Migrant populations are increasingly composed of women, often of childbearing age, so it is important to screen patients for mental health issues during the perinatal period. Mental health issues during pregnancy and the postpartum period are associated with adverse outcomes for both mother and child. This association is stronger in migrants from low- and middle-income countries and low socioeconomic groups. Studies have found that postnatal depression can impact up to 42% of migrant women compared to 10 to 15% of non-migrant women.
What are the big things to be aware of when working with pregnant migrant women?
- Asylum-seeking women in Canada have been found to have the highest prevalence of PTSD in the perinatal period followed by refugees and immigrants.
- Antenatal and postnatal depression is common amongst pregnant and postpartum migrant women and migrant women in Canada are at a higher risk for these forms of depression compared to their Canadian-born counterparts.
- Migrant women are at increased risk for anxiety symptoms during pregnancy.
- Experiences that are stressors associated with being a minority (ie. discrimination, racism, etc.) have a cumulative detrimental effect on maternal health for migrant women.
- Exposure to risk factors such as poverty, social support, language proficiency and legal status, can increase risk of depressive symptoms in perinatal migrant women.
- Lack of social support is one of the biggest risk factors for depression in the perinatal period for migrant women. Migrant women often face separation from social networks, family members, and social isolation in the host country. This effect is amplified if they lack proficiency in English.
What are the risk factors for antenatal & postnatal depression?
- Lack of social support
- Marital strain/lack of marital support
- Marital disharmony
- Time spent in host country
- Socioeconomic difficulty
- Housing difficulties
- Lack of money for fundamental needs
- Stress (ie. perceived stress, life event distress, etc.)
- Prior mental health
- History of depression, emotional distress, perinatal anxiety, pre-migration stress, etc.
- Legal status of migration
- Refugee or asylum-seeker status is highly correlated with postnatal depression
- Less proficient English in the postnatal period
- Low domestic decision-making power has been found to be correlated with postnatal depression
What are some measures I can use to screen for depression in my pregnant migrant patients?
- Edinburgh Postnatal Depression Scale (EPDS)
- Center for Epidemiologic Studies Depression Scale (CES-D)
- Patient Health Questionnaire (PHQ-9)
- Beck Depression Inventory-II (BDI-II)
- Depression Anxiety Stress Scale (DASS)
- Postpartum Depression Screening Scale (PDSS)
Don’t forget that many migrant women are not fluent English speakers and may require translated versions of these scales, interpreters, or someone to assist with explaining specific words/phrases. Assess their English language fluency (without making assumptions) before administering screening questionnaires! Many of these scales also hold an inherent Western-World bias of what depression looks like, so be aware of this when assessing depression in migrant women.
Be mindful that refugee & asylum-seeker women have higher levels of mental health problems, not only because they are more likely to have experienced traumatic life events (ie. peace conflicts, poverty, etc.), but also because they often lose their social support networks in the migration process. Social support is a major protective factor against mental health issues for all people.
Also consider that many diagnostic measures for mental health do not assess valid differences in risk across different cultural groups & conduct a thorough screening by asking questions about food security, housing, discrimination, language proficiency, environmental navigation, legal status (if precarious status is causing them anxiety) and other factors that make the migrant pregnancy experience unique.
Author | Brintha Sivajohan
References
Anderson, F. M., Hatch, S. L., Comacchio, C., & Howard, L. M. (2017). Prevalence and risk of mental disorders in the perinatal period among migrant women: A systematic review and meta-analysis. Archives of Women’s Mental Health, 20(3), 449-462. doi:10.1007/s00737-017-0723-z