Stress of working abroad: a systematic review

The prevalence of common mental disorders, stress, and sleep disturbance among international migrant workers: A meta-analysis with subgroup analysis

International migrant workers face an elevated risk of common mental disorders (CMDs), stress, and sleep disturbances due to various individual, psychosocial, and occupational factors. This meta-analysis systematically evaluated the prevalence of CMDs, stress, and sleep disturbance among international migrant workers. Two independent reviewers systematically searched the literature on five electronic databases from inception to June 2022. Random effects meta-analyses were performed to estimate the pooled prevalence of depressive symptoms, anxiety symptoms, stress, and sleep disturbance among international migrant workers. Additionally, subgroup analyses were conducted to examine potential modifiers for the prevalence rates. Of 8461 records, 57 studies (n = 29,481) were included in this meta-analysis. The pooled prevalence rates of depressive symptoms, anxiety symptoms, stress, and sleep disturbance were 20.3 %, 17.8 %, 17.3 %, and 25.3 %, respectively. Subgroup analyses revealed that the prevalence of CMDs and stress was statistically significantly modified by country of destination and type of work, stress by gender and country of origin, and anxiety by migration type. Potential publication bias was observed only in the meta-analysis of stress. Most of the studies included were of moderate to high methodological quality. However, given that the included studies were predominantly cross-sectional and used non-probability sampling, the results should be interpreted with caution. This meta-analysis highlights that CMDs, stress, and sleep disturbances are prevalent among international migrant workers, posing a significant public health concern for host countries. These findings underscore the urgent need for tailored mental health interventions for specific subgroups within this population.

Generalised anxiety disorder and its determinants amongst patients with diabetes in primary healthcare clinics: a cross-sectional study in Kuwait City, 2024

BACKGROUND

Anxiety disorders are the second most common mental health disorders in terms of disability-adjusted life years and years of life lost across all age groups. A bidirectional relationship between anxiety disorders and diabetes mellitus has been documented. This study aimed to determine the prevalence of anxiety and its associated factors among patients with diabetes receiving care at public primary care clinics in Kuwait during the first quarter of 2024.

METHODOLOGY

A cross-sectional study was conducted in the first quarter of 2024 at three primary healthcare centres within the Capital Governate in Kuwait City. Adults with diabetes mellitus for longer than six months duration were requested to participate by the health promoters and the Generalised Anxiety Disorder questionnaire was shared via a mobile link/QR scan. Data were collected through self-or interviewer-administered surveys, cleaned and coded in Microsoft Excel, and analysed using STATA version 18. Descriptive analysis was initially conducted followed by bivariate and multivariate analysis with a p < 0.05 and a 95% confidence interval used to determine the association between demographic and clinical factors and GAD.

RESULTS

A total of 554 patients participated, yielding an 80% response rate. Anxiety symptoms were observed in 48% of respondents, though only 4% (n = 25) had a GAD score > 10. Among participants with moderate-to-severe anxiety (n = 21), 52% were aged 50-59 years, 90% were non-native Kuwaiti citizens, and 62% had an HbA1C measurement > 7 mmol/L. Multivariate analysis indicated that non-native Kuwait citizens were significantly more likely to have moderate-to-severe anxiety (AOR: 6.99, 95% CI: 1.42-34.43) compared to Kuwaiti nationals. Conversely, participants attending clinic visits every two months were less likely (AOR: 0.30, 95% CI: 0.00-0.50) to report moderate-to-severe anxiety symptoms than those attending monthly.

CONCLUSION

While nearly half of patients with diabetes displayed anxiety symptoms, only a small proportion (4%) experienced moderate-to-severe anxiety. Non-native Kuwaiti residents were significantly more likely to have GAD scores > 10. Integrating anxiety screening into diabetes care may improve outcomes for this high-risk group.

Job Satisfaction Among First-Generation Migrant Physicians in Anesthesiology and Intensive Care Medicine in Germany

BACKGROUND/OBJECTIVES

This study examines job satisfaction, burnout, and well-being among first-generation migrant physicians in anesthesiology and intensive care medicine in Germany, comparing them to their native German counterparts.

