Caught between a rock and a hard place: mental health of migrant live-in caregivers in Canada

Advancing health equity in Nova Scotia by exploring gaps in healthcare delivery: a mixed methods protocol

Population health issues are addressed by various regional initiatives in the Canadian province of Nova Scotia (NS). A need for research on the root causes of health inequities suggests there may be a lack of evidence to inform current initiatives within the region. To address this gap, a three-phase sequential mixed methods study called Advancing Health Equity in NS by Exploring Gaps in Healthcare Delivery will operationalize Intersectionality Theory and employ an integrated knowledge translation approach to identify and explore gaps in health service delivery. This will promote a better understanding of how to improve the integration of health equity in health service and delivery systems and thus population health and well-being. The following objectives will be addressed in each phase: 1) create an inventory of NS-relevant knowledge that relates to health equity, 2) examine the integration of health equity in NS health service and delivery systems using a context-specific health equity lens, and 3) mobilize knowledge on how gaps in service delivery can be addressed to improve the integration of health equity and better meet the needs of people living in NS. The study results from this protocol will be used to integrate health equity in NS health service and delivery systems, enhancing the quality of care for populations rendered vulnerable by structural inequalities, and working to prevent negative impacts to health and wellbeing.

Experiences of live-in migrant caregivers providing long-term care for older adults at home: A qualitative systematic review and meta-ethnography

BACKGROUND

Live-in migrant caregivers have been employed in various developed countries to meet the growing demands of long-term care needs for older adults. Increasingly, nurses in these countries are involved in providing caregiving training to these live-in migrant caregivers. A comprehensive understanding of the caring experiences of these live-in migrant caregivers can better support their caregiving experiences and improve their quality of care.

AIM

To synthesise the experiences of live-in migrant caregivers for older adults requiring long-term home care.

DESIGN

Qualitative systematic review using meta-ethnography.

METHODS

PubMed, CINAHL, Embase, Google Scholar, PsycINFO, Scopus, ProQuest and Web of Science Core Collection were searched from inception to November 2024. Qualitative studies that explored the experiences of migrant caregivers providing live-in care to older adults requiring long-term care were included. Two reviewers screened the articles according to the eligibility criteria, appraised the articles using the Critical Appraisal Skills Programme Tool, and extracted qualitative data independently. Data synthesis was performed using Noblit and Hare's meta-ethnography.

RESULTS

Five themes emerged from the 14 included studies: beyond caring for the older adult, compromising basic rights, being away, coping strategies, and being a better caregiver. These themes contributed to the overall line-of-argument synthesis: 'Treat me as a human being' so that I can grow and 'give my all' - beyond a transactional paid job to provide care. The synthesis revealed the vulnerabilities, challenges, opportunities, and capacity development encountered by live-in migrant caregivers in unleashing their potential to be better caregivers.

CONCLUSION

The findings highlighted the complexities of care intertwined in social structural bounded relationships between live-in migrant caregivers, older care recipients, and employers. Greater advocacy is needed to embrace live-in migrant workers as valued care providers of the eldercare workforce. Nurses have a role in promoting the development, delivery, uptake, and evaluation of structured, culturally contextualised and comprehensible long-term care training programs for live-in migrant caregivers and their employers. Significant opportunities could be provided to equip live-in migrant workers in caregiving roles, ensure and allocate time to rest, communicate their caregiving needs and moderate employers' expectations. Enhancing the quality of caregiving, improving their intertwined relationships and exercising cultural sensitivity contribute to better caregiving experiences and well-being for older adults, migrant caregivers, and employers.

REGISTRATION AND REPORTING CHECKLIST

The study protocol of this review was registered in PROSPERO (CRD42023392767). The eMERGE meta-ethnography guideline was adhered to.

Coping, surviving, or thriving: A scoping review examining social support for migrant care workers through four theoretical lenses

RATIONALE

Migrant care workers (MCWs) play a crucial role in addressing healthcare workforce shortages in many developed countries. Existing reviews document the significant challenges MCWs face-such as language barriers, interpersonal discrimination, and sexual harassment-and describe the social support that MCWs receive, but ambiguous application and heterogeneous measurement of theoretical constructs have thus far precluded researchers from deriving generalizable insights about how various types of social support positively and negatively impact MCWs' well-being. Therefore, we conducted a scoping review on this topic and organized the literature using four theoretical perspectives on social support.

OBJECTIVE

To synthesize interdisciplinary research on social support for MCWs and extend existing reviews, we conducted a scoping review of 56 empirical studies to understand how these studies conceptualize and operationalize social support for MCWs and the theoretical and methodological approaches they adopt.

FINDINGS

Our findings suggest that scholars have implicitly and explicitly adopted a wide array of theoretical perspectives (e.g., stress and coping, social constructivism), with few studies engaging theories in substantive ways. The reviewed studies have demonstrated both positive and negative implications of social support for MCWs' well-being. However, these studies heavily focus on the social support MCWs receive, whereas the negative impacts of MCWs' unmet support needs remain under-investigated. Although empirical studies use diverse methodologies to study this topic, most quantitative studies approach social support from a stress and coping perspective. We advocate for researchers conducting quantitative studies to adopt a critical consciousness and work toward statistically modeling how the intersectionality of MCWs' identities and the multi-level nature of MCWs' power positions within their social networks may impact whether MCWs successfully obtain the support they need to thrive.

