Low-income Singaporean mothers' mental health did not worsen during COVID-19

The advent of COVID-19 has led to much discussion about the severe toll it has taken on people's mental health worldwide. A recent World Health Organization study revealed that the global prevalence of anxiety and depression rose by a staggering 25 percent in the first year of the pandemic, and that young people and women were the worst hit. Multiple stress factors contributed to this, with the report citing the unprecedented levels of stress arising from social isolation during the pandemic as a major reason for the rise.

However, there has been a dearth of research on the mental health conditions of society's long-term poor during this period. Addressing this, a team of NUS researchers from the Department of Social Work at the NUS Faculty of Arts and Social Sciences embarked on a novel study to examine COVID-19's impact on the levels of depression and anxiety of low-income Singaporean mothers and their coping strategies.

The study revealed an unexpected finding—the mental health state of financially-poor mothers was found to be relatively stable in spite of the uncertainties wrought by the pandemic, with many adopting different strategies to cope with financial distress. Also, COVID-19 government support grants helped cushion the financial stress.

Associate Professor Esther Goh, who heads the social work department and led the study, revealed, "This is one of the first studies that empirically tracked the mental health conditions of low-income mothers at the initial phase of COVID-19 pandemic and immediately after the peak of infection in Singapore in June 2020. It gives rich insights into the coping strategies of the poor and government grant provisions that might have mitigated the unprecedented impact of COVID-19 on their mental health."

The team's findings were published in the medical journal BMJ Open in January 2022.

Tracing Singapore's experience with COVID-19 in 2020 and its impact on low-income mothers

In response to the fast-evolving pandemic in Singapore in 2020, a multi-ministry task force was formed to pre-empt the potential risks and mitigate the ramifications of the pandemic. To stem virus spread, a nationwide partial lockdown, known as circuit-breaker, was implemented between 7 April and 4 May 2020, and this was subsequently extended to 1 June 2020. Only essential services and key economic sectors could keep their premises open whereas non-essential industries were ordered to close. On 1 June 2020, circuit-breaker measures were progressively lifted in phases.

The tightened safety measures brought about social, psychological and economic consequences on Singaporeans. To cushion the economic impact, the government introduced four budgets from February to May 2020, with subsequent enhancements. The budgets, which amounted to about S$100 billion, focused on helping companies and saving jobs, providing social support to households, and providing critical support for affected employees and firms.

To understand the pandemic's impact on financially-disadvantaged mothers' mental health, the team rode on a larger study on low-income families in Singapore, conducting five focus group discussions (FGDs) with 39 interviewers who carried out surveys with 424 mothers from low-income families post-lockdown between June and September 2020, and gleaning observations from the interviewers on the risk and stress levels of these mothers during the period leading up to March and April 2020—the height of the COVID-19 pandemic.

In addition, survey data from two time points—pre-COVID-19 (December 2019 to February 2020) and post-COVID-19 pandemic height (June to September 2020), measuring the relationship of mother's job loss, income earner loss, marital status, number of children and, permanency of employment and mother's hope levels with mother's depression and anxiety, were used to triangulate the observations from the FGDs.

Low-income mothers' mental health state linked to availability of support in social milieu

Interestingly, data gathered from the FGDs revealed that about four-fifth of the mothers did not show extreme financial stress despite COVID-19 impacting family finances. Although interviewers observed a higher level of financial stress particularly among those who experienced income and job losses, most mothers were able to cope. The researchers also found few observations of emotional distress that were linked to the pandemic.

In addition, the mothers mentioned a range of strategies to manage their financial and emotional stress. Government COVID-19 payouts were cited as an important resource that tided them over the income reduction months and prevented them from plunging into a state of crisis.

These mothers were also knowledgeable in applying for other applicable COVID-19 grants through the assistance of social workers. In addition, they were found to be well-informed of community resources including Family Service Centers and Social Service Offices, and displayed a willingness to step forward to seek help, thereby revealing their proactive adaptive behaviors.

Another unexpected and prominent finding was that notwithstanding the financial and emotional stress reported, a sense of hope and resilience prevailed amidst the pandemic.

The impact of policy on low-income mothers' resilience

Indeed, a strong link between the significant resources provided by the government and the sense of hope and resilience the mothers felt was observed. The team suggested several attributes in the political and economic context of Singapore that may have facilitated the internal resilience of the study respondents.

First, Singapore has a strong fiscal capacity with a total national reserve that is estimated to be well above S$500 billion, and this reserve has been drawn on during times of crisis. To cushion COVID-19's impact, four budgets amounting to about S$100 billion were rolled out and this translated to practical and timely financial help for Singaporeans. Second, the whole-of-government approach taken in managing the pandemic, coupled with high political centralization meant that the government was able to pass legislation quickly, such as the drawing of past reserves.

Third, the economic schemes were well-timed to coincide with the established domestic laws so that when the public health measures and human control measures kicked in to restrict human and therefore economic activities, the shock on lives and livelihoods was cushioned. Fourth, the vulnerable and low-income groups had access to information on the government support schemes and payouts, as details about the schemes were actively circulated and easily accessible through local news media. Lastly, the administration of the schemes also facilitated the access to help by those from the lower socio-economic group.

Assoc Prof Goh noted, "As a result of the significant resources provided by the Singapore government, the financially poor mothers have gathered various adaptive strategies to cope with the unexpected financial distress. This external (social milieu) resilience bolstered the financially poor mothers' internal (psychological traits) resilience. Specifically, the availability of COVID-19 payout grants facilitated the coping processes and resilience in the familial and individual levels of low-income families, thus enhancing their stress-adaption processes."

She added, "We found that the injection of fiscal policies by the Singapore government was effectively geared to save the livelihoods of the people. However, as Singapore begins transition from a pandemic to an endemic, a vital question to ask is: 'what does this mean for the livelihood and mental health of these poor mothers?' This is a potential area for future research."