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간호학석사학위논문

Factors Related to Perceived Stress and

Stress Responses among Indonesian Migrant

Workers in South Korea

2020년 2월

서울대학교 대학원

간호학과 간호학 전공

Sutrimo Ade

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ABSTRACT

This study aimed to identify factors related to perceived stress and

stress responses among Indonesian migrant workers in South Korea.

A cross-sectional, descriptive, and correlational design was used.

Data were collected in January 2019, and 90 eligible participants were

recruited from Ansan City and the surrounding areas. Perceived stress was

measured using the Perceived Stress Scale-10. Stress appraisal was measured

using the Cognitive Appraisal Inventory. Stress responses were measured

using the Depression Anxiety Stress Scales-21. Demographic characteristics

and environmental demands related to immigration and occupation were

assessed using self-reporting questionnaires. The data were analyzed using

Pearson’s correlation and multiple linear regression.

Factors related to perceived stress were education, work type, and

difficulty practicing religion at work. This study has also shown that

education and perceived stress were related to symptoms of depression. Age

and perceived stress were related to anxiety symptoms. Stress appraisal was

neither correlated to perceived stress nor stress responses. It was also found

that the higher the level of perceived stress, the higher the level of stress

responses (anxiety and depression symptoms).

The findings of this research provide insights for improving mental

health services specific to Indonesian migrant workers in South Korea.

Further rigorous studies may be needed for a broader understanding of the

results.

Keywords: anxiety, depression, Indonesia, migrant workers, perceived stress

Student ID: 2017-28238

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TABLE OF CONTENTS

ABSTRACT ....................................................................................................... iii

TABLE OF CONTENTS ................................................................................... iv

LIST OF TABLES .............................................................................................. vi

LIST OF FIGURES ........................................................................................... vii

CHAPTER I. INTRODUCTION ........................................................................ 1

1. Background ............................................................................................. 1

2. Purpose of the Study ................................................................................ 4

3. Definition of Terms ................................................................................. 4

CHAPTER II. LITERATURE REVIEW............................................................. 7

1. Characteristics of Indoneisan Migrant Workers ...................................... 7

2. Environmental Demands for Migrant Workers ....................................... 9

3. Stress Appraisal and Perceived Stress .................................................... 11

4. Stress Responses .................................................................................... 14

CHAPTER III. THEORETICAL FRAMEWORK ............................................ 17

CHAPTER IV. METHODS ............................................................................... 20

1. Study Design ......................................................................................... 20

2. Setting and Sample ................................................................................ 20

3. Data Collection Procedure ..................................................................... 21

4. Measurements ........................................................................................ 21

5. Data Analysis ......................................................................................... 25

6. Ethical Consideration ............................................................................ 26

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CHAPTER V. RESULTS ................................................................................... 27

1. Characteristics of the Participants ......................................................... 27

2. Environmental Demands ....................................................................... 28

3. Main Variables ....................................................................................... 30

4. Correlation among Main Variables ........................................................ 31

5. Multivariable Analysis of Perceived Stress and Stress Responses ........ 32

CHAPTER VI. DISCUSSION .......................................................................... 34

CHAPTER VII. CONCLUSION ....................................................................... 46

REFERENCES .................................................................................................. 47

APPENDICES ................................................................................................... 63

1. Study Questionnaires ............................................................................. 63

2. Study Questionnaires (Indonesian) ........................................................ 73

3. IRB Approval Letter .............................................................................. 84

ACKNOWLEDGEMENT ................................................................................. 85

ABSTACT (KOREAN) ..................................................................................... 87

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LIST OF TABLES

Table 1. DASS-21 subscale severy ratings ................................................... 23

Table 2. Characteristics of the participants ................................................... 26

Table 3. Environmental demands ................................................................... 27

Table 4. Mean scores of the main variables .................................................. 29

Table 5. Stress responses severity based on DASS-21 ratings ................... 29

Table 6. Correlation among main variables .................................................. 30

Table 7. Factors related to perceived stress .............................................. 31

Table 8. Factors related to the depressive symptoms .................................. 32

Table 9. Factors related to the anxiety symptoms ........................................ 33

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LIST OF FIGURES

Figure 1. Conceptual Framework ................................................................... 19

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CHAPTER I. INTRODUCTION

1. Background

The increasing number of immigrant workers in South Korea has

become a prominent feature of the Employment Permit System (EPS)

founded in 2004. EPS is the policy initiated by the South Korean government

to employ foreign migrant workers originating from 16 countries (Cho et al.,

2018; M. J. Kim, 2015; Yoo, 2005). Though working abroad allows workers

to benefit financially, they must tackle the processes of migration from their

home country to South Korea (Kartikasari, 2013; K. H. Lee, 2015; Prabha &

Jin-Wan, 2016).

Indonesians make up a significant proportion of migrant workers in

South Korea. According to the Korean Statistical Information System

(KOSIS) (2016), there were 42,110 Indonesian immigrants in Korea in 2015,

and more than 90% of them were temporary workers. They were also the

third largest immigrant worker group following the Chinese and Vietnamese.

Although a large number of Indonesian workers contributed to the

development of Indonesia and South Korea, the mental health issues

surrounding Indonesian migrant workers have not been given proper

attention.

Most previous studies related to are immigrants concerned with

marriage-based issues of female migrants and their family members due to

their permanent status in the country (M. Kim, 2015; Shin, 2017). However,

this type of immigrant only makes up 2% of the total Indonesian population

in South Korea (Korean Immigration of Ministry of Justice, 2016).

Additionally, prior studies mostly focus on workers from China and Vietnam

(An, Kim, & Yang, 2013; Joo, Kim, Cho, & Hyungil, 2015; Nho, Kim, Shin,

& Heo, 2017), with limited research on Indonesian migrant workers

(Kartikasari, 2013; Nugroho, Cho, & Collins, 2018; Rustam, 2019, Yazid,

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2018; Yun & Kim, 2017). These previous studies focused on Indonesian

workers’ acculturative stress, part-time student issues, Muslim

characteristics, and issues of labor migration. In fact, perceived stress and

stress responses among Indonesian migrant workers have not yet been

studied.

While the main intention underlying working abroad is productivity,

migrant workers face various environmental demands. Environmental

demand is an objective situation requiring individuals to utilize their

collective resources, overburden resource usage, and/or threaten their

stability (Griffin, 1993; Picou, Nicholls, & Guski, 2015). For migrant

workers, the demands are mostly related to the migration process and

occupational issues. First, migration issues are related to the resettlement

process. Kirmayer et al. (2011) explained that the predominance of specific

mental health disorders has been associated with migration processes. This

distress was caused mostly by a lack of preparation, difficulties in adjusting

to new environments, local system complexity, language barriers, cultural

inequalities, and negative experiences (Virupaksha, Kumar, & Nirmala,

2014). More specifically, migrant workers in South Korea experience

alienation and discrimination as a result of South Koreans’ pride in being an

ethnically homogenous society (A. E. Kim, 2014). Mulyana and Eko (2017)

identified the main barriers for Indonesians in South Korea, which include

differences in language and the values of companionship, cross-cultural

stereotypes, and discriminatory prejudices. Their study also identified some

respondents facing cultural shock engaged in negative coping strategies.

Second, foreign migrant workers also encounter job-related stressors.

Occupational stress among workers was related to the routine of work hours

and workload, work relationships with co-workers and employers, and work

climate (Babatunde, 2013; Michie, 2002). H. Lee et al. (2012) recognized

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that not only acculturative stress but also psychosocial factors in the work

setting were associated with depression. Foo et al. (2017) found a correlation

between the stress levels of migrant workers and occupational factors. These

included poor working environments in terms of excessive work hours, time

constraints in reaching targets, relationships with co-workers and employers,

and work-related policies. The potential health burdens affect not only

workers but also the productivity of the companies.

By confronting and adapting to environmental demands, individuals

commence an appraisal process involving a self-evaluation of the threatening

situations (Folkman, 2010). This is a process of comparison between

available resources and those required to manage the stressful situation; well-

adapted individuals can have a benign-positive appraisal, a condition in

which individuals adaptively cope with the environmental demands at hand.

For successful workers, positive attitudes regarding personal growth and

social relationships are achieved (Harrop et al., 2006; Hobfoll, 2001).

Unfortunately, when people perceive that the demands go beyond their

resource capabilities, the condition is referred to as perceived stress (Cohen,

Kessler, & Gordon, 1997).

The level of perceived stress among migrant workers can vary due to

their personal resources and external factors. Cohen, Gianaros, and Manuck

(2016) explained that perceived stress altered individuals’ psychological and

biological state that potentiating risks to their health. Among health disorders

affected by perceived stress, depression and anxiety are both the most

common mental health disorders globally (World Health Organization,

2017). H. Lee et al. (2012) found that roughly a third of 170 Korean-Chinese

migrant workers in South Korea met the criteria for depression measured

using the Center for Epidemiologic Studies Depression (CESD) Scale.

Similarly, Hiott et al. (2008) also found the prevalence of depression

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symptoms to be 41.6% using the same CESD scale and clinical anxiety to be

18.4% of their respondents using the Personality Assessment Inventory

(PAI) which include Latino farmworkers in the United States. The

consequences of stress can lead to a decrease in their productivity while

residing abroad.

Indonesian migrant workers face environmental demands from the

migration process and job-related stressors while residing in South Korea.

This condition often triggers perceived stress among them, which potentiates

the risk of health problems that impede their productivity. Therefore, it is

important to identify the factors related to perceived stress and stress

responses among Indonesian migrant workers in South Korea.

2. Purpose of the Study

The aim of this study is to identify factors related to perceived stress

and stress responses among Indonesian migrant workers in South Korea. The

specific aims are to: (1) explore the demographic characteristics,

environmental demands, stress appraisal, perceived stress and stress

responses (depressive and anxiety symptoms); (2) examine the relationships

among stress appraisal, perceived stress and stress responses; (3) identify

factors related to perceived stress; and (4) identify factors related to stress

responses among Indonesian migrant workers in South Korea.

3. Definitions of Terms

1) Environmental demands

Conceptual definition. Environmental demands are normative stressful

life events associated with substantial adaptive demands for individuals

(Schwarzer & Schulz, 2002).

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Operational definition. Environmental demands for migrant workers in

this study were measured using self-report questions concerning their

migration experience, work-related questions, and other personal and social

issues.

2) Stress appraisal

Conceptual definition. Stress appraisal is the subjective process

individuals use to judge the abilities needed to meet the demands of specific

events or experiences, it includes evaluation and coping processes (Folkman

et al., 1986).

Operational definition. Stress appraisal was defined as a score measured

using the Cognitive Appraisal Inventory (CAI) developed by Koellner

(1987). The Indonesian version was adapted by Khoirunnisa (2013).

3) Perceived stress

Conceptual definition. Perceived stress is a condition wherein

environmental demands transcend the individuals’ capacity, their feeling or

thoughts about how much stress they are under at a given point in time

(Cohen, Kessler, & Gordon, 1997).

Operational definition. Perceived stress was measured with the Perceived

Stress Scale-10 (PSS-10) developed by Cohen, Kamarck, and Mermelstein

(1983). The Indonesian version was translated and validated by Pin (2011).

4) Stress responses

Conceptual definition. Stress responses are collective signs and

symptoms related to biological, cognitive, and psychological responses of

individuals encountering the perceived stress (Cohen, Kessler, & Gordon,

1997). Symptoms of depression and anxiety were chosen because these are

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behavioral and psychological responses of stress. These symptoms also

include physiological responses.

Operational definition. In this study, stress responses were assessed with

the Depression Anxiety Stress Scales (DASS-21) developed by Lovibond

and Lovibond (1995) and the Indonesian version was adapted by Dewi

(2017). In this study, only the subscales of depression and anxiety were used.