Exploring the association between sleep and health performance of migrant home care workers and elderly care recipients in Taiwan

This study, conducted in June and July 2022 through purposive sampling, aimed to explore the relationship between sleep and health performance in 33 pairs of elderly individuals and their migrant caregivers in southern Taiwan. Participants completed a structured questionnaire and wore an Actiwatch for seven days. Pearson correlation and independent t-test were used for analysis. Nearly 50% of foreign home care workers suffered from insomnia, and 80% of elderly care recipients with disabilities experienced sleep disorders. The number of chronic illnesses and/or dementia among the elderly and insomnia among care workers were associated with poor self-perceived health (r = -0.667, p < .001) and sleep disorders among the elderly (r = 0.368, p = .035). The problem of caregiving should be addressed. Future studies should increase the sample size and extend the duration of the study to enhance the generalizability of the findings.

Psychosocial health of migrant careworkers from Southeast Asian countries in Israel: A mixed methods study

Background

In 2018, 66,859 migrant careworkers were in Israel, most of whom originated from Southeast Asian countries and 81 % of whom are women. Stringent regulations combined with social invisibility creates vulnerabilities that may contribute to emotional distress. This study aimed to assess psychosocial status and determine mechanisms of emotional distress and resilience in this population.

Methods

Mixed methods were used in this cross-section study. An online survey measured demographic variables, psychosocial wellbeing using the HSCL-25 questionnaire, general health, perceived social support, cultural identity, and perceived othering. Based on the survey's results, interviews were conducted with a subpopulation of respondents (n = 15) to further understand the mechanisms of emotional distress and resilience, and were analyzed using a postcolonial feminist framework and grounded theory. Data collection took place during 2018-2019.

Results

In total, 263 careworkers completed the survey and 15 careworkers were interviewed. The overall prevalence of emotional distress according to the HSCL-25 was 36.8 %, 22.6 % on the anxiety subscale, and 41.8 % on the depression subscale. Emotional distress was associated with female sex, not being parents, poorer general health, high perceived othering, and low perceived social support. Interviews revealed that Israeli policy, and relationships with family in their country of origin and with Israeli employers and their families can either contribute to or mitigate emotional stressors.

Conclusions

Symptoms of emotional distress among Southeast Asian migrant careworkers in Israel are frequently reported, and may indicate rates of anxiety and depression higher than in careworkers' countries of origin and host country. Increased monitoring to protect careworkers' rights and including mental health services as part of their health insurance plan are warranted.

'C'mon, let's talk: a pilot study of mental health literacy program for Filipino migrant domestic workers in the United Kingdom

PURPOSE

This pilot study of a culturally adapted online mental health literacy (MHL) program called 'Tara, Usap Tayo!' (C'mon, Let's Talk) aims to assess the acceptability, appropriateness, feasibility, and potential effectiveness in improving the help-seeking behavior of Filipino migrant domestic workers in the United Kingdom (UK).

METHODS

Using mixed methods, we conducted a non-randomized single-group study of the online MHL program with 21 participants. The development of this intervention was guided by the Medical Research Council Framework for developing complex interventions and utilized Heim & Kohrt's (2019) framework for cultural adaptation. Content materials from the WHO Mental Health Gap Action Program (mhGAP), WHO Problem Management Plus (PM +) and Adult Improving Access to Psychological Therapies (IAPT) were modified and translated into the Filipino language. The MHL program was delivered online in three sessions for two hours each session. Data were collected at three time points: (T1) pretest; (T2) posttest; and (3) follow-up test. Quantitative data on participants' attitudes towards help-seeking and level of mental health literacy as outcome measures of potential intervention effectiveness were collected at T1, T2 and T3, while focus group discussions (FGDs) to assess participants' feedback on the acceptability, feasibility, and appropriateness of the online MHL program were conducted immediately at T2. Data analysis was done using a thematic approach for qualitative data from the FGDs and descriptive statistics and repeated-measures ANOVA were used to assess the difference in the T1, T2, and T3 tests. Both quantitative and qualitative results were then integrated and triangulated to answer the research questions.

RESULTS

The online MHL program is generally acceptable, appropriate, and feasible for use among Filipino migrant domestic workers. Preliminary findings lend support for its possible effectiveness in improving mental health literacy and help-seeking propensity. The cultural adaptation made in the content, form, and delivery methods of the intervention was acceptable and feasible for this target subcultural group.

CONCLUSION

By improving their mental health literacy and help-seeking propensity, this online MHL program has the potential to provide support to the mental health and well-being of Filipino migrant domestic workers in the UK. Further feasibility study or large-scale randomized controlled trial is needed to confirm the preliminary findings of this study.

Multifaceted precarity: pandemic experiences of recent immigrant women in the accommodation and food services sector

The COVID-19 pandemic disproportionately affected those who face historical and ongoing marginalization. In centering pandemic experience of recent immigrant women in the accommodation and food services sector in Canada, we examine how their precarious work translated to experiences of work precarity and wellbeing. This paper illuminates how pre-existing and ongoing marginalization are reproduced during a health crisis for those at the intersection of gender, race, migration, and labour inequities. Using semi-structured interviews and systematic analysis using the Work Precarity Framework, we found that the pandemic exacerbated pre-existing socio-economic marginalization and resulted in unique experiences of work precarity. The latter was experienced as precarity of work (unpredictable work hours and job or employment insecurity), precarity from work (inadequate incomes), and precarity at work (physical, psychological, and relational unsafety). Work precarity stood out as a social determinant of health in relation to its outcome of degraded mental health and wellbeing. Recognizing the role of policies in producing, reproducing, and distributing precarity, we recommend policy directions to reduce social inequities in pandemic recovery.

