A comparison of DSM-5 and ICD-11 models of PTSD: Measurement invariance and psychometric validation in Filipino trauma samples.

This study examined and compared the factor structure of DSM-5 and ICD-11 PTSD models and their relationships with transdiagnostic symptoms (i.e., anxiety, depression, negative affect, and somatic symptoms) in eight trauma samples: (1) natural disaster relocatees; (2) Typhoon Haiyan survivors; (3) indigenous people exposed to armed conflict; (4) internally displaced persons due to armed conflict; (5) soldiers regularly involved in armed conflict; (6) police exposed to work-related traumatic events; (7) abused women; and (8) college students with diverse trauma experiences. Results showed that while the ICD-11 PTSD has better model fit than that of DSM-5, the DSM-5 PTSD model has stronger relationships with all transdiagnostic symptoms in almost all of the samples. The study highlights that in choosing which PTSD nomenclature to use, both the factor structure and comorbidity with other symptoms must be considered.

Investigating the Physical and Mental Health Nexus: a Network Analysis of Depression, Cardiometabolic Health, Bone Mass, and Perceived Health Status Among Filipino Domestic Workers.

BACKGROUND: Migrant domestic workers are vulnerable to physical and mental health problems given the many challenges they experience while working abroad. Using network analysis, this study examined the structure of depression, cardiometabolic health indicators (BMI, waist-hip ratio (WHR), blood pressure, and heart rate), bone mass, and perceived health status in this population. The network model allowed for an examination of central symptoms or symptoms with the most direct connections with other symptoms; bridge symptoms, or symptoms that link two or more communities; and edges, or relationships among symptoms. METHOD: Cross-sectional data were gathered from 1375 Filipino domestic workers in Macao (SAR), China. Data from a subsample of 510 participants who met a cutoff indicating depression were analyzed. Anthropometric measurements and surveys were used to collect data, which was analyzed using R statistical software. RESULTS: Results showed four community clusters: three communities consisted of at least two depression symptoms each and the fourth community included physical health indicators. Strong edges were formed between BMI-bone mass, psychomotor-concentration, BMI-WHR, and sad mood-anhedonia. The node with the highest expected influence was BMI. There were three bridges: worthlessness, psychomotor difficulties, and concentration difficulties. CONCLUSION: The link between depression, cardiometabolic indicators, bone mass, and poor perceived health reinforces the need to address multimorbidity within migrant populations. Health promotion interventions that address mental and physical health may improve the health of this population.

Evaluating the Implementation of a Mental Health App for Overseas Filipino Workers in Macao China: A Mixed-Methods Study of Stakeholders' Perspectives.

Background: Overseas Filipino workers (OFWs) is one of the largest communities of international migrant workers. They face systemic barriers to fulfilling their health needs. The COVID-19 pandemic worsened this condition and provided a context to evaluate the utility of a digital mental health intervention delivered within a stepped-care model to address OFW mental health. Using an implementation science framework, this study aimed to evaluate stakeholders' perspectives on the implementation of Kumusta Kabayan, a mobile phone-based mental health app, for OFWs in Macao. Methods: A mixed-methods convergent design was used by conducting two parallel steps, including quantitative and qualitative measures. The quantitative data was collected from Filipino team members and local non-governmental organization (NGO) staff members (N = 12). The qualitative data were gathered from interviews with OFWs in Macao who used the app (N = 25; 80% females, 76% domestic workers). Results: From the online survey, the staff members of the local partner NGO and the Filipino team members strongly perceived that their organization could adapt Kumusta Kabayan to their program and generally evaluated that Kumusta Kabayan achieved its goal and was received well by OFWs. In the interviews, the OFW app users shared their experiences in using Kumusta Kabayan, which was thematically organized into six aspects of the participants' experience: (1) promotional channel and expectation; (2) when to use the app and in what language; (3) lessons learnt; (4) memorable aspects; (5) key facilitators and barriers; and (6) suggestions. Conclusion: Kumusta Kabayan was well accepted and shows potential to be integrated into the existing support services for OFWs in Macao. This app has the promise of being scaled-up for OFWs in other countries by collaborating with local and overseas stakeholders. Lessons learnt from this evaluation could also be implemented in wider digital mental health services in different settings.

Exploring resilience processes of Filipino migrant domestic workers: A multisystemic approach.

