Psychological distress and quality of community life among migratory construction workers in India

INTRODUCTION

The movement of people from one place to another has existed throughout human civilization. The decision on whether to move, how, and where to go is complex and could be driven by several factors.^[1] The National Sample Survey Organization (NSSO) estimated that 326 million of the population are migrants.^[2] According to the Census of India, 31.16% of the urban population are migrants and nearly 20.5 million people migrate annually to urban areas.^[3]

The NSSO reported that seasonal and short-term migrants are young and they are 15–29 years age group.^[2] In the development sector, the construction industry is India’s second-largest generator of the labor force, with 40 million migrants,^[4] most of whom are seasonal and short-term migrants.^[5] This sector attracts and employs many, especially unskilled or semi-skilled manual laborers. However, studies have found that most short-term migrants belong to socioeconomically disadvantaged groups, with basic educational attainment, limited assets and resources, debt cycles, agricultural losses, and huge expenditures on family and social ceremonies.^[5,6]

Migration interrupts social interaction with families, friends, communities, and value systems, changing behavior and adapting to a new psychosocial environment.^[7] In the process of migration, women, children, and elders are more vulnerable and they require psychosocial support at either their origin or destination places.^[8] Migration creates job insecurity, separation from sociogeographical connectivity, poor housing facilities, lack of recreation and health services, lack of protection and safety, and other concerns.^[9,10]

Studies have found social discrimination toward migrants, lack of civic amenities at the destination places is a greater risk to families, and also prolonged stay in destination cities compound the risk of psychiatric disorders.^[9,11-13] The construction industry has high levels of occupational strain, physical and mental health problems could arise related to work and the environment of the workplace.^[14,15] Studies revealed that the threat to mental health depends on the social context, the circumstances, and the act of migration.^[16,17]

Even though distressed people migrate to cities for temporary work in the construction sector, moving from distressing conditions to another stressful job will obviously lead to more psychological distress. In this context, the migratory construction workers might encounter and develop more distress. The unaddressed distress aspect can lead to mental health problems among migrants. Hence, assessing their level of distress and quality of community life (QoCL) such as living conditions, accessibility with civic amenities, availability of social support, and information about social services other aspects are important. By understanding this problem, the mental health professionals could design, develop, and deliver the appropriate community mental health services by following intersectoral services.

The dimension of the QoCL, which is the perception of “being,” “belonging,” and “becoming” a part of one’s community, may also have consequences for mental morbidity.^[18] Indian Council for Medical Research (ICMR) specifies that QoCL is the assessment of the quality of life within a community by understanding a member’s point of view related to the individual, family, and community social support systems.^[19]

Due to the COVID-19 pandemic, the migrant population has encountered various psychosocial stressors in the early phase of the lockdown. The entire country has noticed the vulnerability of the migrants, mainly daily wagers, construction, and other unorganized sector workers. They encountered several psychosocial stressors, such as living in camps, lack of privacy, maintaining physical distance, lack of safety, uncertainty about the duration of the lockdown, fear of losing their jobs, loss of income, social needs of their children and pregnant women, and the urgency to travel to their hometowns, occupational pneumoconiosis, tuberculosis, absence of family support and lack of caretakers during the emergency, social segregation, and inability to access the health and psychiatric services and other aspects have heightened the distress among migrant workers.^[20,21]

All the above factors associated with migration increase their distress and limit the social support in destination places, it leads to poor quality of life among migratory construction workers. Most research has broadly focused on the issues of migratory workers, but their distress and QoCL aspects have been paid little attention.

MATERIALS AND METHODS

The present study was carried out to assess the psychological distress and QoCL of migratory construction workers. The cross-sectional research design was adopted and a survey method of sampling was followed. The Chandapura Panchayat (a group of revenue villages), Anekal Taluk of Bangalore urban district, was considered the universe of study.

In Chandapura panchayat, numerous construction projects were ongoing. One such construction place is a Surya City Layout. The persons who migrated and working as manual/ semi-skilled laborers at construction work, and resided at construction sites or premises/camps, were considered the population of the study. These migrant camps are called Gulbarga camps, Raichur camps, and other names of Northern parts or states of India. Depending on their convenience, comfortability, availability of a job, or better wages, the migrants would stay in these camps/sites for some weeks to months.

Among these camps, one of the Gulbarga camp was selected randomly for the present study. The study constituted the total enumeration of all the individuals living in the Gulbarga camp. During the first visit of the study, it was found that the Gulbarga camp comprises 75 households/sheds, and approximately 300 migrant adults residing in these households. The adult migratory construction workers, who could speak Kannada and Telugu languages, were included in the study. Only one respondent from each household unit was selected for the study. Out of 300 migrant workers, nearly 70 were not included in the study for the reasons of not working in the construction sector, especially females (lactate mothers, working at garments, and housemaids), and senior citizens (taking care of their grandchildren). The remaining 110 persons had not shown interest in participating in the study. The other 12 persons reported their pre-existing neuropsychiatric disorders, such as headache, anxiety, depression, and obsessive and compulsive disorders. Another 33 were not included due to their unavailability during the field visit despite having pre-appointments and coordination with their family members and other concerned persons. Finally, 75 migrants were considered as the sample of the study. The data collection was carried out on Sundays.

A semi-structured interview schedule was prepared to determine the respondent’s sociodemographic details and other aspects of migration. A Self-reporting Questionnaire-20 (SRQ-20) developed by the World Health Organization was applied to assess psychological distress.^[22] The SRQ-20 items were scored through “yes” (score is 1) or “no” (score is 0) responses. A score of “1” indicates that the symptom was present in the previous month. SRQ’s cutoff point was 7/8 out of 20. A score below 7 was considered a non-clinical case, while an eight and above score indicated a clinical case and required psychosocial interventions.