Health, social and legal supports for migrant agricultural workers in France, Italy, Spain, Germany, Canada, Australia and New Zealand: a scoping review

Introduction

We carried out a scoping review to examine what previous literature can teach us about practices and possibilities for support services for migrant agricultural workers.

Methods

Following guidelines for scoping reviews as outlined by Arksey and O'Malley (2005) and further refined by Levac et. al (2010) we conducted searches of several databases and two additional searches to capture regions of focus and more current literature. We used a thematic analysis to generate our themes.

Results

Our analysis yielded four key themes: (1) political, economic and legal factors; (2) living and working conditions; (3) facilitators/barriers to navigating services and supports and; (4) potential and existing strategies for social support for migrant agricultural workers. The first two themes pointed more to structural and material conditions that both posed barriers for this population to access supports, but also illustrated vulnerabilities that pointed to the need for a variety of services and protections. Under the third, we highlighted the ways that the design of services and supports, or their degree of accessibility, could shape the level of help available to this population. Lastly, potential and existing strategies for social support discussed in the literature included an emphasis on mental health and wellbeing, occupational health and safety training and documentation, and policy reforms to secure the status and address the precarity of this workforce.

Discussion

While research on social support and service provision for migrant agricultural workers is still in its infancy, a strength of this body of work is its attention to macro-level issues that advocate for strategies that address root factors that shape this group's health. Further research is required to expand our understanding of social support roles and possibilities across other domains and sectors for this population.

Structural Origins of Poor Health Outcomes in Documented Temporary Foreign Workers and Refugees in High-Income Countries: A Review

Despite growing evidence of racial and institutional discrimination on minoritized communities and its negative effect on health, there are still gaps in the current literature identifying health disparities among minoritized communities. This review aims to identify health barriers faced by relatively less studied migrant subgroups including documented temporary foreign workers and refugees residing in high-income Organisation for Economic Co-operation and Development (OECD) countries focusing on the structural origins of differential health outcomes. We searched Medline, CINAHL, and Embase databases for papers describing health barriers for these groups published in English between 1 January 2011 and 30 July 2021. Two independent reviewers conducted a title, abstract, and full text screening with any discrepancies resolved by consensus or a third reviewer. Extracted data were analyzed using an inductive thematic analysis. Of the 381 articles that underwent full-text review, 27 articles were included in this review. We identified housing conditions, immigration policies, structural discrimination, and exploitative labour practices as the four major emerging themes that impacted the health and the access to healthcare services of our study populations. Our findings highlight the multidimensional nature of health inequities among migrant populations and a need to examine how the broader context of these factors influence their daily experiences.

Prevalence of and Factors Associated with Depressive Symptoms among Indonesian Migrant Workers in Taiwan

International migrant workers contribute significantly to the economic growth of the receiving country, and yet their health, especially their mental health, has long been overlooked. The purpose of this study was to identify the factors associated with depressive symptoms among Indonesian migrant workers in Taiwan. This study used cross-sectional data from 1031 Indonesian migrant workers in Taiwan. Demographic, health, and living- and work-related variables, as well as depressive symptom variables assessed using the Center for Epidemiological Study on depressive symptoms scale, were collected. Logistic regression analysis was used to identify related factors. About 15% of the Indonesian migrant workers had depressive symptoms. The significant factors associated with these symptoms were age, educational level, frequency of contact with families, self-rated health, time spent in Taiwan, region of work, satisfaction with the living environment, and freedom to go out after work. The findings thus identify target groups who are more likely than others to suffer from depressive symptoms, and we suggest appropriate approaches for devising interventions to reduce depressive symptoms. The findings of this research suggest the need for targeted approaches to reducing depressive symptoms among this population group.

Perceptions of health and coping strategies among temporary migrant workers in East and Southeast Asia: a systematic review

BACKGROUND

The rate of international migration for the primary purpose of employment has increased exponentially in recent decades. A significant proportion of this global movement takes place across East and Southeast Asia as workers move on a temporary basis from lower-middle-income home countries such as Indonesia, the Philippines, Thailand and Vietnam to high-income host destinations including Hong Kong and Singapore. Relatively little is known about the unique and long-term health needs of this heterogeneous group of people. This systematic review presents an analysis of recent research into the experiences and perceptions of health of temporary migrant workers in the East and Southeast Asian regions.

METHODS

Five electronic databases CINAHL Complete (via EbscoHost), EMBASE (including Medline), PsycINFO (via ProQuest), PubMed and Web of Science, were systematically searched for qualitative or mixed methods, peer-reviewed literature published in print or online between January 2010 and December 2020. Quality of the studies was assessed using the Critical Appraisal Checklist for Qualitative Research published by the Joanna Briggs Institute. Findings from the included articles were extracted and synthesised using qualitative thematic analysis.

RESULTS

Eight articles were included in the review. Findings from this review indicate that multiple dimensions of workers' health is impacted by the processes of temporary migration. In addition, the research reviewed indicated that migrant workers used various strategies and mechanisms to attempt to address their health-related issues and to take better care of themselves. Such agentic practices could help them manage and maintain their health and wellbeing across physical, psychological and spiritual dimensions within the structural constraints of their employment.

