Work life, relationship, and policy determinants of health and well-being among Filipino domestic Workers in China: a qualitative study

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.

Filipino Immigrants in Santa Cruz de Tenerife, Spain: Health and Access to Services

The Philippines is a source of labor for many countries. Roughly 10 million overseas Filipinos are working and living outside of the Philippines. This paper examines the association between sociodemographic characteristics (sex, age, educational level, and income) and self-rated physical and mental health, access to healthcare, and health habits among immigrant Filipinos living in Santa Cruz de Tenerife, Spain. Through convenience sampling, Filipino migrants (n = 103) aged 18 years and above participated in the online survey between October 2022 and March 2023. The data were analyzed using descriptive statistical analysis and chi-square. Almost all respondents self-rated their health as excellent and very good. Female respondents are more affected by mental health. Most are enrolled in the Universal Health System of Spain (public insurance). There is more utilization of private health insurance among respondents aged 60 years and above and high-wage earners. Cigarette smoking and alcohol drinking are associated with males. More than half of the respondents perform weekly exercise occasionally or never. These findings suggest a potential need for targeted interventions with an emphasis on the practice of preventive health and the promotion of healthy lifestyles, especially among financially disadvantaged migrants with lesser health access.

Employment conditions and mental health of overseas female migrant domestic workers in Hong Kong: a parallel mediation analysis

BACKGROUND

Female migrant domestic workers (MDW), approximately 8.5 million globally, often live in their employer's home under vulnerable conditions. In Hong Kong, MDWs currently comprise 5% of the population. This study was conducted to assess the association between employment conditions and mental health, and the mediating roles stress and job satisfaction have, among female MDWs in Hong Kong.

METHODS

Participants completed an online cross-sectional survey. A total of 1,965 survey were collected between August 2020 and August 2021. Questions in the survey were related to MDWs background information, employment conditions, stress, job satisfaction, and two mental health outcomes: anxiety and depression. An employment conditions score was created to assess the cumulative effect poor employment conditions had on mental health. A multicategorical parallel mediation analysis was used to assess the direct effect employment conditions have on mental health and the indirect effects through stress and job satisfaction.

RESULTS

Overall, 17.7% of MDWs were reported to be suffering from anxiety and 30.8% from depression. An increase in poor employment conditions was statistically associated with an increase in both outcomes, while stress levels and job satisfaction mediated this association.

CONCLUSIONS

The findings call for increased scrutiny of employment conditions and mental well-being of MDWs.

The association between posttraumatic disorder symptoms and addictive behaviours in Macao within a sample of female Filipino migrant workers: a network analysis

Background: Filipino migrant workers in Macao are vulnerable to posttraumatic stress disorder (PTSD) symptoms and addictive behaviours due to trauma histories, postmigration stressors, and access to alcohol and gambling venues. While PTSD addiction comorbidity is well-established in the existing literature, such research among migrant workers is lacking.Objective: The current study investigated differential relations between PTSD symptoms and addictive behaviours in a polytrauma exposed sample of Filipino domestic workers in Macao (SAR), China.Methods: Data were collected from 1375 Filipino migrant workers; data from a subsample of 1200 participants who reported an index traumatic event and PTSD symptoms were used in the analyses. Participants responded to the PTSD Checklist for DSM-5, gambling disorder symptoms checklist from DSM-5, and The Alcohol Use Disorders Identification Test. We estimated a regularized partial correlation network structure of PTSD symptoms and addictive behaviours employing graphical LASSO and extended Bayesian information criterion.Results: PTSD symptoms of arousal and negative emotions had bridge connections with gambling disorder symptoms; while PTSD symptoms of arousal, restricted affect, negative emotions, and emotional reactivity had bridge connections with alcohol misuse.Conclusions: PTSD's arousal and negative emotion symptoms were common in the networks of PTSD and addictive behaviours, while PTSD's restricted affect and emotional reactivity symptoms were unique to the network of PTSD and alcohol misuse. Treatment of the comorbidity of PTSD and addictive behaviours may yield optimal effects when tailored to these symptoms.

Soliciting Social Support from Migrant Domestic Workers' Connections to Storytelling Networks during a Public Health Crisis

Guided by communication infrastructure theory and social support theory, this study scrutinizes how the storytelling networks of marginalized communities, particularly migrant domestic workers (MDWs), provided social support amid the COVID-19 pandemic. Data obtained from in-depth interviews with 32 Indonesian MDWs in Hong Kong revealed that the community storytelling networks, comprising interpersonal relationships, community organizations, and media outlets, played an essential role in assisting the coping efforts of MDWs during the pandemic. These storytelling networks offered various types of social support, including informational, emotional, and instrumental or tangible assistance. However, these connections to the storytelling networks were also sources of the spread of misinformation. Theoretical and practical implications are further discussed.

Therapeutic landscapes, networks, and health and wellbeing during the COVID-19 pandemic: A mixed-methods study among female domestic workers

The COVID-19 pandemic has had profound impacts on access to and use of therapeutic landscapes and networks, especially for people who are vulnerable due to economic, social, and work-related disadvantage. For one such vulnerable population, Indonesian female domestic workers (FDWs) in Hong Kong, this study employed a mixed methods approach to examine the associations between perceptions of therapeutic landscapes (TLs), therapeutic networks (TNs), subjective wellbeing, and self-rated health during the COVID-19 pandemic. Data from an online survey were analyzed via structural equation modeling (SEM) and confirmatory factor analysis (CFA) to investigate the direct and indirect associations between TLs, TNs, and health and wellbeing. The findings demonstrate little or no association among FDWs' perceptions of TLs and TNs and FDWs' self-rated health and subjective wellbeing, except for a negative total association between TL and subjective wellbeing. Using insights gleaned from thematic analysis of in-depth interviews with FDWs, we suggest that these unexpected findings are mainly due to restricted access to public places, reduced social gatherings, and the fact that employers rarely granted days off during the lockdown. Although processes at the employer and municipal scales limited FDWs' access to therapeutic places, increased use of digital communications and spaces provided an important source of social and emotional support during the pandemic.

Investigating the Physical and Mental Health Nexus: a Network Analysis of Depression, Cardiometabolic Health, Bone Mass, and Perceived Health Status Among Filipino Domestic Workers

BACKGROUND

Migrant domestic workers are vulnerable to physical and mental health problems given the many challenges they experience while working abroad. Using network analysis, this study examined the structure of depression, cardiometabolic health indicators (BMI, waist-hip ratio (WHR), blood pressure, and heart rate), bone mass, and perceived health status in this population. The network model allowed for an examination of central symptoms or symptoms with the most direct connections with other symptoms; bridge symptoms, or symptoms that link two or more communities; and edges, or relationships among symptoms.

METHOD

Cross-sectional data were gathered from 1375 Filipino domestic workers in Macao (SAR), China. Data from a subsample of 510 participants who met a cutoff indicating depression were analyzed. Anthropometric measurements and surveys were used to collect data, which was analyzed using R statistical software.

