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Lu L, Shen Y. Postpartum pain and the risk of postpartum depression: A meta-analysis of observational studies. J Obstet Gynaecol Res 2024; 50:358-365. [PMID: 38105372 DOI: 10.1111/jog.15850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE This meta-analysis of observational studies aimed to derive a more precise estimation of the relationship between postpartum pain and postpartum depression (PPD). METHODS A systematic literature search was completed in the following databases from inception to September 26, 2022: PubMed, Embase, and Web of Science. Quality evaluation of each study was achieved through Newcastle-Ottawa scale (NOS) assessment. Heterogeneity across studies was evaluated by Cochran's Q test and I2 test. Pooled estimates of odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were analyzed using fixed-effects model or random-effects model, according to heterogeneity. Subgroup analysis, sensitivity analysis, and Egger's test were also performed. RESULTS From the identified 1884 articles, a total of 8 studies involving 3973 participants were included in the final meta-analysis. Seven of the 8 studies were evaluated as high-quality, with NOS scores ≥7. A significant heterogeneity was observed (I2 = 66.5%, p = 0.004) among eight studies. Therefore, the performed random-effect model suggested a significant association between postpartum pain and PPD risk (OR 1.29, 95% CI 1.10-1.52, p = 0.002). However, the subgroup analyses did not define the source of heterogeneity. Moreover, the sensitivity analysis showed the stability of the pooled results, but the significant publication bias was identified (p = 0.009). The trim and fill method was performed and resulted in an OR of 1.14 (95% CI 0.95-1.37, p = 0.162). CONCLUSIONS This meta-analysis found a potential association between postpartum pain and PPD. Further researches are needed to provide more robust evidences.
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Affiliation(s)
- Limei Lu
- Delivery Room, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang, China
| | - Ya Shen
- Nursing Department, Huzhou Maternity & Child Health Care Hospital, Huzhou, Zhejiang, China
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2
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Heer K, Mahmoud L, Abdelmeguid H, Selvan K, Malvankar-Mehta MS. Prevalence, Risk Factors, and Interventions of Postpartum Depression in Refugees and Asylum-Seeking Women: A Systematic Review and Meta-Analysis. Gynecol Obstet Invest 2024; 89:11-21. [PMID: 38219724 PMCID: PMC10871679 DOI: 10.1159/000535719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/27/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Refugee women are at an increased risk of developing postpartum depression (PPD) due to a combination of various psychosocial stressors. This systematic review aimed to outline the prevalence of PPD among refugee women and explore related risk factors and interventions currently in practice. METHODS A search was conducted using MEDLINE, Embase, PsycINFO, CINAHL, and Core Collection (Web of Science) for articles published until August 2022, yielding 1,678 records. RESULTS The prevalence of refugee and asylum-seeking women was 22.5% (n = 657/2,922), while the prevalence of non-refugee/asylum-seeking women with PPD was 17.5% (n = 400/2,285). Refugee/asylum-seeking women face a unique set of issues such as domestic abuse, separation and lack of support, stress, pre-migrational experiences, prior history of mental illness, low income, and discrimination. Refugee/asylum-seeking women may benefit from support groups, individual support, self-coping mechanisms, and familial support. CONCLUSION This review identifies that a higher prevalence of PPD in refugee and asylum-seeking women compared to other groups can potentially be attributed to the unique risk factors they face. This warrants the need for further research as studies on interventions for this condition are limited among this population.
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Affiliation(s)
- Karnvir Heer
- Department of Human Health and Nutritional Science, University of Guelph, Guelph, ON, Canada
- Department of Biomedical Science, University of Guelph, Guelph, ON, Canada
- RefuHope, London, ON, Canada
| | - Lujayn Mahmoud
- Department of Human Health and Nutritional Science, University of Guelph, Guelph, ON, Canada
- Department of Biomedical Science, University of Guelph, Guelph, ON, Canada
- RefuHope, London, ON, Canada
| | - Hana Abdelmeguid
- RefuHope, London, ON, Canada
- Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Kavin Selvan
- RefuHope, London, ON, Canada
- Genetics and Genome Biology (GGB) Program, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Monali S. Malvankar-Mehta
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
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Johansson M, Ledung Higgins K, Dapi Nzefa L, Benderix Y. Postpartum depression and life experiences of mothers with an immigrant background living in the south of Sweden. Int J Qual Stud Health Well-being 2023; 18:2187333. [PMID: 36880807 PMCID: PMC10013500 DOI: 10.1080/17482631.2023.2187333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
PURPOSE Postpartum Depression (PPD) -a common health problem for mothers' postpartum increases the risk of negative interaction between mothers and infants as it reduces the former's ability to respond to the latter's needs appropriately. Migrant mothers exhibit a higher prevalence of risk factors for PPD. Hence, this study aimed to investigate migrant mothers' life experiences pertaining to motherhood and PPD. METHODS Qualitative interviews were conducted with 10 immigrant mothers in the south of Sweden during 2021. RESULTS The qualitative content analysis revealed the following main themes: 1) PPD (two sub themes-psychosomatic symptoms and burden of responsibility due to feelings of loneliness); 2) mistrust of social services (one sub-theme-afraid of losing their children and Swedish social services' lack of understanding); 3) inadequate healthcare (two sub-themes-limited healthcare literacy for migrant mothers and language barrier; 4) women's coping strategy for well-being (two sub-themes-better awareness and understanding of the Swedish system and society, and freedom and independence in the new country). CONCLUSIONS PPD, mistrust of social services, and inadequate healthcare lacking personal continuity were common among immigrant women, thus precipitating discrimination-including lack of access to services because of limited health literacy, cultural differences, language barriers, and insufficient support.
