All Lives “Still” Matter. Understanding Different Experiences with the COVID-19 Depression among Foreign and Non-foreign Residents in Seoul, South Korea

Ⅰ. Introduction

The COVID-19 pandemic has prompted an economic downturn and triggered fears of disease infection in cities and regions (Chaudhary et al., 2021; Esterwood and Saeed, 2020; Kang et al., 2020; Ozili, 2020), which are associated with psychological distress and mental illness symptoms (Fancourt et al., 2021; Palgi et al., 2020). Mental health issues have continually increased as a result of the COVID-19 pandemic, while social interaction and opportunities for employment, education, and exercise, which could offset these risks, have decreased in our daily lives (Evans, 2020; Teychenne et al., 2017).

There has been growing recognition of the differential impacts of infectious diseases on various groups (or individuals), which affect health equity in the long term (Dimka and Mamelund, 2020; Farmer, 1996; Park, 2021). Those with little access to health services and a limited level of infection mitigation capacity may have a higher risk of experiencing serious symptoms (Farley et al., 2020; Shadmi et al., 2020). Some studies (Avato et al., 2010; Choudhari, 2020; Theng et al., 2020; World Bank, 2020) have indicated that foreign residents may be more severely affected by the COVID-19 than non-foreign residents, especially due to lack of safety nets and social protection in case of job loss or illness. Additionally, because of communication barriers, foreign residents are more likely to suffer from mental health problems such as depression (Gilmour et al., 2019; Heeren et al., 2014).

Although COVID-19 impacts depression in foreign and non-foreign residents differently, little research has explored factors that contribute to such a difference. Most research on mental health has focused mainly on vulnerable groups, such as those with underlying medical conditions (Lu et al., 2020), the elderly (Banerjee, 2020; García-Fernández et al., 2020), and medical staff (Spoorthy et al., 2020). Therefore, this research addresses the need for a comprehensive investigation of differential impacts on depression among foreign and non-foreign residents of cities during the COVID-19. Such an investigation is timely and appropriate given the increasing numbers of migrants and immigrants, particularly in Asia, where the pandemic originated. In practice, most previous research on health equity has focused on the West (e.g., Bartoš et al., 2021; Rye and Andrzejewska, 2010).

This study aims to examine varied factors that affect depression during the pandemic in foreign and non-foreign residents in Seoul, South Korea. Seoul was chosen as the city has seen a growing number of foreign residents, and it faced the issues of health equity between foreign and non-foreign residents (Hong and Lee, 2019; Lee et al., 2021a). We used a social survey of 7,500 residents (i.e., 2,500 foreign and 5,000 non-foreign residents) in Seoul. A partial least squares (PLS) regression model was used for empirical analysis, which was suitable for addressing multicollinearity and non-normality issues. Based on the survey findings, the research outlines policy recommendations that could enhance the mental health of both groups, thus contributing to health equity.

Ⅱ. Literature Review

Ⅲ. Research Design

2. Input variables and methods

<Table 1> presents the variables that were identified as major stressors in the literature review. The dependent variable was a feeling of depression after the COVID-19 outbreak. To measure the variables, we used the following survey question: “Have you ever felt depressed in your daily life during the COVID-19 pandemic?” Responses were given on an 11-point Likert-type scale (0=not depressed at all to 10=very depressed). The independent variables included media reports related to COVID-19, emergency alert messages, minimized relationship and interaction due to social distancing, decrease in income and expenses, fake news on COVID-19, participation in social activities, gender (female), age, housing type (living in detached houses, and multi-unit dwellings), housing occupancy type (owned, jeonse, and monthly rent), employment type (permanent worker, contract worker, day laborer, self-employed), and education.¹⁾ In the category of ‘Employment type,’ those who are unemployed, students, housewives, and unpaid workers were marked as ‘0’ in the ‘Employment status’ section.

Table 1.

Input variables

This study employed PLS regression instead of the traditional ordinary least squares (OLS) regression model in order to estimate the magnitude of the influence of the independent variables. PLS regression repeatedly outper-formed both OLS regression analysis and exploratory factor analysis. The Kolmogorov-Smirnov and Shapiro-Wilk tests rejected the null hypothesis that the independent variable was normally distributed <Table 2>. Therefore, using OLS regression analysis was deemed unsuitable. As an alternative, PLS regression was adopted, as it functions well even when the data are severely non-normal. Furthermore, as noted earlier, PLS regression is useful for analyzing multiple variables, particularly when a model includes a large number of variables or with a high level of multicollinearity. PLS regression shares a common goal with OLS regression in modeling relationships and making predictions from data. However, the process of handling and predicting information differs between them. OLS is the most fundamental method used in regression analysis to identify a linear relationship between dependent and independent variables. On the other hand, PLS regression is akin to OLS regression. However, it proves to be a valuable analytical technique when dealing with multivariate data, particularly when there are more variables than observations and strong correlations among these variables.