RESULTS

Results showed four community clusters: three communities consisted of at least two depression symptoms each and the fourth community included physical health indicators. Strong edges were formed between BMI-bone mass, psychomotor-concentration, BMI-WHR, and sad mood-anhedonia. The node with the highest expected influence was BMI. There were three bridges: worthlessness, psychomotor difficulties, and concentration difficulties.

CONCLUSION

The link between depression, cardiometabolic indicators, bone mass, and poor perceived health reinforces the need to address multimorbidity within migrant populations. Health promotion interventions that address mental and physical health may improve the health of this population.

Health Challenges in Everyday Life of Nigerians in Guangzhou City, China

The presence of Africans in Chinese cities has made their healthcare-related issues an expanding area of interest. However, previous studies have not thoroughly explored how Africans live through health problems. This article explores the taken for granted aspect using the analytical frameworks of migration as a social determinant of health and phenomenological sociology. Based on interviews with 37 Nigerians in Guangzhou city, it describes how health and illnesses are lived and the ways that language barrier, cost of health care, immigration status and racism and discrimination intertwine with quotidian occurrences to shape the experiences of health challenges. Migrant networks and community structure provided critical assistance, but the context of labour circumstances and undocumentedness can overstretch these critical sources of support. The article exposes how the broader context of being and living in China determine how Africans experience health challenges in Chinese cities.

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.

A Descriptive Qualitative Study of Foreign Caregivers of Older Adult Stroke Survivors

BACKGROUND AND OBJECTIVES

With a growing aging stroke population and the changing structure of the society, the demand for foreign caregivers has rapidly increased in Taiwan and many other developed countries. However, little is known regarding the perception, values, and abilities of foreign caregivers and how those may influence their quality of care. This study aimed to explore and describe the experiences of Indonesian foreign caregivers, the largest migrant working population in Taiwan, who reside with and provide support to older adults with stroke and their families.

RESEARCH DESIGN AND METHODS

By adopting a descriptive qualitative approach, we conducted semistructured interviews with 22 Indonesian caregivers (mean age: 36 years) who were providing care to community-dwelling older stroke survivors (age ≥ 65 years) in Taiwan. Data were analyzed through thematic analysis.

RESULTS

Six themes were constructed from the interviews: (a) foreign caregiver's background, (b) foreign caregiver's perception of the health and functional status of stroke survivors, (c) foreign caregiver's values and preferences, (d) consequences of caring for stroke survivors, (e) skills/abilities/knowledge of foreign caregivers to provide stroke survivors with required care, and (f) potential resources that foreign caregivers can use.

DISCUSSION AND IMPLICATIONS

Foreign caregivers described the positive and negative aspects of caring for stroke survivors. Differences in language, religion, culture, values, and expectations between foreign caregivers and stroke survivors influence the caregiving experience. These findings can help Taiwan and other developed countries to better support foreign caregivers providing critical care to older adults with stroke and their families.

Factors Related to Mental Health of Foreign Care Workers in Long-Term Care Facilities in Japan during the COVID-19 Pandemic-A Comparative Study

This study aimed to evaluate the factors related to the mental health of foreign care workers in Japan's long-term care (LTC) facilities and compare their results with those of native care workers. We conducted a cross-sectional survey covering 80 LTC facilities across Japan between August and November 2021. The survey mainly included mental health, workload, reward, sense of coherence, loneliness, COVID-19-specific factors and sociodemographic variables. The results show that workload was a distinct feature associated with the mental health of foreign care workers (n = 172) when compared with those of native care workers (n = 154). In addition, we found that the relationship between cultural adaptation and mental health in a sample of foreign care workers was mediated by loneliness and sense of coherence (SOC). Finally, we found that reward, loneliness, SOC, and COVID-19-specific factors had significant impacts on the mental health of both foreign and native care workers. These findings highlight the importance of support measures from the workplace for foreign care workers. Workplace interventions that focus on workload, reward, and sense of coherence strategies are required to address mental health improvement and may still be of value in dealing with the continuing COVID-19 pandemic.

Exploring resilience processes of Filipino migrant domestic workers: A multisystemic approach

This study identified resilience processes at the individual, family, and community levels among Filipino migrant domestic workers (MDWs). Resilience processes highlight strengths and resources that can enhance positive adaptation to problems that affect this vulnerable migrant group. Data came from focus groups and key informant interviews involving 27 MDWs and 7 key informants. Data was analyzed using thematic analysis and organized according to the socioecological model. Results revealed 7 resilience processes. Financial coping, health management, and spirituality were found across levels. Companionship and emotional support are transacted within family and community levels, whereas expanding knowledge and support occurs at individual and community levels. MDWs and their families prioritize each family member, whereas the community provides legal support. Resilience processes exist across ecological levels. However, individual resilience processes are insufficient, thus necessitating collective agency through familial and community resilience processes and building social structures that facilitate resilience.

Online Peer-Support Group's Role in Addressing Filipino Domestic Workers' Social Support Needs: Content and Social Media Metrics Analysis

The study aimed to examine what types of social support a prominent online peer support group has provided to Filipino domestic workers (FDWs) in Hong Kong (HK), how impactful each type of support was, and to what extent the support could address group members' expressed needs. Posts published from 1 September 2021 to 31 December 2021 in one of the largest online peer-support groups for FDWs in HK and their meta-data were extracted from Facebook. Thematic content analysis was performed to extract relevant information from the posts. Descriptive statistical analysis on the social media metrics was conducted to measure post impacts. A total of 599 posts published over the study period can be categorized to provide informational (76.67%), emotional (33.56%), and instrumental support (13.52%). Posts including emotional support were often more impactful. A total of 58 posts responded to requests explicitly expressed by individual FDWs, of which 13 required external resources. The online peer-support group acts as a new channel to raise FDWs' awareness of important issues related to their well-being, to encourage and facilitate them to seek formal and informal help, and to keep them emotionally attended to. Formal support services should recognize and collaborate with them and support their long-term sustainability.

The Perpetrator-Victim Relationship: An Important Clue in Understanding Intimate Partner Homicide in China

Intimate partner homicide (IPH) is a global public health issue that has serious consequences for an individual's health. Whereas prior research has made some progress analyzing the perpetrator-victim relationship in understanding the dynamics of IPH, research set in the context of China in this field using the perpetrator-victim relationship as a focal variable in analyzing IPH is still lacking. The current study addresses this gap and builds on existing research by exploring the significance of the perpetrator-victim relationship in order to facilitate a deeper understanding of IPH in China. After examining 979 IPH criminal judgments, the findings revealed that the perpetrator-victim relationship is an important clue in understanding IPH in China today. By analyzing the correlation between intimate relationships as a focal variable and other variables such as IPH characteristics and risk factors, it is possible to understand the prevalence of IPH in China in greater detail. Irrespective of the kind of relationship between the perpetrator and victim, the findings revealed that most of them come from lower socioeconomic backgrounds, have no previous history of intimate partner violence, and are not satisfied with their marriages. Although research has provided detailed explanations, the perpetrator-victim relationship remains neglected, especially in the context of research on contemporary China. The findings showed that over half of the perpetrators and victims had intimate relationships with people outside their marriages. This may be the main reason for the rapid increase in the number of instances of IPH, which seems to be in tandem with China's rapid modernization and urbanization.