METHODS

A cross-sectional survey design was utilized, collecting data from 513 physicians, 110 of whom identified as having a migration background. Job satisfaction was measured using the Warr-Cook-Wall (WCW) Job Satisfaction Scale, burnout was assessed with the Copenhagen Burnout Inventory (CBI), and well-being was evaluated using the WHO-5 Well-Being Index.

RESULTS

The job satisfaction ratings revealed no significant differences between migrant and German physicians in most dimensions, including physical workload, freedom to choose work methods, satisfaction with colleagues, responsibility, income, skill utilization, and variety in work tasks. However, migrant physicians reported significantly higher satisfaction with recognition received for their work and lower dissatisfaction with working hours. Burnout assessments showed that migrant physicians experienced higher psychological strain, perceiving every work hour as more exhausting and having significantly less energy for family and friends. Migrant physicians reported higher difficulty and frustration in working with patients. Well-being items indicated that migrant physicians felt less energetic and active but found their daily life more filled with interesting activities. Notably, the multivariate analyses of the total scale scores did not show significant associations between migration background and the overall outcome scales.

CONCLUSIONS

The findings indicate unique challenges faced by migrant physicians, particularly in terms of recognition and patient-related burnout. These results highlight the need for targeted interventions to support migrant physicians, including cultural competence training and flexible working hours to enhance their job satisfaction and overall well-being. Addressing these issues is crucial for maintaining the quality of patient care and the occupational health of migrant physicians in Germany.

Occupational well-being of diplomatic personnel: a qualitative study

BACKGROUND

Diplomatic personnel face unique job demands due to their frequent relocations. There is some evidence that occupational stress contributes to poor well-being in this occupational group, but little research on the aspects of the job that are perceived to be particularly challenging.

AIMS

This study aimed to explore diplomatic personnel's perceptions of their organization and their roles and to identify aspects of the job, which could cause stress and potentially affect well-being.

METHODS

Semi-structured interviews were carried out with 24 employees of the Foreign, Commonwealth and Development Office between September 2021 and February 2022. Participants were asked to reflect on their experiences before the coronavirus disease 2019 pandemic. Thematic analysis was used to analyse data.

RESULTS

Participants enjoyed many aspects of their work including the variety, travel opportunities and feeling that they made a difference. They also identified several stressors relating to job demands, overseas postings, family needs, frequent relocation, hardship posts, workplace relationships, (lack of) appreciation and acknowledgement, and organizational culture. Good relationships with colleagues and managers were perceived to be very important.

CONCLUSIONS

Findings suggest various ways in which diplomatic organizations can better support their personnel, highlighting workload management; cross-cultural training; providing appropriate support to both accompanying families and unaccompanied staff members; practical and psychological preparation for those in high-risk locations; encouraging positive workplace relationships; good management; increased autonomy and increased recognition for good work.

Psychological Profile of Nurse Managers in the Post-COVID-19 Era: Implications for Nursing Leadership

Aim

This study examined the mental health of nurse managers in the Kingdom of Saudi Arabia.

Background

The COVID-19 pandemic has affected the physical and mental health of senior nurses, including effects of shortages of staff and medical supplies. However, no study has examined this topic among nurse managers in the Kingdom of Saudi Arabia despite their exposure to mental stress during the pandemic.

Methods

A cross-sectional design was used to investigate the levels of depression, anxiety, stress, and general psychological distress among nurse managers in Saudi Arabia. Data were collected August 2023 to February 2024. The main tool was the reliable and validated Arabic translation of the Depression, Anxiety, and Stress Scale (DASS-21). Data collection was performed using an online platform. IBM SPSS software was used for data analysis. The data was analysed using multiple regression to examine the relationship between the dependent (outcome) and independent (predictor) variables. A significant p-value was set at 0.05.

Results

Stress and general psychological distress were the most common problems among nurse managers in the post-COVID-19 era. Individual educational attainment was the only significant predictor of anxiety, stress, and general psychological distress. Moreover, the nationalities of nurse managers were correlated with stress outcomes.

