2022 Migrant Workers’ Mental Health Survey Report

Not all intellectual property rights in this work are owned by WeFriends, and permission must be obtained from the respective copyright holder to freely use (modify, reproduce, distribute, or commercially use) this work. This report is based on surveys conducted in 2020 and 2022, and the 2022 survey and report were conducted and written by Misun Kim, Yoona Kim, and Aeran Lee.

2022 Migrant Workers’ Mental Health Survey Report

1. Background

2. Methods

2-1. Participants

2-2 Measures

3. Results

3-1. Sociodemographic characteristics

3-2. Perceived health and happiness

3-3. Adverse childhood experiences

3-4. Depression

3-5. Suicide awareness and related experiences

3-6. Experiences with COVID-19 and the impact on mental health

4. Discussion

4-1. Comparison with South Korean population mental health

4-2. Comparison with existing literature about migrant workers’ mental health

4-3. Mental health in origin countries

4-4. Migratory patterns and mental health by origin country

4-5. Mental health status of migrant workers abroad (Chinese, Nepalese, Myanmar, Thai, Vietnamese, and migrant workers in general)

4-6. Differences in mental health service utilization and health behaviors in origin countries

5. Conclusion Appendix

Survey questionnaire

In-depth Interview guide

Migrant Workers’ Mental Health Survey Report Report Summary

As part of its Migrant Worker Suicide Prevention Project, WeFriends (Migrant Health Association in Korea) conducted a survey of 102 migrant workers living in Korea from China, Nepal, and Myanmar (31 from China, 40 from Nepal, and 31 from Myanmar) in 2020 and 100 migrant workers from Thailand and Vietnam in 2022 (50 from Thailand and 50 from Vietnam) to understand the overall mental health status of migrant workers and their awareness and experience of suicide. Together with items on sociodemographic background, self-report measures of adverse childhood experiences and depression (Adverse Childhood Experiences Questionnaire [ACE-Q] and The Center for Epidemiologic Studies Depression Scale [CES-D]) were used to examine participants’ current mental health and factors associated. 52 participants participated in additional in-depth interviews about suicide awareness and experiences. Data collection occurred at the beginning and end of the COVID-19 pandemic, therefore capturing migrant workers' mental health during COVID-19 and the impact of COVID-19 on mental health.

186 (92.1%) participants rated their general health as fair or better, and 186 (92.1%) rated their subjective well-being as fair or better. The mean ACE-Q score was 0.79, and the mean CES-D score was 14.3. The distribution of CES-D scores showed that 132 (65.3%) were in the normal range (score 15 or less), followed by 21 (10.4%) with a score of 16-20, 17 (8.4%) with a score of 21-24, and 32 (15.3%) with a score of 25 or more. When comparing the mean CES-D scores by country of origin, the mean scores of workers from Vietnam were statistically significantly higher than those of workers from China and Thailand. When comparing the CES-D score categories (<15, 16-20, 21-24, and 32<), the difference between Thai and Vietnamese workers was most pronounced. In other words, Vietnamese workers had statistically significantly higher depression scores and a higher percentage of workers above the diagnostic cutoff point compared to workers from China and Thailand.

Fifty-two of the 202 participants were further interviewed about their experiences and perceptions of suicide. 15 (28.8%) had experienced suicide of an acquaintance in the past. In the past six months, 21 (40.4%) had heard about their acquaintances’ suicidal ideation, 9 (17.3%) had experienced an acquaintances’ suicide attempt, and 12 (23.1%) had experienced suicidal ideation themselves, with three of them reporting ongoing suicidal thoughts. The issues related to suicidal ideation were reported as workplace problems by

31 participants (59.6%), family problems by 30 (57.7%), economic problems by 17 (32.7%), adjustment problems in the Korean society by 12 (23.1%), and personality problems by 11 (21.2%). Migrant workers had experienced COVID-19 infections and movement restrictions during the pandemic, causing them to worry and fear for their own and their families' health and death. This experience seemed to exacerbate existing depression or caused insomnia and anxiety. Korean Chinese migrants also experienced discrimination and stigma related to COVID-19, and in some cases, economic hardship triggered depression as COVID-19 impacted their livelihoods.

The findings in each of the 2020 and 2022 survey indicate that migrant workers as a whole have low levels of depression, but there are groups with high-risk of depression. Migrant workers with additional vulnerabilities, such as female workers, workers with lower levels of education, and workers with adverse childhood experiences, require more attention Varying perceptions of depression and suicide by country of origin may explain higher and lower levels of depression among workers from certain countries. Therefore, developing and providing mental health services that consider the sociocultural characteristics of migrants and their countries of origin will be effective in future mental health promotion and suicide prevention efforts.

1. Background

The number of foreign residents in South Korea (Korea here forth) increased by an average of 7.2% per year from 2017 to 2019, reaching 2.52 million in 2019. However, due to the impact of COVID-19, the number of foreign residents in Korea decreased since 2020, reaching 1.95 million at the end of 2021. This was a decrease of 3.9% from 2020, but with COVID-19 becoming endemic, the number of foreign residents in Korea has been increasing again to 2.19 million as of November 2022. Meanwhile, according to Statistics

Korea's “Domestic and Foreign Residents Population Prediction Reflecting 2021 Future Population Estimates: 2020-2040" released in April 2022, the total population in Korea is expected to decrease from 51.84 million in 2020 to 50.19 million in 2040. The proportion of Koreans in the total population is expected to decrease from 96.7% in 2020 to 95.7% in 2040, while the proportion of foreigners is expected to increase from 3.3% in 2020 to 4.3% in 2040. In particular, the number of Koreans of working age is expected to decrease by 3.62 million over the next 10 years from 35.83 million in 2020 to 32.21 million in 2030 and 26.76 million in 2040.

These figures clearly show the lack of economically active population in Korea, which is already facing a population cliff, and predicts an even greater reliance on migrant workers. However, despite the growing reliance on migrant workers, their conditions and social treatment are far from improving, creating risks of adverse health outcomes

According to the results of the 2022 Immigration and Employment Survey, out of the 843,000 foreigners employed as of May 2022, a total of 584,100 people (69%) were employed in small and medium-sized businesses with fewer than 30 employees, a condition that makes migrants more vulnerable to poor working conditions and occupational health and safety management When the composition is examined in more detail, 184,300 (21.9%) migrants work in businesses with 4 or fewer employees, 159,800 (19.0%) in businesses with 5 to 9 employees, and 240,000 (28.5%) in businesses with 10 to 29 employees. By industry, more than half (56.1%) of all migrant workers were employed in sectors with a high incidence of industrial accidents with 370,300 (43.9%) workers in the mining and manufacturing industry and 102,600 (12.2%) workers in the construction industry.

In the two years and eight months from January 2020 to August 2022, foreign workers filed 22,361 applications for compensation of workplace injuries, of which 96% (21,478

cases) were approved. The number of approvals was 7,778 in 2020, 8,199 in 2021, and 5,501 in January-August 2022. By type, there were 21,006 accidents and 472 diseases, with an approval rate of 97.7% for accidents, but only 54.6% for diseases. When looking at the breakdown of approved accidents by industry, manufacturing accounted for 8,484 cases, followed by construction 7,950 cases, others 4,291 cases, agriculture 338 cases, transportation/warehouse/communication 275 cases, and forestry 64 cases. In particular, many migrant workplace accidents occurred in small businesses 8,191 cases occurred in businesses with 5-29 employees, 6,200 cases in those with less than 5 employees, 1,849 cases in those with over 1,000 employees, 1,788 cases in those with 30-49 employees, and 1,500 cases in those with 50-99 employees (Woo, 2022).

Meanwhile, a total of 46 migrant workers in the Employment Permit System (EPS) died of suicide from 2016 to 2020, with 10 in 2016, 11 in 2017, 3 in 2018, 7 in 2019, and 15 in 2020, the highest number in the last five years. By nationality, Nepalese workers accounted for 23, followed by five Sri Lankan workers, four Myanmar workers, and three Indonesian and Cambodian workers each (Youn, 2021).