Table 2.

The Kolmogorov-Smirnov and Shapiro-Wilk test

Equation 1 shows the formula for PLS (Partial Least Squares) regression. PLS regression is a model that uses the linear combination of explanatory variables, where ‘t’ represents the linear combination in a situation with ‘n’ data points and ‘p’ explanatory variables.

$$

(1)

PLS regression seeks the linear combination of independent variables that can best explain the dependent variable. It utilizes an axis that maximizes the quadratic form of the correlation vector between the variance of the linear combination of independent variables and the matrix of the dependent variable (Abdi, 2003).

Ⅳ. Results

1. Descriptive statistics

<Table 3> provides the descriptive statistics of the sample including the age, gender, and household size distributions of the foreign and non-foreign subsamples. During the pandemic, foreign and non-foreign resident groups felt similar levels of depression: 6.160 for non-foreign residents and 6.092 for foreign residents. The descriptive statistics of some independent variables showed substantial differences between the two sub-samples. Non-foreign residents evaluated participation in social activities (0.570) and minimized relationship and interaction (0.260) at a higher rate than foreign residents (0.202 and .178, respectively). Foreign residents evaluated a decrease in income and expense (0.208) and fake news on COVID-19 (0.065) higher than non-foreign residents (0.150 and 0.050, respectively). Among non-foreign residents, 20.3% (1,017 residents) live in detached houses, while 47.2% (2,358 residents) reside in apartments, the highest proportion. 32.5% (1,625 residents) live in multi-unit dwellings (townhouses and row houses). Meanwhile, among foreign residents, 14.8% (369 residents) live in detached houses, and 21.8% (545 residents) live in apartments. Additionally, 63.5% (1,586 residents) responded that they reside in multi-unit dwellings.

Table 3.

Descriptive statistics

All variables showed sufficient variation for inferential statistics, for which this study consistently used the 95% confidence level.

2. Inferential statistics

This study examined the 18 factors affecting depression during the pandemic through PLS regression. <Figure 1> demonstrates the structure of the research model. The variables named “Media reports and fake news on COVID-19”, “COVID-19 Prevention Behaviors”, “Impact of COVID-19 on financial condition and behavior”, “Socio-Demographic factors” corresponds to the independent variables represented for input purposes, which may affect feeling of depression, the dependent variable.

Figure 1.

The structure of the analysis model

As shown in <Table 4>, the results indicated a substantial difference in factors affecting depression between the two groups. For foreign residents, decrease in income and expense (standardized path coefficient=0.108), monthly rent (0.097), being self-employed (-0.078), media reports related to COVID-19 (0.076), living in a multi-unit dwelling (0.068), fake news on COVID-19 (0.051), minimized relationship and interaction (0.044) were all found to be closely associated with depression during the pandemic.

Table 4.

PLS regression

Economic variables such as decreased income and expenses had the greatest impact on the level of depression for foreign residents. Among those who paid monthly rent, individuals with lower income might have experienced relatively a high level of depression. Self-employed people appeared to be less likely to be depressed. This could be because Seoul lowered the intensity of the social distancing policy at the time of the survey (September to October 2020) (Yeonhap, 2020). The respondents may not have experienced heavy losses from closing down their businesses. In this sense, differing results could be expected if the type of business—whether it is face-to-face or contact-free—was considered for the analysis. The model also showed that continual exposure to pandemicrelated information on media (e.g., fake news on COVID-19) affected the risk perception of foreign residents, increasing their depression level. This finding is in line with previous research on the relationship between mental health and social media exposure (e.g., Gao et al., 2020; Toriumi et al., 2013).

Among the socio-demographic factors, only gender (female) and living in a multi-unit dwelling (condominium) were significant for foreign residents. Females (0.047) experienced more depression than males during the pandemic, echoing the arguments of previous studies (e.g., Mamum and Ullah, 2020; Pieh et al., 2020; Xiong et al., 2020). Living in a multi-unit dwelling (0.068) was more likely to cause depression than other housing types.

For non-foreign residents, decrease in income and expenses (0.115), participation in social activities (0.088), minimized relationships and interactions (0.068), female gender (0.069), living in detached houses (0.060), fake news on COVID-19 (-0.046) were associated with the feeling of depression.