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Affiliation(s)
- Maude Johansson
- Department of Psychology, Linnaeus University, Växjö, Sweden
| | | | | | - Ylva Benderix
- Department of Psychology, Linnaeus University, Växjö, Sweden
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Zlotnick C, Manor-Lavon I, Leahy-Warren P. Relationship between social support and postpartum depression in migrant and non-migrant first-time mothers. J Clin Nurs 2023; 32:1316-1326. [PMID: 35304786 DOI: 10.1111/jocn.16297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/13/2022] [Accepted: 03/08/2022] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES This study examines the relationship between social status and postpartum depression by migrant generation and determines whether social support moderates the relationship between migrant generations and postpartum depression. BACKGROUND Postpartum depression (PPD) afflicts more than 1 in 10 childbearing women worldwide; and this mental health problem may be higher among vulnerable populations of women such as migrants, an increasingly prevalent group in many countries. Social support and migrant generation (1st generation-mother and her parents born outside the host country; 2nd generation-mother born in the host country but not her parents; 2.5 generation-mother and one parent born in the host country) may contribute to the conflicting findings on migrant mothers and postpartum depression. DESIGN This study used a cross-sectional design. METHODS Sample recruitment of migrant and non-migrant first-time mothers (n=515) was implemented through an online platform. A STROBE checklist guided the reporting of this study. RESULTS PPD was lower among mothers with social support. While social support was negatively associated with PPD for all mothers, PPD was not associated with migrant generation nor was a moderation effect found. CONCLUSIONS Social support is negatively associated with PPD for all mothers, but levels of PPD for migrant mothers may be linked to country-specific healthcare resources and immigration policies. Immigrant policies influence migrant mothers' healthcare access; thus, immigration policies may influence PPD among first-time migrant mothers and the manner in which nurses can provide formal support. This study finds that social support, including the formal social support provided by nurses, decreases the likelihood of PPD. Demands on nurses' technical and assessment skills are high, but nurses also need to remember that their skills of providing social support are equally important, and for first-time mothers, may contribute to decreasing PPD.
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Affiliation(s)
- Cheryl Zlotnick
- Department of Nursing, School of Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Inbal Manor-Lavon
- Department of Nursing, School of Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Elshahat S, Moffat T, Gagnon O, Charkatli L, Gomes-Szoke ED. The relationship between diet/nutrition and the mental health of immigrants in Western societies through a holistic bio-psycho-socio-cultural lens: A scoping review. Appetite 2023; 183:106463. [PMID: 36682625 DOI: 10.1016/j.appet.2023.106463] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 12/20/2022] [Accepted: 01/16/2023] [Indexed: 01/20/2023]
Abstract
Epidemiological evidence suggests that diet and nutrition not only impact individuals' physical health but also shape their mental health (MH). The nutrition/diet-MH relationship may be critical among immigrants due to socioeconomic and sociocultural factors. Despite the complex nutrition/diet-MH relationship, most scholarship in this area employs a biomedical perspective. This scoping review of 63 studies deployed a holistic bio-psycho-socio-cultural framework to examine the relationship between diet/nutrition and immigrants' MH. Five automated databases (Embase, PubMed, Medline, PsycINFO and Anthropology Plus) were systematically searched for relevant articles from Western countries. A bio-psycho-socio-cultural conceptual model guided the analysis of the multi-faceted diet/nutrition-MH relationship. Consumption of fruit/vegetables, unsaturated fats, vitamin D-rich foods and whole grains was significantly positively related to MH. Reported pathways included enhanced self-esteem and ability to stay physically active. Energy-dense food consumption emanating from unhealthful dietary acculturation to the Western lifestyle was associated with poor MH through various mechanisms, including exhaustion and worry about developing non-communicable diseases. Food insecurity and related hunger were significantly positively associated with depression and anxiety among immigrants through different pathways, including family conflicts, homesickness, social exclusion, feelings of shame/stigma, and helplessness related to not affording nutritious foods that meet one's cultural dietary requirements. Ethnic food consumption appeared to mitigate MH issues and enhance immigrants' well-being. A bio-psycho-socio-cultural-informed model is needed to gain an in-depth and encompassing understanding of immigrant MH as it relates to diet/nutrition. The first iteration of such a model is presented in this review alongside an illustration of how it may be used to strengthen an analysis and understanding of the multi-faceted diet/nutrition-MH relationship amongst immigrants and inform public health professionals and dieticians/practitioners.
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Affiliation(s)
- Sarah Elshahat
- Department of Anthropology, Faculty of Social Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Tina Moffat
- Department of Anthropology, Faculty of Social Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Olivia Gagnon
- Department of Neuroscience, Faculty of Science, Carleton University, Ottawa, Ontario, Canada
| | - Lein Charkatli
- Department of Psychology, Neuroscience, & Behavior, Faculty of Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Biology, Faculty of Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Emily D Gomes-Szoke
- Department of Biology, Faculty of Sciences, McMaster University, Hamilton, Ontario, Canada
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Stevenson K, Fellmeth G, Edwards S, Calvert C, Bennett P, Campbell OMR, Fuhr DC. The global burden of perinatal common mental health disorders and substance use among migrant women: a systematic review and meta-analysis. Lancet Public Health 2023; 8:e203-e216. [PMID: 36841561 DOI: 10.1016/s2468-2667(22)00342-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 02/25/2023]
Abstract
BACKGROUND There are one billion migrants globally, of whom 82 million are forced migrants. Pregnant migrants face pre-migration stressors such as conflict, transit stressors including poverty, and post-migration stressors including navigating the immigration system; these stressors can make them vulnerable to mental illness. We aimed to assess the global prevalence of and risk factors for perinatal mental health disorders or substance use among women who are migrants. METHODS In this systematic review and meta-analysis, we searched OVID MEDLINE, Embase, PsycINFO, CENTRAL, Global Health, Scopus, and Web of Science for studies published from database inception until July 8, 2022. Cohort, cross-sectional, and interventional studies with prevalence data for any mental illness in pregnancy or the postnatal period (ie, up to a year after delivery) or substance use in pregnancy were included. The primary outcome was the prevalence of perinatal common mental health disorders among women who are migrants, globally. Data for study quality and risk factors were also extracted. A random-effects meta-analysis was used to calculate pooled prevalence estimates, when appropriate. Sensitivity analyses were conducted according to study quality, sample representativeness, and method of outcome assessment. Risk factor data were synthesised narratively. This study is registered with PROSPERO, CRD42021226291. FINDINGS 18 650 studies were retrieved, of which 135 studies comprising data from 621 995 participants met the inclusion criteria. 123 (91%) of 135 studies were conducted in high-income host countries. Five (4%) of 135 studies were interventional, 40 (30%) were cohort, and 90 (66%) were cross-sectional. The most common regions of origin of participants were South America, the Middle East, and north Africa. Only 26 studies presented disaggregated data for forced migrants or economic migrants. The pooled prevalence of perinatal depressive disorders was 24·2% (range 0·5-95·5%; I2 98·8%; τ2 0·01) among all women who are migrants, 32·5% (1·5-81·6; 98·7%; 0·01) among forced migrants, and 13·7% (4·7-35·1; 91·5%; 0·01) among economic migrants (p<0·001). The pooled prevalence of perinatal anxiety disorders was 19·6% (range 1·2-53·1; I2 96·8%; τ2 0·01) among all migrants. The pooled prevalence of perinatal post-traumatic stress disorder (PTSD) among all migrant women was 8·9% (range 3·2-33·3; I2 97·4%; τ2 0·18). The pooled prevalence of perinatal PTSD among forced migrants was 17·1% (range 6·5-44·3; I2 96·6%; τ2 0·32). Key risk factors for perinatal depression were being a recently arrived immigrant (ie, approximately within the past year), having poor social support, and having a poor relationship with one's partner. INTERPRETATION One in four women who are migrants and who are pregnant or post partum experience perinatal depression, one in five perinatal anxiety, and one in 11 perinatal PTSD. The burden of perinatal mental illness appears higher among women who are forced migrants compared with women who are economic migrants. To our knowledge, we have provided the first pooled estimate of perinatal depression and PTSD among women who are forced migrants. Interpreting the prevalence estimate should be observed with caution due to the very wide range found within the included studies. Additionally, 66% of studies were cross-sectional representing low quality evidence. These findings highlight the need for community-based routine perinatal mental health screening for migrant communities, and access to interventions that are culturally sensitive, particularly for forced migrants who might experience a higher burden of disease than economic migrants. FUNDING UK National Institute for Health Research (NIHR); March of Dimes European Preterm Birth Research Centre, Imperial College; Imperial College NIHR Biomedical Research Centre; and Nuffield Department of Population Health, University of Oxford.