Prevalence and associated factors of sexual violence experienced by housemaids in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Housemaids often experience different types of sexual violence by different perpetrators. Sexual violence against housemaids remains usually concealed as victims cannot report such offenses. Except for fragmented studies with varying reports, there is no national prevalence studies conducted on sexual violence among housemaids in Ethiopia. Thus, this systematic review and meta-analysis aimed to determine the pooled prevalence and associated factors of sexual violence amongst housemaids in Ethiopia.

METHODS

A systematic search of PubMed, Embase, Science Direct, HINARI, Scopus, Cochrane Library, and Google Scholar was conducted using relevant search terms. Data were extracted using the Joanna Briggs Institute (JBI) tool. The quality of all selected articles was evaluated using JBI critical appraisal checklist. Data analysis was performed using STATA Version 14 statistical software. Egger's test and funnel plot were used to evaluate publication bias. Heterogeneity was assessed using Cochran's chi-squared test and quantified by I2 values. A random-effects model was applied during meta-analysis if heterogeneity was exhibited; otherwise, a fixed-effects model was used.

RESULTS

After reviewing 37,849 articles, 8 studies involving 3,324 housemaids were included for this systematic review and meta-analysis. The pooled prevalence of life time sexual violence among housemaids in Ethiopia was 46.26% (95% CI: 24.69, 67.84). The pooled prevalence was 55.43% (95% CI: 26.38, 84.47) for sexual harassment, 39.03% (95% CI: 14.55, 63.52) for attempted rape, and 18.85% (95% CI: 7.51, 30.19) for rape. Sexual violence is more likely among housemaid who previously lived rural residence (AOR = 2.25; 95% CI: 1.41, 3.60), drinks alcohol (AOR = 2.79 95% CI: 1.02, 4.56), and employer alcohol consumption (AOR = 6.01; 95% CI: 1.10, 32.96).

CONCLUSION

This study revealed that the prevalence of sexual violence against housemaids in Ethiopia is high. Of the forms of sexual violence against housemaids, sexual harassment is high. Male employers are the vast majority of perpetrators of their housemaids. Thus, concerned stakeholders should develop and implement interventions that could empower housemaids in their struggle toward the elimination of sexual violence, create awareness for men, control and monitor the implementation of legislation and policies, and prompt punishment of the perpetrators. Systematic review and meta-analysis registration PROSPERO CRD42021160511.

Irregular Migrant Workers and Health: A Qualitative Study of Health Status and Access to Healthcare of the Filipino Domestic Workers in Mainland China

In public health research, the health issues of irregular and vulnerable migrant populations remain under-explored. In particular, while mainland China has become a new and popular job-seeking destination for Filipino domestic workers (FDWs), the health status of FDWs and their access to healthcare have been invisible to public and academic concerns. This paper fills this lacuna by conducting a qualitative study that investigates FDWs’ self-reported health status and their healthcare-seeking behaviors. The results show that: (1) respondents do not report significant abusive and exploitative experience because the scarcity of FDWs in China in relation to the high demand enables them a certain degree of agency in labour market; (2) while FDWs do report some health problems, they tend to resort to self-medication and food-healing; (3) the main factors influencing health-seeking behavior include the fear of deportation, language gaps, the lack of knowledge of the local healthcare system and dependence on co-ethnic networks which serves as a double-edged sword; (4) these factors also lead to hesitation in health-seeking choice between public and private hospitals, which sometimes result in delayed treatment. This paper contributes to revealing the health conditions of FDWs in mainland China and calls for more inclusive health policy to enroll foreign domestic workers into the local health system in China.

Peer Support and Mental Health of Migrant Domestic Workers: A Scoping Review

The effectiveness of peer support in improving mental health and well-being has been well documented for vulnerable populations. However, how peer support is delivered to migrant domestic workers (MDWs) to support their mental health is still unknown. This scoping review aimed to synthesize evidence on existing peer support services for improving mental health among MDWs. We systematically searched eight electronic databases, as well as grey literature. Two reviewers independently performed title/abstract and full-text screening, and data extraction. Twelve articles were finally included. Two types of peer support were identified from the included studies, i.e., mutual aid and para-professional trained peer support. MDWs mainly seek support from peers through mutual aid for emotional comfort. The study's findings suggest that the para-professional peer support training program was highly feasible and culturally appropriate for MDWs. However, several barriers were identified to affect the successful implementation of peer support, such as concerns about emotion contagion among peers, worries about disclosure of personal information, and lack of support from health professionals. Culture-specific peer support programs should be developed in the future to overcome these barriers to promote more effective mental health practices.

Heritage Culture Detachment Predicts Hope and Well-Being of Filipino Migrant Workers: A Study of Low- and Semi-skilled Filipino Workers in Macau

Heritage culture detachment occurs when migrants tend to distance themselves from their own cultural norms and values as they engage their host culture; research suggests that this approach to acculturation is often associated with psychological distress. We explore heritage culture detachment and well-being among Filipino migrant workers in Macau. Participants (N = 249) were recruited to answer a questionnaire that inquired into heritage culture detachment and several measures of well-being. The relationships between well-being and heritage culture detachment were examined by testing two structural equation models: Model 1: well-being predicts heritage culture detachment; Model 2: heritage culture detachment predicts well-being. The results show better fit between the data and Model 2; in particular, heritage culture detachment positively predicted satisfaction with life, external-peer locus-of-hope, but also negative self-esteem, and goal disengagement. Heritage culture detachment also negatively predicted external-spiritual locus-of-hope. The results are interpreted as possibly indicating how heritage culture detachment reflects efforts to adjust and cope in a new sociocultural environment. Unlike other migrants, international migrant workers may see their foreign work environment as temporary contexts and circumstances, wherein subordinating their cultural norms may have some utility. The discussion highlights how sources of well-being need to be understood within the specific temporal and sociocultural context of individuals’ life experiences.

Evaluating the Implementation of a Mental Health App for Overseas Filipino Workers in Macao China: A Mixed-Methods Study of Stakeholders' Perspectives

Background

Overseas Filipino workers (OFWs) is one of the largest communities of international migrant workers. They face systemic barriers to fulfilling their health needs. The COVID-19 pandemic worsened this condition and provided a context to evaluate the utility of a digital mental health intervention delivered within a stepped-care model to address OFW mental health. Using an implementation science framework, this study aimed to evaluate stakeholders' perspectives on the implementation of Kumusta Kabayan, a mobile phone-based mental health app, for OFWs in Macao.