In summary, many of the migrant workers in Korea are employed in small workplaces (<30 employees) in the manufacturing and construction industries and are exposed to occupational accidents Moreover, workplace related stress, overwork, and poor living conditions may lead to deaths due to accidents outside of work and suicides.

With the increase in the number of migrant workers entering into Korea, the private and public sectors have provided prevention and support measures for occupational accidents and physical health problems experienced by migrant workers, albeit inadequately However, there has been minimal attention and efforts to identify mental health problems and promote mental health. The shock of the recent suicides of Nepalese migrant workers reported in the media prompted a growing interest in identifying mental health problems and causes of suicide among migrant workers. It will take considerable effort and time to generate data and establish a system to prevent and support migrant suicide.

Since its establishment in 1999, WeFriends (Migrant Health Association in Korea) has recognized the importance of not only physical health but also mental health of migrant populations in Korea. WeFriends has been making various efforts to promote migrant mental health and is currently serving as a private medical safety net for migrant workers. First introduced in 2009, the “Healthy Mind, Smile Migrant Workers” was a program that

involved five diverse groups of migrants, including migrant workers, Korean Chinese, and marriage migrant women, and aimed for them to express their emotions and reduce stress through musical activities and ultimately, keep healthy at work and in their day-to-day lives

In 2011, the program "Establishment of a Mental Health Network and Awareness Raising Training for Psychosocial Adaptation of Foreign Workers" was implemented to promote the mental health of migrant workers and migrant activists in Seoul, Gyeonggi, and Incheon and to establish a mental health network. The program included lectures and consultations by mental health professionals, dance therapy, and art therapy. In addition, a multilingual mental health guidebook was produced in Korean, English, Vietnamese, Chinese, Mongolian, and Thai to help migrants self-assess their mental health status and recognize problems at an early stage and to provide information on services available to them in times of crisis.

In 2013, we implemented the “Psychotherapy Program for Refugee Women” to help women living as refugees in Korea overcome the psychological pain they experienced during the process of leaving their home countries and entering Korea and integrate into the Korean society.

In 2017, a mental health promotion program for migrant workers with the title of “Healthy body, Healthy mind, Healthy Labor” was conducted. Within this program, experts delivered lectures and taught meditation and stretching exercises to relieve depression and stress experienced by migrant workers

However, in recent years, among non-industrial causes, suicide has been the second leading cause of death after traffic accidents among migrant workers in Korea. Specifically, there is a concerning trend of the number of suicides increasing among Nepalese workers, highlighting the urgent need for more active suicide prevention efforts. In 2020, WeFriends launched the “Migrant Worker Suicide Prevention Project” with the goal of promoting mental health and preventing suicide among migrant workers As the first activity, we conducted a migrant workers’ mental health survey. We also established a suicide prevention and crisis intervention plan through memorandum of understandings with suicide prevention centers in Seoul and Gyeonggi-do. Another focus of the Project is to train psychosocial counselors with migrant backgrounds to counsel and intervene with migrant workers in crisis situations. We produced a suicide prevention manual for migrant workers to train the psychosocial counselors and raise awareness in the migrant

communities.

The report is based on the migrant workers’ mental health survey conducted as part of the “Migrant Worker Suicide Prevention Project” in 2020 with migrant workers from Nepal, China, and Myanmar, and additional data collected about the general mental health status and perceptions and experiences of suicide among workers from Thailand and Vietnam in 2022. The second data collection in 2022 was conducted in the context of the ongoing COVID-19 crisis, as did the first survey which was conducted in the height of the COVID19 pandemic in 2020. Although our data is limited to provide an in-depth analysis of the topic, this context left many questions and challenges for us to explore about how the global pandemic and social crisis affect the lives and health of migrant workers, especially their mental health.

2. Methods

2-1. Participants

202 migrants from Nepal, Myanmar, Thailand, Vietnam, and China who have been in Korea for more than 90 days under the EPS or EPS for overseas Korean participated in this survey. Nepalese migrant workers were included in the 2020 survey as the highest number of suicides was found among Nepalese migrant workers in Korea. There was also an increasing number of suicide attempts among Burmese workers due to the recent changes in the community perception of suicide as reported by a community leader. Finally, Korean Chinese migrants working in Korea were included as we wanted to identify additional stressors they may face as they are ethnically Korean but have different cultural backgrounds from other Koreans. In 2022, we further surveyed migrant workers from Thailand and Vietnam, two groups with the largest number of migrant workers in Korea. Participants consisted of migrant workers who entered Korea through the EPS, migrant community leaders with work experience, and migrant activists working in organizations that support migrant workers

We purposively sampled by selecting participants through migrant communities, which was crucial given the difficulty in contacting migrant workers during the COVID-19 pandemic. The total number of survey participants was 202 (40 from Nepal, 31 from Myanmar, 31 from China, 50 from Thailand, and 50 from Vietnam). Among those, 52 participants (10 from Nepal, 11 from Myanmar, 11 from China, 10 from Thailand, and 10 from Vietnam) agreed to a follow-up in-depth interview about their perceptions and experiences of suicide. The first round of survey in 2020 was conducted in various formats: online, over the phone, and in person from June to July 2020, and the second round was conducted in person from July to August 2022. Level one social distancing was in effect at the time of the first survey, and all social distancing measures were lifted at the time of the second survey As the data were collected at the beginning and end of the pandemic, the survey data included migrant workers' mental health during the COVID-19 pandemic and the impact of COVID-19 on mental health.

2-2. Measures

Along with sociodemographic information, adverse childhood experiences were measured with the Adverse Childhood Experiences Questionnaire [ACE-Q] and depression

was measured using the Center for Epidemiologic Studies Depression Scale [CES-D] for all participants. 52 participants answered additional questions about perceptions and experiences related to suicide in the in-depth interview. The ACE-Q, a self-report measure of adverse experiences before age 18, includes the following 10 items: verbal, emotional, physical, and sexual abuse, emotional and physical neglect, parental separation or divorce, witnessing violence against family members, substance (drug, alcohol) use problems in the family, mental illness or suicidal ideation experienced by family members, and criminal involvement of family members.

Each item is scored as 0 or 1, with the total sum of items ranging from 0 (no ACE exposure) to 10 (exposed to all measured types of ACEs). Higher scores indicate more traumatic childhood experiences. Previous studies on ACEs report that higher ACEs scores are associated with more suicide attempts (Jung et al., 2019).

The CES-D was developed by the U.S. National Institute of Mental Health to assess depression and screen for depressive disorders in the general population. The CES-D is widely used as a screening tool in epidemiological studies worldwide. The Korean version of the CES-D has a total of 20 questions and a cutoff score of 16, but when used as a screening tool in community epidemiological studies, a cutoff score of 21 has been suggested (Yoon et al., 2016).

3-1. Sociodemographic characteristics

31 participants came from China (15.3%, including 3 South Korean nationals), 40 from Nepal (19.8%, including 3 South Korean nationals), 31 from Myanmar (15.3%, including 1 South Korean national), 50 from Vietnam (24.8%, including 2 South Korean nationals), and 50 Thailand (24.8%, including two South Korean nationals). Most participants lived in the Seoul metropolitan area, with 153 (75.7%) in Gyeonggi and Incheon and 41 (20.3%) in Seoul.

121 (59.9%) participants were male, and 79 (39.1%) were female. Participants’ age ranged from 22 to 74, with 90 (44.8%) in their 30s. The mean age was 38.12±11.12 years. Most participants (n=179; 88.6%) had a high school education or higher. Most common religion among participants was Buddhism (n=95; 47.0%), followed by no religion (n=58; 28.7%), Hinduism (n=24; 11.9%), Christian (n=12; 5.9%), Catholic (n=8; 4.0%), and other (n=3; 1.5%).