This study identified resilience processes at the individual, family, and community levels among Filipino migrant domestic workers (MDWs). Resilience processes highlight strengths and resources that can enhance positive adaptation to problems that affect this vulnerable migrant group. Data came from focus groups and key informant interviews involving 27 MDWs and 7 key informants. Data was analyzed using thematic analysis and organized according to the socioecological model. Results revealed 7 resilience processes. Financial coping, health management, and spirituality were found across levels. Companionship and emotional support are transacted within family and community levels, whereas expanding knowledge and support occurs at individual and community levels. MDWs and their families prioritize each family member, whereas the community provides legal support. Resilience processes exist across ecological levels. However, individual resilience processes are insufficient, thus necessitating collective agency through familial and community resilience processes and building social structures that facilitate resilience.

Migrant domestic workers' character strengths and the role of work-related factors: A strengths-based perspective.

Most studies on migrant domestic workers (MDW) focus on their problems and vulnerabilities, whereas not much is known about their positive attributes and character strengths. Hence, this study intends to deviate from the usual deficit-based view of MDW, which portrays them as victims, to a strengths-based perspective, which highlights their character strengths. In this study, we examined MDW's character strengths (i.e. positive human attributes that contribute to the thriving of oneself and others) and work-related factors associated with it. The participants of the study were 631 Filipino female MDW in Hong Kong. We examined how work-related factors (employer support and working conditions) predicted different character strength domains (courage, humanity, justice, moderation, transcendence and wisdom) through strengths use. Results of structural equation modelling revealed that employer support consistently predicted all six domains of character strengths through increased strengths use. These findings highlight the important role of employer support on MDW's character strengths. More importantly, it can raise critical awareness on MDW's strengths and well-being, and provide a platform for future strengths-based programmes and policies.

A network analysis investigation of the comorbidity between sleep dysfunction and PTSD symptomatology among Filipino domestic workers in Macao (SAR) China.

Posttraumatic stress disorder (PTSD) is highly comorbid with sleep dysfunction. This association was previously explained based on cognitive and emotional dysfunction. The current study extends this literature by investigating the symptom level comorbidity of sleep dysfunction and DSM-5 PTSD utilizing a network approach. Participants were trauma-exposed female Filipino domestic workers (N = 1241). Network analysis was applied to 23 items: 18 items from PCL-5 measuring PTSD (Community 1) and 5 items from PSQI assessing sleep dysfunction (Community 2). The results showed that the symptoms within each community had the strongest correlations. Bridge connections were identified between the sleep dysfunction and PTSD symptom communities. Symptoms with the highest bridge strength were concentration difficulties, recklessness, irritability, and sleep disturbance. This is among the first studies investigating the comorbidity between PTSD and sleep dysfunction from the network approach. Future interventions may be developed that emphasize the bridge symptoms to address comorbidity among trauma exposed migrants.

A digital mental health intervention to reduce depressive symptoms among overseas Filipino workers: protocol for a pilot hybrid type 1 effectiveness-implementation randomized controlled trial.

BACKGROUND: The current pilot randomized controlled trial (RCT) protocol will comprehensively describe the implementation of a culturally adapted Filipino version of the World Health Organization Step-by-Step (SbS-F) program, unguided online psychological intervention for people with depression based on behavioral activation, among overseas Filipino workers (OFWs) in Macao (Special Administrative Region). The main objective of this pilot study is to explore the preliminary effectiveness of the SbS-F program to decrease participant-reported depressive symptoms compared to enhanced care as usual (ECAU); and the secondary objectives are to explore the preliminary effectiveness of the SbS-F to decrease participant-reported anxiety symptoms and improve wellbeing, and to evaluate the potential for SbS-F implementation in real-world settings. METHODS: This trial will follow an effectiveness-implementation hybrid type 1 trial design and utilize the Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to accelerate the translation of clinical research into more effective implementation strategies and policies. Participants will be randomized 1:1 to control and treatment groups. Control group participants will receive ECAU that consists of brief depression psychoeducation and referral to local community partners. Treatment group participants will receive a 5-session of digital intervention through a mobile phone application. The primary outcome (depression) and psychological secondary outcomes (anxiety symptoms and wellbeing) will be measured using validated instruments. To evaluate study implementation, an embedded mixed-methods design will be used to collect data from various stakeholders. Data then will be analyzed using intention to treat principle and reported following the Consolidated Standards of Reporting Trials (CONSORT) guideline. DISCUSSION: This study will provide important new knowledge about the preliminary effectiveness of SbS-F, a mobile application, as a digital mental health intervention and its scalability. If SbS-F shows positive results among OFWs in Macao, it has strong potential to be used by OFWs in other countries that may also experience depression and difficulty accessing mental health services. TRIAL REGISTRATION: Prospective registration, Chinese Clinical Trial Registry (ChiCTR2000034959) on 26/07/2020.

