio-Demographic, Job, and Company Characteristics by Clusters

There was no statistically significant difference between the 4 clusters in age or marital status. For education, the “Saint” cluster had a significantly higher proportion of members with an undergraduate degree or above and a lower proportion of members with an education below a diploma (see Table 2). No statistically significant difference was identified in years of working as a seafarer, company’s nature, ship types, current rank, working places on board, colleagues’ nationality, or monthly onboard salary. However, the “Saint” cluster had a slightly higher proportion of members who worked with female seafarers (see Table 2).

Proportion of members in the “Sufferer” cluster were requested to work for at least 9 months during one single contract period but could only take a maximum of 2 months holiday before working on board again. Conversely, the single contract period for the “Saint” cluster was comparably shorter.

In addition, the frequency of the shore leave opportunity varied significantly between the 4 clusters. More members in the “Saint” and “Adapter” clusters had frequent access to shore leave. However, a higher proportion of members in the “Sufferer” cluster rarely had shore leave opportunities (see Table 2).

Onboard Welfare and Facilities by Clusters

A comparably higher proportion of the “Saint” cluster enjoyed enhanced onboard welfare and facilities including various entertainment facilities, high-quality internet, high-standard meals and comfortable living environments. Moreover, most of the respondents who experienced sex-related education and onboard psychological consultation belonged to the “Saint” cluster. However, most of those in the “Sufferer” cluster reported no availability of welfare and facilities (see Table 2).

Tolerance Level to Sexual Abstinence and Job Satisfaction Multiple Regression Results

The single-item scale “I get used to sexual abstinence when I am working on the ship” was selected as the dependent variable, which indicated the respondents’ tolerance level to sexual abstinence. The various items used to evaluate the job satisfaction of the respondents were analyzed as the independent variables. A correlation test was conducted first to ensure the reliability of multiple regression analysis. All the independent variables were significantly correlated (P < .01) with the dependent variable. Based on the stepwise method, the overall job satisfaction of seafarers, perceived working environment, ability utilization for other jobs, own choice of working as a seafarer and perceived friendliness of the co-workers had a positive influence on the tolerance level to abstinence. The perceived job responsibility had a negative effect (see Table 3). The other items were not statistically significant and thus excluded from the analysis.

Table 3.

Job Satisfaction and Tolerance Level to Sexual Abstinence.

Item	B	Standard error	t-stat Value	Sig.	VIF
Overall job satisfaction	0.202	0.053	3.814	P < .001	1.417
Good working environment	0.176	0.048	3.686	P < .001	1.344
Ability utilization for other jobs	0.198	0.043	4.592	P < .001	1.030
Own choice for working as a seafarer	0.196	0.051	3.849	P < .001	1.180
Perceived job responsibility	–.145	0.054	–2.716	P < .007	1.022
Friendly co-workers	0.114	0.055	2.070	P < .039	1.199

Discussion

Existing literature has proved that illness and psychological health problems in seafarers are more serious than in average workers.^{11-16,18,51-57} In addition to harsh working and living conditions, the current study suggests that sexual abstinence may contribute to the overall degradation of seafarers’ mental health. Isolated for long periods, current seafarers have limited possibilities to take leave from their ships, which dictates their rhythms. This keeps seafarers away from their loved ones both physically and emotionally and restricts their freedom of movement. Consequently, it is not surprising to note similar difficulties to groups previously studied such as prisoners, soldiers, and people with illnesses.

According to the study, homesickness, suspicion and anxiety were the 3 distinct psychological issues most frequently induced by sexual abstinence. Seafarers and most probably their partners miss one another, and sexual abstinence certainly reinforces the feeling of absence and homesickness. Interviewee 1 (31 years old, first engineer) stated that “I miss my family and feel isolated from my wife (when suffering sexual abstinence on board).” While homesickness and loneliness have been previously reported among the main psychological concerns among seafarers,^11,58,59 their relationship with sexual abstinence has not been studied. Consistent with the results of the research, Miller et al ⁸ indicated that there is a close relationship between sexual abstinence and poor mental conditions, including anxiety and depression. Suspicion and anxiety are also commonly identified among seafarers.^14,51,57,60 Although suspicion and anxiety can be caused by many factors, sexual abstinence might be one of the main reasons due to lack of love, intimacy and changes in hormones.^5,7

Socio-Demographic Characteristics and Sexual Abstinence of Seafarers

The respondents across different age groups were all significantly influenced by sexual abstinence, which shows sexual abstinence as a common problem for seafarers regardless of age. Marital status did not significantly differ between the “Average people,” “Adapter,” “Saint,” and “Sufferer” clusters either, which again emphasizes the universality of the problem. Education level is the only socio-demographic characteristic that highly differentiated the 4 clusters. Higher levels of education are thought to enhance people’s skills, afford important structural advantages, and empower better-coping mechanisms, all of which lead to better mental health.^61-68 This might explain why the “Saint” cluster, containing a higher proportion of members with at least a university degree, was significantly less affected by sexual abstinence than the rest. It would be necessary to explore in more detail if a higher educational level protects seafarers from potential psychological issues associated with sexual abstinence by providing them with general coping and adaptation skills. It could also be that higher education would impact job satisfaction and increase tolerance levels of seafarers to sexual abstinence.