CONCLUSIONS

Limited published research has focused on the health perceptions and needs of temporary migrant workers in East and Southeast Asia. The studies included in this review focused on female migrant domestic workers in Hong Kong, Singapore, and the Philippines. These studies provide valuable insights but do not reflect the heterogeneity of migrants moving within these regions. The findings of this systematic review highlight that temporary migrant workers experience high and sustained levels of stress and are exposed to certain health risks which may compromise long-term health outcomes. These workers demonstrate knowledge and skills in managing their own health. This suggests that strength-based approaches to health promotion interventions may be effective in optimising their health over time. These findings are relevant to policy makers and non-government organisations supporting migrant workers.

Formal and informal support networks as sources of resilience and sources of oppression for temporary foreign workers in Canada

In this article, we explore temporary foreign workers’ (TFWs) access to and experiences with formal and informal supports in Canada. Our study utilized a participatory action research design and four overlapping phases of data collection: individual interviews with current and former TFWs, focus groups, individual interviews with settlement service agencies, and a cross-sectional survey with current and former TFWs. We used an intersectional theoretical framework to analyze these data and explore ways that TFWs interact with formal and informal sources of support for navigating their precarious immigration status and integration in Canada. Our findings show these supports have the potential to both benefit and harm TFWs, depending on their social positioning and availability of institutional resources. The benefits include information that aids settlement and integration processes in Canada, while the harms include misinformation that contributes to status loss. Future research and policy should recognize the complexity of informal and formal support networks available to TFWs. An absence of government support is apparent, as is the need for increased funding for settlement service agencies that serve these workers. In addition, Canada should better monitor employers, immigration consultants, and immigration lawyers to ensure these agents support rather than oppress TFWs.

Experiences of Stress and Help-Seeking Behaviors in Filipino Americans

A qualitative study using basic interpretive design identified the experiences of stress and barriers to professional help seeking among Filipino Americans (N = 12). Filipino Americans employed both engagement and disengagement strategies in response to stress characterized by Indigenous, religious, and cultural responses. Filipino Americans preferred to seek support from friends, family, and community leaders and described individual, cultural, and community barriers to pursuing professional mental health services.

Effects of Acceptance and Commitment Therapy (ACT) on Mental Health and Resiliency of Migrant Live-in Caregivers in Canada: Pilot Randomized Wait List Controlled Trial

Background

Temporary migrant live-in caregivers constitute a vulnerable stream of temporary foreign workers in Canada. This is because the majority are racialized women from the Global South, the gendered nature of caregiving work has historically been undervalued, and their working and living spheres are intertwined which makes application of labor laws and surveillance almost impossible. Their invisible position in the fabric of Canadian society along with their precarious employment and immigration status place their mental health at jeopardy. There is a paucity of research about psychological support for this population.

Objective

Our pilot study Women Empowerment—Caregiver Acceptance and Resilience E-Learning (WE2CARE) aimed to assess the efficacy of a 6-week online delivery of a psychological intervention based on acceptance and commitment therapy (ACT) in reducing psychological distress and promoting resiliency among live-in care givers in the Greater Toronto Area.

Methods

A pilot randomized wait list controlled design was used. Participants were recruited by two community peer champions working with community health organizations serving migrant live-in caregivers. A total of 36 participants were recruited and randomly assigned to the intervention and wait list control groups; 7 dropped out of the study due to competing life priorities. Standardized self-reported surveys were administered online pre-, post-, and 6-week postintervention to assess mental distress (DASS-21), psychological flexibility (AAQ-2), mindfulness (CAMS-R), and Multi-System Model of Resilience (MSMR-I). Independent and dependent t tests were used to compare study outcomes at pre, post, and 6-week follow-up across and within both arms of the study. Linear mixed effects models were created for each outcome of interest from baseline to postintervention among intervention and control participants. Self-reported impact of the WE2CARE intervention was examined using independent t tests across the study arms.

Results

Average age of participants was 38 years. Many were born in the Philippines (23/29, 79%). The data on the impact of the psychological intervention showed a lower level of depression, anxiety, and stress among the intervention group compared with the control. However, the differences were not significant due to small sample size and COVID-19 crisis (6.94 vs 9.50, P=.54; 6.94 vs 10.83, P=.20; 7.76 vs 10.33, P=.44, respectively). There was a significant improvement in mindful qualities and external resilience, particularly in life satisfaction and accessible support among the intervention group (37.18 vs 32.92, t22=2.35, P=.03; 20.29 vs 16.5, t21=2.98, P=.007; 8.47 vs 6.75, t14=2.41, P=.03; 7.59 vs 5.33, t16=.008, respectively).

Conclusions

WE2CARE is among the first studies exploring the efficacy of online delivery of ACT in addressing mental health challenges among live-in caregivers. While there are increased web-based ACT interventions, few use group videoconferencing to promote peer connection and mutual support. WE2CARE showed promising results in reducing psychological distress and promoting mindfulness and resiliency. The intervention highly motivated participants to engage collectively in building social support networks.