Narrative identities of overseas Filipino domestic worker community in Macao (SAR) China.

Domestic workers comprise roughly one-fourth of the total number of overseas Filipino workers (OFWs). They leave the Philippines primarily to provide financial assistance to their families they leave behind. Most of the existing studies investigated the problems they experience at work and with their families. Some studies focused on how they cope with these problems. However, little is known about the narrative identities of this group of labor migrants. This study addresses this gap by identifying the narrative identities of the community of Filipino domestic workers in Macao Special Administrative Region, China. This study utilized qualitative interviews to plot the identities into a three-part timeline: Premigration, during migration, and imagined future. Results show that, before migration, the community of domestic workers identifies as hands-on mothers and inadequate mothers. During migration, work- and family-related identities are present: Modern-day slave, inadequate, fighter, self-sacrificing, employer's family, and hands-on mother. In an imagined future, the community of domestic workers identifies as successful retired OFWs, reconciled life partners, hands-on mothers, and inadequate mothers. Findings highlight the multiple, interacting identities in community narratives and their corresponding effects on experiences. Implications on policies and programs for this labor migrant group are discussed.

The network structure of posttraumatic stress disorder among Filipina migrant domestic workers: comorbidity with depression.

Background: Labour migrants are exposed to potentially traumatic events throughout the migration cycle, making them susceptible to developing mental disorders. Posttraumatic stress disorder (PTSD) is often comorbid with depression. Comorbidity worsens the course of illness, prognosis, treatment response, and increases suicidal risk. Using network analysis, this study examined the structure of PTSD and depression in a sample of migrant domestic workers, an especially vulnerable community of labour migrants. This study sought to derive the central or most important symptoms, strongest edges or relationships among symptoms, and bridge symptoms between PTSD and depression. Methods: Data were obtained from 1,375 Filipina domestic workers in Macao SAR, China. Data from a subsample of 1,258 trauma-exposed participants were analysed using R software. Results: Most of the strongest edges were within the same disorder and, for PTSD, within the same symptom cluster. Highest node centrality were PCL-5's 'avoid thoughts', 'lose interest', 'negative emotions', and 'not concentrate', and PHQ-9's 'sleep difficulties'. The bridge symptoms were PHQ-9's 'sleep difficulties,' 'psychomotor agitation/retardation,' and 'fatigue,' PCL-5's 'not concentrate', and PHQ-9's 'worthlessness' and 'anhedonia'. Limitations: Results may not generalize to Filipino migrant workers in other occupations and to male migrant workers. Potentially relevant symptoms like somatic symptoms and fear of somatic and mental symptoms were not included. Conclusions: Central and bridge symptoms are the most important nodes in the network. Developing interventions targeting these symptoms, particularly depression symptoms, is a promising alternative to PTSD treatment given substantial barriers to specialist care for this population.

