Abstract
Purpose
The objective was to examine and compare risk factors for postpartum depression among: (1) recent (≤5 years) migrant and Canadian-born women, and (2) refugee, asylum-seeking, and non-refugee immigrant women.
Methods
A sample of 1536 women (1024 migrant and 512 Canadian-born) were recruited from 12 hospitals. Women completed questionnaires at 1–2 and 16 weeks postpartum including questions on socio-demographics, biomedical history, health services, and migration and resettlement factors. Bivariate analyses and multivariate logistic regression were performed to examine and compare risk factors for postpartum depressive symptoms at 16 weeks postpartum.
Results
Recent migrant women had significantly higher rates (6%) of depressive symptoms at 16 weeks postpartum than Canadian-born women (2.9%). Asylum-seekers had the highest rate (14.3%), followed by refugee (11.5%) and non-refugee immigrant women (5.1%). Migrant women at greatest risk to develop depressive symptoms were those who experienced abuse, had pain post-birth, worried about family members left behind, had food insecurity, and had reduced access to healthcare (limited insurance and/or no regular care-provider). Conversely, those with higher levels of social support and who felt they belonged to a community had a lower risk of developing depressive symptoms.
Conclusion
All childbearing recent migrant women should be considered at risk for postpartum depression. To prevent and support migrant women suffering postpartum depressive symptoms, barriers to healthcare need to be addressed and interventions should include assessments and support/programmes for abuse/violence, lack of social support, food insecurity, and stress/poor mental health. Treatment of pain during the postpartum period is also critical.
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References
O’Hara MW (2009) Postpartum depression: what we know. J Clin Psychol 65(12):1258–1269
Gaynes B, Gavin N, Meltzer-Brody S, Lohr K, Swinson T, Gartlehner G, Brody S, Miller W (2005) Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evidence Report/Technology Assessment No. 119. AHRQ publication no. 05-E006-2. Agency for Healthcare Research and Quality, Rockville, MD
O’Hara MW, McCabe JE (2013) Postpartum depression: current status and future directions. Annu Rev Clin Psychol 9:379–407
United Nations Department of Economic and Social Affairs Population Division (2016) International Migration Report 2015. United Nations, New York
Sobotka T (2008) Overview Chap. 7: the rising importance of migrants for childbearing in Europe. Demogr Res 19:225–248
Adserà A, Ferrer A (2013) The fertility of recent immigrants to Canada. Discussion Paper Series, No 7289, Forschungsinstitut zur Zukunft der Arbeit. Institute for the Study of Labor (IZA)
Office for National Statistics (2014) Births in England and Wales by Parents’ Country of Birth, 2013
Hilder L, Zhichao Z, Parker M, Jahan S, Chambers GM (2014) Australia’s mothers and babies 2012. Perinatal statistics series no. 30. Cat. no. PER 69. Australian Institute of Health and Welfare. (AIHW, Canberra)
Mather M (2009) Reports on America: Children in Immigrant Families Chart New Path. Population Reference Bureau, Washington, DC
Davies AA, Basten A, Frattini C (2009) Migration: a social determinant of the health of migrants. Eurohealth 16(1):10–12
Falah-Hassani K, Shiri R, Vigod S, Dennis C-L (2015) Prevalence of postpartum depression among immigrant women: a systematic review and meta-analysis. J Psychiatr Res 70:67–82
Collins CH, Zimmerman C, Howard LM (2011) Refugee, asylum seeker, immigrant women and postnatal depression: rates and risk factors. Arch Women’s Mental Health 14(1):3–11
Ganann R, Sword W, Thabane L, Newbold B, Black M (2016) Predictors of postpartum depression among immigrant women in the year after childbirth. J Women’s Health 25(2):155–165
Fung K, Dennis C-L (2010) Postpartum depression among immigrant women. Curr Opin Psychiatry 23(4):342–348
McDonald JT, Kennedy S (2004) Insights into the ‘healthy immigrant effect’: health status and health service use of immigrants to Canada. Soc Sci Med 59(8):1613–1627
Freedman J (2016) Sexual and gender-based violence against refugee women: a hidden aspect of the refugee” crisis”. Reprod Health Matt 24(47):18–26
Kurth E, Jaeger FN, Zemp E, Tschudin S, Bischoff A (2010) Reproductive health care for asylum-seeking women-a challenge for health professionals. BMC Public Health 10(1):659
Merry LA, Gagnon AJ, Kalim N, Bouris SS (2011) Refugee claimant women and barriers to health and social services post-birth. Can J Public Health 102(4):286–290
