“Diver's depression” It's time to tackle stigma and taboos

Diving, mental health, and trust underwater

Mental health issues are no exception today—they are part of the human experience. According to data from the World Health Organization, up to 25% of adults experience anxiety, depression, or other emotional difficulties at some point in their lives. Psychiatric and psychological treatment, like therapy for hypertension or diabetes, has become something normal and necessary for maintaining health.
This phenomenon naturally extends to the world of divers. One in four divers has experienced low mood, anxiety, burnout, or therapy at some point in their history. And yet, in a world that relies so heavily on partnership and mutual trust, talking about mental health still provokes resistance and uncertainty.

Fear of judgment and lack of psychological safety

 Many divers admit that they do not talk about their experiences for fear of being excluded from diving, courses, certification, or trips. They do not want to be excluded, treated as “weaker” or “inferior.” They also do not want anyone to reproach or point fingers at them in any way. Research conducted in the United Kingdom (St Leger Dowse et al., 2019) shows that more than half of divers diagnosed with depression or anxiety do not disclose this fact in their medical records. Even fewer report the medications they are taking.

The reason is not a lack of responsibility, but a lack of trust and psychological security. The medical forms of many training agencies are still formulated in a binary way: “Have you ever had mental health problems?” or “Are you taking psychotropic drugs?” Such questions — without the opportunity for discussion and explanation of the context — encourage concealment of information rather than building honesty.

A diver who fears that honesty will deprive him of the opportunity to participate in training will not be fully transparent. This is paradoxical — because the threat does not come from taking the medication, but from the fact that no one knows about it.

I once worked as a DSO at a field station, where one of the biologists and project managers asked me for a private conversation. She told me that she had been treating depression for several years, was under the supervision of a psychiatrist, and was taking medication regularly. She confessed that she did not want her other colleagues to know about it, but she felt that as the person responsible for diving safety, I should be aware of it. Thanks to the information I received, I was able to deepen my knowledge about the medications she was taking, their effects, and possible complications. Some of the medications she took at night caused deep sleep and sometimes difficulty waking up. I had a more complete picture and knew what symptoms to expect. This information allowed me to better organize the diving day for this scientist's team. I also knew what support I could offer her. This was not a sign of weakness, but of responsibility for the team and our joint results. When someone tells me that their shoulder is sore, I don't expect them to carry the tanks themselves, but I can offer help. This is exactly the same situation.

What are SSRI drugs?

Modern treatment of anxiety and depressive disorders is largely based on drugs from the SSRI (Selective Serotonin Reuptake Inhibitors) group. These include citalopram, sertraline, escitalopram, and fluoxetine.

SSRIs increase the availability of serotonin, a neurotransmitter responsible for mood, motivation, and emotional stability. Compared to older drugs (e.g., tricyclic antidepressants), they have a much milder side effect profile, do not impair reflexes or concentration, and are relatively safe from the point of view of activities requiring focus, such as diving.

Medical literature (including reports by the Undersea and Hyperbaric Medical Society) has found no evidence that the use of SSRIs significantly increases the risk of accidents or decompression sickness. The condition is stable treatment — i.e., no side effects and an adequate adaptation period. In such cases, the diver is fully capable of diving safely.

In other words, it is not the drug that poses a risk, but its unstable use or lack of communication about it.

Why should your partner know?

In diving, the most important safety measure is not an automatic device or a computer — it is another person. The buddy system is not just a procedure, but a relationship of trust. If one partner is taking medication, e.g., from the SSRI group, it is important for the other to know about it — not to judge, but to understand.

In a situation of stress, uncertainty, or an unexpected event, this knowledge helps the partner remain calm, react appropriately, and maintain team continuity. It is trust—based on honesty and psychological safety—that is the factor that really protects against mistakes and the escalation of stress.

Psychological safety in a diving team means being able to say:

“I sometimes struggle with anxiety, I take medication, I feel fine — but I want you to know, just in case something happens.”

The data speaks for itself

A study by St Leger Dowse et al. (2019) conducted among 729 British divers showed that:

• 15% had been diagnosed with mental disorders,
• 6% were taking psychotropic drugs,
• more than half did not report this in their medical records,
• and as many as 90% of respondents said that diving improved their well-being and mental health.