International Registered Report Identifier (IRRID)

RR2-10.2196/preprints.31211

Implementation of an Internet-Based Acceptance and Commitment Therapy for Promoting Mental Health Among Migrant Live-in Caregivers in Canada: Protocol

Background

Psychological distress, isolation, feelings of powerlessness, and limited social support are realities faced by temporary migrant live-in caregivers in Canada. Furthermore, they experience multiple barriers in accessing mental health services due to their long work hours, limited knowledge of health resources, precarious employment, and immigration status.

Objective

The Women Empowerment - Caregiver Acceptance & Resilience E-Learning (WE2CARE) project is a pilot intervention research project that aims to promote the mental well-being and resiliency of migrant live-in caregivers. The objectives include exploring the effectiveness of this program in achieving the following: (1) reducing psychological distress (depression, anxiety, and stress); (2) promoting committed actions of self-care; and (3) building mutual support social networks. Further, participants’ satisfaction with the intervention and their perceived barriers to and facilitators of practicing the self-care strategies embedded in WE2CARE will be examined.

Methods

A total of 36 live-in caregivers residing in the Greater Toronto Area will be recruited and randomly assigned to either the intervention or waitlist control group. The intervention group will receive a 6-week web-based psychosocial intervention that will be based on Acceptance and Commitment Therapy (ACT). Standardized self-reported surveys will be administered online preintervention, postintervention, and at 6 weeks postintervention to assess mental distress (Depression, Anxiety and Stress Scale), psychological flexibility (Acceptance and Action Questionnaire), mindfulness (Cognitive and Affective Mindfulness Scale – Revised), and resilience (Multi-System Model of Resilience Inventory). In addition, two focus groups will be held with a subset of participants to explore their feedback on the utility of the WE2CARE program.

Results

WE2CARE was funded in January 2019 for a year. The protocol was approved by the research ethics boards of Ryerson University (REB 2019-036) and the University of Toronto (RIS37623) in February and May 2019, respectively. Data collection started upon ethics approval and was completed by May 2020. A total of 29 caregivers completed the study and 20 participated in the focus groups. Data analyses are in progress and results will be published in 2021.

Conclusions

WE2CARE could be a promising approach to reducing stress, promoting resilience, and providing a virtual space for peer emotional support and collaborative learning among socially isolated and marginalized women. The results of this pilot study will inform the adaptation of an ACT-based psychological intervention for online delivery and determine its utility in promoting mental health among disadvantaged and vulnerable populations.

International Registered Report Identifier (IRRID)

DERR1-10.2196/31211

Transnational contexts and local embeddedness of HIV/STI vulnerabilities among Thai and Filipino agricultural temporary foreign workers in Canada

Each year Canada approves about 70,000 agricultural temporary foreign worker positions. However, few studies have examined temporary foreign workers' sexual health. In this mixed-methods study, we used surveys and focus groups to explore the knowledge of HIV and sexually transmitted infections (STI), sexual behaviours and the perspectives of sexual health of 100 Thai and Filipino temporary foreign workers in southwestern Ontario, Canada. The findings revealed that transnational migration had opened up social space that workers were not familiar with. Social isolation, stress and prolonged separation from spouses and partners resulted in the formation of new intimate relationships. Close to two-thirds of the 100 participants were sexually active in the twelve months prior to the study and over three-quarters did not use condoms. Many participants had misconceptions about HIV risks and safer sex practices. Few temporary workers accessed sexual health services due to language barriers, time constraints, stigma and lack of transport. As a result, many obtained medical advice and medicine through their families back home and relied on self-treatment in dealing with symptoms of genital infections. Effective sexual health promotion for temporary foreign workers must consider the complex interactive sociocultural and political processes that involve institutional practices in the local and transnational contexts.

Emerging best practices for supporting temporary migrant farmworkers in Western Canada

The aim of this study was to examine the role of support people in determining migrant agricultural workers' access to, or ability to navigate, public spaces and services. While the role of support networks for this population is still in its infancy, much can be gained from understanding the emerging best practices for helping this group. Using a situational analysis research approach, we carried out 4 focus groups and 25 one-on-one interviews, recruiting a total of 30 informal and formal support people as study participants between 2018 and 2019. Data analysis occurred over a 2-year period largely simultaneously with data collection. Developing analytic maps as outlined by Clarke's approach to situational analysis, we reviewed texts and preliminary codes by organising them in terms of situations, social worlds, and discursive positions. Ultimately, we identified four best practices: (a) Anticipating and addressing barriers; (b) building trust and community; (c) acknowledging rights and system accountability and (d) bearing witness and looking to the future. Underlying these best practices was the need for support people to display 'support readiness', or specialised skills, motivation and a personal connection to migrant farmworkers. While these practices have the potential to improve migrant workers' ability to fully participate in public spaces and access public services, until systemic constraints are addressed, support people will be unable to fill the gaps in support for this population.

A rapid assessment of migrant careworkers' psychosocial status during Israel's COVID-19 lockdown

BACKGROUND

Israel hosts nearly 70,000 migrant careworkers. Migrant careworkers work and live with populations extremely vulnerable to the novel Coronavirus, including the elderly and people with pre-existing physical conditions. This rapid assessment aimed to explore psychosocial status and mental wellbeing of migrant careworkers in Israel during the ongoing Covid-19 pandemic and determine risk and protective factors associated with mental distress, anxiety, and depression.