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CHAPTER II. LITERATURE REVIEW

Perceived stress and stress responses have been frequently studied in

the nursing field because these symptoms can negatively affect individuals’

physical and mental health outcomes.

1. Characteristics of Indonesian Migrant Workers

There are an estimated 39,000 Indonesian migrant workers in South

Korea. For them, South Korea has become one of the most sought-after

countries to work in because of a relatively better wage structure; workers

can earn 5-10 times more than they do in their home country (Nugroho,

2017). Several benefits of working abroad include high financial benefits for

them and their families back in Indonesia, skills and work experience for

workers themselves, and benefits to the Indonesian economy as a whole

(World Bank, 2017). They are classified as low-skilled workers and become

a key part of small-medium sized industries (Nugroho, 2018). Indonesian

migrant workers are well known because they behave diligently and rarely

make mistakes that could disrupt standards and rules in the workplace. They

are also recognized among South Korean industries for their thoroughness

and perseverance (Hardum, 2014).

To be able to work in South Korea, Indonesian migrant workers need

to go through complex and extensive document procedures related to the

recruitment process. They have to pass a Korean proficiency test, and after

they are eligible to register with the national agency, there is a waiting period

during the selection of candidates by South Korean employers. After the

candidates are selected, they have to go through several training sessions and

medical checkup procedures. Other bureaucratic processes related to visas

and working contracts are also accounted to add the long waiting period as

mentioned in the protocols of EPS recruitment process by the National

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Agency for the Protection and Placement of International Migrant Workers

(2016). Grzywacz et al. (2006) found that pre-migration situations might

contribute to poor mental health outcomes for migrant workers.

After they arrive in South Korea, they also have to deal with living as

a minority, which may result in alienation, exclusion, and discrimination.

South Korean citizens tend to ignore or dismiss foreign migrant workers. In

a survey, it was reported that 44.2% of native South Koreans did not

consider immigrants as their neighbors and 31.3% did not accept different

religions (Kang, 2014). Meanwhile, Islam is the major religion in Indonesia

and it influences the way most Indonesians live their day-to-day lives. It

includes designated rules on food, lifestyles, praying routines and external

appearances. Muslims need to pray a daily worship called Salah five times a

day at designated times (morning before sunrise, afternoon, late afternoon

before sunset, evening after sunset, and the night). Every Friday afternoon

Muslim men have to perform Salah al-Jumu’ah as their weekly worship. All

Muslims also pray on two celebration days called Eid al-Fitr and Eid al-

‘Adha annually. During Ramadan, the holy month for Muslims, they are

expected to fast during the day (from morning before sunrise to evening

after sunset).

Other than external excellences and the acts of religious activities,

internal ethics emerge from an orientation of thinking that is based on the

Quranic disclosures. It incorporates good intentions, an eagerness to seek

information on the inner self and knowledge of God, which can be

accomplished through considerations of the truth. External and internal

virtues complement one another and are vital for the achievement of bliss

and the well-being of the person (Haque, 2004).

Muslim migrant workers are also expected to become the minority in

South Korea, where Muslims constitute only 0.5% of the population in

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South Korea (Baker, 2006). Though they are free to engage in religious

activities, some of them still find it difficult to do so before receiving

permission from their employers (Kartikasari, 2013). Generally, Indonesian

migrant workers accentuate their identity as a group with several events and

designated acts such as religious occasions, social activities, and community

events (Kartikasari, 2013; Makoto, 2015; Melchert, 2017). Finding such

communities after migration is likely to be an important factor in their

adaptation to the migration processes of South Korea.

Unfortunately, it also has been reported that Indonesian migrant

workers lack Korean language skills and have experienced violations such as

physical or verbal abuse, low wages, discrimination, and vicious work

conditions (Kee, 2009). Some of them respond to these experiences by

spending more or all of their time in the Indonesian community. Moreover,

the South Korean society’s attitude that promotes pride in being part of a

homogenous uniculture may contribute to the psychological difficulties

experienced by migrant workers (Yun & Kim, 2017). The cultural

differences between Indonesia and South Korea are visible in terms of

language, religious practices, characteristics of socialization, and work

culture (Kartikasari, 2013; Mulyana & Eko, 2017; Nugroho, 2017). These

differences make it challenging for Indonesian migrant workers to

harmoniously adjust while living in South Korea.

2. Environmental Demands for Migrant Workers

The types of environmental demands imposed on migrant workers

are mostly evidenced via the difficulties of migration processes and job-

related circumstances. First, migration-related stressors exist in each phase of

resettlement. The expectation of a promising future and other benefits of

working abroad are also followed by some inexorable consequences of the

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immigration process. Grzywacz et al. (2006) revealed that migrants suffer

ambivalence during the migration process, which is associated with anxiety

symptoms. Other factors may also interfere with the adjustment of migrant

workers in the socio-cultural setting. Pocnet et al. (2015) found interaction

effects between workers’ younger age and foreign nationality, with lower

work engagement and higher general job stress among migrant workers. Lu

and Chen (1996) found that higher incomes and educational attainment were

associated with a higher use of coping mechanisms, particularly by seeking

social resources and other planning & hoping strategies.

J. Kim and H. Kim (2017) in their study of demographic and

environmental factors and mental health among workers showed that stress

responses and depression were associated with current smoking and

drinking, accessibility to green space, and exposure to particulate matter 10

(PM-10). The study by Jiang, Tao, Shi, Ning, and Liu (2018) revealed that

male, lower educational levels, transportation work, primary and secondary

professional title, non-smoking, and non-drinking were associated with

higher levels of occupational stress among petrolium workers. Wireko-Gyebi

and Ametepeh’s (2016) findings indicated that there were no significant

differences between employees’ sex and their perception of work stress.

Smith et al. (2005) found that racial discrimination was strongly linked to

gender and ethnicity. This relationship increased the likelihood of work-

related stress among particular groups due to racial discrimination.

Second, job-related issues are another source of environmental

triggers of stress for foreign workers. There are five types of jobs in the EPS

program including manufacturing, construction, agriculture, fishery, and

service fields. Such types of work are classified as the 3Ds – dirty,

dangerous, and difficult work and are regarded as having a low pay, not

being respected, and unwanted by South Koreans (H. J. Kim, Choi, Lee, &

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Li, 2018). The economic development of South Korea has also contributed

to the country’s attitude of looking down upon blue-collar workers (A. E.

Kim, 2014). Flores et al. (2008) explained that perceived discrimination

significantly predicted depression and poorer general health. Perceived

stress also predicted health outcomes and significantly predicted depression

and poorer health in general. Abdul-Aziz (2001) showed that local

employers in Malaysia discriminated against migrant construction workers

in the forms of labor segmentation, schisms of foreign and local workers,

and labor violations. Such discrimination has been a staple feature in this

field, with hardly any opportunities for change.

Ghimire (2014) and Foo et al. (2017) identified that the stress-related

factors for the occupational aspect among migrant workers were working

hours, lack of support, strenuous types of work, high workload, insufficient

time to meet work targets, issues with workplace policy and department

staff, and poor work environments. Some of the most extreme cases of work

stress are prevalent among workers in the agricultural sector. Amnesty

International (2014) pointed out that foreign workers in South Korea have

frequently experienced intimidation, harassment, poor housing situations,

nonexistent weekly rest days, and unpaid overtime. These consequences of

stress impaired not only workers’ well-being but also organizations’

productivity.

3. Stress Appraisal and Perceived Stress

Stress appraisal is a process used by individual to assess certain

situations, whether the situation is mentally stressful or not for them. This

assessment will affect their choice of action. Moreover, it commences as part

of their coping strategies (Folkman, 2010). When individuals evaluate

themselves as competent and having a sufficient support system, this

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condition is called benign appraisal. However, when the situations exceed

their resources, it is classified as perceived stress (Cohen, Kessler, and

Gordon, 1997).

Components of stress appraisal included in this study were based on

Koellner (1987), including perceived control, perceived impact, perceived

predictability, and perceptions of effectiveness in coping with the chosen

event. Perceived control is the belief that people can determine their own

internal conditions and behaviors, influence the environment, and/or achieve

the required outcomes (Wallston, Wallston, Smith, & Dobbins, 1987).

Perceived impact on stress is defined as the subjective perception of health

risks that can be important in predicting individuals’ health outcomes. Keller

et al. (2012) found that adults perceived that stress significantly impacted

their health. Higher stress levels and stress perception were independently

associated with the risks of decreased mental well-being. Perceived

predictability is the personal measurement of uncertainty that predicts the

dynamics of physiological stress. De Berker et al. (2016) found that stress

responses were related to environmental uncertainty, new insight, and likely

adaptive functions. The effectiveness of various coping styles by individuals

includes psychological adaptation, perceived efficacy for problem

management, and improvements in physical and mental health.

Lavoie (2013) found that family relationships, mental health

symptoms, and employment issues were perceived as the most dominant

stressors for discharged psychiatric patients. Problem-oriented coping

reduced perceived stress and increased perceived efficacy, while emotional

coping styles were negatively associated with health outcomes. There are

several factors that may interfere with a person’s choice of coping behaviors,

such as individual characteristics (age, sex, marital status, education, and

family income), stressful events, cognitive appraisal, personality traits, life

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stress levels, and social support networks. Lu and Chen (1996) examined

those possible factors and pointed out that the higher the income, educational

levels, extraversion, and internal locus of control were associated with a

greater use of coping behaviors. They also mentioned that social support was

associated with a high use of coping behaviors.

Tohmiya, Tadaka and Arimoto (2018) identified that individual and

environmental factors were related to workers’ cognitive stress appraisal.

LePine et al. (2016) also explained that stressors appraised as working

difficulty were negatively correlated with work performance. Stress appraisal

and coping are essential variables influencing work engagement among

workers. Kaiseler et al. (2014) found that work engagement was associated

with perceived control. Workers reported higher absorption, vigor, and

dedication and used more active coping and less behavioral disengagement.

In response to stressful situations, workers evaluate their own

resources and related support systems. Migrant workers in South Korea may

receive support not only from their own families but also from resources

based on the Multicultural Families Support Act. Multicultural centers were

established throughout the country (Kang, 2014). Other external supports

that workers can rely on are those provided by employers, healthcare service

provider, organizations they are involved with, and crisis centers provided by

the Indonesian government. If workers adapt successfully to the demands

(benign-positive appraisal), it leads to positive beliefs that enhance positive

feelings and/or increased functioning. Their coping processes contribute to

personal strengths and adaptation attributes. Positive outcomes such as

personal growth, life goals, self-esteem, self-efficacy, a positive self-concept,

and the strengthening of social networks are gained in the process of

adjustment (Harrop et al., 2006; Hobfoll, 2001).

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Van der Ham et al. (2014) and Foo et al. (2017) explained that

though migrant workers perceived high levels of stress, their well-being

abroad was relatively uncompromised. In response to the unique culture of

discriminative exclusion in South Korea, workers used concrete socio-

psychological strategies including accepted separation, compromising

integration, marginalization of conflicts, and harmonious acculturation (H. J.

Kim, Choi, Lee, and Li., 2018). This condition provides long-term benefits

for workers as individuals, since their primary intention is to be productive

while working in South Korea.

On the other hand, the condition in which appraised by individuals

that environmental source of stress relatively go beyond their adaptive

capabilities may put them into the stage called perceived stress. Perceived

stress is feelings or thoughts about how much stress one is under at a given

point in time. Perceived stress also places people at a higher risk for physical

and psychological disorders (Cohen, Gianaros, & Manuck, 2016). According

to the heuristic model of stress processes, components constituting perceived

stress are environmental stimuli; personal evaluation of the situation as an

appraisal or perception of stress; and the behavioral, affective, or biological

responses (Cohen, Kessler, & Gordon, 1997).