For many participants, diving has become a form of natural therapy – a space where they can feel calm, focused, in rhythm with their breathing, and part of a community. It is precisely this combination of physical activity, concentration, and being in the “blue space” that has been scientifically proven to have anti-stress and mood-stabilising effects.

Diving as a form of therapy – Deptherapy UK research

One of the best-documented examples of the therapeutic effects of diving is the British programme Deptherapy UK, whose effectiveness was studied by a team from the University of Sheffield. The results, published in Disability and Rehabilitation, confirmed that diving can support the treatment of mental and physical trauma in war veterans.

The study involved 15 participants with trauma experience. After completing the programme, which combined diving training with a peer support system, there was a significant reduction in symptoms of anxiety and depression and an improvement in social functioning. The strongest effects were seen in people with psychological injuries such as PTSD, which highlights the value of activities taking place in a calm, controlled aquatic environment.

Deptherapy psychologist Richard Castle noted that diving helped participants regain calm, confidence and a sense of agency – key elements in restoring mental balance.

These results teach us an important lesson: diving can be not only a passion, but also a real therapeutic support, which further emphasises the importance of trust and openness in a diving team.

Trust as a safety factor

Trust within a diving team is not an emotional luxury—it is part of the safety system. Equipment can fail, procedures can go wrong, but trust between people is the last line of defense.

Building psychological safety means:

• the ability to talk about your limitations without fear of judgment,
• the awareness that support is the norm, not the exception,
• a culture where openness and honesty are signs of professionalism.

When divers feel they can be themselves — including with their medications, emotions, and experiences — the risk of errors decreases and team effectiveness increases.

Summary. Under pressure, but with balance

Anxiety disorders, depression, and other mental health issues are part of the modern world. SSRIs are one of the most commonly used and safest treatments today, and their use does not preclude diving.

The greatest threat is not the disorders or pharmacotherapy themselves, but silence, shame, and mistrust caused by the stigmatisation and exclusion of people undergoing treatment, which leads to the concealment of information and, as a result, weakens the team.

In an environment where trust underwater saves lives, openness about mental health should be a sign of responsibility, not weakness.

Sources

• St Leger Dowse, M. et al. (2019) – Diving and mental health: The potential benefits and risks from a survey of recreational scuba divers.A study of 729 recreational divers in the UK shows that divers have similar levels of mental health problems to the general population, with as many as 90% reporting an improvement in their well-being thanks to diving.Diving and Hyperbaric Medicine Journal
• Morgan, A. et al. (2019) – Can scuba diving offer therapeutic benefit to military veterans…An analysis of the Deptherapy UK program for veterans, confirming the therapeutic effects of diving in the treatment of PTSD and psychological trauma.Disability and Rehabilitation Journal
• Soldiers Undertaking Disabled Scuba (SUDS) – How Scuba Diving & SUDS Help War Veterans.Description of a therapeutic program in which diving helps war veterans regain their mental and physical balance.sudsdiving.org
• Undersea and Hyperbaric Medical Society (UHMS) – Diving Medical Guidance to the Physician (2023).The latest medical guidelines on diving, psychotropic drugs, and mental health.uhms.org
• World Health Organization (WHO) – Depression and Other Common Mental Disorders: Global Health Estimates (2022).Epidemiological data showing that approximately 25% of adults worldwide experience mental disorders.who.int
• Gascon, M. et al. (2015) – Mental health benefits of long-term exposure to blue spaces.A review of research on the positive effects of aquatic environments (“blue spaces”) on mental health.International Journal of Environmental Research and Public Health
• White, M. P. et al. (2010) – Blue space: The importance of water for preference, affect, and restorativeness ratings.A study confirming that being in a water environment has a strong relaxing effect and reduces stress. Journal of Environmental Psychology

Andrzej is a technical diving and closed-circuit rebreather diving instructor. He works as a safety and performance consultant in the diving industry. With a background in psychology specialising in social psychology and safety psychology, his main interests in these fields are related to human performance in extreme environments and building high-performance teams. Andrzej completed postgraduate studies in underwater archaeology and gained experience as a diving safety officer (DSO) responsible for diving safety in scientific projects. Since 2023, he has been an instructor in Human Factors and leads the Polish branch of The Human Factors. You can find more about him at www.podcisnieniem.com.pl.

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