Job and Company Characteristics and Sexual Abstinence of Seafarers

Amongst the 4 clusters, no significant difference was identified in terms of the years of work, company nature, ship types, current rank, workplaces on the ship, colleagues’ nationality, or salary. This would support that sexual abstinence is a universal problem as reported for same-gender dominated communities, isolated or with limited freedom of movement.^5,69 More studies outside the Chinese seafarer community should be conducted to confirm or refute this lack of relationship between sexual abstinence and the aforementioned job characteristics.

The longer seafarers are isolated at sea and from their families, the more likely they are to develop psychological health issues induced by sexual abstinence. This was supported by respondents in the “Sufferer” cluster, who indicated less shore leave, longer periods on board and shorter vacations than other groups that also reported more serious psychological health issues. Interviewee 2 (28 years old, second engineer) mentioned that “the shore leave could distract my attention on sexual abstinence and is probably my happiest time when working on board.” Therefore, the length of contracts and holidays and shore leave indicate that seafarers need opportunities to reconnect with the world ashore and their communities. It is imperative to sustain seafarers’ well-being and health. ⁷⁰

Onboard Welfare and Facilities

Family contact is very important for seafarers as shown in previous literature.^71,72 Interviewee 2 (28 years old, second engineer) stated that he “feels guilty to his family members for not accompanying them.” During periods at sea, communication systems and the internet enable seafarers to contact their families and sustain a healthy mental state.^73,74 A higher proportion of members in the “Saint” cluster reported the availability of high-quality internet on board while the majority of members in the “Sufferer” cluster did not have access to fast and stable internet when working on board. This suggests that high-quality internet could be vital for reducing the negative impact of sexual abstinence on seafarers as it can enhance contact with their loved ones and effectively reduce psychological stress. ⁷² However, other works suggest that the Internet may have detrimental impacts on socialization leading to increased isolation and serious mental health issues. ⁷⁵ As with internet connectivity, the “Saint” cluster had access to better entertainment facilities than the “Sufferer” cluster. This would indicate the effectiveness of the entertainment facilities in diverting attention and, eventually, overcoming some issues related to sexual abstinence. While entertainment on board has benefits for mental health, the use and abuse of technologies also seem to disrupt social interaction. ⁷⁶

Job Satisfaction and Tolerance Level to Sexual Abstinence

This research shows that the job satisfaction of seafarers is strongly correlated with the tolerance level to sexual abstinence. Indeed, harsh working environments have been reported to detrimentally affect the well-being of seafarers.^77,78 Normally, seafarers who perceive the working environment positively develop stronger adaptability toward work. ⁷⁹ Good interpersonal relationships on board can stimulate the motivation of employees and generate their positive attitude toward the job^80,81 and eventually offset the negative impacts of sexual abstinence suffered by seafarers. The ability utilization for other jobs and their own choices to work as seafarers influence their career identity, ⁸² which can lead to high job satisfaction and strong motivation as a result of career satisfaction.^38,39 Therefore, seafarers with better and clearer career identities might be more likely to accept the negative factors associated with the job, including sexual abstinence. Since the perceived working environment, ability utilization for other jobs, own choices to work as seafarers and friendliness of co-workers all directly contribute to the development of job satisfaction,^37,83 seafarers with higher overall job satisfaction could better tolerate onboard sexual abstinence, which could eventually positively impact psychological health.

Commonly, people with a strong sense of responsibility develop high job stress. ⁸⁴ This may explain why the perceived responsibility of seafarers’ jobs is negatively correlated with tolerance level to sexual abstinence. The higher the job responsibility seafarers feel, the more work stress they have, which would aggravate their inadaptation to life on board and psychological health issues induced by sexual abstinence.

Although no significant correlation was identified between the living conditions on board and tolerance level to sexual abstinence, the working and living environments cannot be discussed separately, considering the unique characteristics of seafarers’ jobs. Therefore, attention should also be paid to the comfort of the living areas and food quality on board as they contribute to overall well-being ⁸⁵ and significantly influence the health condition of seafarers, including their psychological health, ⁸⁶ as also recognized by ILO regulations in title 3 of the MLC, 2006. Again, the 2 opposite (“Saint” and “Sufferer”) groups expressed dissimilar experiences concerning their onboard environment. A higher proportion of members in the “Saint” cluster reported comfortable living environments while most members in the “Sufferer” cluster complained about their living conditions. Once more, the working environment seems to be related to the acceptance level of sexual abstinence.

Management Considerations and the Way Forward

Ships operate in isolation remote from shore. Therefore, a certain level of sexual abstinence is inevitable. The question is how to render it acceptable and limit the detrimental impacts on sea workers and their health.

