Migration and mental health on the Thailand-Burma border: a mixed methods study

Abstract Statement of problem: For individuals who migrate from Burma to Thailand, experiences during migration from Burma to Thailand, and within Thailand, and subsequent working conditions can expose them to exploitation and abuse. Existing literature on migration and mental health focuses primarily on migration from low- resource settings to industrialized settings. Methods: The qualitative phase of research employed in-depth interviews (n=61) with migrant workers, exploring the themes of experiences during migration processes and working conditions in and around Mae Sot, Thailand. These results informed development of a survey instrument designed to assess prevalence of exposure to migration and post-migration stressors, as well as symptoms of depression and anxiety, amongst three samples of migrants: migrants working in agriculture (n=203), migrants working in factories (n=258), and migrants working in the sex industry (n=128). The quantitative study utilized respondent-driven sampling, a sampling approach designed for use with hidden and marginalized populations. Quantitative analyses included mediation analysis and multivariate linear regression, to explore the prevalence of symptoms of depression and anxiety amongst the sub-samples of migrant workers, to explore the relationship between experiences of deceit during migration, coercive working conditions and mental health outcomes, depression and anxiety, and to identify post-migration experiences that are associated with increased symptoms of depression and anxiety in this sample. Results: Qualitative interviews with migrant workers on the Thailand-Burma border revealed migratory processes that often include debt, deceit, and entry into exploitative workplaces in Thailand. Migrants in various industries described experiences of forced labor, violence and abuse, and salary deductions. Mediation analysis of the whole sample indicated that the relationship between deceit during migration and depression and anxiety outcomes is partially mediated by coercive working conditions. Multivariate regression analyses showed that the impact of other working conditions, and safety and security, on depression and anxiety varied by sub-sample, and outcome. Conclusions: Aspects of migratory processes, working conditions, and safety and security amongst migrant workers working in agriculture, factories and the sex industry, have significant influence on depression and anxiety outcomes. Implications for these findings for policy, service provision and future research are discussed, including the need for integrated prevention and treatment approaches to mental health needs of this specific population, and development of frameworks to address gaps in policy and services for migrant workers within the field of global mental health