Methods

A mixed-methods convergent design was used by conducting two parallel steps, including quantitative and qualitative measures. The quantitative data was collected from Filipino team members and local non-governmental organization (NGO) staff members (N = 12). The qualitative data were gathered from interviews with OFWs in Macao who used the app (N = 25; 80% females, 76% domestic workers).

Results

From the online survey, the staff members of the local partner NGO and the Filipino team members strongly perceived that their organization could adapt Kumusta Kabayan to their program and generally evaluated that Kumusta Kabayan achieved its goal and was received well by OFWs. In the interviews, the OFW app users shared their experiences in using Kumusta Kabayan, which was thematically organized into six aspects of the participants' experience: (1) promotional channel and expectation; (2) when to use the app and in what language; (3) lessons learnt; (4) memorable aspects; (5) key facilitators and barriers; and (6) suggestions.

Conclusion

Kumusta Kabayan was well accepted and shows potential to be integrated into the existing support services for OFWs in Macao. This app has the promise of being scaled-up for OFWs in other countries by collaborating with local and overseas stakeholders. Lessons learnt from this evaluation could also be implemented in wider digital mental health services in different settings.

Act Tough and Soft: Video Monitoring, Hongbao Gifts, and the Job Satisfaction of Domestic Workers

There is a rapidly growing demand for domestic services among urban families in China. However, domestic work remains a low-status occupation with a high turnover rate. Focusing on the job satisfaction of domestic workers is useful to interpret this phenomenon. We investigate how the job satisfaction of domestic workers in China is affected by to two distinct labor control strategies used by their employers: the installation of video-monitoring devices in employers' homes (a “tough” control strategy), and the Chinese custom of giving monetary gifts, or “hongbao” (a “soft” control strategy). By analyzing data from surveys of domestic workers in four cities in China (N = 699), we find that video monitoring in employers' homes negatively impacts domestic workers' job satisfaction, and that hongbao gifts from employers significantly promote domestic workers' job satisfaction. The analysis of the causal mechanism based on a structural equation model suggests that video monitoring can increase the discrimination that domestic workers perceive, which in turn reduces their job satisfaction. In particular, we find that domestic workers' perception of discrimination completely mediates the effect of video monitoring on their job satisfaction. However, we also find that hongbao gifts significantly reduce domestic workers' perceptions of discrimination, and thus promote their job satisfaction; that is, the relationship between hongbao gifts and job satisfaction is partially mediated by discrimination. Our study provides a more comprehensive understanding of Chinese employers' labor control strategies and their effects on the job satisfaction of domestic workers.

Internal Migration Experience and Depressive Symptoms among Middle-Aged and Older Adults: Evidence from China

Background: This study aimed to examine the association of internal migration experience with depressive symptoms among middle-aged and elderly Chinese, as well as explore possible mechanisms of the relationship. Methods: Participants were from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative sample of residents aged 45 years and older (n = 43,854). Survey data on depressive symptoms and internal migration experience were collected from biennial CHARLS surveys (CHARLS 2011/2013/2015) and a unique CHARLS life history survey in 2014, respectively. Multiple logistic regressions and the Karlson–Holm–Breen (KHB) method were employed in the statistical analyses. Results: The overall prevalence rate of depressive symptoms among middle-aged and older adults was 34.6%. Internal migration experience was associated with higher risks of depressive symptoms (OR = 1.07, 95% CI = 1.02–1.12, p < 0.01), especially among females (OR = 1.08, 95% CI = 1.01–1.14, p < 0.05), middle-aged adults (OR = 1.12, 95% CI = 1.06–1.19, p < 0.001), rural-to-urban migrants who had not obtained an urban hukou (OR = 1.13, 95% CI = 1.07–1.19, p < 0.001), and those who had low migration frequency and first migrated out at 35 years of age or older. Chronic disease (17.98%, p < 0.001), physical injury (7.04%, p < 0.001), medical expenditure (7.98%, p < 0.001), pension insurance (4.91%, p < 0.001), and parent–child interaction (4.45%, p < 0.01) were shown to mediate the association of internal migration experience with depressive symptoms. Conclusions: This study indicates that there is a significant association between internal migration experience and high risks of depression onset later in life. It is suggested to reduce institutional barriers for migrants and implement evidence-based interventions to improve migrants’ mental health.

Health Literacy among Filipino Domestic Workers in Macao

Migrant worker is a global phenomenon that is associated with the health of individuals and populations. Filipino workers constitute the largest group of non-Chinese migrant workers in Macao, they are mainly employed as domestic workers. The purpose of this study is to investigate the status of health literacy (HL) and associated factors among Filipino domestic workers in Macao. The study is a cross-sectional study. Chi square's test and binary logistic regression models were used for data analyzing. Filipino who was employed by a family in Macao as a domestic worker within the valid contract period was eligible in the study. A total of 379 valid questionnaires were collected during December 2020 and March 2021. Health literacy was measured using the short-form Health Literacy Instrument (HLS-SF12). The results showed that only 37.4% of the respondents have sufficient health literacy. Age was an important factor that was associated with health literacy, with Filipino domestic workers younger than and equal to 30 years of age more likely to have inadequate health literacy. The results will help to make recommendations for further research and public health policy.

A systematic review on noncommunicable diseases among working women

The increasing involvement of women in the paid-labor market has led to multifactorial exposure towards the development of noncommunicable diseases (NCDs). This review aims to identify the prevalence of NCDs and the associated risk factors among working women. A systematic review was performed using PubMed and Scopus databases. Twelve articles published between 2015 and 2019 satisfied the inclusion and exclusion criteria and were selected for qualitative synthesis. Among working women, the prevalence of NCDs was as follows: coronary heart disease, 0.3%-5.9%; metabolic syndrome, 52.0%; diabetes mellitus, 8.9%-16.0%; hypertension, 16.6%-66.4%; non-skin cancer, 3.7%. The prevalence of NCD risk factors was as follows: overweight/obesity, 33.8%-77.0%; low physical activity, 51.0%; unhealthy diet, 44.9%-69.9%; dyslipidemia, 27.8%-44.0%. The factors associated with NCDs were long working hours, double work burden, and stress. NCD is an important burden of working women that will lead to reduced work quality and affect family well-being. Disease prevention approaches, such as the intervention of common workplace risk factors and specific work schedule design, are among the strategies for improving the situation.

A network analysis investigation of the comorbidity between sleep dysfunction and PTSD symptomatology among Filipino domestic workers in Macao (SAR) China

Posttraumatic stress disorder (PTSD) is highly comorbid with sleep dysfunction. This association was previously explained based on cognitive and emotional dysfunction. The current study extends this literature by investigating the symptom level comorbidity of sleep dysfunction and DSM-5 PTSD utilizing a network approach. Participants were trauma-exposed female Filipino domestic workers (N = 1241). Network analysis was applied to 23 items: 18 items from PCL-5 measuring PTSD (Community 1) and 5 items from PSQI assessing sleep dysfunction (Community 2). The results showed that the symptoms within each community had the strongest correlations. Bridge connections were identified between the sleep dysfunction and PTSD symptom communities. Symptoms with the highest bridge strength were concentration difficulties, recklessness, irritability, and sleep disturbance. This is among the first studies investigating the comorbidity between PTSD and sleep dysfunction from the network approach. Future interventions may be developed that emphasize the bridge symptoms to address comorbidity among trauma exposed migrants.

