Exploring COVID-19 circuit breaker (CB) restrictions at a migrant worker dormitory in Singapore: a case study and nested mixed-method analysis of stress management and mental health

Introduction Measures to mitigate the COVID-19 outbreak in the migrant worker dormitories in Singapore included lockdown and isolation of residents for prolonged periods. In this paper, we explore efforts to ease tensions and support mental health under these conditions. Methods Case study of dormitory residents under lockdown from April to August 2020 comprises a nested mixed-method approach using an online questionnaire (n=175) and semistructured interviews (n=23) of migrant workers sampled from the survey (August to September 2020). Logistic regression models were used to analyse survey data. Semistructured interviews were analysed using applied thematic analysis. Results Survey and interview data showed that mental health was largely protected despite initial rising tensions over restrictions during lockdown. Sources of tension negatively affecting low stress responses included job related worries, OR=0.07 (95% CI 0.03 to 0.18, p<0.001), poor communication with employers, OR=0.12 (95% CI 0.03 to 0.44, p<0.001) and loneliness, OR=0.24 (95% CI 0.10 to 0.55, p<0.001). Interview narratives concurrently revealed themes around job insecurity and the effects of the lockdown 'not being good for mind and body', the imposition of new rules and regulations compounded by the most emphasised concern-worry about family back home. Interviewees shared how their adaptive capability played a pivotal protective role alongside social support and solidarity; aided by regular use of messaging applications, which supported mental health, OR=4.81 (95% CI 1.54 to 15.21, p<0.01). Employers were described as central to alleviating tensions, providing feedback loops to improve dorm conditions. Employees feeling their employers cared about their health and well-being was especially protective to mental health, OR=17.24 (95% CI 4.00 to 85.74, p<0.001). Gratitude and trust in government and healthcare provision was widely acknowledged. Concurrently, related attitudes such as believing in the timeliness and appropriateness of the lockdown also protected mental health, OR 2.85 (95% CI 1.08 to 7.39, p=0.03). Conclusion Tensions are mapped to protective solutions informing guidelines for future outbreak stress management response.