METHODS

This quantitative study was conducted via an online survey. The online survey collected social and demographic data, including country of origin, residence, age, sex, and time in Israel. In addition, questions were asked about knowledge of COVID-19 guidelines, access to supplies, and COVID-related racism. Respondents also completed a psychosocial screening tools, the Hopkins Symptom Checklist-10 (HSCL-10), which was used to screen for depression and anxiety.

RESULTS

As of May 3rd, 2020, 307 careworkers responded to the online survey, of whom 120 (39.1%) were found symptomatic using the HSCL-10. Separating the HSCL-10 into subscales, 28.0% were symptomatically anxious, and 38.1% were symptomatic for depression. In multivariate regression, emotional distress was associated with household food insecurity (OR: 5.85; p < 0.001), lack of confidence to care for oneself and employer during the pandemic (OR: 3.85; p < 0.001), poorer general health (OR: 2.98; p < 0.003), non-Philippine country of origin (OR: 2.83; p < 0.01), female sex (OR: 2.34; p < 0.04),, and inversely associated with age (p < 0.03). While 87.6% of careworkers reported having access to hand sanitization materials regularly, only 58.0% had regular access to a medical grade mask, and 21.5% reported household food insecurity. Moreover, 40.0% of careworkers claimed to lack confidence to care for themselves and their employer during the COVID-19 pandemic.

CONCLUSIONS

Migrant careworkers exhibited high levels of mental distress during the COVID-19 lockdown, associated with lack of confidence or resources to properly care for themselves and their employer. Guidelines and support programs specific to the carework sector, that respect their rights and guard their health, must be developed as part of a coordinated COVID-19 response.

Perceptions and experiences of live-in carers: why acknowledging versus neglecting personal identity matters for job satisfaction and wellbeing

For some older people and their families, live-in care offers a way of continuing to live independently at home in their local community. While research in the care industry has consistently highlighted the effects of caring on workers, little research has specifically explored the experiences of live-in carers. The current study examines the ways in which live-in carers construct their role, the different challenges they face and the strategies they use to mitigate them. Semi-structured interviews were carried out with 21 live-in carers in the United Kingdom and the data were analysed using thematic analysis. The findings suggest that carers perceive their role as complex and characterised by a heavy workload and tiredness. Participants emphasised the variability which was introduced to the role as a function of the quality of agency support, the character and condition of the client, and the carer's relationships with the client's family. Participants’ accounts reflected an acknowledgement of the need to orient and respond constantly to the needs and routine of the client. While this orientation was recognised as necessary for effectively fulfilling the demands of the role, it was also linked to feelings of dislocation and loss of identity. Drawing on understandings of personal and social identity, the implications of these findings for the psychological wellbeing of live-in carers and organisational support are discussed.

Filipino help-seeking for mental health problems and associated barriers and facilitators: a systematic review

PURPOSE

This systematic review aims to synthesise the evidence on behavioural and attitudinal patterns as well as barriers and enablers in Filipino formal help-seeking.

METHODS

Using PRISMA framework, 15 studies conducted in 7 countries on Filipino help-seeking were appraised through narrative synthesis.

RESULTS

Filipinos across the world have general reluctance and unfavourable attitude towards formal help-seeking despite high rates of psychological distress. They prefer seeking help from close family and friends. Barriers cited by Filipinos living in the Philippines include financial constraints and inaccessibility of services, whereas overseas Filipinos were hampered by immigration status, lack of health insurance, language difficulty, experience of discrimination and lack of acculturation to host culture. Both groups were hindered by self and social stigma attached to mental disorder, and by concern for loss of face, sense of shame, and adherence to Asian values of conformity to norms where mental illness is considered unacceptable. Filipinos are also prevented from seeking help by their sense of resilience and self-reliance, but this is explored only in qualitative studies. They utilize special mental health care only as the last resort or when problems become severe. Other prominent facilitators include perception of distress, influence of social support, financial capacity and previous positive experience in formal help.

CONCLUSION

We confirmed the low utilization of mental health services among Filipinos regardless of their locations, with mental health stigma as primary barrier, while resilience and self-reliance as coping strategies were cited in qualitative studies. Social support and problem severity were cited as prominent facilitators.

Migrantes y sus condiciones de trabajo y salud: revisión integrativa desde la mirada de enfermería

RESUMEN Objetivo Analizar la producción científica, indexada, asociada a las condiciones laborales y de salud en migrantes. Metodo Revisión integrativa de artículos publicados en el periodo 2009 a 2019, utilizando bases de indización Medline/PUBMED; ScIELO; SCOPUS utilizando los descriptores MeSH y DeCS: Condiciones de Trabajo, Estado de Salud, Inmigrantes. Resultados Se obtuvo un total de 21 estudios., distribuidos en 17 en Medline/PUBMED; 3 en ScIELO y 1 en SCOPUS. La mayoría de artículos cuantitativo fueron realizados en Brasil y España. La discriminación, explotación, mala calidad de vida, nivel de educación, mala autopercepción de salud, fueron principales resultados. Conclusiones Existe una falta de estudios que evidencien la realidad ocurrida en América Latina, para enfermería como disciplina y profesión se abre un gran desafío para estudiar a la población trabajadora migrante, pues permitirá entregar evidencias de este grupo humano, se lograrán generar intervenciones que favorezcan la salud de esta población y se podrán promover conductas saludables a nivel laboral e individual