Antecedentes: Los trabajadores migrantes están expuestos a eventos potencialmente traumáticos durante el ciclo migratorio, tornándolos susceptibles de desarrollar trastornos mentales. El trastorno de estrés postraumático (TEPT) es frecuentemente comórbido con la depresión. La comorbilidad empeora el curso, pronóstico y respuesta al tratamiento de la enfermedad, e incrementa el riesgo suicida. Empleando el análisis en redes, este estudio evaluó la estructura del trastorno de estrés postraumático y la depresión en una muestra de trabajadoras domésticas migrantes, una comunidad especialmente vulnerable de trabajadores migrantes. Este estudio buscó encontrar los síntomas centrales o más importantes, las aristas o relaciones más fuertes entre síntomas, y los síntomas puente entre el TEPT y la depresión.Métodos: Se obtuvo la información de 1375 trabajadoras domésticas filipinas en la Región Administrativa Especial de Macao, China. La información de un subgrupo de 1258 participantes expuestos a trauma fue analizada empleando el lenguaje de programación R.Resultados: La mayoría de las aristas más fuertes se encontraban dentro del mismo trastorno y, para el TEPT, dentro del mismo racimo de síntomas. Los más altos en centralidad fueron 'evitar pensamientos', 'pérdida de interés', 'emociones negativas', y 'falta de concentración' de la Lista de Chequeo de Síntomas Postraumáticos para el DSM-5 (PCL-5, por sus siglas en inglés), y 'dificultades en el sueño' del Cuestionario sobre la Salud del Paciente (PHQ-9, por sus siglas en inglés). Los síntomas puente fueron 'dificultades en el sueño', 'agitación/retraso psicomotor' y 'fatiga' del PHQ-9, 'falta de concentración' de la PCL-5, e 'inutilidad' y 'anhedonia' del PHQ-9.Limitaciones: Los resultados pueden no ser generalizables a trabajadores migrantes filipinos de otras ocupaciones, y a trabajadores migrantes varones. No se incluyeron síntomas potencialmente relevantes, tales como síntomas somáticos, y miedo a los síntomas somáticos y mentales.Conclusiones: Los nodos más importantes en las redes fueron los síntomas centrales y los síntomas puente. Una alternativa promisoria para tratar estos síntomas es el desarrollar intervenciones específicas para estos, en particular hacia síntomas depresivos, dadas las barreras sustanciales para el acceso a tratamiento especializado para esta población.

Psychometric Validation of PHQ-9 and GAD-7 in Filipino Migrant Domestic Workers in Macao (SAR), China.

There are 500,000 female Filipino domestic workers worldwide. However, there are no validated instruments to assess common mental disorders in this population. The Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) are brief measures that could be effective screeners for depression and anxiety in domestic workers. This study aims to establish reliability and validity of the Filipino versions of the PHQ-9 and GAD-7. In Study 1, 131 domestic workers completed the PHQ-9, GAD-7, and other questionnaires with a test-retest interval of 10 days. Convergent validity was examined using measures of posttraumatic stress disorder, direct exposure to traumatic events, and rumination. Discriminant validity was assessed using measures of discrimination, pain, social support, and indirect exposure to traumatic events. In Study 2, criterion validity was established with another sample of domestic workers (N = 100) using clinician-administered Mini International Neuropsychiatric Interviews. Receiver operating characteristic (ROC) curve analysis was performed to evaluate diagnostic efficiency. Results showed acceptable and high internal consistency for PHQ-9 and GAD-7, respectively. Both had acceptable test-retest reliability. Convergent and discriminant validity were also established. ROC curve results demonstrated that optimal cut scores for PHQ-9 and GAD-7 are 6 and 7, respectively. The Filipino versions of PHQ-9 and GAD-7 are reliable and valid for use among Filipino domestic workers.

Perspectives of adolescent and young adults on poverty-related stressors: a qualitative study in Ghana, Malawi and Tanzania.

OBJECTIVES: To define key stressors experienced and coping behaviours within poor agrarian communities in sub-Saharan Africa. DESIGN: Descriptive qualitative study incorporating inductive thematic analysis. PARTICIPANTS: 81 participants purposely sampled, stratified by age (adolescents and young adults) and sex SETTING: The study was conducted in villages in Ghana, Malawi, and Tanzania. RESULTS: Stressors were thematically grouped into those directly related to poverty and the lack of basic necessities (eg, food insecurity), and additional stressors (eg, drought) that worsen poverty-related stress. Impacts on functioning, health and well-being and key coping behaviours, both positive and negative, were identified. The findings together inform a more nuanced view of stress within these contexts. CONCLUSION: Although participants were asked to provide general reflections about stress in their community, the salience of poverty-related stressors was ubiquitously reflected in respondents' responses. Poverty-related stressors affect development, well-being and gender-based violence. Future research should focus on interventions to alleviate poverty-related stress to achieve the United Nations Sustainable Development Goals.

Cultural Adaptation of a Scalable World Health Organization E-Mental Health Program for Overseas Filipino Workers.