Conclusions

Nursing managers are very likely to suffer from stress and general mental health problems in cases of exposure to crises. They may find the results of this study useful in understanding the factors that may play a role in the development of mental health problems during clinical work. Different strategies can be considered to alleviate depression, anxiety, and stress among managers, including the proper delegation of tasks. Top-level management and healthcare stakeholders should give special considerations to the nationality and education level upon selecting nurse mangers at different levels. Implications in Nursing Management. Policy makers involved in planning care for healthcare professionals may find this study valuable in planning for future pandemics by developing a strategy that could reduce stress and psychological distress.

Healthcare Expatriate Adjustment in Qatar: Analyzing Challenges and Opportunities

BACKGROUND

The healthcare sector in the Middle East, particularly in Qatar, relies heavily on expatriate professionals. The successful adaptation of these expatriates to the local environment is crucial as it significantly affects their job satisfaction and the quality of care they deliver to patients. This study aimed to identify and analyze the key factors influencing the adjustment of healthcare expatriates in Qatar to their professional roles and the cultural context of the region.

METHODOLOGY

This study involved the use of a cross-sectional survey approach targeting healthcare professionals in Qatar, with a targeted sample size of 385 participants selected to ensure a comprehensive representation of the expatriate workforce. The survey was disseminated through expatriate-specific WhatsApp groups from October 1, 2022, to December 31, 2022. It was structured to examine a variety of factors influencing expatriate adjustment, including age, gender, proficiency in the Arabic language, social support networks, job type, and length of stay in Qatar. The primary focus of this study is a thematic analysis of the respondents' free-text comments. These comments offer valuable insights into their experiences, both positive and negative, in adapting to life and work in Qatar.

RESULTS

This study achieved a response rate of 51.69% (199 out of 385), with participants representing 10 nationalities, being predominantly aged between 35 and 44 years, and having spent four to seven years in Qatar. The majority of respondents were nurses and doctors, accounting for 83.9% of the sample. The following five main themes emerged from the analysis of 218 free-text comments: personal and family concerns, work-related matters, government and system-related challenges, social and cultural challenges, and Arabic language challenges. Although participants valued supportive employer practices in family relocation and professional environments, they encountered language barriers, bureaucratic complexities, and cultural adaptation challenges.

CONCLUSION

The results of this study shed light on the multifaceted nature of expatriate adjustment in the healthcare sector of Qatar, highlighting the supportive elements and the obstacles encountered. They emphasize the need for comprehensive support mechanisms, including language training, streamlined bureaucratic processes, and cultural orientation programs, to facilitate successful and fulfilling expatriate experiences in the Middle Eastern healthcare context.

The impact of the COVID-19 pandemic on non-national doctors in Ireland

BACKGROUND

International doctors make up nearly half of the physicians working in Ireland and are an integral part of the health service. The COVID-19 pandemic declared in March 2020 led to a global healthcare emergency. Resulting national lockdowns precluded travel at a time of need for family support.

AIM

We aimed to measure the professional, psychosocial, and financial impact of the COVID-19 pandemic on non-EEA doctors working in Ireland.

METHODS

An 88-item online survey of demographics, well-being, and financial resilience was circulated nationally between November 2021 and January 2022. The results were analysed using RStudio and Microsoft Excel 365.

RESULTS

One hundred thirty-eight responses were received. Sixty-two percent of responders reported wishing to stay in Ireland long-term and 44% had applied for citizenship. Despite 80% of responders working in their desired speciality, only 36% were on a specialist training scheme. Forty-seven percent felt their career was affected by the COVID-19 pandemic. Seventy-three percent of respondents reported missing significant events in their home country. Over 50% reported significant mental health issues personally or in their families; however, only a minority sought professional help. Financial issues were a source of anxiety for 15% of respondents. Financial resilience was poor, 20% of respondents cited a 1-month financial reserve, 10% had a personal pension, and 9% had made a will.

CONCLUSIONS

The COVID-19 pandemic has had a multifactorial negative impact on non-national doctors working in Ireland. More must be done to offer multidimensional support to this cohort who are a crucial part of the underserviced Irish healthcare system.

Occupational Stress: A Concept Analysis with Implications for Immigrant Workers' Mental Health in the United States

Background

Occupational stress is a phenomenon affecting people worldwide. Investigating occupational stress among immigrant worker populations will unravel some of the intricacies of this condition and its psychological effects on this population.