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Affiliation(s)
- Kerrie Stevenson
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK; Institute of Reproductive and Developmental Biology, Imperial College London, London, UK; Institute of Health Informatics, University College London, London, UK.
| | - Gracia Fellmeth
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Samuel Edwards
- School of Health Sciences, University of Liverpool, Liverpool, UK
| | - Clara Calvert
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Phillip Bennett
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Daniela C Fuhr
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK; Leibniz Institute of Prevention Research and Epidemiology, Bremen, Germany; Health Sciences, University of Bremen, Bremen, Germany
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Skoog M, Rubertsson C, Kristensson Hallström I. Feasibility of an evidence-based educational intervention in screening immigrant mothers for postpartum depression: A pretest-posttest experimental design. Scand J Caring Sci 2023; 37:173-184. [PMID: 35524434 DOI: 10.1111/scs.13086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/17/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Screening immigrant mothers for postpartum depression has been shown to be challenging for health care professionals in handling cultural implications of postpartum depression, communicating through interpreter and applying translated versions of the screening scale. AIM The aim of the study was to test the feasibility of an evidence-based educational intervention for Child Health Services nurses in screening non-native-speaking immigrant mothers for postpartum depression. ETHICS The approval was obtained from Swedish Ethical Review Authority, 2018/1063. METHOD Thirty Child Health Services nurses who conducted screening with assistance of interpreter at least three times per year participated. The study was registered at ClinicalTrials.gov (NCT04167709) and a one-group pretest-posttest experimental design was applied. Data on the participants' acceptability and response to outcomes of the intervention were collected by an evaluation questionnaire, the Clinical Cultural Competency Training Questionnaire, the General Self-efficacy Scale and by self-reported data on general performance of the task. Descriptive statistics were used to present the results of the evaluation questionnaire and general performance of the task. Paired t-test were used to compare the scores on the General Self-efficacy scale, while Wilcoxon signed-ranked test was used to compare the scores on the Clinical Cultural Competency Training Questionnaire. Qualitative data were analysed by content analysis. RESULTS All 30 participants stated that they found the content of the intervention satisfying. The intervention was shown to provide new knowledge and improved their ability to meet the requirements linked to the screening procedure. The intervention affected their self-estimated cultural competence in some aspects but not their self-efficacy or general performance of the task. CONCLUSIONS The intervention was found feasible but require adjustment in the design of the practical training sessions. The use of the provided material, a comic strip on parental support and interpreter information needs further evaluation.
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Affiliation(s)
- Malin Skoog
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Christine Rubertsson
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Wang R, Shan Y. Hot spots and frontiers of postpartum depression research in the past 5 years: A bibliometric analysis. Front Psychol 2022; 13:901668. [PMID: 36605266 PMCID: PMC9807912 DOI: 10.3389/fpsyg.2022.901668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
Objective This study applied the bibliometric method to analyze the hotspots and frontiers in the field of postpartum depression research from 2017 to 2021. Methods A computer-based search for studies related to postpartum depression (PPD) was conducted in the Web of Science Core Collection from 2017 to 2021. Using CiteSpace 5.8. R3 visualization software, this paper analyzed the hot spots and frontiers of postpartum depression research from countries, institutions, authors, cited references and keywords, and drew corresponding knowledge maps. Results A total of 3,789 articles were retrieved, and the annual publication volume showed a steady increase. The countries and institutions with the most publications were the United States and the University of Toronto, respectively. Cindylee Dennis was the most productive author. The most frequently cited and centrally cited articles were meta-analyses on risk factors associated with antenatal depression or anxiety and meta-analyses on the prevalence of antenatal or postnatal anxiety, respectively. The research hotspots in the field of postpartum depression in the past 5 years mainly focused on the risk factors for PPD, and the impact of the COVID-19 epidemic on PPD. Providing various aspects of social and family support to women with PPD may be a research trend in this field. Conclusion This study provides a trend and frontier in the field of postpartum depression, and valuable information for researchers to find potential partners and partner countries, and a reference for future research topics and development directions.
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Agunwamba AA, Finney Rutten LJ, St Sauver JL, Agunwamba AO, Jacobson DJ, McGree ME, Njeru JW. Higher Rates of Cesarean Sections Found in Somali Immigrant Women in Minnesota. J Racial Ethn Health Disparities 2022; 9:1765-1774. [PMID: 34309817 PMCID: PMC9550004 DOI: 10.1007/s40615-021-01113-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/30/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study was to compare prenatal characteristics and postpartum outcomes among Somali and non-Somali women residing in Olmsted County. METHODS We reviewed the medical records for a cohort of Somali women (≥18 years old; N= 298) who had singleton births between January 2009 and December 2014 and for an age-matched non-Somali cohort (N= 298) of women residing in Olmsted County, Minnesota. Logistic regression models which accounted for repeated measures were used to assess differences in prenatal and postpartum outcomes between Somali and non-Somali women. RESULTS Somali women had a significantly higher odds of cesarean section (adjusted OR=1.81; 95% CI=1.15, 2.84). Additionally, Somali women had a significantly lower odds of postpartum depression (adjusted OR=0.27; 95% CI=0.12, 0.63). CONCLUSION The reported adverse postpartum outcomes have implications for interventions aimed at addressing perinatal care disparity gaps for Somali women immigrant and refugee populations.