BACKGROUND: Electronic mental (e-mental) health interventions can address mental health needs of different populations. Cultural adaptation of these interventions is crucial to establish a better fit with the cultural group and to achieve better treatment outcomes. OBJECTIVE: This study aimed to describe the cultural adaptation of the World Health Organization's e-mental health program Step-by-Step for overseas Filipino workers. We used a framework which posits that cultural adaptation should enhance (1) relevance, wherein the cultural group can relate with the content; (2) acceptability, where the cultural group will not find any element offensive; (3) comprehensibility, where the program is understandable; and (4) completeness, wherein the adapted version covers the same concepts and constructs as the original program. We aimed to have English and Filipino and male and female versions. METHODS: Overall, 3 experienced Filipino psychologists provided their perspectives on the program and how it might be adapted for overseas Filipino workers. We then adapted the program and obtained feedback from 28 overseas Filipino workers from diverse industries through focus group discussions. We conducted 7 and 9 focus group discussions with male and female participants, respectively. Per discussion, cognitive interviewing was used to probe for relevance, acceptability, comprehensibility, and completeness of illustrations and text. Participant feedback guided iterative program adaptations, which were again shown to participants for validation and improvement. RESULTS: Several issues were raised by participants about the generic version of Step-by-Step. There were elements deemed irrelevant, like unfitting characters, lack of Filipino values, and unsuitable problems and activities. There were unacceptable components that were stigmatizing, political, inappropriate to context or subgroups, and too feminine for male users. Some elements were incomprehensible, unclear, or complicated. To address these issues, we made key adaptations. To enhance relevance, we adapted the narrative to match the experiences of overseas Filipino workers, incorporated Filipino values, and illustrated familiar problems and activities. To increase acceptability, our main characters were changed to wise elders rather than health professionals (reducing mental health and help-seeking stigma), political or unacceptable content was removed, and the program was made suitable for overseas Filipino workers from different sectors. To increase comprehension, we used English and Filipino languages, simplified the text to ease interpretation of abstract terms, and ensured that text and illustrations matched. We also used Taglish (ie, merged English and Filipino) when participants deemed pure Filipino translations sounded odd or incomprehensible. Finally, we retained the core elements and concepts included in the original Step-by-Step program to maintain completeness. CONCLUSIONS: This study showed the utility of a 4-point framework that focuses on acceptance, relevance, comprehensibility, and completeness in cultural adaptation. Moreover, we achieved a culturally appropriate adapted version of the Step-by-Step program for overseas Filipino workers. We discuss lessons learned in the process to guide future cultural adaptation projects of e-mental health interventions.

Exploring comorbidity between anxiety and depression among migrant Filipino domestic workers: A network approach.

BACKGROUND: Depression and anxiety are comorbid. From the network model perspective, comorbidity is due to direct interactions between depression and anxiety symptoms. These interacting symptoms are called bridge symptoms, suppression of which is expected to halt other symptoms. This study investigates the network structure of depression, anxiety, and bridge symptoms in a sample of migrant domestic workers, who are among the most vulnerable and marginalized groups of workers. METHOD: Data were collected from 1375 Filipino domestic workers in Macao Special Administrative Region, China. Data from a subsample of 355 consisting of participants who met criteria for depression and anxiety were used in analysis. R software was used to estimate the network. RESULTS: The eight strongest edges were between items from the same disorder. Six were between depression symptoms, like "concentration difficulties" and "psychomotor agitation/retardation," and "psychomotor agitation/retardation" and "thoughts of death." Two were between anxiety symptoms, including "worry too much" and "trouble relaxing." For centrality indices, "fatigue" had highest strength and closeness, and "restlessness" had highest betweenness. Results revealed three bridge symptoms: "fatigue," "depressed mood," and "anhedonia." LIMITATIONS: The results may not generalize to the entire Filipino population. Further, while the centrality index of strength had adequate stability, it was not highly stable. CONCLUSIONS: The current study highlighted critical transdiagnostic bridge symptoms as specific candidates for intervention. "Psychomotor agitation/retardation" was identified as key priority due to its association with suicidal ideation. Systemic multilevel interventions at the person-level (e.g., cognitive therapy and behavioral activation), and at the structural and policy-level to alleviate psychosocial stressors, could be applied to address disorder comorbidity in this population.

Psychometric validation of the PTSD Checklist-5 among female Filipino migrant workers.