Migrant Workers and Psychological Health: A Systematic Review

Migrant workers show an increase in the incidence of serious, psychotic, anxiety, and post-traumatic disorders due to a series of socio-environmental variables, such as loss of social status, discrimination, and separations from the family. The purpose is to elaborate a systematic review and highlight the prevailing psychological pathologies of these workers and categories most at risk. Our research included articles published from 2009 to 2019 on the major databases (Pub Med, Cochrane Library, and Scopus) using a combination of some keywords. The online search indicated 1.228 references. Using inclusion and exclusion criteria, we analyzed 127 articles, in particular 12 reviews and 115 original articles. Principal emerging disorders from the research are depressive syndrome (poor concentration at work, feeling down, or anger and somatization), anxiety, alcohol or substance abuse, and poor sleep quality. This causes low life conditions, which is also due to marginalization from the social context and strenuous work; in fact, migrant workers may suffer verbal or physical abuse, and they are often employed in dangerous, unhealthy jobs. It is therefore essential to increase the role of occupational medicine and promote wellbeing for this vulnerable job category.

Major Depressive Syndrome (MDS) and its Association with Time of Residence among Spanish Speaking Au-Pairs Living in Germany

The number of au-pairs in Germany is on the rise. In 2017, about 13,500 au-pairs were living in German families, almost half of them originating from non-European Union (EU) countries and many of them from Spanish speaking countries. Knowledge about mental health among au-pairs in Germany is limited. Therefore, the main objective of this study was to assess the prevalence of Major Depressive Syndrome (MDS) and its potential association with time of residence among Spanish speaking au-pairs living in Germany via an exploratory analysis. This study included a sample of 409 Spanish speaking au-pairs living in Germany. We classified the au-pairs into those who lived less than three weeks in Germany (newcomer au-pairs) and those who lived more than three weeks (experienced au-pairs). The participants were recruited by an online survey (Facebook and Instagram) from August 2018 to June 2019. Socio-demographic characteristics, time of residence in Germany and the level of education were assessed. MDS was assessed by the Patient Health Questionnaire depression module (PHQ-9). Poisson regression models were calculated to evaluate the association between time of residence in Germany and prevalence of MDS. Most of the participants were female (91%). Almost half of them came from Colombia (48%) and were in the age range between 22–24 years (40%). Prevalence of MDS was 8% among newcomers and 19% among experienced au-pairs (p = 0.002). Differences remained statistically significant after adjustment for potential confounders (age, level of education and time of residence in Germany) (prevalence ratio 2.25; 95% confidence interval: 1.22–4.14). In conclusion, au-pairs may develop mental symptoms during their time abroad. Future prospective studies should aim at identifying potential risk factors and preventive measures.

Qualitative evaluation of an intervention to reduce energy poverty

OBJECTIVE

To evaluate the “ Energía, la justa ” program, aimed at reducing energy poverty in the city of Barcelona, from the point of view of the target population and the workers involved in the intervention.

METHODS

A qualitative, descriptive and exploratory pilot study was carried out, with a phenomenological approach. Twelve semi-structured interviews were conducted: to three users, three energy agents who performed interventions in the homes, and six professionals who participated in the program coordination. A thematic content analysis was carried out using Atlas-ti software . Interviews were conducted between October 2016 and March 2017.

RESULTS

Trust in a contact person (e.g. social workers) facilitated the participation, although there were difficulties reaching people who had illegal energy supplies, immigrant women or immigrants who subrent properties. Regarding implementation, home visits, energy efficiency advice and the relationship with energy agents were the best assessed aspects. However, not being able to carry out reforms in deteriorated dwellings was considered a limitation. The program also contributed to raise awareness on energy rights, to save on utility bills and to generate tranquility and social support.

CONCLUSIONS

Programs such as this one can promote energy empowerment and improve psychosocial status. However, strategies with a gender and equity perspective should be considered to reach other vulnerable groups.

Occupational Health and Safety for Migrant Domestic Workers in Canada: Dimensions of (Im)mobility

This study examines the occupational health and safety experiences of migrant workers employed as live-in caregivers in Fort McMurray, Alberta, Canada. Interviews with and surveys of caregivers identify four categories of common occupational hazards, including fatigue, psychosocial stress, physical hazards, and exposure to harassment and abuse. These hazards are systemically perpetuated, made invisible, and rendered irremediable by intertwined (im)mobilities. At the macrolevel, they include highly circumscribed and precarious conditions of transnational care migration such as indenturing to private and underregulated recruiters, federal policies that tie status to employers and employment, and changeable, rule-bound pathways to permanent residency. At the mesolevel, we find a volatile mix of mobilities and immobilities associated with employment in the oil economy of Fort McMurray, such as high population mobility and turnover, long work and commuting hours, and remoteness. And, at the microlevel, we find the everyday immobilities and highly circumscribed conditions and complexities of working and living with employers in private homes.

Factors Influencing the Health and Safety of Temporary Foreign Workers in Skilled and Low-Skilled Occupations in Canada

This article reports on a study of occupational health and safety (OHS) challenges for temporary foreign workers (TFWs) in low- and high-skilled occupations, based on twenty-two cases drawn from a broader study in three Canadian provinces. Interviewees in construction, meat processing, hospitality, and fast food reported concerns regarding working conditions and OHS issues. They include precarious migration status affecting voice; contrasting access to social support; and mechanisms undermining regulatory effectiveness. Sources of vulnerability include closed work permits (making workers dependent on a single employer for job security and family reunification); ineffective means to ensure contractual compliance; and TFW invisibility attributable to their dispersal throughout the labor market. Violations include increased workload without an increase in pay and non-compliance with OHS and contractual rules without oversight. Positive and negative practices are discussed. Recommendations include improving migration security to preserve worker voice and facilitating communication between immigration and OHS authorities.