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Affiliation(s)
- Amenah A Agunwamba
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First street SW, Rochester, MN, 55905, USA.
| | - Lila J Finney Rutten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First street SW, Rochester, MN, 55905, USA
| | | | | | - Debra J Jacobson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Michaela E McGree
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Jane W Njeru
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Ewesesan R, Chartier MJ, Nickel NC, Wall-Wieler E, Urquia ML. Psychosocial and behavioral health indicators among immigrant and non-immigrant recent mothers. BMC Pregnancy Childbirth 2022; 22:612. [PMID: 36008777 PMCID: PMC9413808 DOI: 10.1186/s12884-022-04937-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Perinatal risk factors can vary by immigration status. We examined psychosocial and behavioral perinatal health indicators according to immigration status and immigrant characteristics. METHODS We conducted a population-based cross-sectional study of 33,754 immigrant and 172,342 non-immigrant childbearing women residents in Manitoba, Canada, aged 15-55 years, who had a live birth and available data from the universal newborn screen completed within 2 weeks postpartum, between January 2000 and December 2017. Immigration characteristics were from the Canadian federal government immigration database. Logistic regressions models were used to obtain Odds Ratios (OR) with 95% confidence intervals (CI) for the associations between immigration characteristics and perinatal health indicators, such as social isolation, relationship distress, partner violence, depression, alcohol, smoking, substance use, and late initiation of prenatal care. RESULTS More immigrant women reported being socially isolated (12.3%) than non-immigrants (3.0%) (Adjusted Odds Ratio (aOR): 6.95, 95% CI: 6.57 to 7.36) but exhibited lower odds of depression, relationship distress, partner violence, smoking, alcohol, substance use, and late initiation of prenatal care. In analyses restricted to immigrants, recent immigrants (< 5 years) had higher odds of being socially isolated (aOR: 9.04, 95% CI: 7.48 to 10.94) and late initiation of prenatal care (aOR: 1.50, 95% CI: 1.07 to 2.12) compared to long-term immigrants (10 years or more) but lower odds of relationship distress, depression, alcohol, smoking and substance use. Refugee status was positively associated with relationship distress, depression, and late initiation of prenatal care. Secondary immigrants, whose last country of permanent residence differed from their country of birth, had lower odds of social isolation, relationship distress, and smoking than primary migrants. There were also differences by maternal region of birth. CONCLUSION Immigrant childbearing women had a higher prevalence of social isolation but a lower prevalence of other psychosocial and behavioral perinatal health indicators than non-immigrants. Health care providers may consider the observed heterogeneity in risk to tailor care approaches for immigrant subgroups at higher risk, such as refugees, recent immigrants, and those from certain world regions.
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Affiliation(s)
- Roheema Ewesesan
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Mariette J Chartier
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Nathan C Nickel
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Elizabeth Wall-Wieler
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Marcelo L Urquia
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada. .,Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
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11
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Khaw SML, Zahroh RI, O'Rourke K, Dearnley R, Homer C, Bohren MA. Community-based doulas for migrant and refugee women: a mixed-method systematic review and narrative synthesis. BMJ Glob Health 2022; 7:e009098. [PMID: 35902203 PMCID: PMC9341177 DOI: 10.1136/bmjgh-2022-009098] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/12/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Community-based doulas share the same cultural, linguistic, ethnic backgrounds or social experiences as the women they support. Community-based doulas may be able to bridge gaps for migrant and refugee women in maternity settings in high-income countries (HICs). The aim of this review was to explore key stakeholders' perceptions and experiences of community-based doula programmes for migrant and refugee women during labour and birth in HICs, and identify factors affecting implementation and sustainability of such programmes. METHODS We conducted a mixed-method systematic review, searching MEDLINE, CINAHL, Web of Science, Embase and grey literature databases from inception to 20th January 2022. Primary qualitative, quantitative and mixed-methods studies focusing on stakeholders' perspectives and experiences of community-based doula support during labour and birth in any HIC and any type of health facility were eligible for inclusion. We used a narrative synthesis approach to analysis and GRADE-CERQual approach to assess confidence in qualitative findings. RESULTS Twelve included studies were from four countries (USA, Sweden, England and Australia). There were 26 findings categorised under three domains: (1) community-based doulas' role in increasing capacity of existing maternity services; (2) impact on migrant and refugee women's experiences and health; and (3) factors associated with implementing and sustaining a community-based doula programme. CONCLUSION Community-based doula programmes can provide culturally-responsive care to migrant and refugee women in HICs. These findings can inform community-based doula organisations, maternity healthcare services and policymakers. Further exploration of the factors that impact programme implementation, sustainability, strategic partnership potential and possible wider-reaching benefits is needed.
