Social Science & Medicine 57 (2003) 769–774

Psychological distress among Thai migrant workers in Israel

Jennifer Griffina, Varda Soskolneb,*a6001 W. Mary Ct. Visalia, CA 93277, USA

bSchool of Social Work, Bar-Ilan University, Ramat-Gan, and Hadassah Medical Organization, Jerusalem, Israel

Abstract

The purpose of this cross-sectional study was to examine the associations between migration stressors and

psychological distress among Thai migrant agricultural workers in Israel, and to examine the direct and indirect

contribution of socio-cultural variables to this relationship. Two hundred and twenty-one Thai male workers were

interviewed using a structured questionnaire that included demographic variables and occupational exposures to

organophosphate pesticides (as control variables), migration stressors, intervening variables (traditional health beliefs,

social support, drinking behavior, and utilization of medical services), and a psychological distress scale. In multivariate

analysis, migration stressors, the migrants’ traditional health beliefs, quality of current social relationships, drinking

behavior, as well as age and occupational exposure were significantly associated with psychological distress. Workers

who reported higher migration stressors (perceived the migration to be difficult, and often felt homesick), those with

higher levels of traditional health beliefs, those whose social relationships with other Thai co-workers were poor, those

who consumed either no alcohol or large amounts of alcohol, and those who reported ‘‘problem drinking’’ had

significantly higher levels of psychological distress. A moderating effect of the quality of social relationships with co-

workers on the association between homesickness and psychological distress was found. Additionally, migrants aged

28–34 and those who were experiencing eye irritation from chemicals at work had significantly increased levels of

distress. The findings demonstrate the focal role of specific migration stressors and the current socio-cultural context on

psychological distress of migrant workers.

r 2003 Elsevier Science Ltd. All rights reserved.

Keywords: Thai migrant workers; Stress; Psychological distress; Traditional beliefs; Social support; Israel

1. Introduction

Trends in economic globalization and widening

disparities between countries have increased migration

to many countries, including Israel (Bartram, 1998;

Stalker, 1994). While migration may offer economic

benefits, physical health problems and psychological

distress are often results of the social stress involved in

moving from one’s country (Chung & Kagawa-Singer,

1993; Shuval, 1993), reduced security in daily life

(Sundquist, 1994), and experiences of alienation and

discrimination (Kaplan &Marks, 1990). Using the stress

process paradigm (Folkman, 1997; Pearlin, Menaghan,

Lieberman, & Mullan, 1981), psychosocial mediators of

the migration-health link, such as social support

(Flaherty, Kohn, Levav, & Birz, 1988), hardy personal-

ities (Kuo & Tsai, 1986), beliefs and other factors

inherent in the sending culture (Alderete, Vega, Kolody,

& Aguilar-Gaxiola, 2000) have been examined.

Thai migrant agricultural workers in Israel

Thai foreign workers make up 26% of the total

agricultural workforce in Israel, with more than 20,000

legally employed workers (Central Bureau of Statistics,

1999). Approximately 14,000 of these workers are

employed through the Moshavim Movement, a collec-

tive of cooperative agricultural villages calledMoshavim.

Most agricultural migrants in Israel are male farmers

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*Corresponding author. Tel.: +972-3-531-7806; fax: +972-

3-534-7228.

E-mail address: varda@vms.huji.ac.il (V. Soskolne).

0277-9536/03/$ - see front matter r 2003 Elsevier Science Ltd. All rights reserved.

PII: S 0 2 7 7 - 9 5 3 6 ( 0 2 ) 0 0 4 4 7 - 1

from northeastern Thailand and are known as Thai-

Isaan (Cohen, 1999).

Migrating to Israel involves profound changes in the

Thai migrant workers’ social, environmental, and

cultural context. Many workers migrate without their

families or existing social networks. Life in Israel limits

opportunities for normative behaviors for young Thai

men, such as drinking with friends and ‘‘going about’’

(pai tiao) (VanLandingham, Knodel, Saengtienchai, &

Pramualratana, 1998). Israeli Moshavim farmers indi-

cated that drinking among Thai workers is moderate,

with occasional incidents of problem drinking. Environ-

mental changes in migrating to Israel include occupa-

tional exposures to organophosphate pesticides, still

commonly used in Moshavim (Richter et al., 1992).