126 (62.4%) participants were married, of which 32 (15.8%) were currently living with their spouse However, only 12 (5.9%) participants were living alone, indicating most live with others. The most common visa type was non-skilled employment (E-9) with 114 (56.4%) participants holding it, followed by 25 (12.4%) participants holding residence, dependent, and marriage visas (F-2, F-3, F-6)

118 (58.4%) had resided in the country for more than five years, and their main occupation was manufacturing (n=130; 66.7%), followed by other (n=20; 10.3%) and hospitality (n=19; 9.7%). The average number of hours worked per week was 39.34±20.57 hours, and 59 (33.9%) worked more than 50 hours. The average monthly income reported was 1-2 million Won for 98 (48.5%) participants and 2-3 million Won for 74 (36.6%) participants. 163 (80.7%) participants were enrolled in national health insurance. All participants who said they had private insurance were enrolled in national health insurance, suggesting presence of vulnerable population without any insurance protection

Table 1. Sociodemographic characteristics of survey participants (n=202)

*Participants who said they had private insurance were all enrolled in the National Health Insurance.

3-1-1. Age and religion by nationality

The mean age of participants from China (n=31) was 57.2±8.4 years, and Chinese participants were predominantly non-religious (n=22). Migrant workers from Nepal (n=40) had a mean age of 36.3±7.9 years and were predominantly Hindu (n=24). The average age of workers from Myanmar (n=31) was 36.7±8.5 years old, and Buddhism was the majority religion among Burmese participants (n=29). Vietnamese participants (n=50) were on average 34.0±6.69 years old, and most of the workers were non-religious (n=35). The average age of workers from Thailand (n=50) was 32.6±6.53 years old, and Buddhism was the majority religion among Thai participants (n=45).

3-1-2. Age and duration of stay

Workers who had been living in Korea for more than 10 years (n=51) were on average 49.4±10.25 years old. Among those who had been in Korea for 5-10 years (n=67), the average age was 37.3±10.42 years. The mean age was 31.6±5.65 years for workers who had been in Korea for 3-5 years (n=34), 32.7±5.71 years for workers who had been in Korea for 1-3 years (n=42), and 28.6±4.43 years for workers who had been in Korea for less than 1 year (n=8).

3-1-3. Hours worked, types of work, and income by industry

Workers in the manufacturing industry (n=130) reported working an average of 39.3±21.5 hours per week, with a majority working in the daytime and earning average monthly incomes between one and two million Won. Those working in the service industry (n=19) worked an average of 29.4±17.6 hours per week. Most service industry workers had daytime shifts and earned between one and two million Won per month. In other industries, participants (n=20) worked an average of 42.5±14.9 hours per week, with most being daytime workers and earning between one and two million Won per month. Migrant workers in the agriculture and livestock industry (n=11) reported higher working hours than other industries (54.5±10.8 hours per week). Five of the eight construction workers who participated in the survey reported an average monthly income of more than 3 million Won.

3-1-4. Average remittances by average monthly income

Participants who earned one to two million Won per month sent 719,000±577,000 Won

to their home country (n=98). The remittance amount was 1,085,000±660,000 Won for those earning an average of two to three million Won per month (n=74) and 1,058,000±1,087,000 Won for those earning more than three million per month on average (n=13). Generally, participants were remitting about half of their monthly income to their home countries.

3-1-5. Health insurance by immigration status

94 out of 114 non-skilled workers (E-9 visa) had health insurance, while all 17 and nine participants with overseas Korean (F-4 visa) and non-skilled overseas Korean (H-2 visa) visas, respectively, had health insurance. In addition, all permanent resident and Korean nationality holders and all but one resident visa (F-2 visa) holder had health insurance. Of the 19 participants who were asylum seekers (G-1 visa) or currently undocumented, 16 did not have health insurance.

3-2. Perceived health and happiness

Participants’ self-rated physical and mental health were generally good, with 186 (92.1%) rating their general health as average or better and 186 (92.1%) rating their perceived happiness as average or better.

Table 2. Perceptions of subjective health and happiness reported by survey participants (n=202)

3-3. Adverse childhood experiences

The mean ACE-Q score in this study was low at 0.79, but 75 (37.1%) participants reported at least one of the 10 items, 38 (18.8%) at least two items, 24 (11.9%) at least three items, and 9 (4.5%) at least 4 items.

For the percentage of participants reporting each of the 10 ACEs, 15.3% reported substance (drug, alcohol) use problems in the family, 13.9% reported verbal abuse, 12.9% reported emotional abuse, 7.9% reported witnessing violence, 7.4% reported physical abuse, 5.9% reported parental separation or divorce, 5.0% reported poor living conditions or neglect, 4.5% reported mental illness in the family, 3.5% reported criminal involvement of a family member, and 2.5% reported sexual abuse.

Table 3. Adverse childhood experiences of survey participants (n=202)

3-4. Depression

3-4-1. Distribution of depression

Scores from CES-D, a self-report scale to measure depression, were 15 or less (normal) for 132 (65.3%) participants. 21 (10.4%) were mildly depressed with scores between 16-20, 17 (8.4%) were moderately depressed with scores between 21-24, and 32 (15.3%) were severely depressed with scores above 25. The overall mean CES-D score among all participants was 14.3±10.44 (Table 3). 70 (34.6%) participants scored 16 or more, and 49 (24.2%) scored 21 or more.

3-4-2. Depression by country of origin

Among the 31 workers from China, the mean CES-D score was 12.4±9.3, with 4 (12.9%) scoring above the cutoff of 21. Among the 40 workers from Nepal, the mean score was 15.3±11.8, with 12 (30%) above the cutoff. Among the 31 workers from Myanmar, the mean score was 13.7±9.6, with 5 (16.1%) above the cutoff. Among the 50 Vietnamese workers, the mean score was 19.5±11.3, with 23 individuals (46%) above the cutoff. Among the 50 workers from Thailand, the mean score was 9.9±6.9, with 5 (10%) above the cutoff.

When the mean scores of CES-D were compared across the five countries, there was a significant difference (p<0.001) Post hoc analysis showed that the mean CES-D scores between Chinese and Vietnamese workers and between Thai and Vietnamese workers were statistically significantly different. When the depression scores were compared using

Table 4. CES-D scores of survey participants

Fisher's exact test, there were also significant differences among the five countries (p<0.001). Post hoc analysis revealed that the difference between Thai and Vietnamese workers was most pronounced. In other words, compared to workers from China and Thailand, workers from Vietnam had statistically significantly higher depression scores and a higher percentage of workers above the cutoff point.

3-4-3. Demographic factors associated with depression

Regression analysis with sociodemographic factors as independent variables and a binary variable of depression (categorized as above or below the CES-D cutoff score of 21) as dependent variable showed that the factors that influenced depression were gender (female OR=2.34, 95% CI: 1.21-4.58), country of origin (Nepal OR=3.86, 95% CI: 1.2813.22; Vietnam OR=7.67, 95% CI: 2.79-25.00; ref: Thailand), education (less than a college degree OR=2.00, 95% CI:1.01-4.12), and ACEs (four or more OR=4.22, 95% CI: 1.05-18.06). In other words, being female compared to male, being from Nepal or Vietnam compared to Thailand, having less than a college degree compared to a college degree or higher, and having four or more ACEs compared to none were associated with increased odds of being depressed.

Although the mean CES-D scores were not found to be statistically significantly different across sectors, the mean CES-D scores of migrant workers in the agriculture and livestock industry were significantly higher than those in other sectors This finding highlights the need to focus on migrant workers in the agriculture and livestock industry in future surveys.

Table 5. Comparison of CES-D scores across countries of origin

Table 6. Mean CES-D Scores by Industry

3-5. Suicide awareness and related experiences

Of the 202 migrant workers who responded to the survey, 52 respondents who agreed to participate in in-depth interviews discussed further about their perceptions and experiences of suicide. The nationalities of the 52 participants included 11 from China, 10 from Nepal, 11 from Myanmar, 10 from Vietnam, and 10 from Thailand. Interviews were conducted by telephone and in person. An interpreter supported interviews with participants who had difficulty communicating in Korean.