"We also deserve help during the pandemic": The effect of the COVID-19 pandemic on foreign domestic workers in Hong Kong

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Foreign domestic workers were disproportionately affected by COVID-19 in Hong Kong.

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They were adversely affected by the pandemic in both their home and host countries.

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Their employment conditions have greatly worsened since the start of the pandemic.

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Hong Kong's policy response has largely been blind to their unique experiences.

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More supportive policies are needed that consider foreign domestic workers’ needs.

The coronavirus disease 2019 (COVID-19) pandemic poses particular challenges for migrant workers around the world. This study explores the unique experiences of foreign domestic workers (FDWs) in Hong Kong, and how COVID-19 impacted their health and economic wellbeing. Interviews with FDWs (n = 15) and key informants (n = 3) were conducted between May and August 2020. FDWs reported a dual-country experience of the pandemic, where they expressed concerns about local transmission risks as well as worries about their family members in their home country. Changes to their current work situation included how their employers treated them, as well as their employment status. FDWs also cited blind spots in the Hong Kong policy response that also affected their experience of the pandemic, including a lack of support from the Hong Kong government. Additional support is needed to mitigate the particularly negative effects of the pandemic on FDWs.

Exploring correlates of depression, quality of life and alcohol misuse: a nationwide cross-sectional study of international migrants during the COVID-19 epidemic in China

OBJECTIVES

The COVID-19 pandemic has overwhelmed health systems globally. With the increase of global migration, quantifying the health needs and key correlates of these outcomes is a global health priority. This study assessed migration characteristics, COVID-19 attitudes and the postmigration social environment as key correlates of depression, quality of life and alcohol misuse among international migrants in China.

DESIGN

A nationwide cross-sectional online survey was conducted from 17 February and 1 March 2020.

SETTING

Links to the online survey were disseminated by migrant-focused community-based organisations through WeChat.

PARTICIPANTS

English speaking international migrants who met the inclusion criteria. Inclusion criteria were being born in a country outside of China, aged 18 years or over, cumulatively living in China for 1 month or more and staying in China between December 2019 and February 2020.

OUTCOME MEASURES

Depression, quality of life and alcohol misuse.

RESULTS

Regression models indicated that planning or considering leaving China due to COVID-19, lacking the confidence to protect themselves and not being confident that the epidemic would end soon was associated with greater depression, lower quality of life and greater levels of alcohol misuse. Worry about contracting COVID-19 and feeling helpless to prevent infection were associated with greater depression and lower quality of life. General perceived social support, and trust in Chinese people, institutions and systems were protective factors for depression and associated with higher reported quality of life.

CONCLUSIONS

This study identifies key correlates that, if adequately addressed through public health outreach, may safeguard migrant well-being during a public health emergency. Trust in people and systems within the postmigration environment is an important consideration for future public health planning efforts.

Social support, well-being and involvement of fathers in transnational families in the Philippines

This study investigated left-behind Filipino fathers and their involvement as child caregivers. It hypothesized that social support and well-being predict paternal involvement, with well-being as the mediator. Results showed that familial and peer support predicted involvement, with well-being as mediator. Spousal support did not predict involvement or well-being. Findings highlight the importance of familial and peer support to left-behind fathers. Interactions between significant predictors of involvement present novel pathways to childcare. The non-significant role of spousal support is discussed in the context of transnational migration. Several interventions involving families and peers are suggested.

The difference in the number of complaints from patient health services using national health insurance at regional general hospitals

OBJECTIVE

Health services can cause different perceptions of each patient as recipients of health services. This study aims to determine the difference in the number of complaints in several regional general hospitals in Gorontalo Province.

METHOD

The method used in this research is interviewing and collecting data in situ at the Gorontalo provincial health office. Data analysis used a one-way analysis of variance. The research sample consisted of seven regional public hospitals in Gorontalo Province.

RESULTS

The results showed that the average number of complaints was 15-22 complaints per month in seven hospitals in Gorontalo Province. The average number of health services complaints in several Gorontalo Provincial Hospitals is at the Aloe Saboe Regional General Hospital, 22 complaints per month.

CONCLUSIONS

The results showed significant differences in the number of complaints about health services at seven regional general hospitals in Gorontalo Province.

Structural validation of The Patient Health Questionnaire-9 (PHQ-9) among Filipina and Indonesian female migrant domestic workers in Macao: STRUCTURAL VALIDATION OF PHQ-9

Within diverse global populations, validated tools are needed to assess common mental disorders. The Patient Health Questionnaire-9 (PHQ-9) is one of the most commonly used depression screeners. However, the PHQ-9 has not been structurally validated among female migrant domestic workers (MDWs). Female MDWs constitute a population numbering 11.5 million, and commonly report depression. This study aimed to structurally validate the PHQ-9 among Filipina and Indonesian female MDWs in Macao Special Administrative Region of China. Participants were recruited using respondent driven sampling. Participants were adult female MDWs from The Philippines (N=1375) or Indonesia (N=367) and legally working in Macao. We used confirmatory factor analysis (CFA) to test five structural models of depression using all PHQ-9 items with the Filipina and Indonesian samples. We applied multi-group CFA to test measurement invariance across samples. A two-factor (cognitive/affective, somatic) model yielded the best fit within both samples, and the multi-group CFA demonstrated invariance across samples. The two-factor model best represents the factor structure of the PHQ-9 among Filipina and Indonesian female MDWs.

The role of the imagination in transnational relating: The case of Nigerian children and their migrant parent in Ireland

This paper explores the role of imagination in the lives of Nigerian transnational children and their migrant parent in Ireland. Migration of a parent is a rupture in a child’s life that triggers imaginary processes that are real in their developmental consequences. Following Zittoun and Gillespie, imagination is a process that generates a disjunction from the person’s experience of the “real” world, and uncouples and loops out before it eventually comes back to the actual experience. For the left-behind child, this imaginative loop remains “open” as parents return becomes extended in time. The dilemmas for the migrant parent and child are explored.

The influence of housing on sexual and reproductive health status and service utilization among Filipina migrant domestic workers in Macao (SAR), China: A population survey

OBJECTIVE

Sexual and reproductive health (SRH) and service utilization among female migrant domestic workers are under-studied. No studies to date have investigated the unique health vulnerabilities that affect female foreign domestic workers. The objective of this study was to investigate how stay-in and stay-out living conditions in domestic work may differentially affect SRH status, service utilization, and sexual risk behavior among female migrant domestic workers in Macao (SAR), China.