Organophosphate pesticide exposures may result in

psychological effects such as anxiety, depression, irrit-

ability, and restlessness (Mearns, Dunn, & Lees-Haley,

1994). Thai–Isaan beliefs about health incorporate

animist and Buddhist elements, including the use of

amulets, spirit houses, meditation, and traditional

medicines. Of particular significance to migrants is the

belief that moving or changing jobs can result in the loss

of one or more of an individual’s thirty-two souls that

reside in the body. The baci ceremony is used to bind

one’s souls in times of change in order to prevent soul

loss and subsequent ill health (Westermeyer, 1988).

To date, no study has examined social stress, living

context, working conditions, and psychological distress of

non-Jewish migrant populations in Israel. The purpose of

this study was to examine the associations between

migration stressors and psychological distress among

Thai migrants, and to examine the direct and indirect

contribution of intervening variables (traditional health

beliefs, social support, health behaviors and utilization of

medical services) on this relationship, controlling for

sociodemographic variables and occupational exposures.

Participants and methods

Male migrant workers employed in Israel for at least

one month were drawn from the 14,000 legal Thai

agricultural workers employed through the Moshavim

Movement (in mid-2000).

In a two-stage sampling process, nine Moshavim were

randomly selected by size of the Thai migrant popula-

tion: six small-to-medium sized Moshavim, and three

large Moshavim (100 Thai workers or more). In each of

the Moshavim, a convenience sample was used due to

time and financial constraints. Thai workers were asked

to attend a meeting where they were informed about the

study and completed the questionnaire in small groups.

While the response rate of those who attended the

meetings was high (>99%) overall, between 25% and

87% of the workers were interviewed in any individual

Moshav. The final sample included 221 participants. We

believe that there was no major selection bias in

participation. Age and the duration of time since

migration of the participants were similar to the total

population of Thai workers (data from the Moshavim

Movement). Some differences may have occurred in the

final convenience sample as those who did not attend

the meetings were generally working at the time of the

interview.

The structured questionnaire was translated from

English into Thai by a professional translator, was

reviewed by a senior researcher in Bangkok, and was

back-translated into English by Thai translators in

Israel. The questionnaire included: (1) control variables;

(2) migration stressors; (3) psychological distress; and

(4) intervening beliefs, social and behavioral variables.

Control variables: Socio-demographics included age,

years of education, marital status, and region in Thai-

land. Occupational exposures included smelling irritat-

ing chemical odors, experiencing eye irritation from

chemicals, and experiencing skin or clothing contamina-

tion from chemicals.

Migration stressors: Variables were designed to assess

aspects of migration stress within the specific context of

the workers’ lives. Objective measures included: dura-

tion of migration, previous migration to other countries,

whether the worker migrated to family or friends, and

English/Hebrew proficiency. Subjective measures in-

cluded: the pre-migration perception of migration,

pre-migration feelings about migration, and current

frequency of homesickness.

Psychological distress: A 9-item scale, originally

developed to address the major forms of distress

(depression and anxiety) in Thai internal migrants was

used. The response categories range on a four-point

Likert scale (from ‘1’ never, to ‘4’ often), with a

dichotomous response to one item (‘1’ no, ‘2’ yes). The

developers reported good validity, a single underlying

factor and an alpha coefficient of 0.84 (Fuller, Edwards,

Sermsri, & Vorakitphokatorn, 1993). In this study, the

alpha coefficient was 0.82.

Intervening variables:

(a) Health beliefs: Based on known traditional health

beliefs held by Thai–Isaan (Westermeyer, 1988), a 4-item

scale of the importance of traditional health practices

was developed for the study: using traditional medicines,

having a baci ceremony to prevent soul loss, having a

spirit house, and wearing an amulet (Cronbach’s alpha

=0.59).