3-5-1. Stigma about depression and suicide by country of origin

In terms of beliefs about depression, 25 (48%) respondents viewed it as a medical illness and 24 (46%) as a personality trait. Only 3 (5.7%) participants attributed it to malicious energy or religious influence. There were different patterns of understanding depending on the country of origin. Nepalese and Chinese workers believed that depression is a disease and is caused by personality traits. The overwhelming majority of respondents from Myanmar and Thailand believed that depression is caused by personality, while the majority of respondents from Vietnam understood depression as a medical condition

Beliefs about suicide included the view that it is a behavior associated with depression (n=35, 67.3%), followed by a morality-based view that it is a sin or something to be punished for (n=13, 25%), the idea that it is related to insanity or mental illness (n=12, 23%), and the view that it is taboo and should not be mentioned (n=3, 5.8%). Other opinions from participants included that those who commit suicide were unable to solve their problem, suffered alone, and committed suicide impulsively. Particularly in China, it is culturally taboo to mention suicide, including the expression of suicidal ideation. Participants reported that it is difficult to obtain an accurate understanding as information such as newspaper articles and statistics are heavily controlled by the government.

3-5-2. Experience of death in the family

Forty-five (86.5%) respondents had experienced a death in the family. Of the respondents, 22 (42.3%) lost their parents and 8 (15.4%) lost grandparents while others had experienced the deaths of spouses and friends. Nine (20.0%) respondents experienced bereavement within two years, six (13.3%) between two and five years, and 30 (66.7%) more than five years ago. The death of the family member was due to illness (n=27, 60.0%), due to old age (n=11, 24.4%), due to an accident (n=5, 11.1%), and due to suicide (n=1, 2.2%).

Twenty-nine (64.4%) said they were distressed at the time of the bereavement, and 22 (48.9%) said the distress was still affecting them today.

3-5-3. Experience of suicide among acquaintances

Fifteen (28.8%) respondents had experienced suicide of an acquaintance in the past. The suicide had occurred less than two years ago for three participants (20.0%) and more than two years for 12 (80.0%).

Ten (66.7%) respondents reported that interpersonal problems were the reason for the acquaintances’ suicide, two (13.3%) reported depression was the reason, and one respondent each reported school pressure and economic issues as causes. One person did not know the reason for their acquaintance's suicide.

Most (n=9, 60.0%) participants responded that the suicide of an acquaintance did not have a significant impact on them at the time. On the other hand, four participants (26.7%) reported experiencing grief and shock after the suicide. While the majority of participants did not report that the suicide of their acquaintances was still affecting them today, two (13.3%) respondents reported that they still think about it occasionally.

3-5-4. Experience of suicidal ideation of an acquaintance

Twenty-one (40.4%) respondents said they had heard about suicidal ideation from an acquaintance in the last six months. After hearing about the suicidal ideation of an acquaintance, seven respondents reported feeling bad (33.3%), another seven felt neutral (33.3%), and three felt so sad that they were very affected (14.3%).

3-5-5. Suicide attempt by an acquaintance

In the past six months, nine (17.3%) respondents had experienced a suicide attempt by an acquaintance, of whom six (66.7%) had remained neutral and three (33.3%) had been severely affected.

3-5-6. Suicidal ideation

Twelve (23.1%) respondents reported having had suicidal ideation in the past six months. The most common reason for suicidal ideation reported by respondents was conflict with their husbands (n=5, 45.5%), including issues such as alcohol use, infidelity, violence, and in-law problems Three (25.0%) respondents said it was due to parenting stress. One participant each cited work, stress, workplace accidents, loneliness, health deterioration, and interpersonal conflict as their reason for suicidal ideation. One participant did not provide a reason. Among those reporting suicidal ideation, three (25.0%) did not receive any help, three received counseling or talked to others, one sought hospital treatment, and one turned to religious practices. Three (25.0%) participants reported that they still have suicidal ideation to this day.

3-5-7. Issues related to suicidal ideation among migrants in the Korean society

When asked to discuss issues related to the experience of suicidal ideation among migrant workers in South Korea, participants listed workplace issues most (n=31, 59.6%), followed by family problems (n=30, 57.7%), economic problems (n=17, 32.7%), acculturation stress (n=12, 23.1%), and personality (n=11, 21.2%).

A Nepalese worker said: “I came to Korea because I heard that I could make a lot of money, but it is hard to work in Korea, and it is difficult for those who came first to teach work to those who came later. The reason for the difficulties at work is that both friendship and work exist at work.” Participant narratives suggested that issues such as overwork, unpaid wages, employers evading filing for workers' compensation, interpersonal relationships, acculturation issues, high fees and disputes with employment agencies, and difficulties in changing jobs may have a large impact on the mental health of migrant workers. Many marriage migrant women were engaging in labor, and for some of them, conflicts with their husbands or in-laws and the stress of raising children after moving to Korea and starting a family often led to the onset of suicidal ideation.

3-5-8. Prevalence of psychiatric conditions such as depression, alcohol abuse, panic disorder, and schizophrenia among acquaintances

29 (55.8%) migrant workers reported knowing someone with a mental illness. Depression, alcoholism, and panic disorder were mentioned.

3-5-9. Experience with suicide prevention centers or mental health community centers

To understand migrant workers' utilization of community resources, we asked them if they had ever used the services provided in suicide prevention centers or mental health community centers. A total of 10 respondents (19.2%) said they had. Overall, there was little awareness of community mental health organizations in Korea among migrant workers.

3-5-10. How to help migrant workers who are depressed or suicidal

The most helpful options listed by participants were face-to-face counseling at a counseling center (n=22, 42.3%), followed by psychiatric care (n=17, 32.7%), counseling by someone from their home country (n=13, 25.0%), telephone counseling (n=4, 7.7%), and religious counseling (n=2, 3.8%).

The least helpful option was religious counseling, reported by 18 (34.6%) participants as not helpful. 15 (28.8%) participants mentioned telephone counseling, 5 (9.6%) mentioned psychiatric care, and one participant each mentioned face-to-face counseling at a counseling center and counseling by someone from their home country as not helpful Most respondents said there was nothing that would not help them.

3-5-11. How to help migrant workers in mental health crisis

The most helpful options were counseling with a counselor from their home country (n=23, 44.2%), face-to-face counseling at a counseling center (n=17, 32.7%), and psychiatric care (n=10, 19.2%), followed by telephone counseling and religious counseling (n=3 and 2, respectively).

23 (44.2%) participants selected religious counseling as the least helpful option, along with telephone counseling (n=14, 26.9%), psychiatric care (n=3, 5.8%), and face-to-face

counseling (n=1). Most other respondents said that all methods were helpful.

In interviews, there were reports of difficulties in accessing psychiatric inpatient care in crisis situations, such as self-harm, due to the absence of a legal representative. These experiences suggest that foreigners living alone in Korea and without a legal representative have difficulty accessing care under Korea's Mental Health Act Such legal issue should be recognized by embassies, which should take an active role in resolving it.

3-6. Experiences with COVID-19 and the impact on mental health

As the data collection took place during the COVID-19 pandemic, in-depth interviews included migrant workers' experiences with COVID-19 and the mental health impacts of COVID-19. Migrant workers who experienced contracting COVID-19 felt that their health was worse than before even after they recovered. Many participants reported that distancing measures and travel restrictions made it difficult to gather in their communities and travel to their home countries. One Vietnamese worker said they “felt lonely, like having my legs tied.” because they couldn't meet people during the COVID-19 pandemic. Many participants reported family members or relatives back home had died or become unwell due to COVID-19.

The primary emotion described by migrant workers as they shared their experiences with the Pandemic was fear. One Vietnamese worker who had COVID-19 twice said: “I was scared and worried. What if I die… I don't have any family around me. I'm worried”. For some, the COVID-19 pandemic exacerbated their pre-existing depression. A Thai migrant worker shared the following experience.

Iusedtobedepressedsometimes.Since2020whenCOVID-19startedanduntilnow, IwassoscaredatthebeginningbecauseIdidn’tknowanythingaboutthisnewdisease So, Iwasreallydepressedatthattime.WhatifIgetit[…]I'mokay,butIwasworried whatifmyhusband,mychildren,whatiftheygetit. [...]IfIdie,whatwillhappento my daughters, what about my husband I kept getting depressed because I was worriedmoreandmore.