Nilvarangkul, Rungreangkulkij, and Wongprom (2010) explained

that perceived stress among migrants was related to issues of poverty,

employment, loneliness, poor relationships, and workplace competition

combined with job uncertainty and invisibility. Migrants were unable to meet

their preferences or expectations in addressing those issues. Similarly,

Weishaar (2008) also identified stressors among migrant workers; they were

reported to have poor health conditions, particularly psychological and

psychosomatic distress, and these conditions were attributed to their limited

physical, socio-cultural, and psychological adaptability due to a variety of

15

stressors including communication difficulties, unfamiliarity with the new

environment and culture, work-related stress, practical stress, and social

stress. Tohmiya, Tadaka, and Arimoto (2018) also stated that lower

economic status, lower health literacy, higher traditional organizational

climates, and lower perceived social support networks were correlated with

higher levels of perceived stress. The stressors among migrant workers and

their consequences were highlighted along with effective approaches to

reduce psychological stress responses, covering not only alleviation of

burdens but also strengthening cognitive and behavioral coping capacities.

4. Stress Responses

Stress responses among migrant workers lead to psychological

consequences because they perceive inadequate resources to handle external

demands. Kesornsri et al. (2017) found that perceived general stress directly

affected the incidence of mental health disorders. The correlation between

perceived stress and psychological problems, such as chronic stress,

depression, and anxiety were emphasized in previous studies (Flores et al.,

2008; Hovey & Magaña, 2000; Kim-Godwin & Bechtel, 2004; Müller, Zink,

& Koch, 2017). Depression and anxiety are the most common global mental

disorders, affecting not only the individual’s mental health but also their

general well-being (World Health Organization, 2017).

In previous studies, a positive relationship was found among work-

related psychosocial factors, acculturative stress, family life stress, and

depression symptoms among migrant workers living in South Korea (S. W.

Lee et al, 2009; Rustam, 2019; Thao, 2016). Rusli, Edimansyah, and Naing

(2008) found that perceived stress was directly related to anxiety and

depression and inversely to physical health, environmental conditions and

social relationships. The physical environment, job demands, and

16

occupational climate were the most common triggers for depression. Social

support and stress management were used as assimilation strategies for

managing depression symptoms among migrants.

Mou et al. (2011) found a rate of 21.4% for depressive symptoms

among internal migrant factory workers in China. Al-Maskari et al. (2011)

also found a 25.1% depression prevalence among male migrant workers in

United Arab Emirates. S. W. Lee et al. (2009) pointed out that a high

prevalence of clinical depression is at 25.2%. These prevalence rates were

significantly higher among these workers than in the general population.

This prevalence is related to minority status, shorter intentions to stay, long

working hours, having addictive behavior such as smoking or frequent

internet use, and having lower levels of education.

Bernstein, Park, Shin, Cho, and Park (2011) noted that living

arrangements (particularly living alone), being single, having less than a

university degree, living abroad longer than 5 years but failing to gain

familiarity with community culture, securing better employment, stabilizing

their income, improving English proficiency, gaining more confidence and

mastery over one’s new life and environment, worsened by lower household

income all increased depression scores. In their study, the incidence of

depression among Korean immigrants was almost twice the rate of

depression observed in the general population of the United States. In the

study by Ghorbani, Krauss, Watson, and LeBreton (2008), perceived stress

predicted anxiety better than depression. Pereira-Morales, Adan, and Forero

(2019) explained that perceived stress was a significant mediator of the

relationship between the neurotic trait and depression and anxiety symptoms.

These significant relationships among perceived stress and stress responses

emphasize the prominence of effective strategies better assimilation for

migrant workers while working abroad.

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CHAPTER III. THEORETICAL FRAMEWORK

The theoretical framework for this study was adapted from the

heuristic model of the stress process developed by Cohen, Kessler, and

Gordon (1997). This model outlined ways to interpret the possible

integration of three common stress theories, namely the environmental,

psychological, and biological theories. Each theory emphasizes a unique

perspective of the stress process and often ignores the other parts.

Environment-focused studies concentrate on determining whether life events

increase the risk of disease and often ignore or overlook the potential

influences of psychological and biological pathways. Thus, integrating the

theories of the heuristic model of stress provides a substantial understanding

of the perceived stress process.

Perceived stress is defined as a general process in which

environmental stressors transcend and individuals’ adaptive capacity. Based

on this model, subjective stress results in psychological and biological

changes, increasing the potential for disease and other adverse health

outcomes in a person. The components constituting perceived stress are

environmental stimuli (e.g., a demand, stressor, or event); personal

evaluation of the situation as an appraisal or perception of stress; and the

behavioral, affective, or biological response to the stressor/appraisal (stress

response).

When facing environmental stressors, a person appraises whether the

demands may trigger a potential threat and if there are enough coping

capabilities to deal with those situations. Unfortunately, when lacking the

capacity, they identify themselves as being under a stressful condition.

Cohen, Gianaros, and Manuck (2016), in their updated version called the

stage model, explained that each stress component was interrelated. Those

elements were structured as a series of stages in a unidirectional model.

18

They realized that there could be other mechanisms involved and that not all

stages are needed.

In describing the concept, Cohen, Kessler, & Gordon (1997) also

recognized that feedback mechanisms exist. One possible feedback loop

indicated that emotional states could alter appraisal. For instance, an

emotionally disturbed person may have a confused view of the demands

posed either by the stressors or their resources. Another potential loop is that

physiological arousal might alter appraisals and emotional responses.

However, in this study, stress responses were only investigated by symptoms

of depression and anxiety and there was no assumption of other feedback or

partial correlations.

Migrant workers’ environmental demands are related to immigration

and job-related stressors. The appraisal process for immigrant workers is

broader, which includes the available resources individually and within their

support system while dealing with the external demands they face abroad.

Lu and Chen (1996) found that demographic characteristics, stressful events,

cognitive appraisals, personality traits, life stress, and social support

networks were related to stress appraisal. Levitt, Lane, and Levitt (2005)

highlighted that immigration stress and economic worries undermine the

psychological adjustment of the immigrants. The relationship between

stress, support, and adjustment could be compared regardless of the country-

of-origin as job-related demands are often related to the environmental

triggers of stress rather than country-of-origin.

The heuristic model of stress provides practical applicability of

transcultural mental health nursing, the migration process, workplace-related

stress, and social and other personal issues faced by migrant workers. By

integrating components of stress, this framework summarizes major stress

theories and provides a broader concept for visualizing perceived stress

19

among migrant workers. This conceptual framework is expected to guide this

research by examining the factors related to perceived stress and stress

responses among Indonesian migrant workers in South Korea (Figure 1).

Figure 1. Conceptual framework based on the heuristic model of the stress

process developed by Cohen, Kessler, & Gordon (1997).

Stress

Appraisal

Perceived

Stress

Stress Response

Depressive &

Anxiety Symptoms

Individual Characteristics

(Age, Sex, Education, Marital

Status, Religion, and Salary)

Environmental Demands

(Migration process and Job-

related issues)

20

CHAPTER IV. METHODS

1. Study Design

This was a cross-sectional, descriptive, and correlational study. The

levels of perceived stress, stress appraisal, and stress responses, as well as

relationships among these variables were examined. Also, factors related to

perceived stress and stress responses among Indonesian migrant workers in

South Korea were investigated.

2. Setting and Sample

Indonesian migrant workers were recruited from Ansan City and the

surrounding areas at several institutions where Indonesian migrant workers

gathered. Convenience sampling with a snowballing technique was used for

this study. To calculate the sample size, the G*power software program

version 3.1 was utilized (Faul et al., 2007). The significance level (alpha)

was .05 and the power was set at .80. The moderate effect size of r = .25 was

used based on a study by H. Lee et al. (2012). A linear regression analysis

with seven variables required a sample size of 86 respondents. Accounting

for missing values and withdrawal, an 8% attrition rate was added.

Accordingly, the investigator had to approach 93 potential respondents for

the study. Due to incompletion of the study questionnaire, data from three

participants were excluded in the analysis for this study. A total of 90

eligible Indonesian migrant workers participated in this study. The inclusion

criteria for this study were as follows.

1) Being an Indonesian migrant worker in South Korea

2) Being able to speak and read the Indonesian language

3) Being aged 19 years or older based on the criteria of the EPS

working contract

21

Anyone with severe physical or mental problems that may interfere

with their ability to complete the survey were excluded.

3. Data Collection Procedure

Data collection occurred in January 2019. After obtaining approval

from the institutional review board, the investigator visited the institutions,

distributed the study information sheets, and explained the study upon

obtaining permission from potential participants. The study was then

continued with only the people who expressed interest in the study. The

investigator briefly explained the study’s purpose and provided a written

summary of the study.

If the migrant worker was interested in participating in the study and

was eligible for it, the investigator obtained signed informed consent. Then,

the participant received a set of self-administered questionnaires designed to

assess perceived stress, environmental demands, stress appraisal, and stress

responses. Respondents were instructed to answer the questions concerning

their experience of recent stress situations and to not refer to their previous

psychological disorder or trauma. In addition, information about their

demographic characteristics were also obtained.

4. Measurements

1) Demographic characteristics

Migrant’s characteristics and other related entities of Indonesian

migrant workers that may be associated with the response of individuals to

environmental stressors were investigated. In this study, a questionnaire was

used to collect information on respondents’ demographic characteristics,

including age, sex, marital status, religion, education, and monthly salary.

22

2) Environmental demands

Self-report questions were used to assess their migration experience

and work-related context. These were length of stay in South Korea, being

part-time students, type of work, type of residence, weekly working hours,

possession of health insurance, involvement in social/religious

organizations, fluency in Korean, social interaction with friends in South

Korea, interaction with family in Indonesia, and difficulty practicing

religious activities at the workplace.

3) Stress appraisal

The instrument for measuring stress appraisal was the CAI, a

psychometric instrument developed by Koellner (1987). The CAI contains

11 items pertaining to the most disruptive event that had occurred within the

past month which were then answered by the respondents. Three factors

were used based on the factor analysis: perceived control; perceived impact;

and perceived predictability. In addition, there was an item that assesses the

respondent’s perception of effectiveness in coping with the chosen event.

Each item was assigned the integer values of 0 through 4 against the

response options. To form CAI score, the integer values were calculated

corresponding to the items after reversing the four negatively stated items

(items 1, 5, and 6). The possible range was between 0 and 44 representing

the level of adaptive appraisal by the participants. In this study, the

Cronbach’s alpha of the CAI questionnaire study was .76.

4) Perceived stress

For measuring perceived stress, the PSS-10 was used. This 10-item

instrument was developed by Cohen, Kamarck, and Mermelstein et al.

(1983) and is the most widely used psychological tool to measure the

23

perception of stress and the degree of its measure on unpredictability,

uncontrollability, and overload in people’s lives. The PSS-10 has been

designed for people with at least a junior high school education in the

community samples. The items of PSS-10 are understandable and it is

convenient to choose from the alternatives in responses. Respondents were

asked how often they experienced certain feeling and thoughts during the

last month.

PSS-10 scores are obtained by reversing the answers to the four

positively stated items (items 4, 5, 7, and 8) and then summing them up

across all scale items. The possible range is from 0 to 40; the more severe

the perceived stress is, the higher the score. As the PSS-10 is not a

diagnostic tool, score cut-offs are not available. The Cronbach’s alpha for

the PSS-10 was .78 in the study by Cohen, Kamarck, and Mermelstein et al.

(1983) and was .96 for the Indonesian version by Pin (2010). Meanwhile in

this study, the Cronbach’s alpha for PSS-10 was .77.

