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      Migrant well-being and undocumented status in South Korea: a cross-sectional assessment of physical, psychological, social well-being, and health behaviors

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          Abstract

          Background

          A high burden of physical, mental, and occupational health problems among migrant workers has been well-documented, but data on undocumented migrant workers are limited and their well-being has rarely been compared to that of the general population.

          Methods

          Using data from a cross-sectional survey of non-professional migrant workers in South Korea in early 2021, we described their physical, psychological, social well-being and health behaviors across a wide range of outcomes, including self-rated health, occupational injury, cigarette smoking, heavy alcohol consumption, meal pattern, happiness, mental illness, social support, and social participation. The outcomes were first compared between documented and undocumented migrant workers in generalized linear regressions adjusting for potential confounders. Then, the well-being of the migrant workers was compared against that of the general population using data from the Korean Happiness Survey, which is a nationally representative survey of the South Korean general population conducted in late 2020. The parametric g-formula was performed to adjust for potential confounders.

          Results

          After adjusting for potential confounders, the undocumented migrant workers were less likely to be happy or participate in social communities, and much more likely to have anxiety or depression, smoke cigarettes, or engage in heavy alcohol consumption than the documented migrant workers. When compared to the general South Korean population, an evident social gradient emerged for happiness and mental illness; the undocumented experienced the worst outcome, followed by the documented, and then the general population. Also, the undocumented migrant workers were more likely to smoke cigarettes than the general population.

          Conclusion

          The undocumented migrant workers face considerably greater challenges in terms of mental health and happiness, demonstrate higher rates of risky health behaviors such as smoking and heavy drinking, and experience a lack of social support and community integration. A stark social gradient in happiness, mental illness, and cigarette smoking exists among the documented, undocumented migrant workers and the general population in South Korea. Socio-structural factors are likely to play a crucial role in contributing to the suboptimal level of overall well-being of undocumented migrant workers. Policy-level interventions as well as interpersonal efforts are in urgent need.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12939-024-02126-2.

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          Most cited references52

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          Controlling the False Discovery Rate: A Practical and Powerful Approach to Multiple Testing

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            Sensitivity Analysis in Observational Research: Introducing the E-Value.

            Sensitivity analysis is useful in assessing how robust an association is to potential unmeasured or uncontrolled confounding. This article introduces a new measure called the "E-value," which is related to the evidence for causality in observational studies that are potentially subject to confounding. The E-value is defined as the minimum strength of association, on the risk ratio scale, that an unmeasured confounder would need to have with both the treatment and the outcome to fully explain away a specific treatment-outcome association, conditional on the measured covariates. A large E-value implies that considerable unmeasured confounding would be needed to explain away an effect estimate. A small E-value implies little unmeasured confounding would be needed to explain away an effect estimate. The authors propose that in all observational studies intended to produce evidence for causality, the E-value be reported or some other sensitivity analysis be used. They suggest calculating the E-value for both the observed association estimate (after adjustments for measured confounders) and the limit of the confidence interval closest to the null. If this were to become standard practice, the ability of the scientific community to assess evidence from observational studies would improve considerably, and ultimately, science would be strengthened.
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              The Patient Health Questionnaire-2: validity of a two-item depression screener.

              A number of self-administered questionnaires are available for assessing depression severity, including the 9-item Patient Health Questionnaire depression module (PHQ-9). Because even briefer measures might be desirable for use in busy clinical settings or as part of comprehensive health questionnaires, we evaluated a 2-item version of the PHQ depression module, the PHQ-2. The PHQ-2 inquires about the frequency of depressed mood and anhedonia over the past 2 weeks, scoring each as 0 ("not at all") to 3 ("nearly every day"). The PHQ-2 was completed by 6000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-2 depression severity increased from 0 to 6, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and healthcare utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-2 score > or =3 had a sensitivity of 83% and a specificity of 92% for major depression. Likelihood ratio and receiver operator characteristic analysis identified a PHQ-2 score of 3 as the optimal cutpoint for screening purposes. Results were similar in the primary care and obstetrics-gynecology samples. The construct and criterion validity of the PHQ-2 make it an attractive measure for depression screening.
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                Author and article information

                Contributors
                daniel0926@snu.ac.kr
                Journal
                Int J Equity Health
                Int J Equity Health
                International Journal for Equity in Health
                BioMed Central (London )
                1475-9276
                26 February 2024
                26 February 2024
                2024
                : 23
                : 38
                Affiliations
                [1 ]JW LEE Center for Global Medicine, Seoul National University College of Medicine, ( https://ror.org/04h9pn542) Seoul, 03087 Republic of Korea
                [2 ]Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, ( https://ror.org/04h9pn542) Seoul, 03080 Republic of Korea
                [3 ]GRID grid.453481.f, ISNI 0000 0004 0379 095X, National Assembly Futures Institute, ; Seoul, 07233 Republic of Korea
                [4 ]Department of Human Systems Medicine, Seoul National University College of Medicine, ( https://ror.org/04h9pn542) Seoul, 03080 Republic of Korea
                Article
                2126
                10.1186/s12939-024-02126-2
                10895811
                38409005
                5ae77d4c-f184-489e-97b1-3e519bc3751b
                © The Author(s) 2024

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 14 August 2023
                : 10 February 2024
                Funding
                Funded by: JW LEE Center for Global Medicine
                Categories
                Research
                Custom metadata
                © BioMed Central Ltd., part of Springer Nature 2024

                Health & Social care
                immigrant,migrant worker,undocumented,health,physical well-being,health behavior,psychological well-being,social well-being,south korea

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