Mental Health of International Migrant Workers Amidst Large-Scale Dormitory Outbreaks of COVID-19: A Population Survey

  1. Young Ern Saw
  2. Edina YQ Tan
  3. P Buvanaswari
  4. Kinjal Doshi
  5. Jean CJ Liu

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Abstract

Background

In the COVID-19 pandemic, international migrant workers have faced increased vulnerability on account of their status. This study examined the mental health burden of COVID-19 amongst low-waged migrant workers involved in large-scale dormitory outbreaks within Singapore.

Methods

Between 22 June to 11 October 2020, questionnaires were distributed in-person and online to 1011 migrant workers undergoing movement restrictions. Mental health symptoms were measured using the 21-item Depression, Anxiety and Stress Scale (DASS-21). As covariates, we assessed participants’ socio-demographics, quarantine status, COVID-19 health concerns, financial stability, and exposure to news and misinformation. Linear regression models were fitted to identify factors associated with each DASS-21 subscale.

Findings

Complete movement restrictions were associated with increased depression and stress symptoms, while being diagnosed with COVID-19 was associated with increased anxiety. Participants who harboured fears about their health or job, perceived their health to be poorer, or had greater exposure to COVID-19 rumours reported higher depression, anxiety, and stress levels. Across the cohort, rates of severe or extremely severe depression (3.1%, 95% CI: 2.1-4.3%), anxiety (4.1%, 95% CI: 2.9-5.5%), and stress (1.3%, 95% CI: 0.7-2.2%) were similar to those observed in the general population for the host country (Singapore).

Interpretation

The risk factors identified underscore how the ongoing pandemic may impact the mental health of migrant workers. At the same time, we observed resilience within the cohort, with no evidence of increased symptomology (relative to the general population).

Funding

JY Pillay Global Asia Grant

Research in Context

Evidence before this study

We searched PubMed and Google Scholar for articles published in English between Jan 1, 2020 and Feb 20, 2021 using the following keywords: (“COVID*” OR “coronavirus”) AND (“mental*” OR “psychiatr*”) AND (“labo*r migra*” OR “migrant work” OR “foreign-work” OR “immigrant work” OR “economic migra*” OR “economic immigra*”). Focusing on international migrant workers employed in low-wage manual labour positions, we identified commentaries and interview-based studies describing the stressors faced by workers during the COVID-19 pandemic. However, we found no study documenting mental health symptoms within this group.

Added value of this study

To our knowledge, this is the first mental health survey of low-wage migrant workers during the COVID-19 pandemic. We observed that the mental health burden was highest amongst participants who encountered pandemic-related adversities (complete movement restrictions, testing positive for COVID-19), perceived the situation negatively (being fearful of their health or job, or judging their health to be poorer), or had higher exposure to COVID-19 rumours.

Implications of the available evidence

Our findings provide a basis to identify and support at-risk migrant workers during the pandemic. Although we did not observe elevated rates of depression, anxiety, and stress symptoms within the migrant worker cohort, individual workers who experience poor mental health may find it harder to access health-care services (relative to the general population). Correspondingly, targeted support for at-risk migrant workers may serve to reduce mental health inequalities.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2021.02.24.21252414: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: All participants provided informed consent.
    IRB: The study was approved by the Institutional Review Boards of the National University of Singapore and Singapore Health Services, and was pre-registered on ClinicalTrials.gov (NCT04448704).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableStudy design and participants: We used data from the COVID-19 Migrant Health Study, a cross-sectional survey of 1011 male migrants employed in manual labour jobs within Singapore.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    In presenting our findings, we note several study limitations. First, we captured participants’ mental health at only one time-point. Future studies should monitor participants’ depression, anxiety, and stress levels longitudinally, allowing us to assess the impact of changing movement restrictions over time. Second, the context for COVID-19 research is dynamic, and further studies are needed to assess whether our results generalize across stages of the pandemic and to other migrant groups. Finally, we used an epidemiological approach to identify risk factors for poor mental health. Although this method is commonly-used (particularly during the pandemic), the cross-sectional design precludes conclusions about causality. Notwithstanding the study limitations, our study provides a rare window into the mental health of low-waged migrant workers during the COVID-19 pandemic. To the best of our knowledge, this is the first such survey since the pandemic started, and remains one of the largest mental health studies involving dormitory-housed migrant workers to date (even pre-pandemic). Although we observed resilience within our sample, the risk factors we identified underscore the need to ensure COVID-19 policies do not leave vulnerable groups behind.

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT04448704CompletedUnderstanding the Mental Health of Migrant Workers During th…

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2021.02.24.21252414v1 on medRxiv
  3. Version published to 10.1016/j.jmh.2021.100062