Decreases in income and expenses (0.115) were the most significant variables that affected the depression of non-foreign residents during the pandemic. The variables related to social interaction, such as participation in social activities (second strongest variables) and minimized relationship and interaction (third strongest variables), greatly impacted this group. The descriptive analysis showed that non-foreign residents are more likely to participate in social activities than foreign residents (see <Table 2>). Unlike foreign residents, fake news on COVID-19 (-0.046) appeared to reduce the level of depression among non-foreigners, the opposite of the results for foreign residents. It was also noted that the impacts of media reports related to COVID-19 on non-foreign residents were insignificant.

Female residents were more depressed than their male counterparts during the pandemic, as with foreign residents. These consistent results strengthen the findings of previous studies regarding the relationship between gender and COVID-19 depression (Gerhold, 2020; Vloo et al., 2021). Detached housing was associated with a higher level of depression for non-foreign residents, contrary to the fact that living in a multi-unit dwelling (condominium) brought about depression among foreign residents.

Ⅴ. Discussion and Conclusions

This study investigated differences in the factors affecting COVID-19-related depression between foreign and non-foreign residents using the case of Seoul, South Korea. Although both residents evaluated their degree of depression during the COVID-19 pandemic to be similar, this study found that the factors affecting depression varied in significance and magnitude.

The analysis of the result suggests that economic factors such as decreases in income and expenses as well as paying monthly rent can be strongly associated with depression during the pandemic, especially for foreign residents. Like many other disasters, the COVID-19 pandemic has resulted in substantial economic losses, leading to high unemployment and business closure rates (see Ozili, 2020; UNDP, 2020). The economic burden of purchasing protection measures tends to increase while access to health care services decreases particularly among vulnerable groups (Tai et al., 2020). With unequal access to health services and social protection in the context of an economic downturn, foreign residents can be at greater risk of having mental health problems (Karasapan, 2020). Thus, tailored alternatives are required to mitigate these varied detrimental impacts related to economic losses during the pandemic (e.g., temporary wage subsidy) (ISSA, 2020; OECD, 2020) to reduce the depression level of foreign residents.

Our research indicates that vulnerable living conditions during the pandemic may cause depression for foreign residents. In Seoul, multi-unit dwellings (e.g., condominiums), in which multiple people live together and share common spaces and facilities, appeared to increase the depression of foreign residents. Indeed, living in densely populated and closed spaces in cities increased the risk of COVID-infection (e.g., infection through air vents) even though there was no physical contact between residents (Han et al., 2021; World Health Organization, 2021; Zhang et al., 2020). To fundamentally tackle fear and depression induced by the pandemic, particular attention should be paid to comprehending the relation between types of housing and vulnerable living conditions for COVID-19 infection (Han et al., 2021; Kuang et al., 2020).

For non-foreign residents, variables related to social interaction such as social activity participation and social relationships can have a significant impact on their depression levels. As shown by the descriptive analysis (see <Table 2>), people who actively participated in social activities and had to minimize physical interactions due to the social distancing policies reported higher depression. Non-foreign residents may feel more affected by the restrictions on social networking than foreign residents because they are likely to have a wider social network and more social interaction. This finding contributes to the literature on mental health and social interaction (e.g., Pietrabissa and Simpson, 2020; Sommerlad et al, 2021) by clarifying the groups of individuals that the results of previous studies apply to, showing their relevance for non-foreign residents. The finding further highlights that while contact-free communication is expected to replace face-to-face interaction during the pandemic (Nguyen et al., 2021), social activities still assume an important role in facilitating effective communication. Specific policies to keep essential social activities during the pandemic should be considered in order to maintain the mental health of the urban population.

Living in detached houses can be also associated with high levels of depression, particularly for non-foreign residents, as they are likely to have a higher feeling of social isolation. Detached houses tend to have a smaller living space per household, in which one to two people reside (KOSIS, as of 2023). In this study, small households occupied 50.8% of detached houses, and most residents were in their 20’s and 30’s (see <Table 3>). When work, study, social interaction, and living all become integrated into the one place of home, due to involuntary and voluntary isolation (Kang et al., 2020), people living in detached houses could be more significantly affected by depression due to higher feeling of isolation. Single-person households face difficulties in dealing with illness, injury, adversity, social isolation, and loneliness (Shin, 2021), being more likely to have a higher level of depression (Benke et al., 2020).