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Affiliation(s)
- Sarah Min-Lee Khaw
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Rana Islamiah Zahroh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Kerryn O'Rourke
- School of Nursing and Midwifery, Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- College of Indigenous Futures, Education and the Arts, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Red Dearnley
- Birth for Humankind, North Melbourne, Victoria, Australia
| | - Caroline Homer
- Child and Adolescent Health, Burnet Institute, Melbourne, Victoria, Australia
| | - Meghan A Bohren
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
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Gingell T, Murray K, Correa-Velez I, Gallegos D. Determinants of food security among people from refugee backgrounds resettled in high-income countries: A systematic review and thematic synthesis. PLoS One 2022; 17:e0268830. [PMID: 35653308 PMCID: PMC9162305 DOI: 10.1371/journal.pone.0268830] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 05/08/2022] [Indexed: 11/18/2022] Open
Abstract
Food is intrinsically linked to culture, identity, and for people with lived refugee experiences, cultural foods are a critical part of settlement into a new country, which is often a time of high stress and dislocation from friends and family. However, cultural foods in settlement countries may be unavailable or inaccessible, adversely impacting on food security. This systematic review aimed to identify facilitators and barriers to accessing foods in high-income countries for people with lived refugee experiences. Sixteen health databases were searched from June 2020 and April 2021 and 22 articles met the inclusion criteria. Bias was assessed using a modified thematic synthesis method and the relevant Joanna Briggs Institute risk assessment checklist. Findings were thematically synthesised and the socio-ecological model and postcolonialism were used as a lens through which the data was viewed. Analysis revealed three themes: "Practicalities and Pragmatism"; "Identity, Belonging and Placemaking"; and "Postcolonial and Societal Influences". The determinants of food security were present across all levels of the socio-ecological model and people with lived refugee experiences used practical and pragmatic strategies to feed their families. Food was intrinsically linked to identity, belonging and placemaking, and as such, people preferred consuming cultural foods. Societies adversely affected the food security of people from refugee backgrounds by limiting their access to resources and restricting cultural food gathering practices, impacting on their ability to access or afford foods, especially cultural foods. To improve food security for people with lived refugee backgrounds, governments and organisations should collaborate with the cultural communities with lived experiences of accessing cultural foods, appreciate their strengths, and recognise the value of social and cultural capital.
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Affiliation(s)
- Tina Gingell
- School of Nutrition and Exercise Sciences, Queensland University of Technology (QUT), and Woolworths Centre for Childhood Nutrition Research (WCCNR), South Brisbane, QLD, Australia
| | - Kate Murray
- School of School of Psychology and Counselling, QUT, Kelvin Grove, QLD, Australia
| | | | - Danielle Gallegos
- School of Nutrition and Exercise Sciences, QUT, and WCCNR, South Brisbane, QLD, Australia
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13
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Dosani A, Yim IS, Shaikh K, Lalani S, Alcantara J, Letourneau N, Premji SS. Psychometric analysis of the Edinburgh Postnatal Depression Scale and Pregnancy Related Anxiety Questionnaire in Pakistani pregnant women. Asian J Psychiatr 2022; 72:103066. [PMID: 35334284 DOI: 10.1016/j.ajp.2022.103066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Edinburgh Postnatal Depression Scale (EPDS) and the Pregnancy-Related Anxiety Scale (PRAQ) are frequently used perinatal mental health scales. OBJECTIVE To identify the factor structure of the Urdu language versions of EPDS and PRAQ in 280 Pakistani pregnant women. METHOD The tools were administered at 12-19 weeks' and 22-29 weeks' gestational age (GA). Exploratory factor analyses were undertaken on data collected at 12-19 weeks' GA, to assess both scales. Results obtained at the second time point were used to examine test-retest reliability. The correlation between the scales was computed. RESULTS A two-factor model yielded the best fit for both scales, which is consistent with findings from previous studies. For the EPDS, acceptable reliability was attained for the overall score (α = 0.77) and for the factor related to depressive symptoms (α = 0.73), but not for the factor related to anhedonia/suicide (α = 0.64). For the PRAQ, acceptable reliability was attained for the overall score (α = 0.83) and for the factor related to pregnancy concerns (α = 0.84), but not for the factor related to childbirth (α = 0.64). Test-retest reliability was acceptable for both overall scales EPDS: r = 0.50; PRAQ: r = 0.45; both p < .001). The Pearson correlation between the EPDS and PRAQ were r = 0.145, p < .05. CONCLUSION Analysis of the tools confirmed a two-factor structure for both depression and anxiety among Pakistani pregnant women. A weak correlation was found between the EPDS and PRAQ. Further research is required to develop screening instruments for perinatal mental disorders that are applicable to cultural contexts.
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Affiliation(s)
- Aliyah Dosani
- School of Nursing and Midwifery, Mount Royal University, 4825 Mount Royal Gate S.W., Calgary, Alberta, T3E 6K6 Canada; Department of Community Health Sciences, University of Calgary, 3D10, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6 Canada; O'Brien Institute for Public Health, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive N.W., Calgary, Alberta, T2N 4Z6 Canada.
| | - Ilona S Yim
- Department of Psychological Science, University of California, Irvine, 4562 Social and Behavioral Sciences Gateway, Irvine, CA, USA
| | - Kiran Shaikh
- School of Nursing and Midwifery, Aga Khan University, Stadium Road, P/O Box 3500, Karachi 74800, Pakistan
| | - Sharifa Lalani
- School of Nursing and Midwifery, Aga Khan University, Stadium Road, P/O Box 3500, Karachi 74800, Pakistan
| | - Jade Alcantara
- School of Nursing and Midwifery, Mount Royal University, 4825 Mount Royal Gate S.W., Calgary, Alberta, T3E 6K6 Canada
| | - Nicole Letourneau
- Department of Community Health Sciences, University of Calgary, 3D10, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6 Canada; Faculty of Nursing, University of Calgary, 2500 University Drive N.W., Calgary, Alberta, T2N 1N4 Canada; Departments of Pediatrics and Psychiatry, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta,T2N 4N1 Canada
| | - Shahirose S Premji
- School of Nursing, Faculty of Health, York University, Health, Nursing & Environmental Studies Building, Room 313, 4700 Keele St, Toronto, M3J 1P3 Canada
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Vaillancourt M, Lane V, Ditto B, Da Costa D. Parity and Psychosocial Risk Factors Increase the Risk of Depression During Pregnancy Among Recent Immigrant Women in Canada. J Immigr Minor Health 2022; 24:570-579. [PMID: 34595614 DOI: 10.1007/s10903-021-01284-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
Prior investigations have examined risk factors associated to postpartum depression in immigrant women, but depression during pregnancy has received less attention. This study describes the prevalence and early determinants of antenatal depression among recent (≤ 5 years) and long-term immigrants (> 5 years), compared to Canadian-born women. 503 women completed standardized self-report questionnaires measuring sociodemographics and psychosocial factors. Multivariate logistic regressions identified first trimester risk factors for depression in each immigrant group. The prevalence of depressive symptoms was highest for recent immigrant (25.3-30.8%) compared to long-term immigrant (16.9-19.2%) and Canadian-born women (11.7-13.8%). Among recent immigrants, multiparity, higher stress and pregnancy-specific anxiety in early pregnancy increased the risk of antenatal depression. Among long-term immigrants, stress in the first trimester was significantly associated with antenatal depressive symptoms. Knowledge of modifiable risk factors (pregnancy-specific anxiety and stress) may help improve antenatal screening and inform the development of tailored interventions to meet the mental health needs of immigrant women during the perinatal period.