5) Stress response

Stress responses were assessed using the short 21-item version of the

DASS-21, a measure of related signs and symptoms associated with

depression, anxiety, and stress developed by Lovibond and Lovibond

(1995). In this study, the signs and symptoms of depression and anxiety

were explored based on subscales of the DASS-21 developed by Lovibond

and Lovibond (1995). The depression subscale or so-called DASS-21D

identifies low levels of positive affect including dysphoria, hopelessness, life

devaluation, self-deprecation, lack of interest and/or involvement,

anhedonia, and inertia. The subscale of anxiety (DASS-21A) evaluates a

mixture of general distress such as autonomic excitement, skeletal muscle

24

effects, situational anxiety, and subjective experience of anxiety (Lovibond

& Lovibond, 1995).

Only subscales for the symptoms of depression and anxiety were

used in this study. Respondents were asked using the four-point frequency

scales to rate the degree to which each symptom of depression and anxiety

had been experienced over the past week. The scores for the depression and

anxiety subscale were calculated by summing up several relevant item

scores of DASS-21 and multiplying the obtained scale scores by 2. The

possible ranges for each subscale are from 0 to 42; the higher the score the

more severe the emotional distress. The cut-off scores established by

Lovibond & Lovibond (1995) for each DASS-21 subscale and are shown in

Table 1.

Table 1. DASS-21 subscale severity ratings

Severity Depression Anxiety

Normal 0-9 0-7

Mild 10-13 8-9

Moderate 14-20 10-14

Severe 21-27 15-19

Extremely severe 28-42 20-42

For validity and reliability, the DASS-21 scales have been shown to

have high internal consistency. The Cronbach’s alpha ranged from 0.81 to

0.97 for each subscale (McDowell, 2006). The Cronbach’s alpha for the

Indonesian version of DASS-21 by Dewi (2017) was .90 and in this study,

the DASS-21 Cronbach’s alpha was .93.

25

5. Data Analysis

SPSS version 23.0 IBM was used for statistical analysis. First,

descriptive statistics were performed using frequency distributions for

categorical data. For numerical data scales, descriptive statistics including

means, standard deviation, and maximum and minimum values were

presented. The normality test was also performed. Especially for DASS-21,

the severity of symptoms was also analyzed in this study using a frequency

distribution table. Next, the bivariate analysis was performed to assess

correlations among the main variables including: stress appraisal, perceived

stress, and depression and anxiety symptoms using Pearson’s correlation

coefficients.

Lastly, factors related to perceived stress and stress responses were

examined using multiple linear regression. Perceived stress, anxiety and

depression were used as the dependent variables in each model. The

simultaneous method was utilized for creating all three models. This method

does not rely upon statistical results for selecting predictors; variables were

simultaneously entered based on theory and logical practicality. In this study,

the variable selection was based on the distribution data for each variable,

the theoretical framework based on the heuristic model of stress process, and

findings from previous studies by Jiang et al. (2018), J. Kim and H. Kim,

(2017), Wireko-Gyebi and Ametepeh, (2016); Pocnet et al. (2015), and

Smith et al. (2005). As a result, the variables of age, education, salary, length

of stay in South Korea, type of work, difficulty in practicing religious

activities at work, stress appraisal, and perceived stress were included in the

regression models. Classical assumptions of multiple linear regression

including normality, collinearity, autocorrelation, and homoscedasticity were

evaluated for each model.

26

6. Ethical Consideration

University institutional review board approval for this study was

obtained prior to respondent recruitment. The principles of human dignity

and justice were followed throughout this study. The investigator discussed

the study process with eligible candidates, after which they were asked to

participate in the study voluntarily. Verbal and written information was

given on the study’s purpose and procedures. Moreover, participants were

informed that their participation was voluntary and that they could withdraw

at any time Individuals read and signed the informed consent form if they

agreed to participate in the study. The investigator protected respondents’

confidentiality by transcribing all the data via code numbers. All data

obtained was used solely for the study purposes. The data were entered into a

computer, which was accessed only by the investigator. For this study, the

signed consent and completed questionnaires will be kept for three years.

27

CHAPTER V. RESULTS

1. Respondent Characteristics

Table 2 present the respondent characteristics. A total of 93 eligible

Indonesian migrant workers participated in this study and 90 participants

were used for data analysis. Their mean age was 30.13 (SD=6.36) years old.

The majority of the participants were male (95.6%) and Muslim (98.9%).

Moreover, most respondents were high school graduates and unmarried.

Twenty percent of the respondents earned less than 1,500,000 KRW

monthly.

Table 2. Demographic characteristics of the participants (n=90)

Characteristic Category n (%)

Age

(Mean [SD] = 30.13 [6.36],

Min–Max = 21–46)

19–25 years old

26–35 years old

>35 years old

28 (31.1)

45 (50)

17 (18.9)

Sex Male

Female

86 (95.6)

4 (4.4)

Marital status Not married/divorced

Currently married

55 (61.1)

35 (38.9)

Religion Islam

Christianity

89 (98.9)

1 (1.1)

Education Completed middle school

Completed high school

Completed university/higher

9 (9.9)

74 (82.2)

7 (7.8)

Monthly salary <1,500,000 KRW

≥1,500,000 KRW

18 (20)

72 (80)

Note. SD = Standard deviation; KRW = South Korean Won

28

2. Environmental Demands

Table 3 shows participants’ responses for environmental demands

(migration and occupation) related to perceived stress and stress responses.

More than 50% of respondents in this study had been living in South Korea

for 1–5 years. Most participants worked in the manufacturing field and lived

in dormitories. Only 7.8% of them were part-time students in South Korea.

Most of the participants were able to communicate in Korean in their daily

lives. They also socialized with others in South Korea while continuing to

communicate with family in Indonesia. They worked for an average of 48.67

hours per week, but 37.8% of them work more than 52 hours per week. The

majority of them were involved in organizational activities and had health

insurance. However, 36.7% of respondents had difficulty practicing religious

activities at work.

Table 3. Environmental demands of the participants (n = 90)

Characteristic Category n (%)

Length of stay in South Korea < 1year

1–5 years

>5 years

17 (18.9)

50 (55.6)

23 (25.6)

Part-time student Yes

No

7 (7.8)

83 (92.2)

Type of work Manufacturing

Others

83 (92.2)

7 (7.8)

Type of living place Dormitory

Private

Communal

67 (74.4)

11 (12.2)

12 (13.3)

29

Weekly working hours

(Mean [SD] = 48.67 [11.35],

Min–Max = 21–72)

<40 hours/week

40–52 hours/week

>52 hours/week

7 (7.8)

49 (54.4)

34 (37.8)

Health insurance ownership Yes

No

83 (92.2)

7 (7.8)

Involvement in social/religious

organization

Yes

No

78 (86.7)

12 (13.3)

Ability to communicate in Korean Yes

No

75 (83.3)

15 (16.7)

Socialization with friends in South

Korea

Rarely

Often

Always

19 (21.1)

54 (60)

17 (18.9)

Interaction with family in Indonesia Daily

Weekly

Monthly/Rare

46 (51.1)

37 (41.1)

7 (7.8)

Difficulty practicing religious

activities at work

Yes

No

33 (36.7)

57 (63.3)

Note. SD = Standard deviation

30

3. Main Variables

The mean scores for stress appraisal, perceived stress, and stress

responses are shown in Table 4. The mean score of perceived stress in this

study was 15.87, while stress appraisal was 24.05. Based on the cut-off

scores of the DASS-21 subscales, most participants had depression and

anxiety at a normal to moderate level. However, five respondents (5.56%)

were classified as having severe to extremely severe depression and 16

(17.78%) as having severe to extremely severe anxiety symptoms (Table 5).

Table 4. Mean scores of the main variables (n = 90)

Variable Mean (SD)* Min-Max Possible Range

Stress appraisal 24.05 (4.62) 13– 36 0–44

Perceived stress 15.87 (4.02) 4–25 0–40

Depressive symptoms 7.31 (7.05) 0–28 0–42

Anxiety symptoms 9.29 (8.49) 0–38 0–42

Note. SD = Standard deviation

Table 5. Stress responses severity based on DASS-21 ratings (n = 90)

Severity Depression Anxiety

Normal 61 (67.78%) 44 (48.89%)

Mild 12 (13.33%) 9 (10%)

Moderate 12 (13.33%) 21 (23.33%)

Severe 3 (3.33%) 4 (4.44%)

Extremely severe 2 (2.22%) 12 (13.33%)

Note. DASS-21 = Depression Anxiety and Stress Scales 21

31

4. Correlation among Main Variables

Significant positive correlations were noted among stress responses

(both depressive and anxiety symptoms) and perceived stress. However, no

significant correlations were found between stress appraisal, perceived stress,

and stress responses. The correlation between stress appraisal, perceived

stress, and stress responses are shown in Table 6.

Table 6. Correlation among main variables

Variables Perceived

stress

Stress

appraisal

Depressive

symptoms

Anxiety

symptoms

Perceived

stress -

-0.09

(p=0.41)

0.29

(p=0.006)*

0.32

(p=0.002)*

Stress

appraisal

- -

0.11

(p=0.305)

0.02

(p=0.807)

Depressive

symptoms

- - -

0.79

(p<0.001)*

Anxiety

symptoms

- - - -

32

5. Multivariable Analyses of Perceived Stress and Stress Responses

Three multiple linear regression models are presented in Tables 7 to

9. The classical assumption for perceived stress, depressive and anxiety

symptom models were accepted by the linearity test of the scatter plot

showing the linear image, as normally distributed (histogram graphic and

plot were normal), mean of the null residue (x=0), constant residue or

homoscedasticity from the graph formed no certain pattern, independency by

the variance inflation factors (VIF) and Durbin Watson closed to 2, and no

collinearity with tolerance >.40.

The overall linear regression model using the enter method resulted

in the inclusion of variables correlated with perceived stress (F=2.438,

p<.05) and predicting perceived stress by 12.7% (adjusted R2=.127).

Particularly, level of education, work type and difficulty practicing religion

were significantly related to the perceived stress (p<.05). Middle school

graduates reported having higher levels of perceived stress than did

university graduates. Manufacturing workers had lower levels of stress than

did those working in other areas. Respondents who had difficulty practicing

religious activities at work had higher levels of perceived stress (Table 7).

33

Table 7. Factors related to perceived stress

Variables Β T p

Age -0.01 -0.12 0.903

Education (completed university)

Completed middle school

0.38

2.23

0.028*

Completed high school 0.30 1.70 0.093

Salary (≥1,500,000 KRW)

<1,500,000 KRW

0.16

1.34

0.184

Length of stay in South Korea (≥ 5 years)

<1 year

-0.09

-0.69

0.495

1–5 years 0.08 0.57 0.573

Type of work (Others)

Manufacturing

-0.33

-2.49

0.015*

Difficulty practicing religious activities at work (No)

Yes

0.21

2.01

0.048*

Stress appraisal -0.04 -0.39 0.697

R2= 0.215, Adjusted R2=0.127, F = 2.438, p= 0.017*

The factors related to depressive symptoms are presented in Table 8.

The collective linear regression model using the enter method indicated that

the overall variables were correlated with depressive symptoms (F=2.089,

p<.05) predicting the symptoms of depression by 10.9% (adjusted R2=.109).

More specifically, education and perceived stress were significantly related

to depressive symptoms (p<.05). Respondents with a lower level of

education had more severe depressive symptoms than did university

graduates. Moreover, a significant positive correlation was found between

perceived stress and depressive symptoms. The higher the level of perceived

stress, the higher the depressive symptoms among respondents.