Migrant populations are at increased risk for exposure to traumatic life events. Presently, there are no reliable and valid screening instruments for posttraumatic stress disorder (PTSD) among Filipino migrant workers, a population that numbers over 2.3 million worldwide. This study evaluated the psychometric properties of the PTSD Checklist for DSM-5 (PCL-5) in a sample of female Filipino migrant workers in Macao (SAR), China, in two studies. The first examined the reliability (internal and test-retest), convergent validity (with depression, anxiety, and rumination), and discriminant validity (with pain and social support) in a sample of 131 participants. The second study established criterion validity of the PCL-5 using the PTSD module of the Mini-International Neuropsychiatric Interview (MINI), delivered by a female Filipino psychologist as the criterion, in a sample of 100 participants. Results indicated excellent internal consistency (Cronbach's alpha = 0.95) and moderate 10-day test-retest reliability (ρ = 0.58, p < .001). PCL-5 scores correlated strongly with scores on measures of depression (ρ = 0.71, p < .001), anxiety (ρ = 0.61, p < .001), and rumination (ρ = 0.68, p < .001), supporting convergent validity. Discriminant validity was demonstrated by a weaker association with scores on measures of pain (ρ = 0.33, p < .001) and social support (ρ = -0.11, p = .22). The diagnostic accuracy of the scale was good (AUC = 0.87). The optimal cutoff score of 25 optimized sensitivity (0.89) while maintaining adequate specificity (0.73), with a weighted Kappa of κ[1]) = 0.82. Our results demonstrated that the PCL-5 is a reliable and valid screening instrument for use among female Filipino migrant workers.

Las poblaciones migrantes tienen un mayor riesgo de exposición a eventos traumáticos en la vida. Actualmente, no hay instrumentos de detección fiables y válidos para el trastorno de estrés postraumático (TEPT) entre los trabajadores migrantes filipinos, una población que cuenta con más de 2,3 millones en todo el mundo. Este estudio evaluó las propiedades psicométricas de la Lista de chequeo-5 para TEPT según el DSM-5 (PCL-5) en una muestra de trabajadoras migrantes filipinas en Macao (SAR), China, en dos estudios. El primero examinó la confiabilidad (reevaluación interna y de prueba), la validez convergente (con depresión, ansiedad y rumiación) y la validez discriminante (con dolor y apoyo social) en una muestra de 131 participantes. El segundo estudio estableció la validez de criterio del PCL-5 utilizando el módulo TEPT de la Entrevista Internacional Neuropsiquiátrica Mini (MINI) aplicado por una psicóloga filipina como criterio, en una muestra de 100 participantes. Los resultados indicaron una excelente consistencia interna (alfa de Cronbach 0.95) y moderada fiabilidad de 10 días de prueba-reevaluación (ρ = 0.58, p <0.001). Las puntuaciones de PCL-5 se correlacionaron fuertemente con las puntuaciones en las medidas de depresión (ρ = 0.71, p <0.001), ansiedad (ρ = 0.61, p <0.001) y rumiación (ρ = 0.68, p <0.001), apoyando la validez convergente. La validez discriminante se demostró por una asociación más débil con las puntuaciones en las medidas del dolor (p= 0.33, p<0.001) y apoyo social (p= −0.11, p= 0.22).La precisión diagnóstica de la escala fue buena (AUC = 0.87). El punto de corte óptimo de 25 sensibilidad optimizada (0,89) manteniendo una especificidad adecuada (0,73), con un Kappa ponderado de κ [1]) = 0,82. Nuestros resultados demostraron que el PCL-5 es un instrumento de detección confiable y válido para el uso entre trabajadoras migrantes filipinas.

Work life, relationship, and policy determinants of health and well-being among Filipino domestic Workers in China: a qualitative study.