Aim

This paper conceptually examined occupational stress within the context of immigrant workers' mental health and offer an operational definition to aid nurse researchers, educators, and practitioners in assessing and managing patients and developing culturally appropriate interventions for this population.

Design

Walker and Avant's eight-step concept analysis is used as an organizing framework.

Data Source

MEDLINE, CINAHL, OVID, PubMed, and APA Psych Info.

Review Methods

Keywords job stress, immigrant work stress, occupational stress scale, immigrant work-related stress, and mental health were used. The search yielded 142 articles; 17 were selected based on the effect of work stress on mental health.

Results

This analysis found that occupational stress can be attributed to communication problems, alienation, discrimination, and barriers to work-life balance can cause negative consequences among immigrants. An operational definition is also provided.

Conclusion

There is a growing need to examine closely and differentiate between occupational and acculturative stress to navigate a more profound understanding of how these conditions negatively complement each other.

Association between Precarious Employment and Chronic Stress: Effect of Gender, Stress Measurement and Precariousness Dimensions-A Cross-Sectional Study

Precarious employment has been highlighted as a social determinant of health, given, among others, to its alleged association with chronic stress. However, few studies have been conducted analyzing such association, using both perceived stress indicators and biological markers. Accordingly, the present study analyzed the association of multidimensional (6 dimensions) precarious employment scale with perceived stress and 23 markers of adrenal and gonadal hormone production, including cortisol. The sample consisted of 255 salaried workers from Barcelona (125 men, 130 women) aged 25-60. OLS regression models stratified by sex were conducted. Results demonstrated that precarious employment increased the probabilities of having perceived stress in both sexes. In addition, the production of adrenal hormones among men is associated with precarious wages and among women with precarious contracts ("Temporariness", "Disempowerment", and "Rights" dimensions). Therefore, precarious employment could be embodied by workers, altering their perceived well-being and physiological characteristics. Differences between men and women in the physiological effect of precarious employment could express not just the biochemical differences inherent to biological sex, but also the social construction of gender identities, positions and roles in society and family, as well as gender inequalities in the labour market.

Psychological distress among the nursing workforce in the United Arab Emirates: Comparing levels before and during the COVID-19 pandemic

BACKGROUND

Nurses make up the majority of the healthcare workforce. They contribute to the development of healthcare systems and the provision of high-quality, effective, and patient-centered healthcare services. However, nurses need good mental and emotional well-being to provide adequate care and the necessary physical and mental health support for their clients. This study aimed to determine the level of generalized psychological distress among nurses in the United Arab Emirates. As this study was initiated before the coronavirus disease 2019 (COVID-19) pandemic, we were able to compare data gathered before and during the pandemic.

METHOD

This study used a cross-sectional correlational design. The Kessler Psychological Distress Scale (K10) was used to measure generalized psychological distress. Nurses' distress levels were measured and compared before and during the COVID-19 pandemic.

RESULTS

In total, 988 participants completed the questionnaire. The majority (n = 629, 63.7%) were employed in hospitals and the remainder worked in primary healthcare settings (n = 359, 36.3%). The mean distress score was 27.1 ± 13.7; 42.1% (n = 416) of participants had a severe level of distress, and only 36.4% (n = 360) reported no distress. More participants had severe stress levels before COVID-19 (59.5%, n = 386) compared with during COVID-19 (10.9%, n = 30).

CONCLUSIONS

Participants' K10 scores suggest that nurses experience significant distress, which may compromise their ability to care for their clients. This study emphasizes the importance of supporting nurses as a preliminary step to improving patient care. Despite the pressure of working during the COVID-19 pandemic, participants' general distress scores were lower during than before the pandemic. Organizational, governmental, and global support and appreciation may have contributed to relieving the distress nurses experienced. This may be a useful ongoing approach for enhancing healthcare systems.