Except for pre-identified “mental, cognitive, or behavioral disorders,” seafarers’ psychological assessments are not required during pre-sea medical examination. ⁸⁷ As sexual abstinence might destabilize isolated seafarers, medical practitioners issuing pre-sea certificates should be trained to detect the subjects at risk. Furthermore, at-sea monitoring and psychological support would be beneficial to workers. Preventive measures guaranteeing a healthy workplace should prevail, but once potential problems are identified, the employer should deploy psychological consultation, interventions, and support as well as eventually remove the seafarer from the ship to protect his/her health and safeguard the workplace. To support the mental health of seafarers in general, Lefkowitz and Slade ¹⁵ recommend strengthening preventive measures (training and work environment including job satisfaction enhancement) as well as monitoring and support systems through many maritime stakeholders.

Consistent with Bindman, ⁸⁸ strong evidence was obtained through this research to support the effectiveness of psychological consultations in minimizing the negative psychological influence of sexual abstinence. While most of the members in the “Sufferer” group never experienced psychological consultation, a significantly higher proportion of the members in the “Saint” cluster participated in such a consultation. This is also encouraged by interviewee 1 (31 years old, first engineer) who suggested “a psychologist is urgently needed on board to help seafarers to solve the psychological problems.”

Similarly, appropriate sex-related education contributes to the acceptance of abstinence. Therefore, the international framework regulating seafarers’ competencies (The 1978 International Convention on Standards of Training, Certification, and Watchkeeping for Seafarers (STCW) as amended.) should include health awareness of the effects of sexual abstinence and mitigation measures.

As suggested in the study, workplace quality, duration at sea, and education level influence seafarers’ acceptance of abstinence. While the tolerance level to sexual abstinence remains deeply individual, the outcome of the research emphasizes the importance of working and living environments on individuals’ health. Significant differences between the “Sufferer” and the “Saint” groups with regard to the availability of welfare support and facilities onboard (ie, entertainment facilities, psychological consultations, high-quality internet) indicate that despite individual differences the mental health of people is highly influenced by the physical and psychosocial work environment. ⁴ Therefore, regulators should enhance crew welfare facilities and review the regulations having detrimental effects on accommodation. ⁸⁹

The periods at sea and the access to shore facilities should be adjusted to enhance seafarers’ well-being. The MLC could adjust the maximum continuous periods at sea and minimum vacation periods. Shore leave is one of the seafarers’ rights as free workers. ³² However, security constraints, short port stays and intense work do not often allow seafarers to effectively release their stress and psychological issues through shore leave. ⁷⁰ Measures to exercise this right in practice are needed, particularly during pandemics or other unexpected events. In addition, shipping companies should take effective actions to enhance the perceived career identity of seafarers by improving their work benefits and social recognition. At the same time, appropriate organizational culture must be developed to encourage interpersonal relationships and strengthen teamwork on board.

Currently, the overall education level of seafarers in China is comparably low. ⁹⁰ Shipping companies should develop an education improvement scheme and encourage seafarers to participate in continuing education. This not only increases the work competence of seafarers but can also improve their psychological resilience toward sexual abstinence, both of which are vital for the operational safety of the ship.

Finally, the role of mixed gender crews (ie, increased number of female seafarers) in reducing sex-induced psychological pressure should be explored. So far, there is no study directly supporting the notion that male seafarers can have better performance when working with female seafarers. However, findings from this research indicate that having mixed-gender crews on ships could reduce the negative psychological influence caused by sexual abstinence. Unfortunately, female seafarers in shipping still face numerous difficulties including sexual harassment and the weight of masculine norms.^91,92

Conclusion

This study innovates and contributes to the extant literature on seafarers’ sexual health by examining the relationship between work-imposed sexual abstinence and the psychological health of seafarers. While existing literature highlights that sexual abstinence may impact individuals’ mental health, no previous research has specifically focused on seafarers. Furthermore, this study extends the study of the function of job satisfaction in the context of the shipping industry by stressing that job satisfaction contributes positively to the tolerance to sexual abstinence in seafarers and their psychological health. This finding is valuable for not only shipping but also other industries whose employees work in a closed environment and away from their loved ones for extended periods such as offshore workers, fishers or astronauts. Replication of this finding in other seafarer samples and safety-critical industry workers could be the focus of future studies. Sexual abstinence is a universal problem for seafarers and requires a multidimensional approach involving regulators, private companies, maritime education and training institutions, and workers. To better protect seafarers’ health and enhance the operational safety of the ship, an appropriate management framework should be proposed to minimize the negative impacts of sexual abstinence.

Although trying to be as rigorous as possible, the researchers acknowledge limitations. First, this research only focuses on Chinese male seafarers. It is hoped that the findings can be extended to seafarers worldwide in the future. The perspectives of the government authorities, industry associations and shipping companies toward the issues related to seafarers’ sexual abstinence are vital. Therefore, further research including multiple stakeholders and additional research methods such as observation and in-depth interviews is deemed necessary. Furthermore, additional factors, such as cultural dimensions and moral identities as well as the possibilities of having sex during time on board and the moderating effect of these factors on actual sexual abstinence can be included in future research. Limitations notwithstanding, this novel research intended to explore a new topic leading to protecting seafarers’ mental health and enhancing ship safety.