Psychosocial Risk Prevention in a Global Occupational Health Perspective. A Descriptive Analysis

This study aimed to find out which countries around the world require psychosocial hazards and workplace violence to be assessed by employers through a mandatory occupational risk assessment process and to compare the type of legislation between countries. We systematically searched the International Labour Office (ILO) “LEGOSH” database for documents published during the period between December 2017 and February 2018. The search included 132 countries, of which 23 were considered as developed and 109 as developing according to the United Nations. Our review showed that most countries (85, i.e., 64%) have not included mandatory psychosocial risk assessment and prevention in their national occupational safety and health legislation. Moreover, we found differences between developed and developing countries, showing that developed countries more frequently have legislative measures. Within developed countries, we also found differences between countries following the Scandinavian model of workplace health and safety culture and other countries. Moreover, in many countries, workplace violence was prohibited only if it involves an offence to moral or religious customs. In conclusion, the marked difference in psychosocial hazards and workplace violence regulations among countries leads to unequal levels of workers’ protection, with adverse effects on global health.

Young internal migrants' major health issues and health seeking barriers in Shanghai, China: a qualitative study

Background

China is experiencing a sizeable rural-urban flow, which may influence the health of internal migrant youth deeply. Disadvantages in the city are highly likely to contribute to health issues among the young internal migrant population. The current qualitative study is to explore how internal migrant young people view the health issues they face, and the services and opportunities they could seek in their host community.

Methods

Data were collected from 90 internal migrant youth aged between 15 and 19 years old and 20 adult service providers who worked with them in a community of Shanghai, where the population of internal migrants was relatively large. Four types of qualitative research methods were used, including key informant interviews with adults, in-depth interviews with adolescents, a photovoice activity with adolescents and community mapping & focus group discussions with adolescents. Guided by the ecological systems framework and the acculturation theory, thematic analysis was conducted using ATLAS.Ti 7.0 software.

Results

While younger migrants had a limited understanding of health, elder migrant youths were more sensitive to societal and political factors related to their health. Mental health and health risk behaviors such as smoking, violence and premarital unsafe sex were thought as major health issues. Internal migrant youths rarely seek health information and services initiatively from formal sources. They believed their health concerns weren’t as pressing as the pressure coming from the high cost of living, the experience of being unfairly treated and the lack of opportunities. Participants also cited lack of family and social support, lack of awareness and supportive policies to get access to community and public services as impacting health factors.

Conclusions

The study’s findings provide the insight to the social contexts which influence the health experience, health seeking behaviors, and city adaptation of young internal migrants in their host community. This research stresses the importance of understanding social networks and structural barriers faced by migrant youth in vulnerable environments. A multidimensional social support is essential for internal migrant youth facing present and potential health risks.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6661-0) contains supplementary material, which is available to authorized users.

The effect of ethnicity and immigration on treatment resistance in schizophrenia

BACKGROUND

Treatment resistance is a common issue among schizophrenia patients undergoing antipsychotic treatment. According to the American Psychiatric Association (APA) guidelines, treatment-resistant status is defined as little or no symptom reduction to at least two antipsychotics at a therapeutic dose for a trial of at least six weeks. The aim of the current study is to determine whether ethnicity and migration are associated with treatment resistance.

METHODS

In a sample of 251 participants with schizophrenia spectrum disorders, we conducted cross-sectional assessments to collect information regarding self-identified ethnicity, immigration and treatment history. Ancestry was identified using 292 markers overlapping with the HapMap project. Using a regression analysis, we tested whether a history of migration, ethnicity or genetic ancestry were predictive of treatment resistance.

RESULTS

Our logistic regression model revealed no significant association between immigration (OR = 0.04; 95%CI = 0.35-3.07; p = 0.93) and treatment resistant schizophrenia. White Europeans did not show significant association with resistance status regardless of whether ethnicity was determined by self-report (OR = 1.89; 95%CI = 0.89-4.20; p = 0.105) or genetic analysis (OR = -0.73; 95%CI = -0.18-2.97; p = 0.667).

CONCLUSION

Neither ethnicity nor migrant status was significantly associated with treatment resistance in this Canadian study. However, these conclusions are limited by the small sample size of our investigation.

Migration among temporary foreign workers: Examining health and access to health care among Filipina live-in caregivers

In 2015, approximately 14,000 migrants were accepted into Canada as live-in caregivers. While extensive research has documented the working conditions of migrant live-in caregivers, few studies examine the health experiences of this population related to their employment as caregivers. This research examines the relationship between employment under the Federal Government's (Live-in) Caregiver Program and health and access to healthcare services among 21 Filipina caregivers working in the Greater Toronto Area, Ontario. Results of in-depth interviews reveal that long work hours are perceived to negatively affect physical health while separation from family negatively impacts mental health. Among the women interviewed, work responsibilities and living-in the place of employment are perceived to negatively impact both physical and mental health. The research also demonstrates that working as a live-in caregiver both facilitates and creates barriers to accessing health services. Future research is needed to better understand the health of more socially isolated caregivers and caregivers living-out(side) their place of employment.