Many migrant workers reported suffering from insomnia and experiencing anxiety due to concerns about their health and the health of their families.

In addition to these concerns and fears, Korean Chinese workers have also experienced discrimination. Since the outbreak of COVID-19 occurred in China, Korean Chinese migrants living in Korea have also become targets of discrimination and hatred due to their association with China. A migrant worker from China described the social stigma towards Korean Chinese: “I have become more cautious and less active due to the risk of contracting the disease. I told other Korean Chinese migrants not to meet if Korean Chinese get infected, people will direct blame to us and call us out for not keeping social distancing measure..." The service sector (restaurant servers, domestic helpers, nursing caregivers, babysitters, etc.), which is mainly occupied by Korean Chinese workers, has been particularly affected by the COVID-19 pandemic. Consequently, Korean Chinese workers experienced economic difficulties, which led to depression.

4. Discussion

4-1. Comparison with South Korean population mental health

According to the Mental Health Survey conducted by the Korea National Center for Mental Health in 2021, the lifetime prevalence rate of depressive disorders among Koreans was 7.7%, and the one-year prevalence rate was 1.7%. The lifetime prevalence of suiciderelated behaviors (ideation, planning, and attempt) was 10.7%, 2.5%, and 1.7%, respectively, and the one-year prevalence was 1.3%, 0.5%, and 0.1%, respectively (National Center for Mental Health, 2021). In 2020, Nam et al. surveyed 2,011 young adults aged 19-34 living in Seoul and found that the average CES-D score was 20.46, indicating that the overall level of depression in South Korean society is very high (“Corona Blue”, n.d.).

Among studies that used CES-D score of 21 as a cutoff point, a study of 998 office workers screened by the Kangbuk Samsung Medical Center's Corporate Mental Health Research Institute reported prevalence of depression at 6.2% (Lee at al., 2016). The prevalence was 5.7% in a study of 194,226 people who underwent routine employment health examinations at a general medical examination center in Suwon, Seoul (Jung et al., 2017), 10.5% in a study of 711 public officers in a city (Kang et al., 2017), and 19.2% in a study of 17,457 on-duty firefighters (Kim et al., 2010).

4-2. Comparison with existing literature about migrant workers’ mental health

According to a survey of workers from Vietnam and Cambodia during the COVID-19 pandemic in South Korea, 29.9% were found to have depression when measured using the CES-D (Kim et al., 2022). Measured with the Patient Health Questionnaire-9 (PHQ-9), 41.7% of migrant workers in South Korea reported severe depressive symptoms during the COVID-19 pandemic (Acharya et al., 2022). A study that examined the mental health of 187 migrant workers in South Korea before the COVID-19 pandemic using the Symptom Checklist-90-Revised (SCL-90-R) found that the raw score of the SCL-90-R converted to a T-score indicate workers were overall healthy (Global Severity Index M=47.70, sd=12.03; depression M=46.67, sd=10.46; fear anxiety M=52.86; sd=13.95) (Yang et al., 2009). In a study of 488 migrant workers in Gyeonggi Province, the mean CES-D score was 14.1, and those with a score of 21 or more was 25.2%. The percentage was higher among workers from countries other than China and undocumented migrants,

with 32.1% and 32.8%, respectively (Lee et al., 2016). Moreover, a study of 287 migrant workers in manufacturing plants in Gyeongnam Province found that the mean CES-D score was 16.6, and 36.9% had a score of 21 or higher (Kim et al., 2012). Compared to past studies, participants in this study had more favorable mental health outcomes. However, the results of self-report measurement scales can only describe the status and severity of symptoms and cannot be directly interpreted as equivalent to a diagnosis of depression.

4-3. Mental health in origin countries

According to a study published in 2019, 3.6% of the Chinese population reported experiencing depression in the past year. Among them, the prevalence was higher among women than men, with 4.2% in women and 3.0% in men. Anxiety disorders were more prevalent than depression, with 5.0% of the total population experiencing anxiety disorders in the past year (5.2% in women and 4.8% in men). Both depression and anxiety disorders were higher in the population aged 50 years and older (Huang et al., 2019). Prevalence of lifetime suicidal ideation was 3.9%, and prevalence of lifetime suicide attempt was 0.8%. Similarly, the prevalence among women was higher than that among men (female - suicidal ideation 4.9%, suicide attempt 1.1%; male - suicidal ideation 2.8%, suicide attempt 0.5%) (Cao et al., 2015).

In Nepal, the national prevalence of depression and anxiety disorders was significantly higher than in China, at 11.7% and 22.7% (Risal et al., 2016). Alcohol abuse is a social problem, with 7.3% of those visiting a primary care center being diagnosed with alcoholism (Luitel et al., 2018). Suicide rates were also high. A 2014 World Health Organization survey found that 20.3 people per 100,000 were losing their lives to suicide in Nepal. Suicide rates were particularly high among women of childbearing age and the middle-aged and elderly (World Health Organization, 2014).

There is little data reported about population-level mental health in Myanmar. A recently published study reported the prevalence of depression and anxiety disorders as 18.0%, similar to the figures reported in Nepal (Aye et al., 2020). The suicide rate in Myanmar was lower than that in Nepal, at 7.8 people per 100,000 (World Health Organization, 2016). Notably, a survey of students found a high rate of suicidal ideation at 9.2% (Myanmar Global School-based Student Health Survey, 2016).

In Thailand, the prevalence of depression and anxiety disorders were 19.9% and 10.2%, respectively among age 15-60 living in Bangkok. This result contrasts with reports from Nepal, where anxiety disorders were more prevalent than depression (Thavichachart et al., 2001). In the same study, prevalence of related disorders such as suicidal ideation (7.1%), substance abuse (11.2%), and alcohol abuse (18.4%) was also high. A Thai government survey conducted in 2008 found that 2.4% out of a representative sample of 20,000 people had depression, and 58.5% of those with depression were at risk of suicide (Kongsuk et al., 2010, Sriruenthong et al., 2011). In the same year, the suicide rate was 5.98 per 100,000 people (Ministry of Public Health, 2016).

A recent study conducted in Ho Chi Minh City, Vietnam, found the prevalence of depression was 15.8% among patients visiting primary healthcare providers (Yen Phi et al., 2022). In a survey conducted in the Mekong region, the prevalence of depression and anxiety was 4.8% (Liddell et al., 2013). In Hanoi, a survey about suicide was conducted in 2003. This study reported prevalence of suicide ideation (8.9%), planning suicide (1.1%), and suicide attempts (0.4%). The figures about suicide planning and attempts were similar to those reported in China, but the prevalence of suicide ideation was much higher (Thanh et al., 2006). The suicide rate in rural areas was reported to be 10.2 per 100,000 people (Nguyen et al., 2010).

4-4. Migratory patterns and mental health by origin country

In China, the rapid development of large cities has led to a steady increase in the number of laborers migrating from rural to urban areas. According to a study published in 2011, among 1,180 internal migrant workers in Chengdu, 23.7% had clinically significant levels of depressive symptoms (CES-D score greater than 16), and 12.8% had depression (CESD score greater than 21) (Qiu et al., 2011). A study of factory workers in Shenzhen found similar figures, with 21.4% reporting significant depressive symptoms (CES-D greater than 16) (Mou et al., 2011). Compared to a non-migrant sample living in rural areas, internal migrant workers were less likely to experience depression, but there were no differences in suicidal ideation, planning suicide, or suicide attempts (Dai et al., 2015). However, based on the previous findings about depression, the prevalence of depression is high among internal migrant workers in China While the prevalence of suicide among migrants in China has not been published, suicide among internal migrant workers has been raised as an important issue in the Chinese society, with 13 workers committing or attempting suicide in two factories owned by Taiwanese company Foxconn from January to May 2010

(Chan and Pun, 2010).