34

Table 8. Factors related to depressive symptoms

Variable β T p

Age -0.14 -1.17 0.245

Education (completed university)

Completed middle school

0.37

2.14

0.035*

Completed high school 0.44 2.45 0.016*

Salary (≥1,500,000 KRW)

<1,500,000 KRW

0.14

1.18

0.242

Length of stay in South Korea (≥ 5 years)

<1 year

-0.13

-0.94

0.352

1–5 years -0.18 -1.30 0.196

Type of work (Others)

Manufacturing

-0.05

-0.37

0.712

Difficulty practicing religious activities at work (No)

Yes

0.13

1.22

0.224

Stress appraisal 0.21 1.88 0.063

Perceived stress 0.23 2.04 0.044*

R2= 0.209, Adjusted R2=0.109, F = 2.089, p=0.035*

The factors related to anxiety symptoms are presented in Table 9.

Cumulatively, the linear regression model indicated that overall variables

were correlated with depressive symptoms (F=2.677, p<.05) predicting the

symptoms of anxiety symptoms by 15.9% (adjusted R2=.159). Furthermore,

age and perceived stress were significantly related to anxiety symptoms in

this study. A negative correlation was found between the respondents’ age

and anxiety symptoms (p<.05). The younger the respondents’ age, the higher

the anxiety symptoms they have. Similar to depressive symptoms, a

35

significant positive correlation between perceived stress and anxiety

symptoms was found in this model. The higher level of perceived stress, the

higher the degree of anxiety symptoms among respondents.

Table 9. Factors Related to anxiety symptoms

Variables β T p

Age -0.30 -2.67 0.009*

Education (completed university)

Completed middle school

0.14

0.82

0.415

Completed high school 0.29 1.68 0.098

Salary (≥1,500,000 KRW)

<1,500,000 KRW

0.21

1.79

0.077

Length of stay in South Korea (≥ 5 years)

<1 year

-0.03

-0.26

0.795

1–5 years -0.12 -0.87 0.390

Type of work (Others)

Manufacturing

0.09

0.67

0.506

Difficulty practicing religious activities at work (No)

Yes

0.06

0.60

0.548

Stress appraisal 0.14 1.33 0.186

Perceived stress 0.30 2.75 0.007*

R2= 0.253, Adjusted R2=0.159, F = 2.677, p=0.007*

36

CHAPTER VI. DISCUSSION

The majority of Indonesian migrant workers who participated in this

study were male, aged 20–30 years old, and high school graduates. These

characteristics might reflect the qualification and recruitment process of the

EPS program (M. J. Kim, 2015). Specifically, the enlisted work types of the

program are typically done by male migrant workers as they require more

physical strength (A. E. Kim, 2014; H. J. Kim et al., 2018). The National

Agency for the Protection and Placement of International Migrant Workers

(2016) reported that the male-to-female ratio of job placement in South

Korea was 30:1. Furthermore, in 2019, the agency reported that Indonesian

migrant workers had different job characteristics from those in other

countries. For example, in Taiwan, Japan or Singapore, Indonesian migrant

workers were predominately females working in domestic services, health

care, and other service sectors. Meanwhile in this study, most respondents

worked in the manufacturing field that requires strenuous work.

Environmental demands, which are factors related to the migration

process and occupational issues, are a concern for Indonesian migrant

workers’ productive lives while residing in South Korea. In this study, the

respondents worked for an average of 48.67 hours per week, but 37.8% of

them work more than 52 hours per week. Moreover, twenty percent of the

respondents earned less than 1,500,000 KRW monthly. Individuals with

lower incomes encounter greater stressful life events and challenges than

higher paid workers. Moreover, they have less access to resources to

overcome hardships (Kessler and Cleary 1980).

Wong and Leung (2008) explained that among the element of

migration stress, financial and employment difficulties were particular

contributors to the mental health of migrant workers. Hiott et al. (2008)

mentioned that working conditions were related to anxiety and depression

37

symptoms. K. H. Lee et al. (2015) categorized migrant workers as a high-risk

group in terms of job demand, job insecurity, and work culture. Um (2012)

also highlighted that labor market regulations, migrant workers’ pay, and

working conditions placed migrant workers in the lowest levels of care in the

workforce. These conditions were also influenced by their mental and

physical health. Therefore, mitigation strategies, and earlier exposure to

knowing the real condition they will face will better prepare migrants facing

the environmental demands associated with working in South Korea, via pre-

migration sharing and the provision of more relevant training.

In this study, the religious background of Indonesian migrant workers

was predominantly Muslim (98.9%). Islamic values associate stressors as a

challenge, and believers generally believe that stressors occur automatically

as a consequence of their choices. Accordingly, they strive to be responsible

for each problem they face and to become strong enough to overcome that

problem. To this end, they may rely on God whom they believe has arranged

for them the best scenario to overcome. Weekly prayer and routine

gatherings may also offer them a support system. Religiosity is positively

correlated with a variety of indices of mental health and psychological well-

being, but only a small number of studies investigate the coping mechanism

of Muslims who are living in a non-Muslim country (Gardner, Krägeloh, &

Henning, 2014). Religious values are highly functional in facilitating

emotional and physical health. Forms of involvement regarding religious

practices were associated with increased well-being, less depression and

anxiety, less anxiety, less alcohol and drug abuse, and better coping with

illness (Koenig, 1997).

Although most Muslim workers can pray freely, some of them have

difficulty practicing their religion because they find it hard to get permission

to do so from their employers (Kartikasari, 2013). Unfortunately, a third of

38

the respondents in this study had difficulty practicing their religious

activities at work. The regulations concerning religious accommodations in

the workplace encourage the employers to provide reasonable

accommodations for the religious practices of workers or prospective

workers, unless doing so would create an undue hardship upon the employer

(Anti-Defamation League, 2015). In South Korea, the Enforcement Decree

of The Multicultural Families Support Act of Presidential Decree No. 29426

and Labor Standards Act No. 11270 also cover the needs for workers and

their ability to engage in their religious activities. More constructive

communication between workers and the employer, and a better

understanding of each other’s perspective may be a solution in terms of

religious accommodations. This issue highlights the importance of cross-

cultural understandings to create productive and more harmonious lives for

migrant workers while also being a part of the community in South Korea.

As found in this study, the majority of Indonesian migrant workers

were able to socialize with others while in South Korea maintain contact

with their family members and relatives in Indonesia. Indonesians are in

general highly sociable, allowing them to be more engaged socially by

attending cultural events, social occasions, and entertainment activities

(Mulyana & Eko, 2017; Nugroho, 2017; Kartikasari, 2013). The majority

were also actively involved in organizational and/or social activities. Taken

together, the findings suggest that there is a need for health strategies

focusing on the socio-spiritual aspects while considering workers’ activities

when conducting programs to enhance mental health services among

Indonesian migrant workers in South Korea.

Stress appraisal in this study was not correlated with perceived stress

or with stress responses. The CAI questionnaire might not have been the

most suitable instrument for migrant workers because its subscales might not

39

accommodate their evaluation of the environmental demands focused on

migrant workers. Moreover, the CAI questionnaire targets a wide spectrum

of the population from women with chronic illnesses (Koellner, 1987) to

high school students (Khoirunnisa, 2013). Although in this study, workers

were asked to choose an event that was most disruptive and related to either

migration or their work during the past month, respondents may have

appraised the events ambiguously and seen themselves as having less control

over the chosen event. The appraisal process is also a dynamic process that

could be influenced by previous stressors and/or exposure to similar events.

It may necessary to develop instruments measuring the processes of appraisal

for migrant workers, which meet the specificity of their experiences

rendering them more comprehensive in reflecting the subjective processes of

stress appraisal among this unique population.

In the present study, the mean score for perceived stress among

Indonesian migrant workers in South Korea was 15.87. This result was

similar to that of a previous study using the same instrument (PSS-10) on

different immigrant populations in several host countries (Ekwonye,

DeLauer, & Cahill, 2018; Elliott et al., 1995; Lin et al., 2016; Perera et al.,

2017). In this study, stress responses were explained in terms of mean scores

for depressive and anxiety symptoms (7.31 and 9.29, respectively).

Accordingly, respondents were largely classified as having symptoms of

normal to mild severity based on the cut-off score of the DASS-21.

However, five respondents (5.56%) were classified as severely depressed

and 16 of them (17.78%) were classified as having severe anxiety. Nugraha,

Hirano, and Sumihisha (2017), in their study on Indonesian care workers in

Japan, found that women, workers with lower economic status, and workers

having less socio-cultural adaptation competency tend to have poor mental

health. Lu (2010) noted that among the strategies to mitigate the negative

40

consequences of migration are levels of social support, social skills, and

educational level in the company. These results highlighted the importance

of mental health improvement among migrant workers from the socio-

cultural and occupational perspectives. An awareness of the stress and

mental health of migrant workers is needed to explore more effective

strategies for the improvement of their well-being.

A significant positive correlation was found between perceived stress

and stress responses (both anxiety and depression symptoms). These

correlations were consistent with the findings of Hiott et al. (2008); Hovey

and Magaña (2000), and Kim-Godwin and Bechtel (2004) which indicated

that the increased levels of stress were followed by higher levels of anxiety

and depression among immigrants in several countries. Rustam's (2019)

study of acculturative stress among Indonesian migrant workers also found a

significant positive correlation between stress and depression and a negative

correlation between stress and quality of life. Chae, Park, and Kang (2014)

noted that social support and acculturative stress were related to the

prevention of depression and the improvement of migrants’ quality of life.

Taken together, these findings emphasize the need for nursing interventions

aimed at teaching stress management strategies to workers meant to mitigate

the consequences of stress.

In this study, lower levels of education, work types other than

manufacturing, and having difficulty practicing religion were associated with

higher levels of perceived stress. Most Indonesian migrant workers in this

study had completed high school compared, compared to only 7.8% who

completed a university or higher level degree while same percentage (7.8%)

were part-time students in South Korea. Daly et al. (2018) found a significant

correlation between low education levels and psychosocial distress.

Moreover, Dalgard et al. (2007) reported an association between low

41

education levels and a low sense of mastery, low social and emotional

support, a high number of negative events, low family income, and

joblessness. It was in line with the premise that more educated individuals

may be better equipped intellectually and mentally to navigate new

environments and may have a broader social network than people with lower

levels of education.

In the present study, manufacturing workers had lower levels of

perceived stress than did other types of workers, most of who were in the

service sector. The manufacturing field has comparatively less physical work

compared to the fields of construction, agriculture, or fishery. Manufacturing

workers also have limited interactions or barely handle customers directly

relative to those in the service sector. The result is that the job descriptions

for manufacturing sector become more favorable among work enlistments in

the EPS program; in this study the majority of respondents were

manufacturing workers (92.2%). Scheduled and predicted activities among

manufacturing workers also gave them the routine, scheduled and predictable

work activities that drive manufacturing workers to perform processes of

habit formation. As a result, workers in the manufacturing field may have

better mental wellbeing because of the regularity in their day-to-day life

rather than other types of work enlisted in the EPS program. Lally, Van

Jaarsveld, Potts, and Wardle (2010) explained in their study that repetition of

behaviours in a consistent context impacts automaticity at the individual

level. Galla and Duckworth (2015) noted that scheduled activities are an

important factor linked to self-control and positive life outcomes.

Verlplanken (2006) highlighted that habits should be considered as a mental

construct involving features of automaticity, such as awareness, self-control,

and mental efficiency. This is in line with a fundamental notion of

occupational therapy which states that a healthy lifestyle reflects an adapted

42

balance between work, play/leisure, self-care, and rest activities, which

promotes occupational function (Crist, Davis, & Coffin, 2000).