Our study suggests that fake news related to COVID-19 has differential impacts on depression depending on individual characteristics and circumstances (Larson, 2020; Naeem and Bhatti, 2020; Toriumi et al., 2013), including the ability to comprehend information and accessibility to adequate information (Abdoli and Heidarejadi, 2020; Xiong et al., 2020). The substantial move to the information society has triggered the spread of fake news, such as false reports of confirmed cases through social media, affecting risk perception (Ahmad and Murad, 2020; Moscadeli et al., 2020; Larson, 2020). In the case of Seoul, such fake news increased the level of depression of foreign residents and decreased the depression of non-foreign residents. Compared with foreign residents, non-foreign residents are more likely to have a chance to check the credibility of fake news through various media channels or human networks. On the other hand, foreign residents may have difficulty verifying the information authenticity (Bailer et al., 2021) partially because of language barriers or limited social networks (Gilmour et al., 2019; Heeren et al., 2014; Wang et al., 2020). Consequently, fake news can raise concerns about the COVID-19 pandemic for foreign residents, leading to depression. In the vein, preventive measures are required to verify the authenticity of information and deliver accurate information, especially to foreign residents (e.g., see OECD, 2020; World Bank, 2020).

In short, the factors affecting depression in foreign and non-foreign residents of cities were varied in significance and magnitude. The impact of economic factors was graver for foreign residents while social isolation as induced by the pandemic appeared to affect non-foreign residents’ depression more profoundly. These varying results indicate that, under the same pandemic situation, factors affecting depression are different depending on resident characteristics. Minimized social interaction increases feelings of depression among both foreign residents and non-foreign residents, and the social isolation resulting from the COVID-19 pandemic exacerbates depression in non-foreign residents. In relation to this, the UK has implemented a social prescribing system that strengthens communities by connecting clients with link workers through remote counseling. This UK’s social prescribing service has been effective in reducing loneliness caused by over-reporting in the media due to COVID-19 and isolation due to public health policies, as shown by Younan et al. (2020).

Depression is affected by multiple factors and achieving equity in health among various groups requires measures to improve access to economic support, social interaction, and accurate information. Policy to enhance health equity can be developed based on understanding the different levels of adaptivity, vulnerability, and sensitivity of each group to varied socio-economic factors affected by the pandemic. For example, COVID-19-related policies should consider prioritizing economic supports, including emergency relief grants for foreign residents, as economic factors could affect the depression of these groups more severely. Moreover, as foreign residents may have different digital literacy compared to non-foreign residents, policy measures to deliver and manage accurate information must be considered. As noted in this study, foreign residents tend to refer to fake news without a chance to verify it, which can bring about depression. Jeong and Park (2021) revealed that many of the fake news reports filed from January to October 2020 were related to creating distortion and fear about the epidemic situation, COVID-19 policies, and international scenarios. In this context, while non-foreign residents experience a decrease in depression by identifying misinformation, foreign residents face limitations in discerning the authenticity of negative and distorted information, potentially increasing their depression. Subsequent research into the mental health problems that can arise from fake news, and the changes in depression based on the content (positive/negative) of the fake news, can be used in controlling the impact of fake news in future pandemic situations.

Amid growing international concern and policy recommendations for the mental health of foreign residents (e.g., Office for Health Improvement and Disparities, 2022/09/28; WHO, 2023/10/10), this study is significant for identifying that factors affecting depression during crises like pandemics differ between foreign residents and non-foreign residents. Particularly, this study enhanced its reliability by using survey data collected, considering the characteristics of the actual foreign resident population registered with the Ministry of Justice (gender, nationality, age, duration of stay), not for tourism purposes. This data can serve as a foundation for improving health equity in Asian regions with similar foreign resident characteristics. For future policy expansion, followup studies should compare and analyze the differences in factors affecting depression according to the duration of stay among foreign residents, considering the characteristics of migrants.

A limitation of this study is the potential for omitted variable bias, as general characteristics (e.g., personality) concerning depression were not considered due to the reliance on secondary data. Additionally, this study constructed models for both foreign and non-foreign resident groups to identify factors influencing depression during the pandemic in each group and compared these factors. Since the results were not compared using an integrated model, there are limitations in comparing the significant independent variables affecting each group on the same scale. Moreover, considering that past experiences with depression can influence its severity and impact during the pandemic, comparative studies with pre-pandemic periods are necessary. For a more detailed comparison, in-depth studies are required that conduct panel surveys at pre-pandemic, pandemic, and endemic stages to investigate the subjective perceptions of depression and its factors. As considerable time has passed since the beginning of the pandemic, further research is recommended to analyze the impact of vaccination and relaxed COVID-19 restriction standards. Furthermore, inasmuch, as this study was solely based on the case of Seoul, it is desirable to assess the replicability of its findings across different time, space, and population settings.

Acknowledgments

This work was supported by Seoul National University Research Grant in 2020 and under the framework of international cooperation program managed by the National Research Foundation of Korea(NRF-2020K2A9A1A01095494, FY2020).

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