METHODS

Data were analyzed from a cross-sectional survey conducted between November 2016 and August 2017 among 1368 female Filipina migrant domestic workers living and working in Macao. Participants were recruited through respondent-driven sampling. Bivariable and multivariable logistic regression analyses were used to assess relationships between living context and outcomes of interest.

RESULTS

Domestic workers' living context (i.e. stay-in versus stay-out) was significantly related to sexual risk behavior patterns and SRH status and service utilization. Compared to stay-out workers, stay-in workers had reduced odds of sexual risk behaviors but were also more likely to report that their sexual partners were likely to have concurrent sexual partners. In addition, stay-in workers had significantly decreased odds of having visited an OBGYN in Macao in the past year.

CONCLUSIONS

This research is the first to evaluate the impact of stay-in and stay-out conditions within a foreign domestic worker population. This study further provides novel evidence of contextual factors (e.g. financial, employment, living conditions) that contribute to inequalities in SRH status and service utilization among Filipina migrant domestic workers. Results indicate that living context is significantly correlated with sexual risk behaviors, SRH status, and service utilization among domestic workers in Macao, highlighting the need to more effectively tailor specific interventions to meet female domestic workers' needs.

A digital mental health intervention to reduce depressive symptoms among overseas Filipino workers: protocol for a pilot hybrid type 1 effectiveness-implementation randomized controlled trial

BACKGROUND

The current pilot randomized controlled trial (RCT) protocol will comprehensively describe the implementation of a culturally adapted Filipino version of the World Health Organization Step-by-Step (SbS-F) program, unguided online psychological intervention for people with depression based on behavioral activation, among overseas Filipino workers (OFWs) in Macao (Special Administrative Region). The main objective of this pilot study is to explore the preliminary effectiveness of the SbS-F program to decrease participant-reported depressive symptoms compared to enhanced care as usual (ECAU); and the secondary objectives are to explore the preliminary effectiveness of the SbS-F to decrease participant-reported anxiety symptoms and improve wellbeing, and to evaluate the potential for SbS-F implementation in real-world settings.

METHODS

This trial will follow an effectiveness-implementation hybrid type 1 trial design and utilize the Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to accelerate the translation of clinical research into more effective implementation strategies and policies. Participants will be randomized 1:1 to control and treatment groups. Control group participants will receive ECAU that consists of brief depression psychoeducation and referral to local community partners. Treatment group participants will receive a 5-session of digital intervention through a mobile phone application. The primary outcome (depression) and psychological secondary outcomes (anxiety symptoms and wellbeing) will be measured using validated instruments. To evaluate study implementation, an embedded mixed-methods design will be used to collect data from various stakeholders. Data then will be analyzed using intention to treat principle and reported following the Consolidated Standards of Reporting Trials (CONSORT) guideline.

DISCUSSION

This study will provide important new knowledge about the preliminary effectiveness of SbS-F, a mobile application, as a digital mental health intervention and its scalability. If SbS-F shows positive results among OFWs in Macao, it has strong potential to be used by OFWs in other countries that may also experience depression and difficulty accessing mental health services.

TRIAL REGISTRATION

Prospective registration, Chinese Clinical Trial Registry (ChiCTR2000034959) on 26/07/2020.

Validation of Obesity Status Based on Self-Reported Data among Filipina and Indonesian Female Migrant Domestic Workers in Macao (SAR), China

BACKGROUND

Migrant domestic workers are at high risk of overweight and obesity. It is crucial to assess the prevalence of obesity among this migrant population, for surveillance and intervention. Self-reported height and weight are commonly used to derive body mass index (BMI) and assess the prevalence of obesity. The accuracy of BMI from self-reported height and weight in migrant populations remains unknown. The aim of this study was to assess the accuracy of BMI from self-reported measures and identify the optimal adjustment to be made to overweight and obesity cut-off points when using self-reported body mass index among migrant workers.

METHODS

Self-reported and objectively measured height and weight were obtained from 1388 female Filipina domestic workers and 369 female Indonesian domestic workers recruited using respondent-driven sampling between November 2016 and August 2017. Self-reported BMI (based on self-reported height and weight) and measured BMI (based on objectively measured height and weight) were calculated as weight in kilograms divided by the square of height in meters for all participants (kg/m2).

RESULTS

BMI derived from self-reported height and weight was underestimated for both Filipina (z = -27.5, p < 0.001) and Indonesian (z = -9.9, p < 0.001) participants. Applying the gold standard of Asian BMI cut-off points to self-reported BMI, the sensitivity in identifying overweight or obesity was 64.4% for Filipina participants and 78.6% for Indonesian participants and the specificity was 97.9% for Filipina participants and 93.8% for Indonesian participants for overweight or obesity. When self-reported measures were used, the receiver operator characteristic (ROC) curves and the corresponding area under the curve (AUC) indicated optimal cut-off points of 22.0 kg/m2 and 22.3 kg/m2 for Filipina and female Indonesian participants for overweight or obesity.

CONCLUSIONS

Although BMI derived from self-reported height and weight allows for quick and low-cost obesity screening, a considerable underestimation of overweight or obesity prevalence was observed in Filipina and female Indonesian migrant domestic workers in Macao (Special Administrative Region, SAR), China. With the best compromise between sensitivity and specificity, the new cut-off points can be used in future studies to identify overweight or obesity in these two populations using self-reported height and weight.

Fast food restaurant density and weight status: A spatial analysis among Filipina migrant workers in Macao (SAR), People's Republic of China

BACKGROUND

Female migrant populations are at high risk of being overweight or obese. Beyond individual risk factors, exposure to the neighborhood food environment may contribute to their unhealthy weight status in the host region. Incorporating spatial analysis, this study examined the association between exposure to fast food restaurants and unhealthy weight status among Filipina domestic workers in Macao (SAR), China.

METHODS AND FINDINGS

Data were collected from 1388 Filipina domestic workers recruited using respondent-driven sampling between November 2016 to August 2017. Self-reported data on demographic characteristics, residential mailing address, and health-related behaviors were collected using tablet devices. Height and weight were objectively measured at the study site. Restaurant locations and resident addresses were geocoded and integrated into a shapefile for residential locations using ArcGIS. Nearly 64% of participants were classified as being overweight or obese, with 25.02% overweight and 38.96% obese. Adjusted multivariable logistic regression indicated that increased fast food restaurant density within a 0.5-mile buffer zone around a residential address was positively associated with higher odds of being overweight and obese (aOR = 1.07; 95% CI [1.01-1.14].

CONCLUSIONS

Increased fast food restaurant density was associated with unhealthy weight status among Filipina domestic workers in Macao (SAR), China. Providing healthy working environment, including access to healthy food, is indicated to improve the health of this population.

