歸國的柬埔寨移工之心理健康相關風險因素的量性和質性調查

Abstract

背景：移工的心理健康近年來備受關注，尤其是那些在國外遭逢艱困甚至剝削壓迫性工作條件，返國後仍持續面臨身心挑戰的勞動者。本論文旨在探討 COVID-19 疫情期間，自泰國返回之柬埔寨移工的心理健康風險因素。研究採用混合方法研究，以全面探索影響其心理健康與職業風險之複雜脈絡。本論文整合大規模問卷調查所得量化資料與深度訪談質性見解，深入分析影響此弱勢族群心理健康問題的關鍵因素。 方法：本論文的量化研究部分採橫斷式調查，對象為來自班迭棉吉省、馬德望省、暹粒省及貢布省之 392 名返國柬埔寨移工。研究方法使用已驗證之病患健康量表第四版（PHQ-4）作為資料蒐集工具，以評估焦慮與憂鬱症狀。本研究旨在確定心理健康問題的盛行率，並檢驗其與職業健康風險因素之間的關聯性，包括長工時、不安全工作環境，以及暴露於具風險之作業情境等。另外質性研究部分則進行 25 份深度訪談，涵蓋 8 位返國移工與多位移工議題相關者。質性資料探討移工的個人經歷，重點關注其心理健康問題、職業風險以及 COVID-19 疫情對其生活的影響。質性資料以主題分析法進行，藉以採取反覆出現之主題與趨勢，並為量化資料提供更豐富的背景解釋分析。 結果：量化分析PHQ-4 結果顯示，近半數受訪移工呈現心理健康相關症狀，其中 42% 有焦慮症狀，35% 出現憂鬱症狀。研究亦發現不良的職業衛生狀況與心理健康風險之間具高度相關性。具體而言，自我報告長時間工時、缺乏安全措施或暴露於危險環境的移工，較易出現焦慮與憂鬱症狀。此外，性別差異亦為重要因素，女性移工的壓力與焦慮程度顯著高於男性，突顯考慮性別差異對預防介入措施之必要性。 質性結果支持量化分析結果，受訪移工普遍描述艱困工作環境、文化孤立感以及疫情期間跨國處境所造成的複合心理負擔。受訪移工提及遭遇剝削、恐懼與不確定性的經驗，這些因素均加劇其身心脆弱性。疫情更使情況惡化，許多移工面臨失業、收入減少，以及難以取得醫療與支持服務等問題。此外，返國後的心理困難並未立即消失，部分移工仍持續面臨重新融入社會的挑戰及海外經歷所造成的長期影響。 結論：本研究凸顯柬埔寨返國移工在 COVID-19 疫情期間所面臨之重大顯著心理健康風險，特別是自泰國返國者。透過量化與質性並行之混合研究方法，本研究提供對此議題更全面的理解，並為政策制定者與實務工作者提供重要洞見，以期改善此弱勢群體之心理衛生。研究結果強調，應採取整體性且具性別敏感度的策略，以有效因應返國移工所面臨的心理健康挑戰。

Background The mental health of migrant workers is a growing concern, particularly for those who return home after working under demanding and often precarious conditions abroad. This study examines the occupational and psychosocial factors influencing mental health among Cambodian migrant workers who returned from Thailand during the COVID-19 period. The quantitative and qualitative approach was used to develop a comprehensive understanding of how prior work environments, economic pressures and reintegration challenges shape psychological well-being after return. By integrating quantitative findings from a cross-sectional survey with qualitative insights from in-depth interviews, the study provides a nuanced analysis of the determinants of mental health among this vulnerable population. Methods The quantitative component employed a cross-sectional survey of 392 returned Cambodian migrant workers from four provinces (Banteay Meanchey, Battambang, Siem Reap and Kampot). Mental health symptoms were assessed using the Patient Health Questionnaire-4 (PHQ-4), a validated screening tool for anxiety and depression. Occupational health risk factors such as long working hours, unsafe working conditions and exposure to hazardous environments were examined to determine their association with psychological outcomes. The qualitative component consisted of in-depth semi-structured interviews with eight returned migrant workers (n = 8) to explore personal experiences of migration, emotional challenges after return and coping processes during reintegration. Interviews were conducted in Khmer, transcribed, translated into English and analyzed using reflexive thematic analysis which provided contextual depth and elaborated the mechanisms underlying the quantitative trends. Results The quantitative analysis revealed that nearly half of the surveyed Cambodian migrant workers reported anxiety symptoms showed symptoms of mental health issues with 42% showing signs of anxiety and 35% presenting symptoms of depression, as measured by the PHQ-4. The study found strong associations between poor occupational health conditions and elevated mental health risks. Specifically, workers who reported long working hours, a lack of safety measures and exposure to hazardous environments were more likely to experience anxiety and depression. Gender differences were also apparent, with female workers reporting higher levels of stress and anxiety compared to their male counterparts, highlighting the need for gender-sensitive interventions. The qualitative findings supported the quantitative results, with interviewees frequently describing the psychological burden of harsh working conditions, cultural isolation and the compounded stress of navigating the COVID-19 pandemic while abroad. Workers detailed experiences of exploitation, fear and uncertainty, all of which contributed to a heightened sense of vulnerability. The pandemic exacerbated these challenges, as many workers faced job losses, reduced income and difficulty accessing healthcare and support services. The interviews also revealed that returning to Cambodia did not necessarily alleviate these mental health challenges, as many workers continued to struggle with reintegration and the long-term impacts of their experiences abroad. Conclusion This study demonstrates that the mental health of returned Cambodian migrant worker is closely shaped by their occupational conditions abroad and the challenges they encounter during reintegration. By integrating quantitative findings with qualitative insights, the study highlights how job insecurity, financial pressure and cultural expectations contribute to psychological distress among returnees from Thailand. The results underscore the need for reintegration strategies that combine livelihood support with accessible, community-based mental health services and emphasize the importance of gender- and sector-sensitive approaches to promoting well-being among returned migrant workers.