From Nepal, the largest number of workers migrated to Gulf Cooperation Council (GCC) countries and Malaysia on temporary employment contracts. In 2018/19, Nepalese migrant workers in Qatar, United Arab Emirates, Saudi Arabia, Kuwait, and Malaysia accounted for 88% of all Nepalese migrant workers. Ninety-five percent of migrant workers are male, and the average age of migrant workers was 29. From 2008 to 2018, a total of 893 Nepalese migrant workers died by suicide, of which 240 deaths occurred in Malaysia, 102 in Saudi Arabia, 87 in Qatar, 74 in the United Arab Emirates, and 21 in Kuwait (Government of Nepal, 2020). There is currently no data on the prevalence of depression or anxiety disorders among Nepalese migrant workers in the Middle East or Malaysia.

In Myanmar, workers migrating to Thailand account for 70% of all overseas migrant workers. A survey of Burmese migrant workers in Thailand found that 11.9% suffered from depression or anxiety disorders (Kesornsri et al., 2019). Similar to that among internal migrant workers in China, the suicide rate among Burmese migrant workers is not officially reported. However, it is a topic that deserves special attention, with 17 Burmese workers committing suicide in Malaysia during a four-month period as working conditions deteriorated with the COVID-19 pandemic (Lwin Myo Thu, 2020). Thailand is more often recognized as a destination than a labor sending country, and we were unable to find any data on the mental health of Thai workers abroad.

The Vietnam War has created a Vietnamese diaspora around the world. A study comparing the prevalence of depression and anxiety among Vietnamese living in the Mekong Delta region of Vietnam, Vietnamese migrants settled in Australia, and Australian-born Vietnamese found that those living in Vietnam had the lowest prevalence (4.8%), followed by Vietnamese migrants living in Australia (7.0%) and Australian-born Vietnamese (10.2%) (Liddell et al., 2013). After the war, many Vietnamese migrated to other Asian countries in search of economic opportunities. In 2019, over 147,000 Vietnamese migrated to Japan, Taiwan, and South Korea, primarily through employment contracts (International Organization for Migration, 2022). A previous study of Vietnamese migrant workers living in South Korea in 2014 found that the depression score measured by the CES-D was 15.33±7.32, which was lower than the mean score reported in this study (Jeon and Lee, 2015). This study was conducted during the COVID-19 pandemic, which may have resulted in higher depression scores among Vietnamese

workers in South Korea

4-5. Mental health status of migrant workers abroad (Chinese, Nepalese, Myanmar, Thai, Vietnamese, and migrant workers in general)

A systematic review of the mental health status of 44,365 migrant workers in 17 countries reported that the combined prevalence of depression was 38.99% and of anxiety was 27.31%. Biological factors (physical health, family history of mental illness), individual factors (coping behaviors), job-related factors (job stress, work environment, income and benefits, abuse), environmental factors (access to health care, length of stay, living conditions), and social factors (social support) influenced the mental health of migrant workers (Hasan et al., 2021).

In the United Arab Emirates, where 80% of the total population is consisted of migrant workers, 25.1% of a sample of migrant workers reported depression, 6.3% reported suicidal ideation, and 2.5% reported suicide attempts (Al-Maskari et al., 2011). In Singapore, where large numbers of migrant workers from Bangladesh reside, the prevalence of depression was 21.9% (Ang et al., 2017). Among Chinese workers in factories in Japan, depression scores were slightly higher (CES-D score mean 14.1) than the Japanese average (CES-D score mean 13.2) (Date et al., 2009). Even in the Americas and Europe, regions with relatively long histories of migrant labor, there is little data on the mental health of migrant workers. In Spain, a survey of employed migrant workers found that 15.8% of men and 30.1% of women reported mild to moderate depression and anxiety (Cayuela et al., 2015). Particularly high prevalence rates of depression (11%45.8%) and alcohol dependence (50.1%) have been found among seasonal agricultural workers from South America working in the United States (Chaney and Torres, 2017, Mora et al., 2016, Ramos et al., 2016, Georges et al., 2013, Sandberg et al., 2012).

4-6. Differences in mental health service utilization and health behaviors in origin countries

4-6-1. China

At the national level, mental health services in China are focused on severe mental illness. Some primary health care centers provide mental health diagnosis and treatment referrals, and telephone hotlines are available to people in crisis (Liang et al., 2018). In the private

sector, there are no established mental health service network that can be identified, other than counseling services provided by some workplaces, schools, or private organizations. Since there is low social awareness of mental illness and negative societal attitudes towards people with mental illness, the Chinese government is making efforts to improve awareness (Liang et al., 2018). According to a survey, only 8.3-15.5% of patients with mental illness visit a healthcare provider, and 4.9-6.7% receive mental health services (Patel et al., 2016). To reduce this treatment gap, services are being developed to provide online counseling and therapy (Liu et al., 2020).

4-6-2. Nepal

Nepal is currently in the process of expanding mental health services nationally. This expansion, which began in 2017, has resulted in the availability of diagnosis and treatment referrals for mental illness in the primary health care facilities in some districts. Counseling is being provided for depression, postpartum depression, and anxiety disorders, and medication is available for epilepsy and alcohol abuse (Jordans et al., 2016). In the private sector, mental health services exist for vulnerable groups such as victims of natural disasters and civil war, victims of torture, widows, the homeless, and youth, but they are mainly located in the capital, Kathmandu. A suicide prevention hotline is also in operation However, surveys show that less than 10% of people suffering from depression or alcoholism visit a healthcare provider or receive treatment. The most common reason for not using mental health services was financial, followed by fear of appearing weak or crazy to others (Luitel et al., 2017).

4-6-3. Myanmar

Although Myanmar has a national mental health policy, the country has insufficient human and other resources to effectively provide mental health services in the populationlevel, with only around 200 mental health professionals for a population of 54,000,000. In addition to the lack of resources, social stigma and low societal awareness of mental illness are creating treatment gaps (Lin et al., 2020). In Myanmar, similar to the figures reported from China and Nepal, it is estimated that only about 10% of people in need of mental health services visit a healthcare provider or receive treatment (Downing, 2016).

4-6-4. Thailand

A 2005 survey using the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) found that there was a shortage of mental health service providers, with 7.29 per 100,000 population, in Thailand (Ministry of Public Health, 2006). Only a small percentage of people with depression were diagnosed and treated due to shortages of staff, difficulties in obtaining medication, low public awareness of mental illness, and stigmatization of mental illness and treatment (Kongsuk et al., 2017). To address these issues, the Thai government introduced a system to promote mental health awareness, diagnosis, treatment and prevention of relapse, and prevention of suicide in 2010. With the introduction of this system, it was found that in 2016, 48.5% of those with depression had access to services while in 2008, only 3.7% did (Kongsuk et al., 2017). Currently, diagnosis, medication and counseling treatment, relapse and suicide prevention programs are available nationwide.

4-6-5. Vietnam

According to data published in 2022, in primary healthcare centers in Ho Chi Minh City, only 2.5% of patients with depression were diagnosed (Yen Phi et al., 2022). State-run community-based mental health services focus on the management of illnesses such as schizophrenia and epilepsy, and are poorly organized and resourced for the diagnosis, treatment, and management of other conditions. In one rural area, about half of the people in need of mental health services were not receiving any treatment. Of those who were receiving treatment, most were receiving services from private organizations or selfmedicating. Only 5% of those in need of services were receiving treatment in institutions with mental health services (Bao Giang et al., 2010). A review of the medical records of 104 people who attempted suicide in a rural area found that 99 had used pesticides or drugs, suggesting that strengthening drug control systems, especially in rural areas, will be important to prevent suicide in Vietnam (Nguyen et al., 2010).

5. Conclusion

This survey was conducted as part of the Migrant Worker Suicide Prevention Project by WeFriends (Migrant Health Association in Korea) to understand the overall mental health status of migrant workers and their perceptions and experiences of suicide. Results of this survey can inform the public about the current situation and provide evidence-based data for the design of effective measures.