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Affiliation(s)
| | - Victoria Lane
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Blaine Ditto
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Deborah Da Costa
- Department of Medicine, McGill University, Montreal, QC, Canada.
- Centre for Outcomes Research & Evaluation (CORE), Research Institute of the McGill University Health Centre (RI-MUHC), 5252 de Maisonneuve Boulevard W., Montreal, QC, H4A 3S9, Canada.
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15
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The Relationship between Social Support and Postnatal Anxiety and Depression: Results from the Listening to Mothers in California Survey. Womens Health Issues 2022; 32:251-260. [PMID: 35246352 DOI: 10.1016/j.whi.2022.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 01/16/2022] [Accepted: 01/19/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Perinatal mood and anxiety disorders (PMADs) impact multiple domains of maternal and child well-being. Estimates of postpartum depressive symptoms range from 6.5% to 12.9% and from 8.6% to 9.9% for postpartum anxiety. We sought to identify the role social support could play in mitigating PMADs. METHODS The data are drawn from the Listening to Mothers in California survey; results are representative of women who gave birth in 2016 in a California hospital. The Patient Health Questionnaire-4 was used to assess total symptoms of PMADs and anxiety and depressive symptoms individually. Two questions adapted from the Medical Outcomes Study Social Support Survey were used to assess emotional, practical, and functional (combined) social support. After exclusions for missing data related to PMADs or social support, we analyzed data from 2,372 women. RESULTS At the time of survey administration (mean 5.7 months after birth), 7.0% of respondents reported elevated PMAD symptoms and 45.9% reported that they always received functional social support. In multivariable analysis, controlling for demographic and pregnancy-related factors and prenatal anxiety and depressive symptoms, women who reported consistent support had a prevalence of elevated PMAD symptoms one-half that of those who did not (adjusted odds ratio, 0.50; 95% confidence interval, 0.34-0.74). CONCLUSIONS This study suggests that consistent social support serves as a robust protective factor against postpartum symptoms of PMADs. Because many predictors of PMADs are not modifiable, social support stands out as an important target for programmatic intervention, particularly in light of increased isolation related to the COVID-19 pandemic.
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Seidi PA, Abas NQ, Jaff D, Dunstan R, Soltan L, Brumwell A, Wilson M, Nicholson T, Palmquist AEL. Assessment of Perinatal Depression Risk among internally displaced Yazidi Women in Iraq: a descriptive cross-sectional study. BMC Pregnancy Childbirth 2022; 22:359. [PMID: 35468737 PMCID: PMC9040272 DOI: 10.1186/s12884-022-04658-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 03/03/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Yazidi survivors of a 2014 genocidal attack by the self-proclaimed Islamic State of Iraq and Syria (ISIS) have complex medical and mental health needs in the perinatal and postpartum period. Few studies have assessed perinatal mental health needs for this population of women who are living in camps for Internally Displaced Persons (IDP) in the Kurdistan Region of Iraq (KRI). METHODS The specific aim of this formative cross-sectional study was to assess the prevalence of perinatal depressive symptoms, specifically the risk of perinatal depression symptoms, among a purposive sample of Yazidi women living in camps for internally displaced persons in the Kurdistan region of Iraq. One hundred twenty-two pregnant and recently postpartum (<1 year) Yazidi women completed a Kurdish-language version of the Edinburgh Postnatal Depression Scale (EPDS) questionnaire. Pregnant and postpartum participants' responses were analyzed together, in order to assess an overall combined risk of perinatal mental health issues for the study population. Logistic regression analyses were used to measure the association of participant characteristics with an elevated risk of perinatal depressive symptoms. RESULTS Participants were 17-45 years of age (mean 32 years, SD 7.63) Among the 122 women, 67.2% (n=82) were pregnant and 32.8% (n=40) were <1 year postpartum. Overall, 78% (n=95) of participants were at an elevated risk of depression (EPDS >10), and 53% (n=65) of all participants were at risk of moderate to severe depression (EPDS >12). Thoughts of self-harm (EPDS item 10) were reported among 97% (n=118) of participants. Logistic regression analysis indicated that increased risk of perinatal depressive symptoms was significantly associated with reports of health problems during pregnancy (OR=3.22, 95% [CI]:1.08-9.61) and marital status (OR=16.00; 95% [CI]: 0.42-0.50). Age (OR= 0.84; 95% [CI]: 0.75-0.94) and level of education (OR=0.15; 95% [CI]: 0.42-0.50) had protective effects. CONCLUSIONS Rates of perinatal depressive symptoms risk among internally displaced Yazid pregnant and postpartum women are higher than the general Kurdish-speaking population in Iraq (28.4%). Culturally responsive trauma informed perinatal and postpartum care services, which include both community-based and clinical strategies for perinatal depressive symptoms and suicide prevention for this population, are critically needed.
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Affiliation(s)
- Pegah Am Seidi
- Research Center, University of Garmian, Kurdistan, Iraq.
- Research Center, University of Garmian Kalar, Kurdistand, Sulaimania, Iraq.
| | | | - Dilshad Jaff
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Raven Dunstan
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lein Soltan
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | - Aunchalee E L Palmquist
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Sia D, Tchouaket Nguemeleu E, Beogo I, Séguin C, Roch G, Cleveland J, Greenaway C. Interventions facilitating access to perinatal care for migrant women without medical insurance: A scoping review protocol. PLoS One 2022; 17:e0265232. [PMID: 35286364 PMCID: PMC8920260 DOI: 10.1371/journal.pone.0265232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/24/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Inadequate pregnancy monitoring for pregnant migrant women without medical insurance (PMWMI) exposes them to severe complications during childbirth and consequences for the health of their child (e.g. preterm delivery, low birth weight, etc.). This scoping review aims to identify existing interventions globally to improve access to perinatal care for PMWMI. It will also highlight the strengths, weaknesses as well as the costs of these interventions. Materials and methods The methodological framework developed by Arksey & O’Malley (2005) will be used. An electronic search of studies from 2000 to 2021, published in French or English, will be conducted in 12 databases. Publication in Websites of non-governmental organizations working on migrant women without medical insurance issues will be also searched. All articles related to perinatal follow-up and care of PMWMIs, regardless of design, will be included. Editorial comments will be excluded. Outcomes of interest will focus on the impacts, strengths, weaknesses, and cost of interventions. Selection of articles and data extraction will be done by two independent researchers following the Tricco et al. (2018) reporting guide. Finally, a deliberative workshop with experts will allow to identify the most promising and appropriate interventions that can facilitate access to perinatal services by PMWMIs in the Quebec province of Canada.