Dias SF, Severo M, Barros H (2008) Determinants of health care utilization by immigrants in Portugal. BMC Health Serv Res 8(1):1
Leduc N, Proulx M (2004) Patterns of health services utilization by recent immigrants. J Immigr Health 6(1):15–27
Dennis C-L, Merry L, Stewart D, Gagnon AJ (2016) Prevalence, continuation, and identification of postpartum depressive symptomatology among refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women: results from a prospective cohort study. Arch Women’s Mental Health 19(6):959–967
Gagnon AJ, Wahoush O, Dougherty G, Saucier J-F, Dennis C-L, Merry L, Stanger E, Stewart DE (2006) The childbearing health and related service needs of newcomers (CHARSNN) study protocol. BMC Pregnancy Childbirth 6(1):31
Citizenship and Immigration Canada (2007) Facts and figs. 2006: immigration overview-permanent and temporary residents. Minister of Public Works and Government Services Canada, Ottawa, ON
UNHCR (2000) The State of the World’s refugees: fifty years of Humanitarian Action. Oxford University Press, USA
Kingston D, Heaman M, Chalmers B, Kaczorowski J, O’Brien B, Lee L, Dzakpasu S, O’Campo P, Maternity Experiences Study Group of the Canadian Perinatal Surveillance System, Public Health Agency of Canada (2011) Comparison of maternity experiences of Canadian-born and recent and non-recent immigrant women: findings from the Canadian Maternity Experiences Survey. J Obstet Gynaecol Can 33(11):1105–1115
Merry L, Gagnon AJ, Hemlin I, Clarke H, Hickey J (2011) Cross-border movement and women’s health: how to capture the data. Int J Equity Health 10(1):56
Ruppenthal L, Tuck J, Gagnon AJ (2005) Enhancing research with migrant women through focus groups. West J Nurs Res 27(6):735–754
Strohschein FJ, Merry L, Thomas J, Gagnon AJ (2010) Strengthening data quality in studies of migrants not fluent in host languages: a Canadian example with reproductive health questionnaires. Res Nurs Health 33(4):369–379
Gagnon A, Tuck J (2004) A systematic review of questionnaires measuring the health of resettling refugee women. Health Care Women Int 25(2):111–149
Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry 150(6):782–786
Gibson J, McKenzie-McHarg K, Shakespeare J, Price J, Gray R (2009) A systematic review of studies validating the Edinburgh postnatal depression scale in antepartum and postpartum women. Acta Psychiatr Scand 119(5):350–364
Egger M, Davey Smith G, Altman D (2001) Systematic reviews in health care: meta-analysis in context, 2nd edn. BMJ Publishing Group, London
Stewart DE, Gagnon A, Saucier J, Wahoush O (2008) Postpartum depression symptoms in newcomers. Can J Psychiatry 53(2):121
Sword W, Watt S, Krueger P (2006) Postpartum health, service needs, and access to care experiences of immigrant and Canadian-born women. J Obstet Gynecol Neonatal Nurs 35(6):717–727
Mechakra-Tahiri S, Zunzunegui MV, Seguin L (2007) Self-rated health and postnatal depressive symptoms among immigrant mothers in Quebec. Women Health 45(4):1–17
Zelkowitz P, Saucier J-F, Wang T, Katofsky L, Valenzuela M, Westreich R (2008) Stability and change in depressive symptoms from pregnancy to two months postpartum in childbearing immigrant women. Arch Women’s Mental Health 11(1):1–11
Howard LM, Oram S, Galley H, Trevillion K, Feder G (2013) Domestic violence and perinatal mental disorders: a systematic review and meta-analysis. PLoS Med 10(5):e1001452
Miszkurka M, Zunzunegui MV, Goulet L (2012) Immigrant status, antenatal depressive symptoms, and frequency and source of violence: what’s the relationship? Arch Women’s Mental Health 15(5):387–396
Carballo M, Grocutt M, Hadzihasanovic A (1995) Women and migration: a public health issue. World Health Stat Q 49(2):158–164
Adanu RM, Johnson TR (2009) Migration and women’s health. Int J Gynecol Obstet 106(2):179–181
Kalt A, Hossain M, Kiss L, Zimmerman C (2013) Asylum seekers, violence and health: a systematic review of research in high-income host countries. Am J Public Health 103(3):e30–e42
Bair MJ, Robinson RL, Katon W, Kroenke K (2003) Depression and pain comorbidity: a literature review. Arch Intern Med 163(20):2433–2445
Trivedi MH (2004) The link between depression and physical symptoms. Prim Care Companion J Clin Psychiatry 6(Suppl 1):12–16
Kirmayer LJ (2001) Cultural variations in the clinical presentation of depression and anxiety: implications for diagnosis and treatment. J Clin Psychiatry 62:22–30
Simon GE, VonKorff M, Piccinelli M, Fullerton C, Ormel J (1999) An international study of the relation between somatic symptoms and depression. N Engl J Med 341(18):1329–1335