(b) Social support and relationships with peers:

Perceived support was measured by a 3-item scale

(Cronbach’s alpha =0.63) that determined the current

frequency of: (1) receiving practical assistance if sick and

confined to bed; (2) having friends to ‘‘go around with’’

(pai tiao) and; (3) having a confidante. Adequacy of

similar short-form (2–4 item) scales of social support has

ARTICLE IN PRESSJ. Griffin, V. Soskolne / Social Science & Medicine 57 (2003) 769–774770

been reported in other studies of psychosocial factors

(Karlsson, Sjostrom, & Sullivan, 1995). In addition,

perceived quality of relationships with other Thai

workers on the Moshav was measured by a single item.

(c) Health behaviors: Alcohol consumption was

measured by one single factor, volume of weekly

drinking, a combination of the frequency and quantity

of beer and vodka consumption (Rehm, 1998). A second

question investigated if the respondent ever ‘‘feels bad’’

about drinking.

(d) Utilization of health services: The number of

doctor visits was dichotomized into use vs. non-use since

migration.

For univariate analyses, Student’s t-test, one-way

analyses of variance, and Pearson’s correlation were

used to measure associations with psychological distress.

A multiple general linear model (GLM) was conducted

for the multivariate analysis. Variables significant at

po0:25 in the univariate analysis were included, withcontrol variables, migration stressors, and the size of the

Thai population in the Moshav being entered first,

intervening variables and their interaction terms with

migration stressors (to examine modifying effects)

entered second. Variables from the first and second

steps that remained significant at po0:10 were includedsimultaneously in the final linear regression, with the

significance level set at po0:05:

Results

Fifty percent of the migrant workers were between 21

and 30 years old and had low levels of education (70%

had 6 or less years). The majority (89.6%) came from

northeastern Thailand, were married (81.9%), and had

children (76.9%). Many workers reported occupational

exposures, with 81.4% smelling irritating chemical

odors, 60.7% experiencing eye irritation from chemicals,

and 64.5% experiencing clothing/skin contamination

from chemicals at work.

Most Thai migrants, while having lived in Israel for

more than one year (64%), having immigrated to friends

(54%) or family (23%), having some ability to speak

English or Hebrew (61%), and having previous migra-

tion experiences (46%), report expectations of migration

difficulties (85%) and felt homesick (74%). As presented

in Table 1, Thai migrants tended to hold some

traditional beliefs (M ¼ 2:4; SD=0.72), had moderatelevels of social support (M ¼ 8:3; SD=2.2) but withsome poor relationships with peers (53%), and drank

moderately (53.4 had 1–7 drinks per week); 61% had

some ability to speak Hebrew or English. Finally, they

reported moderate levels of psychological distress

(M ¼ 18:8; SD=5.0).The univariate and multiple linear model for the three

groups of variables on psychological distress are

presented in Table 2. The multiple linear model

explained 34.4% of the variance in psychological

distress. Two migration stressors remained associated

with psychological distress. Workers who felt that

migration would be difficult or very difficult reported

greater psychological distress (approximately 2 scale

points higher) compared to those who reported easy

migration. Additionally, workers who were homesick

frequently were more distressed compared to those who

were infrequently homesick. The intervening and control

variables associated with greater distress were high levels

of traditional beliefs, poor quality of social relation-

ships, drinking behaviors, younger age, and reporting

eye irritation from chemicals. Only one interaction,

between homesickness and the quality of social relation-

ships, was significant. Among the workers who per-

ceived their social relationships to be very good, there

was a clear ordinal association, namely psychological

distress was higher when homesickness was frequent.

However, the workers who perceived their social

relationships to be poor had relatively high levels of

psychological distress regardless of the frequency of

homesickness.