Prevalence of common mental health issues among migrant workers: A systematic review and meta-analysis

Previous literature has shown that migrant workers manifested higher common mental issues (especially depressive symptom) compared to local workers due to stressors such as financial constraint and lack of access to healthcare. The aim of this systematic review and meta-analysis is to summarize the current body of evidence for the prevalence of depression and anxiety among migrant workers as well as exploring the risk factors and the availability of social support for migrant workers. Seven electronic databases, grey literature and Google Scholar were searched for studies from 2015 to 2021 related to mental health, social support and migrant workers. Study quality was assessed using the Newcastle Ottawa Scale and the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). Study heterogeneity was evaluated using I2 statistics. Random effects meta-analysis results were presented given heterogeneity among studies. The search returned 27 articles and only seven studies were included in meta-analysis, involving 44 365 migrant workers in 17 different countries. The overall prevalence of depression and anxiety among migrant workers was 38.99% (95% CI = 0.27, 0.51) and 27.31% (95% CI = 0.06, 0.58), respectively. Factors such as age, biological (health issue, family history of psychiatric disorder), individual (poor coping skills), occupational (workplace psychosocial stressors, poor working condition, salary and benefits issue, abuse), environmental (limited access towards healthcare, duration of residence, living condition) and social factor (limited social support) were associated with a mental health outcome in migrant workers. The availability of social support for migrant workers was mainly concentrated in emotional type of support. A high prevalence of depression and anxiety was found among migrant workers across the globe. This finding warrants a collective effort by different parties in providing assistance for migrant workers to promote their mental well-being.

Health Status and Barriers to Healthcare Access among "Son-in-Law Westerners": A Qualitative Case Study in the Northeast of Thailand

The northeast of Thailand is well-known as a popular destination where many male Westerners marry Thai women and settle down there. However, little is known about their health and well-being. This study aims to explore the Western husbands’ health status and identify barriers hindering their healthcare access. A qualitative case study was conducted from November 2020 to May 2021. In-depth interviews and focus group discussions with 42 key informants who were involved with social and health issues among these expatriates were carried out. The social determinants framework was adapted for guiding the interviews. Data were triangulated with field notes, document reviews, and researchers’ observations. Inductive thematic analysis was applied. Results showed that most male expatriates who married Thai women in the northeast were in their retirement years and had non-communicable diseases, health risk behaviors, and mental health problems. Most of them did not purchase health insurance and held negative impressions toward Thai public hospitals’ quality of care, which was denoted as the main barrier to accessing healthcare services. Other significant barriers consisted of high treatment costs commonly charged by private hospitals and language issues. While the improvement of healthcare quality and the provision of friendly health services are important, public communication with foreign residents, especially male expatriates, is recommended to increase understanding and improve perceptions of the Thai healthcare systems. A regular population-based survey on the health and well-being of expatriates in Thailand, a cost study of a health insurance package, a survey study on willingness to pay for health insurance premiums, and a feasibility survey exploring the opportunity to establish either voluntary or compulsory health insurance among this group should be undertaken.

Burnout and work-life balance among physicians: the role of migration background

Background

We want to analyze the effect of migration background (MB) on physician burnout and work-life balance.

Methods

In September 2019, physicians from various specialties answered a questionnaire on work and health. We analyzed a subsample of 526 physicians that were working full time in a hospital, 14% with an MB and 47.9% were female.

Results

Multivariate analysis showed that physicians with an MB exhibit significantly less favorable scores on all three burnout dimensions, and this effect persisted in the regression analysis after adding age, gender, and marital status as control variables. There were no differences with regard to work-life balance.

Conclusions

To our knowledge, our study is the first one to suggest that MB plays a significant role in physician mental health. Future research will benefit from identifying the factors behind that connection, e.g., problems related to acculturation, communication and social integration, which can then be addressed by policymakers in order to maintain and improve the medical infrastructure.

Norwegian physiotherapy teachers' experience from working in a partnership project in Sudan - A case study approach

Introduction and Aims: Professionals working abroad as part of a partnership program is a central act of internationalization among higher education institutions. Little research has been carried out on this topic. The goal of this study was, therefore, to explore, describe and discuss the workplace learning factors - especially cultural factors - influencing Norwegian physiotherapy teachers, working in an international partnership project at a women's university in Sudan. Methods: The study had a qualitative case-study design, intended to provide an in-depth understanding of workplace learning processes. We used a multifaceted approach which included individual interviews and document analyses. Results: We identified individual, social and institutional factors that influenced workplace learning. Culture is decisive at all levels, and knowledge, skills and attitudes are culturally situated. The Norwegian teachers' learning was found to be dependent on both internal and external factors and the pre- and post-project periods. Conclusion: This study shows that a workplace perspective on the experience of Norwegian physiotherapy teachers gives us a better understanding of the important factors, associated with such a project. Working abroad not only requires preparation on the part of the sending and host institution but also from the person working abroad (prior to, during and after the stay abroad) if workplace learning is to occur.