The related factors for depressive symptoms in this study were

education and perceived stress. Respondents with a lower level of education

had more severe depressive symptoms than did university graduates. Mou et

al. (2011) and H. Lee et al. (2012) found that a higher prevalence of

depression was related to having lower levels of education. Similarly,

Bernstein, Park, Shin, Cho, and Park (2011) noted that their Korean

respondents in the United States having less than a university degree, higher

perceptions of discrimination, and lower language abilities were associated

with having more severe depressive symptoms. Furthermore, Chevalier and

Feinstein (2006) noted that education reduces the risk of depression by 5% to

7% among people with a secondary education qualification. This finding was

consistent with those from Shin’s (1993) study, which suggests that

immigrants with more education and greater financial resources are better

able to cope with the stress associated with immigration. Bernstein, Park,

Shin, Cho, and Park (2011) stated that it is possible that well-educated

persons are better able to navigate changing environments intellectually and

mentally, and can have larger networks for job stability and a wider social

network for themselves compared to those who are less educated. This

assumption is also supported by the study by Oh et al. (2002), which

reported that immigrants who have advanced their education and achieved

higher salaries could perceive the environment as benign and benevolent,

compared to those with lower levels in education and salaries. When

developing mental health education programs aimed at promoting workers’

health management and/or health seeking behaviors, client’s educational

backgrounds should be considered.

43

Age and perceived stress were significantly related to anxiety

symptoms in this study; the younger the respondents were, the more severe

their anxiety symptoms. Shallcross, Ford, Floerke, & Mauss (2013) found

that age was correlated with a higher level of acceptance and lower levels of

anger and anxiety. Krasucki, Howard, & Mann (1998) found a positive

association between anxiety and age. Pillay & Sargent (1999) also found that

older age and lower educational attainment were significantly correlated with

higher levels of distress. These results align with the notion that acceptance

plays an important role in the relationship between age and fewer negative

health outcomes. Stressors have an age-dependent effect that intertwines

with many psychosocial factors such as a reduction in physical ability,

financial constraints, a loss in coping capacity, social support, and emotional

flexibility (Anisman & Merali, 1999). Emotional and psychological maturity

can be developed in younger workers through initiatives such as mentoring.

Limitations

When interpreting the findings of this study, several limitations

should be considered. First, the use of a convenience sample of Indonesian

migrant workers might affect the representativeness of the sample. Second,

the cross-sectional design of this study could limit the ability to detect causal

relationships between variables. We recommend a larger sample population

and/or purposive sampling with a mix-methodological design to assure

generalizability of the results for other samples. A longitudinal method could

be used to better understand the direct and indirect relationships among the

variables. Furthermore, future studies should use questionnaires that

specifically target migrant workers. In their recent publication, Cohen,

Gianaros, and Manuck (2016) explained that environmental demands were

understood as collective life stress events, this notion emerged that stress

44

processed should be studied more comprehensively. A qualitative study

could also lead to a better understanding of the subjective and dynamic

phenomena related to stressful life events, perceived stress, and stress

appraisal among Indonesian migrant workers.

Implications to Nursing Education and Practice

The social and cultural adjustments during the resettlement process

and occupational issues can be stressful for migrant workers, which can lead

to symptoms of depression and anxiety. The more well-adapted migrant

workers are, the more likely they are to be productive and engage in

productive activities, which provide great benefits for them as workers and to

the companies. Also, they are able to better assimilate and become part of the

community while residing in the host country. In this study, environmental

demands, stress appraisal, perceived stress, and stress responses among

Indonesian migrant workers in South Korea, as well as the relationships

among these variables, were explored. The findings from this study provide

us with foundational knowledge concerning the need for positive mental

health outcomes and their relative attributes among Indonesian migrant

workers in South Korea. An awareness of mental health issues can help to

improve workers’ mental health in personal, social, cultural, and

occupational context.

Nurses who provide care for migrant workers ought to be socially

and culturally competent to facilitate workers’ needs. Moreover, these study

findings demonstrate the urgency for the incorporation of cross-cultural

understandings in nursing education. It is relevant to developing modules in

the nursing practicum, courses, or continuing educational pursuits such as

workshop or training intended to extend nurses’ competency. In addition,

nurses working with migrant workers should be aware of their health

45

concerns and regularly assess their health conditions. Accordingly, more

attention should be paid to workers with high levels of perceived stress,

depressive and anxiety symptoms. Clinical and educational guidelines and

screening forms for mental health for workers should be available both

clinical and community settings.

46

CHAPTER VII. CONCLUSION

The findings of this study indicate that certain characteristics of the

respondents and environmental demands were related to perceived stress and

stress responses among Indonesian migrant workers in South Korea. In this

study, Indonesian migrant workers were predominantly male, aged 20–30

years old, and high school graduates. Twenty percent of the respondents

earned less than 1,500,000 KRW monthly and 37.8% of them work more

than 52 hours per week. Being Muslim and a minority in South Korean

society, where people tend to take pride in being part of a monoculture, were

potential environmental demands in this study. Relatedly, a third of the

respondents experienced difficulty practicing religious activities at work.

The mean score of perceived stress in this study was 15.87 and that of

stress appraisal was 24.05. The stress response scores indicate that

individuals had normal to moderate depressive and anxiety symptoms. In the

bivariate analysis, stress appraisal was neither correlated with perceived

stress nor with stress responses. Moreover, the higher the level of perceived

stress, the higher the level of stress responses (anxiety and depressive

symptoms). Educational levels, work type, and difficulty practicing religion

were correlated to perceived stress. Education and perceived stress were

related to depressive symptoms, whereas age and perceived stress were

related to anxiety symptoms. More specifically, the younger the respondent’s

age, the more anxiety symptoms they had.

The findings provide insightful knowledge for the improvement of

migrant workers’ mental health in personal, social, cultural, and job-related

contexts. Through the promotion of the preventive strategies aimed at

enhancing culturally sensitive care, perceived stress and stress responses can

be minimized in community mental health settings. Interventions that

alleviate their environmental demands and support mental health wellbeing

47

may include community health initiative, educational training, and an

increase in humanistic care and psychological counseling. For implementing

those strategies, it can be utilized more focused on the socio-spiritual aspects

and considering workers’ activities because they mostly live together in the

factory mess or communal in one place. They have existing social and/or

religious organizations, and most of them involved in those routine activities.

The multicultural centers were also located near the location where

Indonesian worker communities mostly gathered.

Directions for Future Research

Future research using a longitudinal design may reveal the direct and

indirect relationships among the variables. Moreover, qualitative methods

can help us understand the subjective and dynamic phenomena related to

stress appraisal and perceived stress, as well as shed light on the stress

processes among migrant workers. A larger sample population and/or

purposive sampling with a mix-methodological design could also enhance

the generalizability of the results. Moreover, it is necessary to use a stress

appraisal tool that is more suitable for migrant workers, as well as the

incorporation of more objective measurements such as cortisol (for stress

levels) and mental health screenings.

48

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63

APPENDICES

Inform Consent IRB NO. 1901/001-00919 Approved on January 7th, 2019

LETTER OF INFORMATION

Research Title:

Factors Related to Levels of Perceived Stress among Indonesian Migrant

Workers in South Korea

Researcher's Name:

Ade Sutrimo - Masters of Science Nursing Program, Psychiatric-Mental

Health Nursing, College of Nursing, Seoul National University

This is a study to identify factors that influence stress levels in Indonesian

migrant workers in Korea. You are asked to participate in this study because

you are an Indonesian working in Korea and aged 19 years old or older. A

researcher (Ade Sutrimo) from the Seoul National University who will

conduct this research will explain the purpose and procedure of the research

to you. This research will be carried out only for those of you who are willing

to participate and it is important that you understand the reason for the research

and everything about this research before you decide to participate. We ask

you to read the information below carefully. Please inform the researcher if

you are willing to participate. If you have questions, the researcher will explain

to you in detail.

1. Why is this research done?

To find out the factors that influence the stress level of Indonesian migrant

workers living in Korea.

2. How many people participated?

93 Indonesian migrant workers aged over 19 years

64

3. What should I do in this study?

You will be asked to fill out the questionnaire in this study. This

questionnaire consists of 4 parts with a total of 60 questions. You will fill

out the questionnaire personally, not as a group.

4. How long does this research take?

Completion of this questionnaire will take 10-15 minutes.

5. Can I withdraw from the study after I participate?

You can choose to participate or not. If you voluntarily participate in this

research, you can withdraw at any time without any consequences. You

may also refuse to answer a number of questions that you do not want to

answer and continue to participate in this research. If you want to stop

participating in this research, please immediately inform the researcher. If

you decide to withdraw from the study, the information you provided will

be discarded.

6. Are there side effects or risks?

There is little chance that you will feel a little uncomfortable when you are

free to refuse to participate in this research. There is no loss if you do not

participate in this study.

7. Are all personal data in this study guaranteed confidentiality?

The researcher (Ade Sutrimo) is the person in charge of managing the

participant's personal data. We will do our best to ensure the confidentiality

of all personal information in this study. When research results are

presented for academic purposes, your name and all your personal

information will not be used. However, if needed by law, your personal

65

information can be shown. In addition, SNUIRB monitors, supervisors, and

SNU Institutional Review committees, without violating the confidentiality

of participants' personal information, read directly, the results of the

research to check the reliability of data processing and storage. By signing

an agreement, you are considered to have understood and agreed to this.

8. Will I be paid to participate in this research?

Sorry, but there is no prize money for your participation in this study.

9. What should I do if I questions about this research?

If you have questions about this research or have problems diving into the

research, please contact the researcher through the contact below:

Name: Ade Sutrimo Phone: 010-***

10. If you have questions about your rights as a research participant, you can

contact the Seoul National University Institutional Review Board

(SNUIRB) at any time through the contact below:

SNUIRB Committee Phone: 02-880-5153

66

LETTER OF CONCENT

1. I have read these instructions and discussed them with researchers.

2. I have heard about the risks and benefits of participating in this research

and have received a satisfying answer to my question.

3. I agree to participate voluntarily in this study.

4. I agree to participate on the data collection and processing of information

from this study by researchers to the extent permitted by current laws and

SNU Institutional Review Board (SNUIRB) regulations.

5. I will not share my personal information in this research or when

processing of results by the researcher, health authority, academic

authority, and SNUIRB, except needed by law.

6. I can withdraw from this research and I understand that this decision will

not affect me in any form.

7. My signature indicates that I have received a copy of this consent form

and I will save this copy until the end of the study.

_____________ _______________ _____________________

Signature Respondent Date (Year / Month / Day)

_____________ _______________ _____________________

Signature Researcher Date (Year / Month / Day)

67

QUESTIONNAIRE

Demographical Data Code Number: ________*filled by the researcher

Age :________years

Sex : □ Male □ Female

Marital Status : □ Never Married □ Currently Married

□Widowed □ Divorced

Religion : □ Islam □ Christian □ Catholic

□ Buddha □ Hindu □ Kong-Hu Chu

Education : □ Less Than Middle School

□ Completed Middle School

□ Completed High School

□ Completed College/University

□ Completed Master Degree or higher

Part time student : □ Yes □ No

Length of stay in Korea : □ < 1year □ 1-5 years □ >5 years

Living Place : □ Dorm □ Private □ Communal

Type of Work : □ Manufacture□ Construction□ Agriculture

□ Fishery □ Service Others_________

68

Salary (KRW) : □ <1,500,000 □1,500,000-3,000,000

□ 3,000,001 – 5,000,000 □ >5,000,000

Work hour : ______/day or ______/week

Are you covered by the health insurance?

□ Yes □ No

Do you have ability to communicate using Korean Language?

□ Yes □ No

Do you join any social organization/association?

□ Yes □ No

How often do you socialize with your friends in Korea?

□ Never □ Rarely □ Often □ Always

How often do you contact your family/friends in Indonesia?

□ Daily □ Weekly □ Monthly/Occasionally □ Rarely

Do you have any difficulty to practice in your religion/praying?