The survey found high levels of self-perceived general health and subjective well-being among migrant workers, and the mean and percentages above the cutoff point of ACEQ and CES-D scores were also improved compared to findings from past surveys. It can be inferred that various efforts to improve the mental health of migrant workers in South Korea are slowly bearing fruit.

However, it is important to note that migrant workers in the high-risk group for depression exist Although the overall proportions decreased, 70 (34.6%) participants scored 16 or higher on the CES-D and 49 (24.2%) scored 21 or higher. While the overall level of depression among migrant workers may be lower or not significantly different than that of Koreans, the proportion of the high-risk group is still greater among migrant workers than Koreans. This finding of lower overall depression levels and higher proportion of those in the high-risk group suggests that there are groups of migrant workers vulnerable to depression and anxiety

Survey results identified migrant workers with additional sociodemographic vulnerabilities were at higher risk for depression. Female workers, those with lower levels of education, and those with adverse childhood experiences require extra attention. Workers from particular countries were also found to have higher levels of depression. In-depth interviews revealed the differences may be due to different understandings of depression and suicide in the surveyed countries. Therefore, when providing mental health services, it would be effective to provide services that take into account the socio-cultural characteristics of migrant workers’ country of origin.

Further in-depth examination of experiences and perceptions related to suicide among migrant workers revealed that very few were affected by suicide-related behaviors of acquaintances. Twelve out of 52 participants reported having experienced suicidal ideation in the past six months, but only three reported persistent suicidal thoughts. In-

depth interviews revealed that depression and suicidal ideation among migrant workers were often attributed to problems at work and conflicts with family members, suggesting that counselors should help migrant workers resolve problems at work and at home as an important part of mental health services.

The findings of this report suggest that in the future, in addition to general mental health services for migrant workers, there is a need to develop services that identify and focus on high-risk groups among migrant workers

References

ACHARYA, S. R., MOON, D. H. & SHIN, Y. C. 2022. Depressive symptoms among migrant workers in South Korea amid COVID-19 pandemic. Psychiatry Clin. Psychopharmacol, 32, 118-124.

AL-MASKARI, F., SHAH, S., AL-SHARHAN, R., AL-HAJ, E., AL-KAABI, K., KHONJI, D., SCHNEIDER, J., NAGELKERKE, N. & BERNSEN, R. 2011. Prevalence of depression and suicidal behaviors among male migrant workers in United Arab Emirates. Journal of immigrant and minority health, 13, 1027.

ANG, J. W., CHIA, C., KOH, C. J., CHUA, B. W., NARAYANASWAMY, S., WIJAYA, L., CHAN, L. G., GOH, W. L. & VASOO, S. 2017. Healthcare-seeking behaviour, barriers and mental health of non-domestic migrant workers in Singapore. BMJ global health, 2, e000213.

AYE, W. T., LIEN, L., STIGUM, H., WIN, H. H., OO, T. & BJERTNESS, E. 2020. The prevalence of mental distress and the association with education: a cross-sectional study of 18-49-year-old citizens of Yangon Region, Myanmar. BMC public health, 20, 94.

BAO GIANG, K., VIET DZUNG, T., KULLGREN, G. & ALLEBECK, P. 2010. Prevalence of mental distress and use of health services in a rural district in Vietnam. Global Health Action, 3, 2025.

CAO, X.-L., ZHONG, B.-L., XIANG, Y.-T., UNGVARI, G. S., LAI, K. Y., CHIU, H. F. & CAINE, E. D. 2015. Prevalence of suicidal ideation and suicide attempts in the general population of China: a meta-analysis. The International Journal of Psychiatry in Medicine, 49, 296-308.

CAYUELA, A., MALMUSI, D., LOPEZ-JACOB, M. J., GOTSENS, M. & RONDA, E. 2015. The impact of education and socioeconomic and occupational conditions on selfperceived and mental health inequalities among immigrants and native workers in Spain. Journal of immigrant and minority health, 17, 1906-1910.

CHAN, J. & PUN, N. 2010. Suicide as protest for the new generation of Chinese migrant workers: Foxconn, global capital, and the state. The Asia-Pacific Journal, 37, 1-50.

CHANEY, B. H. & TORRES, E. 2017. Covariates of identified stress and depression among seasonal farmworkers. International journal of environmental research and public health, 14, 711.

DAI, J., ZHONG, B.-L., XIANG, Y.-T., CHIU, H. F., CHAN, S. S., YU, X. & CAINE, E. D. 2015. Internal migration, mental health, and suicidal behaviors in young rural Chinese. Social psychiatry and psychiatric epidemiology, 50, 621-631.

DATE, Y., ABE, Y., AOYAGI, K., YE, Z., TAKAMURA, N., TOMITA, M., OSAKI, M. & HONDA, S. 2009. Depressive symptoms in Chinese factory workers in Nagasaki, Japan. Industrial health, 47, 376-382.

DOWNING, J. 2016. Mending troubled minds. Frontier Myanmar.

GEORGES, A., ALTERMAN, T., GABBARD, S., GRZYWACZ, J., SHEN, R., NAKAMOTO, J., CARROLL, D. & MUNTANER, C. 2013. Depression, social factors, and farmworker health care utilization. The Journal of Rural Health, 29, s7-s16.

GOVERNMENT OF NEPAL 2020. Nepal Labour Migration Report 2020. Kathmandu, Nepal: Ministry of Labour, Employment and Social Security.

HASAN, S. I., YEE, A., RINALDI, A., AZHAM, A. A., MOHD HAIRI, F. & AMER NORDIN, A. S. 2021. Prevalence of common mental health issues among migrant workers: A systematic review and meta-analysis. PloS one, 16, e0260221.

HUANG, Y., WANG, Y., WANG, H., LIU, Z., YU, X., YAN, J., YU, Y., KOU, C., XU, X. & LU, J. 2019. Prevalence of mental disorders in China: a cross-sectional epidemiological study. The Lancet Psychiatry, 6, 211-224.

INTERNATIONAL ORGANIZATION FOR MIGRATION 2022. Access to Information and Health care Services for Vietnamese Migrant Workers Overseas During the COVID-19 Pandemic. Hanoi, Vietnam: IOM.

JEON, H. J. & LEE, G. E. 2015. Acculturative stress and depression of Vietnamese immigrant workers in Korea. Journal of Korean Academy of Community Health Nursing, 26, 380-389.

Jung CH, Lim SW, Shin DW, Oh KS. 2017. Association of Overlapped Job Stress Components with Depressive Symptoms and Suicidal Idea. Anxiety and Mood,13:32-38.

JORDANS, M., LUITEL, N., POKHREL, P. & PATEL, V. 2016. Development and pilot testing of a mental healthcare plan in Nepal. The British Journal of Psychiatry, 208, s21-s28.

Kang H. 2017. Depressive Symptoms and Its Related Factors of the Public Enterprise Workers Who Relocated to an Innovation City. Mood Emot 15(3): 156-162

KESORNSRI, S., SITTHIMONGKOL, Y., PUNPUING, S., VONGSIRIMAS, N. & HEGADOREN, K. M. 2019. Mental Health and Related Factors among Migrants from Myanmar in Thailand. Journal of Population and Social Studies [JPSS], 27, 124-138.

KIM, J.-K., KIM, J.-E., MOON, D.-H., 2012. Effect of Occupational Stress and Sleep Quality on Depression among Male Immigrant Workers Manufacturing Industry, Korea. J. Korean Soc. Occup. Environ. Hyg. 22, 244.256.

KIM TW, KIM KS, AHN YS. 2010. Relationship between Job Stress and Depressive Symptoms among Field Firefighters. Korean J Occup Environ Med, 22:378-387.

KIM, Y., LEE, H. & LEE, M. 2022. Social Support for Acculturative Stress, Job Stress, and Perceived Discrimination Among Migrant Workers Moderates COVID-19 Pandemic Depression. International Journal of Public Health, 151.

KONGSUK, T., KITTIRATTANAPAIBOON, P., KENBUBPHA, K., SUKAWAHA, S. & LEEJONGPERMPOON, J. 2010. The prevalence of major depressive disorders in Thailand: Results from the Epidemiology of Mental Disorders National Survey 2008. Epidemiology and Public Health Meeting. Lisbon, Portugal.

