Introduction Worldwide, COVID-19 clusters have emerged within communities of international migrant workers operating in high-density work and living environments. Despite their increased vulnerability, no study has documented the mental health burden of COVID-19 amongst these groups. To address this gap, we conducted a survey of migrant workers involved in large-scale dormitory outbreaks within Singapore. Methods Between 22 June to 11 October 2020, questionnaires were distributed to 1011 migrant workers undergoing extended movement restrictions. Mental health symptoms were measured using the 21-item Depression, Anxiety and Stress Scale (DASS-21). As covariates, we assessed participants’ socio-demographics, quarantine status, COVID-19 health concerns, financial stability, and exposure to news and misinformation. Linear regression models were fitted to identify factors associated with DASS-21 scores. Results Complete movement restrictions were associated with increased depression and stress symptoms, while being diagnosed with COVID-19 was associated with increased anxiety. Participants who harboured fears about their health or job, perceived their health to be poorer, or had greater exposure to COVID-19 rumours reported higher depression, anxiety, and stress levels. Across the cohort, rates of severe or extremely severe depression (3.1%, 95% CI: 2.1-4.3%), anxiety (4.1%, 95% CI: 2.9-5.5%), and stress (1.3%, 95% CI: 0.7-2.2%) were similar to those observed in the general population for the host country (Singapore). Conclusions As the first mental health survey of low-waged migrant workers during the pandemic, our findings provide a basis to identify and support at-risk individuals. This is critical as migrant workers often have limited access to healthcare services. At the same time, we documented resilience within the cohort as a whole.

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SummaryBackgroundIn the COVID-19 pandemic, international migrant workers have faced increased vulnerability on account of their status. This study examined the mental health burden of COVID-19 amongst low-waged migrant workers involved in large-scale dormitory outbreaks within Singapore.MethodsBetween 22 June to 11 October 2020, questionnaires were distributed in-person and online to 1011 migrant workers undergoing movement restrictions. Mental health symptoms were measured using the 21-item Depression, Anxiety and Stress Scale (DASS-21). As covariates, we assessed participants’ socio-demographics, quarantine status, COVID-19 health concerns, financial stability, and exposure to news and misinformation. Linear regression models were fitted to identify factors associated with each DASS-21 subscale.FindingsComplete movement restrictions were associated with increased depression and stress symptoms, while being diagnosed with COVID-19 was associated with increased anxiety. Participants who harboured fears about their health or job, perceived their health to be poorer, or had greater exposure to COVID-19 rumours reported higher depression, anxiety, and stress levels. Across the cohort, rates of severe or extremely severe depression (3.1%, 95% CI: 2.1-4.3%), anxiety (4.1%, 95% CI: 2.9-5.5%), and stress (1.3%, 95% CI: 0.7-2.2%) were similar to those observed in the general population for the host country (Singapore).InterpretationThe risk factors identified underscore how the ongoing pandemic may impact the mental health of migrant workers. At the same time, we observed resilience within the cohort, with no evidence of increased symptomology (relative to the general population).FundingJY Pillay Global Asia GrantResearch in ContextEvidence before this studyWe searched PubMed and Google Scholar for articles published in English between Jan 1, 2020 and Feb 20, 2021 using the following keywords: (“COVID*” OR “coronavirus”) AND (“mental*” OR “psychiatr*”) AND (“labo*r migra*” OR “migrant work” OR “foreign-work” OR “immigrant work” OR “economic migra*” OR “economic immigra*”). Focusing on international migrant workers employed in low-wage manual labour positions, we identified commentaries and interview-based studies describing the stressors faced by workers during the COVID-19 pandemic. However, we found no study documenting mental health symptoms within this group.Added value of this studyTo our knowledge, this is the first mental health survey of low-wage migrant workers during the COVID-19 pandemic. We observed that the mental health burden was highest amongst participants who encountered pandemic-related adversities (complete movement restrictions, testing positive for COVID-19), perceived the situation negatively (being fearful of their health or job, or judging their health to be poorer), or had higher exposure to COVID-19 rumours.Implications of the available evidenceOur findings provide a basis to identify and support at-risk migrant workers during the pandemic. Although we did not observe elevated rates of depression, anxiety, and stress symptoms within the migrant worker cohort, individual workers who experience poor mental health may find it harder to access health-care services (relative to the general population). Correspondingly, targeted support for at-risk migrant workers may serve to reduce mental health inequalities.

Background Worldwide, social media traffic increased following the onset of the COVID-19 pandemic. Although the spread of COVID-19 content has been described for several social media platforms (eg, Twitter and Facebook), little is known about how such content is spread via private messaging platforms, such as WhatsApp (WhatsApp LLC). Objective In this study, we documented (1) how WhatsApp is used to transmit COVID-19 content, (2) the characteristics of WhatsApp users based on their usage patterns, and (3) how usage patterns link to COVID-19 concerns. Methods We used the experience sampling method to track day-to-day WhatsApp usage during the COVID-19 pandemic. For 1 week, participants reported each day the extent to which they had received, forwarded, or discussed COVID-19 content. The final data set comprised 924 data points, which were collected from 151 participants. Results During the weeklong monitoring process, most participants (143/151, 94.7%) reported at least 1 COVID-19–related use of WhatsApp. When a taxonomy was generated based on usage patterns, around 1 in 10 participants (21/151, 13.9%) were found to have received and shared a high volume of forwarded COVID-19 content, akin to super-spreaders identified on other social media platforms. Finally, those who engaged with more COVID-19 content in their personal chats were more likely to report having COVID-19–related thoughts throughout the day. Conclusions Our findings provide a rare window into discourse on private messaging platforms. Such data can be used to inform risk communication strategies during the pandemic. Trial Registration ClinicalTrials.gov NCT04367363; https://clinicaltrials.gov/ct2/show/NCT04367363

BackgroundIn the coronavirus disease (COVID-19) pandemic, confidence in the government and access to accurate information have been critical to the control of outbreaks. Although outbreaks have emerged amongst communities of international migrant workers worldwide, little is known about how they perceive the government’s response or their exposure to rumors.MethodsBetween 22 June to 11 October 2020, we surveyed 1011 low-waged migrant workers involved in dormitory outbreaks within Singapore. Participants reported their confidence in the government; whether they had heard, shared, or believed widely-disseminated COVID-19 rumors; and their socio-demographics. Logistic regression models were fitted to identify factors associated with confidence and rumor exposure.Results1 in 2 participants (54.2%, 95% CI: 51.1-57.3%) reported that they believed at least one COVID-19 rumor. This incidence was higher than that observed in the general population for the host country (Singapore). Nonetheless, most participants (90.0%, 95% CI: 87.6-91.5%) reported being confident that the government could control the spread of COVID-19. Age was significantly associated with belief in rumors, while educational level was associated with confidence in government.ConclusionsOur findings suggest that language and cultural differences may limit the access that migrant workers have to official COVID-19 updates. Correspondingly, public health agencies should use targeted messaging strategies to promote health knowledge within migrant worker communities.