BACKGROUND: Overseas Filipino workers (OFWs) comprise one of the largest populations of migrant workers globally. Within China, they represent the largest group of imported domestic workers. Little is known about their working conditions or how this might affect their health and wellbeing. METHODS: This qualitative study explored the working conditions and risk factors for poor health in a sample of temporary female Filipino domestic workers in Macao, China. Focus group discussions with female domestic workers (n = 22) and in-depth interviews with key informants (n = 7) were conducted. RESULTS: Domestic workers reported physical (e.g., hypertension, chronic pain, diabetes, poor sleep), and mental health problems (depression, anxiety), and addictive behaviors (gambling, alcohol misuse), along with significant structural, linguistic, financial, and cultural barriers to healthcare access to address these concerns. Adverse working conditions including poor treatment and abuse by employers, lack of privacy and inadequate sleeping areas in employers' homes or in crowded boarding houses, language barriers, inadequate and poor enforcement of labor protections, and discrimination. Domestic workers also cited exorbitant agency fees and remittances causing significant financial stress. Kinship network ties with family members back home were fraught with infidelity, difficulty parenting, misuse of remittances, and family misconceptions of domestic workers' situation abroad. Lack of quality social support and peer social networks exacerbated these conditions. CONCLUSIONS: In this sample of Filipino migrant domestic workers, stressors experienced within the host country were commonly reported. Indebtedness and low salaries limits social mobility. Psychosocial and policy-level interventions are needed to improve the health and wellbeing of this population of migrant women.

Correlates of expected eMental Health intervention uptake among Filipino domestic workers in China.

BACKGROUND: Transnational migrant populations face critical barriers to mental health service utilization that perpetuate mental health disparities globally. Overseas Filipino workers (OFWs) number over 2 million globally and 25% are female domestic workers. Structural barriers prevent equitable access to mental health services for this population. Electronic mental health (eMental Health) intervention is a scalable alternative to face-to-face treatment. The current study sought to identify key correlates of intention to use eMental Health within a community of female Filipino domestic workers living and working in Macao (SAR), China. METHODS: Respondent-driven sampling implemented at a community field site was used to reach a sample of 1364 female domestic workers. A multivariable adjusted partial proportional-odds (PPO) model was used to assess relevant correlates of intent to use eMental Health. RESULTS: The majority (62.8%) reported being likely to utilize eMental Health. The adjusted PPO model showed that younger age (18-25, 26-35, 36-45 v. over 55), longer time as an OFW, being likely (v. neutral and unlikely) to seek professional services, willingness to pay for services (v. not), belief that mental health services are a priority (v. low priority), having access to Wi-Fi outside the employer's home (v. not), and higher levels of social support were associated with increased odds of intent to use eMental Health. CONCLUSIONS: eMental Health is a promising intervention with high potential for uptake among OFWs. The majority of the study population owned a smartphone and were able to connect to the Internet or Wi-Fi. Future work will rigorously evaluate eMental Health programs for use among OFWs.

Towards a model of resilience for transnational families of Filipina domestic workers.

Many Filipinos experience poverty and poor employment opportunities. In order to alleviate poverty and provide sufficient resources for their families, numerous mothers leave the Philippines to become domestic workers. The present study aimed to build a model of family resilience for transnational families. A total of 33 participants consisting of Filipino transnational families, domestic workers, and key informants participated in a series of focus group discussions and interviews. A new model of resilience among transnational families of Filipina domestic helpers was created using a constructivist grounded theory approach. The model highlighted how temporal and spatial elements are embedded in collective migration experiences. Family narratives begin with the sacrifice of separation, where mothers leave their families for a chance to solve economic problems. To successfully adapt to their separation, the families undergo five relational processes. First, families communicate across space using technology to bridge relational distance. Second, families restructure across space through role sharing and the validation of each other's efforts in their family roles. Third, families rebuild ties through temporary family reunification that bridge physical and relational distance. Fourth, families have the collective goal of permanent family reunification by ending migration to become complete again. Fifth, they strive to commit to their families by prioritizing them instead of succumbing to difficulties. Family resilience for transnational migrants is a collectivistic process, negotiated by each family member.

Relations between harsh discipline from teachers, perceived teacher support, and bullying victimization among high school students.

This study examined how the experience of harsh discipline from teachers is related to students' experience of bullying victimization in a Philippine high school. Respondents were 401 first- to fourth-year high school students of an urban public school in the Philippines. Using structural equation modeling, a hypothesized model with direct associations between harsh discipline and bullying victimization, and an indirect path via students' perception of teacher support, was tested. The data adequately fit the model and showed that experiences of harsh teacher discipline predicted higher bullying victimization and students' negative perception of teacher support. There were no significant indirect effects. The findings suggest that school discipline strategies may have repercussions on students' behaviors and relationships, highlighting the teacher's role in modeling and setting norms for acceptable behaviors. Future studies can examine further how teachers' harsh or positive discipline behaviors relate to bullying.