KONGSUK, T., SUPANYA, S., KENBUBPHA, K., PHIMTRA, S., SUKHAWAHA, S. & LEEJONGPERMPOON, J. 2017. Services for depression and suicide in Thailand. WHO South-East Asia journal of public health, 6, 34.

LEE WH, KIM EJ, OH KS, SHIN YC, LIM SW. 2016. The Sleep Characteristics of Employees and its Influence on Depression and Anxiety. Anxiety and Mood, 12:97-102.

LEE, S.W., KIM, K.S., KIM, T.G., RYU, H.W., LEE, M.Y., WON, Y.L., SONG, Y.H., 2016. The Relationship between Job Stress and Depressive Symptoms in Migrant Workers in Kyung-gi Province in Korea [WWW Document]. Korean J. Occup. Environ. Med. URL

http://www.koreamed.org/SearchBasic.php?RID=2141516 (accessed 1.4.21).

LIANG, D., MAYS, V. M. & HWANG, W.-C. 2018. Integrated mental health services in China: challenges and planning for the future. Health policy and planning, 33, 107-122.

LIDDELL, B. J., CHEY, T., SILOVE, D., PHAN, T. T. B., GIAO, N. M. & STEEL, Z. 2013. Patterns of risk for anxiety-depression amongst Vietnamese-immigrants: a comparison with source and host populations. BMC psychiatry, 13, 1-11.

LIN, K., LIN, S. & SEIN, T. T. 2020. The challenges faced by service providers on satellite mental health-care facilities in Yangon, Myanmar: a qualitative study. Journal of Health Research.

LIU, S., YANG, L., ZHANG, C., XIANG, Y.-T., LIU, Z., HU, S. & ZHANG, B. 2020. Online mental health services in China during the COVID-19 outbreak. The Lancet Psychiatry.

LUITEL, N. P., BARON, E. C., KOHRT, B. A., KOMPROE, I. H. & JORDANS, M. J. 2018. Prevalence and correlates of depression and alcohol use disorder among adults attending primary health care services in Nepal: a cross sectional study. BMC health services research, 18, 215.

LUITEL, N. P., JORDANS, M. J., KOHRT, B. A., RATHOD, S. D. & KOMPROE, I. H. 2017. Treatment gap and barriers for mental health care: a cross-sectional community survey in Nepal. PloS one, 12, e0183223.

LWIN MYO THU. 2020. Suicide cases among Myanmar workers in Malaysia reached 17. Eleven Media Group.

MINISTRY OF PUBLIC HEALTH 2006. WHO-AIMS report on mental health system in Thailand. Bangkok, Thailand: World Health Organization.

MINISTRY OF PUBLIC HEALTH 2016. Reported rates of suicide, year 2540.2558. Nonthaburi: Department of Mental Health, Ministry of Public Health, Thailand.

MORA, D. C., QUANDT, S. A., CHEN, H. & ARCURY, T. A. 2016. Associations of poor housing with mental health among North Carolina Latino migrant farmworkers. Journal of agromedicine, 21, 327-334.

MOU, J., CHENG, J., GRIFFITHS, S. M., WONG, S. Y., HILLIER, S. & ZHANG, D. 2011. Internal migration and depressive symptoms among migrant factory workers in Shenzhen, China. Journal of Community Psychology, 39, 212-230.

NGUYEN, T. V., DALMAN, C., LE, T. C., NGUYEN, T. V., TRAN, N. V. & ALLEBECK, P. 2010. Suicide attempt in a rural area of Vietnam: Incidence, methods used and access to mental health care. International Journal of Mental Health Systems, 4, 1-6.

Oh, D.H., Kim, S.A., Lee, H.Y., Seo, J.Y., Choi, B.Y., Nam, J.H., 2016. Prevalence and Correlates of Depressive Symptoms in Korean Adults: Results of a 2009 Korean Community Health Survey [WWW Document]. J. Korean Med. Sci. URL http://www.koreamed.org/SearchBasic.php?RID=2158012 (accessed 1.4.21).

PATEL, V., XIAO, S., CHEN, H., HANNA, F., JOTHEESWARAN, A., LUO, D., PARIKH, R., SHARMA, E., USMANI, S. & YU, Y. 2016. The magnitude of and health system responses to the mental health treatment gap in adults in India and China. The Lancet, 388, 30743084.

QIU, P., CAINE, E., YANG, Y., CHEN, Q., LI, J. & MA, X. 2011. Depression and associated factors in internal migrant workers in China. Journal of affective disorders, 134, 198207.

RAMOS, A. K., CARLO, G., GRANT, K., TRINIDAD, N. & CORREA, A. 2016. Stress, depression, and occupational injury among migrant farmworkers in Nebraska. Safety, 2, 23.

RISAL, A., MANANDHAR, K., LINDE, M., STEINER, T. J. & HOLEN, A. 2016. Anxiety and depression in Nepal: prevalence, comorbidity and associations. BMC psychiatry, 16, 102.

SANDBERG, J. C., GRZYWACZ, J. G., TALTON, J. W., QUANDT, S. A., CHEN, H., CHATTERJEE, A. B. & ARCURY, T. A. 2012. A cross-sectional exploration of excessive daytime sleepiness, depression, and musculoskeletal pain among migrant farmworkers. Journal of agromedicine, 17, 70-80.

SRIRUENTHONG, W., KONGSUK, T., PENGCHUNTR, W., KITTIRATTANAPAIBOON, P., KENBUBPHA, K. & YINGYEUN, R. 2011. The suicidality in Thai population: a national survey. Journal of the Psychiatric Association of Thailand, 56, 413-24.

THANH, H. T. T., TRAN, T. N., JIANG, G.-X., LEENAARS, A. & WASSERMAN, D. 2006. Life time suicidal thoughts in an urban community in Hanoi, Vietnam. BMC Public Health, 6, 1-8.

THAVICHACHART, N., INTOH, P., THAVICHACHART, T., MEKSUPA, O., TANGWONGCHAI, S., SUGHONDHABIROM, A. & WORAKUL, P. 2001. Epidemiological survey of mental disorders and knowledge attitude practice upon mental health among people in Bangkok Metropolis. Journal of the Medical Association of Thailand= Chotmaihet thangphaet, 84, S118-26.

WORLD HEALTH ORGANIZATION 2014. Preventing suicide: A global imperative. World Health Organization.

WOO, WONSIK 2022. Around 21,000 cases of occupational injury among foreign workers in the past three years, 300 deaths. Yonhap News.

https://www.yna.co.kr/view/AKR20221007169600530

WORLD HEALTH ORGANIZATION 2016. Suicide mortality rate (per 100,000 population) - Myanmar. In: REPOSITORY, G. H. O. D. (ed.).

YEN PHI, H. N., QUOC THO, T., XUAN MANH, B., ANH NGOC, T., MINH CHAU, P. T.,

TRUNG NGHIA, N., NGHIA, T. T., NGOC QUYNH, H. H., HUY, N. T. & LINH, N. T. 2022. Prevalence of depressive disorders in a primary care setting in Ho Chi Minh City, Vietnam: A cross-sectional epidemiological study. The International Journal of Psychiatry in Medicine, 00912174221141757.

YOON, S.Y., LIM, J.H., HAN, C., 2016. Rating Scales for Measurement-Based Clinical

YOUN, MI-HYANG 2021. Press Release of the National Assembly Member, Youn Meehyang. https://blog.naver.com/mhyang530/222526236924

Practice of Depression [WWW Document]. Korean J. Psychopharmacol. http://www.koreamed.org/SearchBasic.php?RID=2287463 (accessed 1.4.21). URL

Corona Blue [WWW Document], n.d. https://www.hankookilbo.com/News/Read/A2020110113560003924 (accessed 1.4.21). URL

National Center for Mental Health Annual Mental Health Survey Report 2021. Ministry of Health and Welfare.