Psychosocial Working Conditions and Well-Being of Migrant Workers in Spain

This study examines the relationship beween employment and psychosocial working conditions and well-being of native and migrant workers in the working population of Spain. Data from the 7th Spanish Survey of Working Conditions was used to conduct a confirmatory factor analysis (n = 8508) to identify the main latent variables that influenced well-being. Using structural equation modeling and multivariate analysis, we found different patterns and perceptions of well-being and working conditions in these two groups. We discuss the reasons for these differences and suggest directions for further research in this area.

Precarious employment and migrant workers' mental health: a protocol for a systematic review of observational studies

BACKGROUND

Precarious employment has become an urgent public health issue at a global scale with potential consequences for quality of life and health of employees, especially in vulnerable groups such as migrants. The primary aim of this systematic review is thus to analyze and summarize existing research on the association between precarious employment and migrant workers' mental health.

METHODS

We will search PubMed/MEDLINE, PsycINFO, Web of Science (from January 1970 onwards) for original articles on observational studies (e.g., cohort, case-control and cross-sectional, and qualitative) published in English, German, Turkish, and Spanish. The primary outcome will be depression and anxiety disorders. Secondary outcomes will be burnout, sleeping problems, and occupational stress. Two reviewers will independently screen all citations, full-text articles, and abstract data. Potential conflicts will be resolved through discussion. The methodological quality (or risk of bias) of individual studies will be appraised using an appropriate tool. A narrative synthesis will summarize and explain the characteristics and findings of the studies. If feasible, we will conduct random effects meta-analyses where appropriate.

DISCUSSION

This systematic review will analyze the ways in which precarious employment affects migrant workers' mental health and the process that underlies this relationship. The results from the systematic review outlined in this protocol will be of interest to labor and health professionals, policy makers, labor unions, and non-governmental organizations. Our findings may encourage and impel related policy makers to establish human-focused, safe and healthy work environments, and workplace conditions.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO, CRD42019132560.

Salivary Cortisol, Subjective Stress and Quality of Sleep Among Female Healthcare Professionals

Background

Stress is globally recognised as a risk factor impacting workers’ health and workplace safety. Women healthcare professionals are at risk for considerable stress given the demanding nature of their jobs and current working conditions. This study assessed levels of stress among women healthcare professionals using measures of their cortisol levels, subjective stress and quality of sleep.

Participants and Methods

This study used a cross-sectional design. Data were collected from 335 apparently healthy adult women healthcare professionals working in the United Arab Emirates. Participants provided morning and bedtime saliva samples for analysis of their cortisol levels. The Perceived Stress Scale, Stress Symptoms Scale, Brief Coping Scale and Pittsburgh Sleep Quality Index were used to assess perceived stress level, symptoms of stress, stress-coping strategies and sleep quality, respectively.

Results

In total, 121 (36.15%) women had impaired morning cortisol levels (below the normal range of 0.094–1.551 µg/dL) and 48 (14.3%) had impaired bedtime cortisol levels (above 0.359 µg/dL). Around 57% of women reported moderate levels of perceived stress, with the most frequently reported stress symptoms being heart rate and back/neck pain. Poor sleep quality was reported by around 60% of participating women. No significant association was found between cortisol and psychosocial measurements of stress or sleep quality. However, night shift and longer shift duration (more than 8 hrs) were significantly associated with impaired morning and bedtime cortisol levels (P ≥ 0.05). Impaired cortisol levels were strongly dependent on using adaptive coping strategies such as active coping, acceptance and seeking emotional support (P ≥ 0.05).

Conclusion

Evaluating cortisol levels and subjective stress could help to identify groups with impaired response to stress and elevated cortisol levels. Our findings support the need to examine shift work patterns and stress coping strategies in women healthcare professionals to promote their health and productivity and maintain workplace safety.