□ Yes □ No

Perceived Stress Scale 10 (PSS-10)

Here is a question to measure the level of perceived stress. The existing

questions ask about your feelings and thoughts in the last month. There is an

answer that indicates how often the feeling and the mind by ticking (√) in the

column above as the available answers from the questions below. There are

no right or wrong answers. Please answer all questions.

69

Stress Appraisal (Cognitive Appraisal Inventory/CAI)

Answer these questions as they relate to your current situation. Please read

each of the questions below and answer them as best you can. Answer each

questions on the basis of how you felt or still feel about your condition.

No Questions

0

Nev

er

1

Rare

ly

2

Some

times

3

Fairly

often

4

Very

often

1 In the last month, how often have you

been upset because of something that

happened unexpectedly?

2 In the last month, how often have you

felt that you were unable to control

the important things in your life?

3 In the last month, how often have you

felt nervous and “stressed”?

4 In the last month, how often have you

dealt successfully with irritating life

hassles?

5 In the last month, how often have you

felt you were effectively coping with

important changes that were

occurring in your life?

6 In the last month, how often have you

felt confident about your ability to

handle your personal problems?

7 In the last month, how often have you

felt that things were going your way?

8 In the last month, how often have you

found that you could not cope with all

the things that you have to do?

9 In the last month, how often have you

been able to control irritations in your

life?

10 In the last month, how often have you

felt that you were on top of things?

70

Answer each question by ticking (√) the appropriate number corresponding to

the scale.

No. Questions

0

Not At

All

1

Slight

ly

2

Mode

rately

3

Mostly

4

Totally

1 How upsetting was the event

for you?

2 How favorable was the event

for you?

3 How much control over the

occurrence of this event did

you have?

4 How much had you expected

this event to occur?

5 How much uncertainty have

you experienced in your life as

a result of this event?

6 How likely do you feel a

similar event will occur in your

life in the next three years?

(Try to give an estimate based

on your personal feeling rather

than based on a rational

judgment.)

7 How responsible were you for

this events occurrence?

8 Did this event occur primarily

because of something about

you (such as personality,

effort) or was it primarily due

to something about the

situation or another person or

persons?

9 Please answer either 9A or 9B but not both. Only answer the one that is

appropriate for your event.

9A If this event occurred primarily

because of something about

you, to what extent did you

intend for it to happen?

71

9B It this event occurred primarily

because of something about

the situation or person, to what

extent did the other person or

persons intentionally cause this

event to happen to you?

10 Did this event occur primarily

because of something of

something that changes readily

(such as mood, effort, luck or

fate) or because of something

relatively unchanging (e.g.,

ability, unchanging qualities of

a situation or person)?

11 How effective were you in

coping with the event?

Stress Response DASS-21

Please read each statement and tick a number which indicates how much the

statement applied to you over the past week. There are no right or wrong

answers. Do not spend too much time on any statement. The rating scale is as

follows:

0 - Did not apply to me at all

1 - Applied to me to some degree, or some of the time

2 - Applied to me to a considerable degree, or a good part of time

3 - Applied to me very much, or most of the time

No Questions 0 1 2 3

1 I found it hard to wind down

2 I was aware of dryness of my mouth

3 I couldn't seem to experience any positive feeling at

all

4 I experienced breathing difficulty (e.g., excessively

rapid breathing, breathlessness in the absence of

physical exertion)

5 I found it difficult to work up the initiative to do

things

6 I tended to over-react to situations

72

7 I experienced trembling (e.g., in the hands)

8 I felt that I was using a lot of nervous energy

9 I was worried about situations in which I might panic

and make a fool of myself

10 I felt that I had nothing to look forward to

11 I found myself getting agitated

12 I found it difficult to relax

13 I felt down-hearted and blue

14 I was intolerant of anything that kept me from

getting on with what I was doing

15 I felt I was close to panic

16 I was unable to become enthusiastic about anything

17 I felt I wasn't worth much as a person

18 I felt that I was rather touchy

19 I was aware of the action of my heart in the absence

of physical exertion (e.g., sense of heart rate

increase, heart missing a beat)

20 I felt scared without any good reason

21 I felt that life was meaningless

73

INDONESIAN VERSION

LEMBAR INFORMASI

Judul Penelitian:

Analisis faktor-faktor yang berhubungan dengan tingkat stres pekerja migran

Indonesia di Korea

Nama Peneliti:

Ade Sutrimo – Program Magister/S2 Keperawatan, College of Nursing, Seoul

National University

Penelitian ini adalah sebuah studi tentang analisis faktor-faktor yang

berhubungan dengan tingkat stres pada pekerja migran Indonesia di Korea.

Anda diminta untuk berpartisipasi dalam penelitian ini karena Anda

merupakan pekerja migran Indonesia dan berumur 19 tahun atau lebih.

Seorang peneliti (Ade Sutrimo) dari Seoul National University yang akan

melakukan penelitian ini akan menjelaskan tujuan dan prosedur penelitian

kepada anda.

Penelitian ini akan dilakukan hanya kepada anda yang bersedia untuk

berpartisipasi, dan penting bagi anda untuk memahami alasan penelitian

dilakukan serta segala sesuatu mengenai penelitian ini sebelum anda

memutuskan untuk berpartisipasi. Anda diminta untuk membaca keterangan

dibawah ini secara teliti dan harap memberitahukan kepada peneliti jika anda

bersedia untuk berpartisipasi. Jika anda memiliki pertanyaan, peneliti akan

menjelaskan kepada anda secara terperinci.

74

a. Mengapa penelitian ini dilakukan?

Untuk mengetahui faktor-faktor yang berhubungan dengan tingkat stres

pekerja migran Indonesia yang tinggal di Korea.

b. Berapa orang yang berpartisipasi?

93 orang pekerja migran Indonesia berumur diatas 19 tahun

c. Apa yang harus saya lakukan dalam penelitian ini?

Anda akan diminta untuk mengisi kuisoner dalam penelitian ini. Kuisioner ini

terdiri dari 4 bagian dengan total 60 pertanyaan. Anda akan mengisi kuisioner

secara pribadi, bukan sebagai grup.

d. Berapa lama waktu yang dibutuhkan dalam penelitian ini?

Pengisian kuisioner ini akan membutuhkan waktu 10-15 menit.

e. Dapatkah saya mengundurkan diri selama saya berpartisipasi?

Anda dapat memilih untuk berpartisipasi atau tidak. Jika anda dengan suka

rela berpartisipasi dalam penelitian ini, anda dapat mengundurkan diri

kapanpun tanpa konsekuensi apapun. Anda juga diperbolehkan untuk

menolak menjawab beberapa pertanyaan yang tidak ingin anda jawab dan

tetap berpartisipasi dalam penelitian ini. Apabila anda ingin berhenti

berpartisipasi dalam penelitian ini, harap segera memberitahukan kepada

peneliti. Apabila anda berhenti berpartisipasi dalam penelitian ini, segala

informasi yang Anda berikan sebelumnya akan dihapus.

f. Apakah ada efek samping atau resiko?

Ada sedikit kemungkinan bahwa anda akan merasa sedikit tidak nyaman

saat mengisi kuisioner, Anda bebas untuk menolak berpartisipasi dan tidak

ada kerugian apabila anda tidak berpartisipasi dalam penelitian ini.

75

g. Apakah semua data pribadi dalam penelitian ini dijamin kerahasiaannya?

Peneliti (Ade Sutrimo) adalah penanggungjawab pengelolaan data pribadi

partisipan. Kami akan melakukan yang terbaik untuk menjamin

kerahasiaan semua informasi pribadi dalam penelitian ini. Ketika hasil

penelitian dipresentasikan untuk tujuan akademis, nama dan semua

informasi pribadi anda tidak akan digunakan. Namun, apabila dibutuhkan

oleh hukum, informasi pribadi anda dapat ditunjukkan. Sebagai tambahan,

petugas pemantau, pengawas, dan komite SNU Institutional Review Board

(SNUIRB), tanpa melanggar kerahasiaan informasi pribadi milik partisipan,

dapat membaca seecara langsung hasil penelitian untuk memeriksa

keandalan proses dan penyimpanan data. Dengan menandatangani

persetujuan, anda dianggap telah memahami dan menyetujui tentang ini.

h. Apakah saya akan dibayar untuk berpartisipasi dalam penelitian ini?

Mohon maaf, namun tidak ada hadiah uang untuk partisipasi anda dalam

penelitian ini.

i. Apa yang harus saya lakukan dalam penelitian ini?

Apabila anda memiliki pertanyaan mengenai penelitian ini atau memiliki

masalah selama mengikuti penelitian, harap menghubungi peneliti melalui:

Nama : Ade Sutrimo No. Telp.: 010-*****

j. Apabila anda memiliki pertanyaan mengenai hak anda sebagai partisipan

penelitian, anda dapat menghubungi Seoul National University

Institutional Review Board (SNUIRB) kapanpun melalui kontak:

SNUIRB Committee Phone: 02-880-5153

76

LEMBAR PERSETUJUAN

1. Saya telah membaca petunjuk ini dan mendiskusikannya dengan

peneliti.

2. Saya telah mendengar tentang resiko dan keuntungan dan telah

mendapat jawaban yang memuaskan dari pertanyaan saya.

3. Saya setuju untuk berpartisipasi secara sukarela dalam penelitian ini.

4. Saya menyetujui pengumpulan data dan pengolahan informasi yang

didapatkan dari penelitian ini oleh peneliti sampai ke batas yang

diizinkan oleh undang-undang yang berlaku saat ini dan peraturan

SNU Institutional Review Board (SNUIRB).

5. Saya tidak akan memberitahukan informasi personal saya dalam

penelitian yang saya setujui ini, terkecuali kepada peneliti maupun

utusan resmi wewenang kesehatan, wewenang akademis, dan

SNUIRB melakukan penelitian atau pengolahan hasil penelitian..

6. Saya dapat mengundurkan diri dari penelitian ini dan saya memahami

bahwa keputusan ini tidak akan memengaruhi saya dalam bentuk

apapun.

7. Tanda tangan saya menunjukkan bahwa saya telah menerima salinan

lembar persetujuan ini dan saya akan menyimpan salinan ini hingga

akhir penelitian.

________________ __________ _________________________

Tanda Tangan Responden Tanggal (Tahun/Bulan/Hari)

________________ __________ _________________________

Tanda Tangan Peneliti Tanggal (Tahun/Bulan/Hari)

77

Kuisioner Penelitian

Data Demografi Kode Nomor: ___________*diisi peneliti

Usia :________tahun

Jenis Kelamin : □ Laki-laki □ Perempuan

Status Pernikahan : □ Belum menikah □ Menikah

□ Istri/suami Meninggal □ Janda/Duda

Agama : □ Islam □ Kristen

□ Katolik □ Budha

□ Hindu □ Kong-Hu Chu

Pendidikan : □ Tidak Lulus SMP

□ Lulus SMP

□ Lulus SMA

□ Lulusan Perguruan Tinggi

□ Lulusan S2/lebih tinggi

Mahasiswa UT Korea : □ Ya □ Tidak

Lama tinggal di Korea : □ < 1tahun □ 1-5tahun □>5tahun

Tempat tinggal di Korea : □ Mess Perusahaan □ Kos Pribadi

□ Tempat Tinggal Bersama

Tipe pekerjaan : □ Pabrik □ Pelayanan

78

□ Perikanan □ Pertanian

□ Konstruksi □ Lainnya_________

Penghasilan perbulan (Won) : □ <1,500,000 □1,500,000–3,000,000

□ 3,000,001–5.000.000□>5,000,000

Waktu kerja : _____jam/hari atau _____jam/minggu

Apakah anda bisa berkomunikasi menggunakan bahasa Korea?

