Occupational health challenges in commercial diving: a qualitative study of psychological risk, training gaps, and organisational responsibilities.

Introduction: Little is known about the occupational health needs of commercial divers, particularly regarding psychological wellbeing, trauma exposure, organisational support, and the adequacy of training for high‑risk environments. This study qualitatively explored pathways into commercial diving, experiences of psychological strain and trauma, perceptions of support, and the relevance of training from the perspectives of divers, supervisors, and industry representatives. Methods: This qualitative study used semi‑structured interviews and focus groups with purposively sampled participants (n = 20 men). Data were analysed using reflexive thematic analysis. Results: Three themes were identified: (1) pathways into a high‑risk occupation shaped by financial incentives, risk acceptance, and informal entry routes; (2) psychological strain characterised by reported exposure to traumatic events, normalisation of distress, stigma surrounding mental health disclosure, and predominantly reactive organisational support; and (3) perceived inadequacies in training, described as generic, low‑fidelity, and insufficiently aligned with the operational realities of offshore and saturation diving, alongside limited opportunities to practise key skills, contributing to feelings of unpreparedness during emergencies. Conclusions: Participants described commercial diving as associated with substantial and often unaddressed psychological burden, compounded by cultural stigma, structural barriers to help‑seeking, and predominantly reactive support systems. Training provision was perceived as outdated and insufficiently aligned with operational demands, with limited organisational investment in development. Findings suggest that industry‑wide efforts may be needed to implement proactive mental‑health strategies and improve the alignment of training with operational realities.