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Affiliation(s)
- Drissa Sia
- Department of Nursing, Université du Québec en Outaouais, Saint-Jérôme, Québec, Canada
- Département de médecine sociale et préventive de l’École de santé publique de l’Université de Montréal, Montreal, Quebec, Canada
- Département de gestion, d’éducation et politique de santé de l’École de santé publique de l’Université de Montréal, Montreal, Quebec, Canada
- * E-mail:
| | - Eric Tchouaket Nguemeleu
- Department of Nursing, Université du Québec en Outaouais, Saint-Jérôme, Québec, Canada
- École des sciences infirmières | School of Nursing. Faculty of Health Sciences. University of Ottawa, Ottawa, Ontario, Canada
| | - Idrissa Beogo
- École des sciences infirmières | School of Nursing. Faculty of Health Sciences. University of Ottawa, Ottawa, Ontario, Canada
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Catherine Séguin
- Library, Université du Québec en Outaouais, Saint-Jérôme, Quebec, Canada
| | - Geneviève Roch
- Faculty of Nursing, Université Laval, Quebec, Quebec, Canada
| | - Janet Cleveland
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Christina Greenaway
- Jewish General Hospital and Department of Medicine, McGill University, Montreal, Quebec, Canada
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Khalil D, Giurgescu C, Misra DP, Javanbakht A, Templin T, Jenuwine E. Acculturative Stress and Postpartum Depressive Symptoms among Immigrant Arab American Couples. MCN Am J Matern Child Nurs 2022; 47:92-99. [PMID: 35202011 DOI: 10.1097/nmc.0000000000000804] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to examine the relationships between acculturative stress, perceived stress, social support, and postpartum depression (PPD) symptoms among immigrant Arab American couples. METHODS Using a cross-sectional design, 30 Arab American immigrant couples were enrolled. During home visits, couples completed the demographic information, the Multi-Dimensional Acculturative Stress Inventory, Perceived Stress, the Multidimensional Scale of Perceived Social Support among Arab Women, and the Edinburgh Postnatal Depression Scale. Data were analyzed using bivariate linear regression and Pearson correlation. RESULTS In bivariate regressions, paternal and maternal acculturative stress was moderately associated with maternal PPD symptoms (r = .39, and .46, respectively; p < .05). Maternal perceived stress (r = .70, P < .01) was strongly associated with PPD and maternal perceived social support was moderately associated with PPD (r = -.42, p < .05). Maternal and paternal acculturative stress was strongly correlated (r = .61, p < .001). CONCLUSION Couple's acculturative stress and mother's perceived stress were positively associated with mother's PPD symptoms. Our findings suggest the need to develop a culturally appropriate procedure to assess couple's stress that may affect immigrant women at high risk for PPD.
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Santos MLC, Reis JF, Silva RDP, Santos DF, Leite FMC. Sintomas de depressão pós-parto e sua associação com as características socieconômicas e de apoio social. ESCOLA ANNA NERY 2022. [DOI: 10.1590/2177-9465-ean-2021-0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo verificar a prevalência de sintomas de depressão pós-parto em puérperas atendidas em uma maternidade pública e sua associação com características socioeconômicas e de apoio social. Método estudo epidemiológico, analítico, do tipo transversal, em uma maternidade pública conduzido de agosto a outubro de 2017. A amostra de 330 puérperas foi entrevistada por meio da aplicação de um formulário, para mensuração da presença de sintomas de depressão pós-parto. Foi utilizada a escala de depressão pós-natal de Edimburgo. Já para mensuração do apoio social, foi utilizado o instrumento Medical Outcomes Study. A medida de associação adotada foi a razão de prevalência (RP) com intervalos de confiança de 95% (IC95%), e aplicada a regressão de Poisson ajustada. Resultados a prevalência de sintomas de DPP foi de 29,7%. A idade entre 14 e 24 anos (PR:1,60; 95%CI: 1,10–2,34), ter até 8 anos de escolaridade (RP:1,39; IC95%:1,01–2,14) e o baixo nível de suporte social afetivo (RP:1,52; IC95%:1,07–2,14) e emocional (RP:2,12; IC95%:1,41-3,19) estiveram associados à maior prevalência de sintomas de DPP. Conclusão e implicações para a prática nesse contexto, os profissionais de saúde podem possuir um papel essencial no qual podem desenvolver, em conjunto, um plano de cuidados de acordo com as necessidades da mulher em período gravídico-puerperal.
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Marti-Castaner M, Hvidtfeldt C, Villadsen SF, Laursen B, Pedersen TP, Norredam M. Disparities in postpartum depression screening participation between immigrant and Danish-born women. Eur J Public Health 2021; 32:41-48. [PMID: 34864938 PMCID: PMC9090168 DOI: 10.1093/eurpub/ckab197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Qualitative studies suggest that immigrant women experience barriers for postpartum depression (PPD) screening. This study examines the prevalence of participation in PPD screening in the universal home-visiting programme in Denmark, in relation to migrant status and its association with acculturation factors, such as length of residence and age at migration. METHODS The sample consists of 77 694 births from 72 292 mothers (2015-18) that participated in the programme and were registered in the National Child Health Database. Lack of PPD screening using the Edinburgh Postpartum Depression Scale (EPDS) was examined in relation to migrant group and acculturation factors. We used Poisson regression with cluster robust standard errors to estimate crude and adjusted relative risk. RESULTS In total, 27.8% of Danish-born women and 54.7% of immigrant women lacked screening. Compared with Danish-born women, immigrant women in all groups were more likely to lack PPD screening (aRR ranging from 1.81 to 1.90). Women with low acculturation were more likely to lack screening. Women who migrated as adults [aRR = 1.27 (95% CI 1.16, 1.38)] and women who had resided in Demark for <5 years [aRR = 1.37 (95% CI 1.28, 1.46)] were more likely to lack screening. CONCLUSIONS Immigrant women in Denmark, particularly recent immigrants, are at increased risk of not being screened for PPD using the EPDS. This can lead to under-recognition of PPD among immigrant women. More work is needed to understand how health visitors recognize the mental health needs of immigrant women who are not screened, and whether this gap results in reduced use of mental health services.