The QoCL questionnaire was developed by the ICMR.^[19] The QoCL scale consisted of 11 factors, with a range of scores for each factor is 3–9. Each factor contained three questions and a total of 33 questions, and the total score range for all the factors is 33–99. The average score of a single factor is “6,” and for all factors, the overall average score is ‘“66’,” kept as a cutoff for determining the QoCL. The higher the score, the greater the QoCL.

All these tools have been translated into Kannada and Telugu languages. A total of 75 respondents were interviewed for the study. The data were analyzed using SPSS-16 version software. The frequency distribution and descriptive statistics were used to analyze the respondents’ sociodemographic status, migration details, level of distress, and QoCL. A t-test was computed to determine the significance of gender differences between distress and QoCL domains. The Pearson correlation test was administered to find out the relationship between SRQ-20 (distress), QoCL, and other variables.

Ethical clearance was obtained from the Institutional Ethics Committee (Behavioral Science Division), NIMHANS, Bengaluru. Informed consent was obtained from each respondent for their participation.

RESULTS

DISCUSSION

In low- and middle-income countries, internal and seasonal migration is a survival strategy for many individuals and families, especially agricultural laborers and poor income groups. In the present study, the mean age of the respondents was 32 ± 9.82 years. Other studies also reported more or less similar findings, such as 26.25 ± 8.49 years and 26 ± 8.2 years.^[12,23]

In this study, most of the respondents, that is, 53 (70.7%) were male, 59 (78.7%) were married, 37 (49.3%) did not have formal education, and 65 (86.7%) of the respondent’s monthly income was between ₹5000 and ₹10,999. Similarly, other studies have reported that most of the migrant construction workers are male (95.2%), unskilled (79.4%), seasonal workers, belong to poor socioeconomic backgrounds, and are illiterates.^[2,12,24,25] However, the respondents’ monthly income is more or less similar as mentioned in the minimum wages act. As per the minimum wages act, the semi and unskilled worker’s monthly income is about ₹7000-00 in Zone-1 cities (Bengaluru).^[26]

The present study found that 50.7% had migrated for less than a month, and another 37.3% had migrated for 1–6 months. Studies reported that construction workers have maximum mobility because of the nature of their work.^[5,6,27] In the present study, the migrant workers worked daily or weekly basis and did not follow any contractual work period. Hence, this could be a reason for the less duration of the migration. In this study, 57 (76.0%) of the respondents migrated with a spouse, or spouse and children. Studies found that migration along with the family could facilitate better psychosocial support.^[13,25]

The distress is higher among the male (9.50 ± 4.56) than the female (12.90 ± 4.03) respondents. In this way, in terms of age group, gender, population category, and migration status. Studies have reported that distress is highest between 18 and 29 years age group population,^[25] ranging between 5% and 27% in the general population,^[28,29] and 13–39% among the immigrants.^[30] The prevalence of distress is higher in women than men.^[31-33] Other studies also noted that a considerable proportion of construction workers had the symptoms of common mental disorders and post-traumatic stress disorders due to life events.^[34,35]

However, the other sector workers (non-construction workers) also have higher stress levels in the country. The Marsh India (insurance company) study found that 59% of employees in India reported feeling stressed in everyday life, which is at higher levels than the global average in the post-pandemic (COVID-19) phase.^[36]

In this study, respondents reported higher distress levels. It might be possible that pre-migratory (crop loss, drought, debts, loss of capital investments, poverty, and unemployment), and post-migratory factors (adjustment at a destination place, temporary jobs, lacking basic amenities, and living at construction sites) might lead to higher levels of distress. Contrary to this, a study on migratory quarry workers reported that only 16.5% of respondents had higher distress.^[37] It might be possible that they were quarry workers by occupation; they have been working in quarry sites and might have adjusted to the lifestyle and nature of the work. A mixed-method study reported that construction workers had higher psychological and occupational hazards, which are also affecting their well-being and decreasing their construction work performance.^[38]

The majority of respondents have below moderate QoCL (59.08 ± 8.31) and the gender-wise difference shows that men (60.73 ± 8.13) have a better QoCL compared to women (55.09 ± 7.48). With this connection, another study reported poor quality of life (55.9 ± 3.7) among construction workers.^[24] Furthermore, studies have revealed that migration brings numerous stressors, including job uncertainty, poverty, social and geographic isolation, intense time and work pressures, poor housing conditions, separation from family, lack of recreation, poor health, shelter, and safety concerns.^[9,10]

Other studies found that adequate wages for construction workers were not competitive to satisfy the needs of the present economic situation. At the same time, gender discrimination is widespread and lack of support at the workplace in the construction industry.^[39-42] Studies also reported that construction workers turned to substance abuse as a diversion from dealing with work stress and substance abuse was associated with anxiety.^[3,43] Thus, our study also noted that all these factors might have contributed to the migrants having higher distress levels and poor QoCL.

CONCLUSION

The present study showed that migratory construction workers had a higher level of distress, and their QoCL was below moderate. It was observed that pre-and post-migration factors such as poor living and working conditions, lower wages, job uncertainty, and lack of social security schemes might create psychosocial stress. The stress led to distress and resulted in poor QoCL. Intersectoral approaches have been required at the primary, secondary, and tertiary care levels to reduce distress and enhance the QoCL of the migratory construction workers.