Psychometric and Structural Validity of the Pittsburgh Sleep Quality Index among Filipino Domestic Workers

Objectives : Evaluate the psychometric properties and structural validity of the Filipino version of the Pittsburgh Sleep Quality Index (PSQI) among Filipino domestic workers (FDWs). Methods : In Study 1, 131 FDWs completed PSQI and other scales, along with 10-day actigraphic assessment with accompanying electronic daily sleep dairy. A subsample of 61 participants completed follow-up assessment after 10 days. In Study 2, 1363 FDWs were recruited and randomized into two halves. Exploratory factor analysis (EFA) and Confirmatory factor analysis (CFA) were used in the two halves, respectively. Results : In Study 1, the Cronbach’s alpha of the PSQI was 0.63 at baseline and 0.67 at follow-up. Test-retest reliability for the PSQI global score based on intraclass correlation was 0.63. Convergent validity was supported by the significant associations between the PSQI global score, PSQI components scores, sleep patterns from the daily sleep diary, and measures of depression, anxiety, and rumination. Small correlations between the PSQI global score and measures of daytime sleepiness, social support, and self-reported height, supported discriminant validity. In Study 2, EFA yielded two PSQI factors with acceptable factor loadings. CFA established that this two-factor model, comprised of perceived sleep quality and sleep efficiency, evidenced better model fit than alternative models tested. The Cronbach’s alpha of two factors was 0.70 and 0.81, respectively. Conclusions : The PSQI demonstrated good internal consistency of two factors, and good convergent, and divergent validity. Results can be referenced in future studies to measure and screen sleep dysfunction among clinical and non-clinical populations in the Philippines.

Barriers and Facilitators of Rapid HIV and Syphilis Testing Uptake Among Filipino Transnational Migrants in China

Transnational migrant workers are known to be at high risk for HIV/STIs. This study estimated the point prevalence of HIV/syphilis and examined correlates of HIV/syphilis testing uptake among female migrant domestic workers in Macao, China. Data was obtained from 1363 female Filipino domestic workers who were offered free rapid HIV and syphilis testing. A mixed methods analysis was undertaken to examine correlates of testing and themes about reasons for not testing. Among 1164 women tested, there were no cases of HIV/syphilis observed and 199 (14.6%) refused HIV/syphilis testing. Greater social integration (aOR 1.12; 95% CI 1.02-1.24), having more than one sexual partner (aOR 1.65; 95% CI 1.02-2.65), and longer working hours on the testing day (aOR 0.97; 95% CI 0.94-1.00), were associated with testing uptake. Among those who tested, the majority (> 70%) had never tested before, suggesting the need to improve testing outreach. Qualitative themes about reasons for not testing included low perceived need and insufficient time. Individual and structural testing barriers should be reduced to optimize HIV/STI testing in migrant populations.

The network structure of posttraumatic stress disorder among Filipina migrant domestic workers: comorbidity with depression

BACKGROUND

Labour migrants are exposed to potentially traumatic events throughout the migration cycle, making them susceptible to developing mental disorders. Posttraumatic stress disorder (PTSD) is often comorbid with depression. Comorbidity worsens the course of illness, prognosis, treatment response, and increases suicidal risk. Using network analysis, this study examined the structure of PTSD and depression in a sample of migrant domestic workers, an especially vulnerable community of labour migrants. This study sought to derive the central or most important symptoms, strongest edges or relationships among symptoms, and bridge symptoms between PTSD and depression.

METHODS

Data were obtained from 1,375 Filipina domestic workers in Macao SAR, China. Data from a subsample of 1,258 trauma-exposed participants were analysed using R software.

RESULTS

Most of the strongest edges were within the same disorder and, for PTSD, within the same symptom cluster. Highest node centrality were PCL-5's 'avoid thoughts', 'lose interest', 'negative emotions', and 'not concentrate', and PHQ-9's 'sleep difficulties'. The bridge symptoms were PHQ-9's 'sleep difficulties,' 'psychomotor agitation/retardation,' and 'fatigue,' PCL-5's 'not concentrate', and PHQ-9's 'worthlessness' and 'anhedonia'.

LIMITATIONS

Results may not generalize to Filipino migrant workers in other occupations and to male migrant workers. Potentially relevant symptoms like somatic symptoms and fear of somatic and mental symptoms were not included.

CONCLUSIONS

Central and bridge symptoms are the most important nodes in the network. Developing interventions targeting these symptoms, particularly depression symptoms, is a promising alternative to PTSD treatment given substantial barriers to specialist care for this population.

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.

Spatial and sociodemographic correlates of gambling participation and disorder among female Filipino migrant workers in Macao, People's Republic of China

BACKGROUND AND AIMS

Correlates and risk factors for gambling disorder among vulnerable or transient populations such as transnational migrant workers are unknown. The current study examined sociodemographic and spatial correlates of gambling disorder among female Filipino domestic workers in Macao (SAR), China.

DESIGN

Survey-based, respondent-driven sampling study administered from November 2016 to August 2017.

SETTING

Macao (SAR), which encompassed 38 casinos within its 30.4 km² area at the time of this study.

PARTICIPANTS

Representative sample of N = 1194 female Filipino domestic workers in Macao.

MEASUREMENTS

Symptoms of gambling disorder based on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Correlates evaluated included sociodemographic information, proximity to venues, perceived social support, and symptoms of depression and anxiety.

FINDINGS

Prevalence of gambling disorder was 5.1%. Multivariable regression analyses indicated that likelihood of gambling participation (i.e., ever gambling) was associated with current indebtedness (RR = 1.56, 95%CI = 1.08-2.25, p = .017) and worse self-reported health (RR = 1.31, 95%CI = 1.04-1.65, p = .02). Increased symptoms of gambling disorder were independently associated with lower perceived social support (RR = 0.92, 95%CI = 0.87-0.98, p = .006), increased dependents relying upon monthly remittances (RR = 1.10, 95%CI = 1.06-1.16, p < .001), increased depression severity (RR = 1.16, 95%CI = 1.07-1.25, p < .001), decreased salary quintile (RR = 0.97, 95%CI = 0.94-1.00, p = .04), and proximity to the nearest Mocha Club gaming venues (RR = 1.04, 95%CI = 1.02-1.07, p = .005). The association between proximity to casinos and increased symptoms of gambling disorder was significant only for domestic workers living apart from employers (RR = 1.07, 95%CI = 1.00-1.14, p = .04).

CONCLUSIONS

Increased spatial proximity to gambling venues and greater financial and psychosocial burdens are associated with gambling disorder among domestic workers in Macao.