□ Ya □ Tidak

Apakah anda memiliki asuransi kesehatan?

□ Ya □ Tidak

Apakah anda mengikuti organisasi sosial/agama?

□ Ya □ Tidak

Seberapa sering anda berinteraksi dengan teman anda di Korea?

□ Tidak Pernah □ Jarang □ Sering □ Selalu

Seberapa sering anda berkomunikasi dengan keluarga/orang terdekat di

Indonesia?

□ Setiap hari □ Setiap minggu □ Bulanan □ Jarang

Apakah anda mengalami kesulitan dalam melaksanakan ibadah?

□ Ya □ Tidak

79

Pengukuran Tingkat Stres (PSS-10)

Berikut ini adalah pertanyaan untuk mengukur tingkat stress yang anda

rasakan. Soal-soal yang ada menanyakan tentang perasaan dan pikiran anda

dalam satu bulan terakhir ini. ada jawaban yang mengindikaasikan seberapa

sering perasaan maupun pikiran dengan memberikan tanda centang (√) pada

kolom atas jawaban yang tersedia dari pertanyaan dibawah ini.

No Pertanyaan

0

Tidak

Pernah

1

Jarang

2

Kadang-

Kadang

3

Sering

4

Hampir

Selalu

1 Merasa sedih/terganggu

karena hal-hal yang terjadi

tanpa diduga

2 Merasa tidak dapat

mengontrol hal-hal penting

dalam hidup anda

3 Merasa gelisah dan tertekan

4 Yakin terhadap kemampuan

diri untuk menangani

masalah pribadi

5 Hal-hal yang terjadi sesuai

kehendak anda

6 Menemukan bahwa anda

tidak dapat menyelesaikan

hal-hal yang harus anda

kerjakan

7 Telah dapat mengontrol rasa

mudah tersinggung dalam

kehidupan anda

8 Merasa seperti pecundang

dan murung yang

disebabkan karena saya tidak

melakukan sesuatu

9 Marah karena hal-hal terjadi

di luar kendali anda

10 Merasa banyak kesulitan

yang menumpuk sehingga

anda tidak dapat

mengatasinya

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Penilaian terhadap stress

Kuisioner ini berkaitan dengan pemikiran Anda tentang berbagai aspek dari

situasi yang diidentifikasi sebelumnya. Tidak ada jawaban yang benar atau

salah. Tolong tanggap sesuai dengan bagaimana Anda melihat situasi yang

sedang Anda hadapi sekarang. Tolong jawab semua pertanyaan. Jawab

setiap pertanyaan dengan mencentang (√) nomor yang sesuai dengan skala.

No. Pertanyaan

0

Tidak

Sesuai

1

Agak

Sesuai

2

Netral

3

Sesuai

4

Sangat

sesuai

1 Apakah ini benar-benar

mengecewakan bagi anda?

2 Apakah situasi ini

menguntungkan dalam diri

saya?

3 Apakah situasi ini dapat

dikendalikan oleh anda?

4 Bagaimana harapan anda

dari peristiwa ini terjadi?

5 Berapa banyak

ketidakpastian yang Anda

alami dalam hidup Anda

sebagai hasil dari peristiwa

ini?

6 Seberapa mungkin Anda

merasakan peristiwa serupa

akan terjadi dalam hidup

Anda dalam tiga tahun ke

depan? (Coba berikan

perkiraan berdasarkan pada

Anda perasaan pribadi

daripada berdasarkan

penilaian yang rasional.)

7 Seberapa Anda bertanggung

jawab untuk kejadian ini?

8 Apakah peristiwa ini terjadi

disebabkan oleh Anda

(seperti kepribadian, usaha)

atau karena sesuatu tentang

81

situasi atau orang atau orang

lain?

9 Harap dijawab salah satu saja 9a atau 9B, tidak keduanya. Hanya jawab

pada kondisi yang sesuai dengan anda saja.

9A Jika peristiwa ini terjadi

terutama karena sesuatu

tentang Anda, sampai sejauh

mana Anda berniat untuk

mewujudkannya?

9B Itu peristiwa ini terjadi

terutama karena sesuatu

tentang situasi atau orang,

sejauh mana orang lain atau

orang-orang yang dengan

sengaja menyebabkan

peristiwa ini terjadi pada

Anda?

10 Apakah peristiwa ini terjadi

terutama karena sesuatu

yang mudah berubah

(seperti suasana hati, upaya,

keberuntungan atau nasib)

atau karena sesuatu yang

relatif tidak berubah

(misalnya, kemampuan,

kualitas yang tidak berubah

dari suatu situasi atau

orang)?

11 Seberapa efektifkah Anda

dalam menghadapi

peristiwa tersebut?

Respon Stres (DASS-21)

Selanjutnya, Bapak/Ibu/Saudara diminta untuk menjawab dengan cara

memberi tanda silang (√) pada salah satu kolom yang paling sesuai dengan

pengalaman Bapak/Ibu/Saudara satu minggu belakangan ini. Terdapat empat

pilihan jawaban yang disediakan untuk setiap pernyataan yaitu:

0 : Tidak sesuai dengan saya sama sekali, atau tidak pernah.

1 : Sesuai dengan saya sampai tingkat tertentu, atau kadang kadang.

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2 : Sesuai dengan saya sampai batas yang dapat dipertimbangkan, atau

lumayan sering.

3 : Sangat sesuai dengan saya, atau sering sekali.

No Pertanyaan 0 1 2 3

1 Saya sulit untuk menenangkan diri

2 Saya menyadari mulut saya kering

3 Saya tidak pernah mengalami perasaan positif sama sekali

4 Saya mengalami kesulitan bernafas (contoh: bernafas

cepat dan berat, sulit bernafas saat tidak ada aktivitas fisik)

5 Saya kesulitan untuk berinisiatif melakukan sesuatu

6 Saya cenderung bereaksi berlebihan terhadap situasi

7 Saya mengalami gemetar (contoh: di tangan)

8 Saya merasa bahwa saya menggunakan banyak energi

untuk gelisah

9 Saya mengkhawatirkan tentang situasi yang dapat

mengakibatkan saya panik dan membuat diri saya tampak

bodoh

10 Saya merasa bahwa tidak ada hal baik yang saya tunggu

di masa depan

11 Saya mendapati diri saya merasa gelisah

12 Saya sulit untuk tenang / relaks

13 Saya merasa rendah diri dan sedih

14 Saya tidak toleran terhadap apapun yang mengganggu

saya dari mengerjakan sesuatu yang sedang saya kerjakan

15 Saya merasa saya mudah untuk panik

16 Saya tidak bisa antusias terhadap apapun

17 Saya merasa saya tidak berharga sebagai seseorang

83

18 Saya merasa saya agak mudah tersinggung

19 Saya menyadari reaksi jantung saya saat tidak ada

aktivitas fisik (cth: merasakan peningkatan denyut

jantung, jantung tidak berdetak 1 kali)

20 Saya merasa takut

21 Saya merasa bahwa hidup itu tidak berarti

84

85

ACKNOWLEDGEMENT

All praise belongs to the almighty Allah who has bestowed His

mercy and grace, also His messenger prophet Muhammad may peace be

upon him. It has such a great opportunity and courage for completing this

study.

For me myself, you have been able to go through this challenge,

please make this moment being a stepping stone towards a brighter journey

in the near future.

Professor Hwang Boyoung, Ph.D, RN, FAHA as the advisor for

every guidance, great help and every effort you have given throughout the

entire thesis processes. These mean a world to me. Thank you so much,

Professor.

My gratitude for the committee member Professor Heeseung Choi,

Ph.D, MPH, RN and Professor Chae Sun-Mi, Ph.D, RN, PNP for the

encouragement, feedback and support for the better version of my thesis.

Dean, Associate Deans, and faculty members of the College of

Nursing who taught me being a broader mindset and deeper understanding of

psychiatric-mental health nursing and related topics. Also, the academic

staffs for the helpful service, and all facility for my thesis and study.

Indonesia Endowment for Education (LPDP) Scholarship, Indonesian

Government for providing a full funding for my master study here. I will

come back to contribute to Indonesia to pay it back.

Ns. Wahyu Ekowati, Sp.J and Ns. Shanti Wardhaningsih, Ph.D. for

giving me recommendations for pursuing my master degree and all faculty

members in School of Nursing, Jenderal Soedirman University and the

Muhammadiyah University of Yogyakarta.

86

My precious parents who always poured out their sweat for me every

time. As a form of respect and my devotion, thank you for prayers that keep

flowing, affection, sacrifice, and encouragement that never ends for your

oldest son.

My beloved sister, hopefully, I can give you a better example,

achieve what you want and be the best version of yourself.

SNU IRB, research participants, and coordinator in each Indonesian

community in this study who helped to facilitate the data collection.

My SNUCON buddies: Lailil, Farah, Firma, Yu Hyejin, Song

Giyeong, Oh Sangjun, Park Hanna and Park Sanga, all classmates in College

of Nursing thank you for all kindness, supports, and motivations while

studying here.

My fellow Indonesian sisters and brothers in SNU Gwanak Team:

Bang Herry, Bang Faisal, Bang Tono, Bang Yudhi, Ridwan, Dewa, Dwi,

Alfina, Etis, Stella, Hana, Novi, Nina, Lina, Desica, Syifa & Rizka who

taught me the meaning of togetherness, friendship, caring, and life journey.

My friends and partners at Amazon Yogyakarta, Asdos UMY 2016,

Alumni Keperawatan Unsoed, LPDP Korea, LPDP PK-83, Pare Kampung

Inggris, Perpika (PPI Korea), L Seoul U group, IMUSKA, IKMI, and PCIM

who have created my unforgettable moments in my life.

The one and only Seoul National University, Veritas Luxmea!

Seoul, 31 December 2019

Sutrimo Ade (아데)

87

국문초록

본 연구는 한국의 인도네시아 이주 노동자들 사이에서 인식된

스트레스와 스트레스 반응과 관련된 요소들을 식별하는 것을 목표로 했다.

본 연구를 진행하기 위해 횡단적, 서술적 및 상관적 설계가

사용되었다. 2019 년 1월에 자료를 수집해 안산시와 주변 지역에서 90 명의

참가자를 모집했으며 연구의 인지응력은 인지응력 척도-10 을 사용하여

측정되었다. 스트레스 평가는 인지 평가 목록을 사용하여 스트레스 반응은

우울증 불안 스트레스 척도를 사용하여 측정되었다. 인구통계학적 특성과

이민 및 직업과 관련된 환경적 요구는 자체 보고 설문지를 사용하여

평가되었다. 데이터는 Pearson 의 상관 관계와 다중 선형 회귀 분석을 통해

분석되었다.

인식된 스트레스와 관련된 요소들은 교육, 직업 및 직장에서 종교를

실천하는 어려움이었다. 본 연구는 또한 교육과 인식된 스트레스가 우울증의

증상과 관련이 있다는 것을 보여주었다. 나이와 인지된 스트레스는 불안

증상과 관련이 있었다. 스트레스 평가는 인식된 스트레스 반응이나 스트레스

반응과 상관관계가 없었다. 뿐만 아니라, 인식된 스트레스 수준이 높을수록

스트레스 반응(불안증, 우울증 증상)이 높은 것으로 조사되었다.

본 연구의 결과는 한국에서 일하는 인도네시아 이주 노동자들 특유의

정신 건강 서비스를 개선하기 위한 통찰력을 제공한다. 그 결과에 대한 보다

광범위한 이해를 위해서는 더 개발적인 연구가 필요하다는 것을 볼 수 있다.

주요어: 불안, 우울증, 인도네시아, 이주 노동자, 인지된 스트레스

학번: 2017-28238