Mahon A, Merry L, Lu O, Gagnon AJ (2016) Postpartum pain in the community among migrant and non-migrant women in Canada. J Immigr Minor Health 1–8
Asanin J, Wilson K (2008) “I spent nine years looking for a doctor”: exploring access to health care among immigrants in Mississauga, Ontario, Canada. Soc Sci Med 66(6):1271–1283
Lindert J, Schouler-Ocak M, Heinz A, Priebe S (2008) Mental health, health care utilisation of migrants in Europe. Eur Psychiatry 23:14–20
Anderson SA (1990) Core indicators of nutritional state for difficult-to-sample populations. J Nutr 120(11):1557–1599
Whitaker RC, Phillips SM, Orzol SM (2006) Food insecurity and the risks of depression and anxiety in mothers and behavior problems in their preschool-aged children. Pediatrics 118(3):e859–e868
Huddleston-Casas C, Charnigo R, Simmons LA (2009) Food insecurity and maternal depression in rural, low-income families: a longitudinal investigation. Public Health Nutr 12(08):1133–1140
Lent MD, Petrovic LE, Swanson JA, Olson CM (2009) Maternal mental health and the persistence of food insecurity in poor rural families. J Health Care Poor Underserved 20(3):645–661
Laraia BA, Borja JB, Bentley ME (2009) Grandmothers, fathers, and depressive symptoms are associated with food insecurity among low-income first-time African-American mothers in North Carolina. J Am Diet Assoc 109(6):1042–1047
Dewing S, Tomlinson M, le Roux IM, Chopra M, Tsai AC (2013) Food insecurity and its association with co-occurring postnatal depression, hazardous drinking, and suicidality among women in peri-urban South Africa. J Affect Disord 150(2):460–465
Hromi-Fiedler A, Bermúdez-Millán A, Segura-Pérez S, Pérez-Escamilla R (2011) Household food insecurity is associated with depressive symptoms among low-income pregnant Latinas. Matern Child Nutr 7(4):421–430
Howard A, Edge J (2013) Enough for All: Household Food Security in Canada. The Conference Board of Canada, Ottawa
Howard A, Edge J, Daniel M (2013) What’s to Eat? Improving Food Literacy in Canada. The Conference Board of Canada, Ottawa
Robertson E, Grace S, Wallington T, Stewart DE (2004) Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry 26(4):289–295
Suårez-Orozco C, Todorova IL, Louie J (2002) Making up for lost time: the experience of separation and reunification among immigrant families. Fam Process 41(4):625–643
Schweitzer R, Melville F, Steel Z, Lacherez P (2006) Trauma, post-migration living difficulties, and social support as predictors of psychological adjustment in resettled Sudanese refugees. Aust N Z J Psychiatry 40(2):179–187
Miranda J, Siddique J, Der-Martirosian C, Belin TR (2005) Depression among Latina immigrant mothers separated from their children. Psychiatric Serv 56(6):717–720
Rousseau C, Mekki-Berrada A, Moreau S (2001) Trauma and extended separation from family among Latin American and African refugees in Montreal. Psychiatry 64(1):40–59
Carpiano RM, Hystad PW (2011) “Sense of community belonging” in health surveys: what social capital is it measuring? Health Place 17(2):606–617
Lin N (1999) Building a network theory of social capital. Connections 22(1):28–51
McMichael C, Manderson L (2004) Somali women and well-being: social networks and social capital among immigrant women in Australia. Human Org 63(1):88–99
Takenoshita H (2015) Social capital and mental health among Brazilian immigrants in Japan. Int J Jpn Sociol 24(1):48–64
Dennis CL, Hodnett E, Kenton L, Weston J, Zupancic J, Stewart DE, Kiss A (2009) Effect of peer support on prevention of postnatal depression among high risk women: multisite randomised controlled trial. Bmj 338:a3064
Lanes A, Kuk JL, Tamim H (2011) Prevalence and characteristics of postpartum depression symptomatology among Canadian women: a cross-sectional study. BMC Public Health 11(1):302
Gagnon AJ, Dougherty G, Wahoush O, Saucier J-F, Dennis C-L, Stanger E, Palmer B, Merry L, Stewart DE (2013) International migration to Canada: The post-birth health of mothers and infants by immigration class. Soc Sci Med 76:197–207
Acknowledgements
This study was funded by the Canadian Institutes of Health Research (CIHR), Immigration et métropoles (Center of Excellence in Immigration Studies - Montreal) and the Réseau de recherche en santé des populations du Québec (RRSPQ).
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Dennis, CL., Merry, L. & Gagnon, A.J. Postpartum depression risk factors among recent refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women: results from a prospective cohort study. Soc Psychiatry Psychiatr Epidemiol 52, 411–422 (2017). https://doi.org/10.1007/s00127-017-1353-5
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DOI: https://doi.org/10.1007/s00127-017-1353-5