Psychometric Validation of PHQ-9 and GAD-7 in Filipino Migrant Domestic Workers in Macao (SAR), China

There are 500,000 female Filipino domestic workers worldwide. However, there are no validated instruments to assess common mental disorders in this population. The Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) are brief measures that could be effective screeners for depression and anxiety in domestic workers. This study aims to establish reliability and validity of the Filipino versions of the PHQ-9 and GAD-7. In Study 1, 131 domestic workers completed the PHQ-9, GAD-7, and other questionnaires with a test-retest interval of 10 days. Convergent validity was examined using measures of posttraumatic stress disorder, direct exposure to traumatic events, and rumination. Discriminant validity was assessed using measures of discrimination, pain, social support, and indirect exposure to traumatic events. In Study 2, criterion validity was established with another sample of domestic workers (N = 100) using clinician-administered Mini International Neuropsychiatric Interviews. Receiver operating characteristic (ROC) curve analysis was performed to evaluate diagnostic efficiency. Results showed acceptable and high internal consistency for PHQ-9 and GAD-7, respectively. Both had acceptable test-retest reliability. Convergent and discriminant validity were also established. ROC curve results demonstrated that optimal cut scores for PHQ-9 and GAD-7 are 6 and 7, respectively. The Filipino versions of PHQ-9 and GAD-7 are reliable and valid for use among Filipino domestic workers.

Exploring comorbidity between anxiety and depression among migrant Filipino domestic workers: A network approach

BACKGROUND

Depression and anxiety are comorbid. From the network model perspective, comorbidity is due to direct interactions between depression and anxiety symptoms. These interacting symptoms are called bridge symptoms, suppression of which is expected to halt other symptoms. This study investigates the network structure of depression, anxiety, and bridge symptoms in a sample of migrant domestic workers, who are among the most vulnerable and marginalized groups of workers.

METHOD

Data were collected from 1375 Filipino domestic workers in Macao Special Administrative Region, China. Data from a subsample of 355 consisting of participants who met criteria for depression and anxiety were used in analysis. R software was used to estimate the network.

RESULTS

The eight strongest edges were between items from the same disorder. Six were between depression symptoms, like "concentration difficulties" and "psychomotor agitation/retardation," and "psychomotor agitation/retardation" and "thoughts of death." Two were between anxiety symptoms, including "worry too much" and "trouble relaxing." For centrality indices, "fatigue" had highest strength and closeness, and "restlessness" had highest betweenness. Results revealed three bridge symptoms: "fatigue," "depressed mood," and "anhedonia."

LIMITATIONS

The results may not generalize to the entire Filipino population. Further, while the centrality index of strength had adequate stability, it was not highly stable.

CONCLUSIONS

The current study highlighted critical transdiagnostic bridge symptoms as specific candidates for intervention. "Psychomotor agitation/retardation" was identified as key priority due to its association with suicidal ideation. Systemic multilevel interventions at the person-level (e.g., cognitive therapy and behavioral activation), and at the structural and policy-level to alleviate psychosocial stressors, could be applied to address disorder comorbidity in this population.

Cultural Adaptation of a Scalable World Health Organization E-Mental Health Program for Overseas Filipino Workers

Background

Electronic mental (e-mental) health interventions can address mental health needs of different populations. Cultural adaptation of these interventions is crucial to establish a better fit with the cultural group and to achieve better treatment outcomes.

Objective

This study aimed to describe the cultural adaptation of the World Health Organization’s e-mental health program Step-by-Step for overseas Filipino workers. We used a framework which posits that cultural adaptation should enhance (1) relevance, wherein the cultural group can relate with the content; (2) acceptability, where the cultural group will not find any element offensive; (3) comprehensibility, where the program is understandable; and (4) completeness, wherein the adapted version covers the same concepts and constructs as the original program. We aimed to have English and Filipino and male and female versions.

Methods

Overall, 3 experienced Filipino psychologists provided their perspectives on the program and how it might be adapted for overseas Filipino workers. We then adapted the program and obtained feedback from 28 overseas Filipino workers from diverse industries through focus group discussions. We conducted 7 and 9 focus group discussions with male and female participants, respectively. Per discussion, cognitive interviewing was used to probe for relevance, acceptability, comprehensibility, and completeness of illustrations and text. Participant feedback guided iterative program adaptations, which were again shown to participants for validation and improvement.

Results

Several issues were raised by participants about the generic version of Step-by-Step. There were elements deemed irrelevant, like unfitting characters, lack of Filipino values, and unsuitable problems and activities. There were unacceptable components that were stigmatizing, political, inappropriate to context or subgroups, and too feminine for male users. Some elements were incomprehensible, unclear, or complicated. To address these issues, we made key adaptations. To enhance relevance, we adapted the narrative to match the experiences of overseas Filipino workers, incorporated Filipino values, and illustrated familiar problems and activities. To increase acceptability, our main characters were changed to wise elders rather than health professionals (reducing mental health and help-seeking stigma), political or unacceptable content was removed, and the program was made suitable for overseas Filipino workers from different sectors. To increase comprehension, we used English and Filipino languages, simplified the text to ease interpretation of abstract terms, and ensured that text and illustrations matched. We also used Taglish (ie, merged English and Filipino) when participants deemed pure Filipino translations sounded odd or incomprehensible. Finally, we retained the core elements and concepts included in the original Step-by-Step program to maintain completeness.

Conclusions

This study showed the utility of a 4-point framework that focuses on acceptance, relevance, comprehensibility, and completeness in cultural adaptation. Moreover, we achieved a culturally appropriate adapted version of the Step-by-Step program for overseas Filipino workers. We discuss lessons learned in the process to guide future cultural adaptation projects of e-mental health interventions.

Psychometric validation of the PTSD Checklist-5 among female Filipino migrant workers

Migrant populations are at increased risk for exposure to traumatic life events. Presently, there are no reliable and valid screening instruments for posttraumatic stress disorder (PTSD) among Filipino migrant workers, a population that numbers over 2.3 million worldwide. This study evaluated the psychometric properties of the PTSD Checklist for DSM-5 (PCL-5) in a sample of female Filipino migrant workers in Macao (SAR), China, in two studies. The first examined the reliability (internal and test-retest), convergent validity (with depression, anxiety, and rumination), and discriminant validity (with pain and social support) in a sample of 131 participants. The second study established criterion validity of the PCL-5 using the PTSD module of the Mini-International Neuropsychiatric Interview (MINI), delivered by a female Filipino psychologist as the criterion, in a sample of 100 participants. Results indicated excellent internal consistency (Cronbach's alpha = 0.95) and moderate 10-day test-retest reliability (ρ = 0.58, p < .001). PCL-5 scores correlated strongly with scores on measures of depression (ρ = 0.71, p < .001), anxiety (ρ = 0.61, p < .001), and rumination (ρ = 0.68, p < .001), supporting convergent validity. Discriminant validity was demonstrated by a weaker association with scores on measures of pain (ρ = 0.33, p < .001) and social support (ρ = -0.11, p = .22). The diagnostic accuracy of the scale was good (AUC = 0.87). The optimal cutoff score of 25 optimized sensitivity (0.89) while maintaining adequate specificity (0.73), with a weighted Kappa of κ[1]) = 0.82. Our results demonstrated that the PCL-5 is a reliable and valid screening instrument for use among female Filipino migrant workers.