In recent years, the North Sea oil and gas industry has been exposed to widespread change, including organizational restructuring, "down-sizing", and increased safety regulation. This article reviews the literature on psychosocial stress, health, and safety among offshore personnel in the light of these developments. Few studies directly compare onshore and offshore populations; the available data suggest that, relative to their onshore counterparts, offshore personnel experience greater anxiety, more sleep problems, and higher work load. Within the offshore population, objective factors (eg, size, age, type of installation, work patterns, and occupational differences), subjective work perceptions, individual differences (age and personality), and health behavior, all play significant roles in relation to health and safety outcomes. However, much of the research in stress and health offshore has methodological limitations and does not allow causal interpretation. The need for prospective studies of the long-term mental and physical health of offshore personnel, and for research in several specific areas, is noted.