Discussion and implications

The results of this study supported the hypothesis that

migration stressors would be associated with higher

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Table 1

Intervening variables and psychological distress

(N ¼ 2162221)

Variables Percent Mean (SD, range)

Health beliefs

Traditional beliefs scale 2.4 (0.72, 0.5–4.0)

Social support

Perceived social support

scale

8.3 (2.2, 3.0–12.0)

Poor quality of peer

relationshipsa53.0

Health behavior

Total alcohol/week

None 19.0

1–2 drinks 38.0

3–7 drinks 15.4

8 or more drinks 27.6

Feel bad about

drinkinga48.9

Utilization of services

Ever utilized medical

services in Israela42.2

Psychological distress

18.8 (4.98, 9.0–31.0)

aDichotomous variable.

J. Griffin, V. Soskolne / Social Science & Medicine 57 (2003) 769–774 771

levels of psychological distress, and the significant role

of cultural and social intervening factors. In the case of

Thai migrant workers in Israel, sociocultural and

occupational variables, including traditional beliefs,

poor social relationships, drinking behaviors, and

occupational exposures, unique to the present migrant

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Table 2

Analysis of psychological distress as a function of control variables, migration stressors, and intervening variables

Variables N Univariate analysis Multivariate analysisa

Mean (SD) B 95% CI for B F

Control Variables

Agep26 51 18.7 (4.6)c 1.45 �0.08–2.97 7.93d

27–30 53 19.6 (5.3) 3.29 1.81–4.7631–34 60 20.1 (4.7) 2.88 1.41–4.35X35 52 16.8 (4.8) — —

Smell irritating chemical odorsYes 174 19.4 (4.7)d N/INo 41 16.1 (5.1)

Eye irritation from chemicalsYes 129 20.1 (4.6)d 2.62 1.54–3.69 22.99d

No 85 16.9 (4.9) — —Clothing/skin chemical contaminationYes 135 19.7 (4.7)d N/INo 77 17.1 (4.9)

Migration Stressors

Previous migration experienceYes 98 19.4 (4.9) N/INo 116 18.3 (5.1)

Pre-migration perception of migrationVery difficult 89 19.3 (5.0) 2.00 0.29–3.72 3.29b

Difficult 94 18.8 (4.9) 2.11 0.44–3.78Easy 33 17.6 (4.9) — —

Feel homesick in the past monthFrequently 118 19.7 (5.0)c 1.43 0.38–2.49 7.17c

Infrequently 98 17.6 (4.7) — —Intervening Variables

Quality of peer relationshipsNot so good/Poor 113 20.2 (4.8)d 2.82 1.62–4.03 21.32d

Very good 103 17.3 (4.7) — —Total alcohol per week8 or more drinks 50 20.2 (4.5)b 1.82 0.47–3.18 3.36b

3–7 drinks 51 18.7 (4.8) 1.86 0.17–3.551–2 drinks 85 17.7 (5.0) — —None 29 20.1 (5.2) 1.47 �0.17–2.95

Feel bad about drinkingYes 106 19.9 (4.5)d 2.03 0.88–3.18 12.20d

No 110 17.1 (5.2) — —Utilization of ServicesYes 91 19.6 (4.9)b N/INo 123 18.2 (5.0)

Pearson’s CorrelationTraditional beliefs scale 214 0.220d N/A 7.15c

Perceived social support scale 213 0.014 N/IInteraction term

Homesickb Quality of peer relationships N/A 4.26c

aFinal multiple linear model (GLM) includes only the variables that remained in the model. R2=0.39, Adjusted R2=0.34.bpo0.05.cpo0.01.dpo0.001.

N/I= Not included in the final model. N/A=not applicable and — represents the reference group.

J. Griffin, V. Soskolne / Social Science & Medicine 57 (2003) 769–774772

status of the workers, were found to be significantly

associated with their psychological health.

Thai migrant workers in Israel reported psychological

distress levels similar to those of a Bangkok sample of

internal Thai migrants (mean=18.4775.86, Fuller,2000). This may indicate that rural–urban migration in

Thailand, or migration to other countries entails

comparable consequences for psychological distress

despite the differences in culture and location.

Two migration stressors significantly associated with

psychological distress in the multivariate analysis relate

to different aspects. While the one stressor, pre-

migration perception of the ease of migration could

have been subject to retrospective recall bias, home-

sickness was a concurrent stressor that was experienced

by 74% of the men. This rate is more than double the

rate (32%) of homesickness while overseas reported by

Thai migrant workers after returning to their homes,

highlighting the problematic use of retrospective report-

ing of stress (Jirojwong, Chutangkorn, & Leelakraiwan,

2000). The significant association of homesickness and

psychological distress is consistent with previous evi-

dence of its extensive negative effects (VanTilburg,

Vingerhoets, & VanHeck, 1996).

Intervening variables in the stress and health model,

namely the current context of the migrant’s beliefs,

social support, and behavior, were all related to distress.

The finding that maintaining traditional beliefs is related

to greater distress contradicts previous research in other

migrants (Alderete et al., 2000; Escobar, Gara, &

Compton, 1998; Palinkas & Pickwell, 1995). The

different nature of migration in these studies, being

permanent or temporary, may partially explain this

contradiction.

The significant association of coworker support with

psychological distress, and its interaction with home-

sickness, reaffirms the protective, buffering role of social

support among individuals in general (Berkman, Glass,

Brissette, & Seeman, 2000) and migrants in particular

(Chung & Kagawa-Singer, 1993; Rousseau, Drapeau, &

Corin, 1997). These associations with distress highlight

the importance of measuring variables proximate to the

individual’s life, rather than general perceptions of

available support.

The J-shaped association of drinking behaviors with

psychological distress (heavy drinkers and non-drinkers

had higher psychological distress scores than did light to

moderate users of alcohol) has been previously described

among Latino migrant populations (Goldberg, Soleas,

& Levesque, 1999). Yet, not only the volume of drinking

but also the self-image of the drinkers, as measured by

feeling bad about drinking, was significantly associated

with psychological distress.

The only sociodemographic variable associated with

psychological distress was age, with migrants having a

monotonic increase in psychological distress until the

age of 35 and older, in which there was a dramatic drop

in the level of psychological distress. Similar findings

have been reported in Asian migrant populations

(Abbott, Wong, Williams, Au, & Young, 2000; Fuller,

2000), contradicting the consensus in the migrant

literature which has generally placed adolescents and

the elderly at the highest levels of risk (Chung &

Kagawa-Singer, 1993; Sundquist, 1994). A more thor-

ough investigation of this association in East and

Southeast Asian migrant populations is required.

Additionally, this study demonstrates that the specific

occupational hazard of Thai agricultural workers’

exposure to pesticides must be considered as a con-

tributing factor to psychological distress, similar to the

proven associations between anti-cholinesterase pesti-

cides and depression (Bazylewicz-Walczak, Majczako-

wa, & Szymczak, 1999; Parron, Hernandez, Pla, &

Villanueva, 1996).

Although the cross-sectional nature of this study

limits any comment on causality, it demonstrates the

focal role of the specific migration context on psycho-

logical distress. Even though some potential differences

may exist between the participants and non-participants,

the consistency of the findings with theoretical predic-

tions and research findings in other migrant samples is

an indication of their generalizability. To date, this

research provides the most comprehensive study of

factors associated with psychological distress among

Thai labor migrants in Israel, and provides a needed

baseline for futures studies and for interventions that

target their social, cultural, and occupational context.

Acknowledgements

We would like to thank the Thai migrant workers for

their participation in the study. Thank you to Dr. Vipan

Prachuabmoh and Ms. Mayuree Nokyoungthong from

Chulalongkorn University in Bangkok for translating

the questionnaire. Special thanks to the Moshavim

Movement, the manpower companies, and the local

Israeli coordinators and farmers for their excellent

cooperation in reaching the Thai workers, and to the

Thai coordinators in the Moshavim who assisted in the

interviews.

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