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Affiliation(s)
- Maria Marti-Castaner
- Department of Public Health, Section of Health Services Research, University of Copenhagen, Copenhagen, Denmark
| | | | - Sarah Fredsted Villadsen
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bjarne Laursen
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Trine Pagh Pedersen
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Marie Norredam
- Department of Public Health, Section of Health Services Research, University of Copenhagen, Copenhagen, Denmark
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First perinatal psychiatric episode among refugee and family-reunified immigrant women compared to Danish-born women: a register-based study. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2239-2250. [PMID: 34008058 DOI: 10.1007/s00127-021-02104-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE This study aimed at examining psychiatric morbidity in the perinatal period among refugees and family-reunified immigrants compared to Danish-born women, including predictors of psychiatric morbidity according to migration history. METHODS Inclusion criteria were women who had a residence permit in Denmark and gave birth to a live child between 1 April 1998 and 31 December 2014. The study included 7804 refugee women, 21,257 family-reunified women, and 245,865 Danish-born women. We estimated Odds Ratios (ORs) of having a first-time perinatal psychiatric episode (PPE) and specific risk for affective, psychotic, and neurotic disorders. RESULTS Compared with Danish-born women, women family-reunified with immigrants had lower (aOR 0.37, 95% CI 0.22-0.64) and refugees had higher ORs of PPE (OR 1.46, 95% CI 1.22-1.76). In fully adjusted models, refugees no longer presented increased risk of PPE (OR 1.16, 95% CI 0.95-1.42) but showed higher ORs for psychotic (aOR 4.72, 95% CI 2.18-9.84) and neurotic disorders (aOR 1.31, 95% CI 1.01-1.72). Women family-reunified with refugees and to Nordic citizens had higher ORs of psychotic disorders. Among migrants, refugees had higher ORs of PPE. CONCLUSIONS Results suggest that elevation in risk of PPE among refugees compared to Danish-born may be related to higher likelihood of poverty and single-parenting among refugees. Still, refugees appear to have increased risk for neurotic and psychotic disorders. In contrast, family-reunified to immigrants may have lower risk of PPE. Maternal health programs need to focus on promotion of mental health and tackle social risks that disproportionately affect immigrant women, particularly refugees.
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Bains S, Skråning S, Sundby J, Vangen S, Sørbye IK, Lindskog BV. Challenges and barriers to optimal maternity care for recently migrated women - a mixed-method study in Norway. BMC Pregnancy Childbirth 2021; 21:686. [PMID: 34620114 PMCID: PMC8495671 DOI: 10.1186/s12884-021-04131-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Migrant women are at increased risk for complications related to pregnancy and childbirth, possibly due to inadequate access and utilisation of healthcare. Recently migrated women are considered a vulnerable group who may experience challenges in adapting to a new country. We aimed to identify challenges and barriers recently migrated women face in accessing and utilising maternity healthcare services. METHODS In the mixed-method MiPreg-study, we included recently migrated (≤ five years) pregnant women born in low- or middle-income countries and healthcare personnel. First, we conducted 20 in-depth interviews with migrant women at Maternal and Child Health Centres (MCHC) and seven in-depth interviews with midwives working at either the hospital or the MCHCs in Oslo. Afterwards, we triangulated our findings with 401 face-to-face questionnaires post-partum at hospitals among migrant women. The data were thematically analysed by grouping codes after careful consideration and consensus between the researchers. RESULTS Four main themes of challenges and barriers faced by the migrant women were identified: (1) Navigating the healthcare system, (2) Language, (3) Psychosocial and structural factors, and (4) Expectations of care. Within the four themes we identified a range of individual and structural challenges, such as limited knowledge about available healthcare services, unmet needs for interpreter use, limited social support and conflicting recommendations for pregnancy-related care. The majority of migrant women (83.6%) initiated antenatal care in the first trimester. Several of the challenges were associated with vulnerabilities not directly related to maternal health. CONCLUSION A combination of individual, structural and institutional barriers hinder recently migrated women in achieving optimal maternal healthcare. Suggested strategies to address the challenges include improved provision of information about healthcare structure to migrant women, increased use of interpreter services, appropriate psychosocial support and strengthening diversity- and intercultural competence training among healthcare personnel.
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Affiliation(s)
- Sukhjeet Bains
- Department of Obstetrics and Gynecology, Norwegian Research Centre for Women's Health, Oslo University Hospital, Rikshospitalet; PO box 4950 Nydalen, 0424, Oslo, Norway. .,Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Susanne Skråning
- Department of labour, Welfare and Local Communites, Stovner District, City of Oslo, Oslo, Norway
| | - Johanne Sundby
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Siri Vangen
- Department of Obstetrics and Gynecology, Norwegian Research Centre for Women's Health, Oslo University Hospital, Rikshospitalet; PO box 4950 Nydalen, 0424, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ingvil K Sørbye
- Department of Obstetrics and Gynecology, Norwegian Research Centre for Women's Health, Oslo University Hospital, Rikshospitalet; PO box 4950 Nydalen, 0424, Oslo, Norway
| | - Benedikte V Lindskog
- Department of Social Work, Child Welfare and Social Policy, Oslo Metropolitan University, Oslo, Norway
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O'Mahony J, Kassam S, Marcellus L. Facilitators and barriers to accessing mental health care services and social supports among perinatal refugee women: a qualitative systematic review protocol. JBI Evid Synth 2021; 20:674-680. [PMID: 34494614 DOI: 10.11124/jbies-21-00119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this qualitative review is to identify, critically appraise, and synthesize evidence describing facilitators and barriers to perinatal refugee women's access to mental health care services and social supports. INTRODUCTION Perinatal refugee women are a vulnerable population and at risk of mental health illness. Understanding facilitators and barriers will provide a better understanding of their experiences to inform health care practices, programs, and policies. INCLUSION CRITERIA This qualitative review will consider all peer-reviewed qualitative studies and gray literature on perinatal refugee women's experiences of accessing mental health care services and social supports. Non-English articles and studies that do not explicitly state participants' migration status as refugees will be excluded. METHODS This review will adhere to the JBI methodology for conducting qualitative systematic reviews. Key information sources searched will be CINAHL, PsycINFO, PubMed, Web of Science, and the Social Sciences Citation Index. Search terms will be modified for each information source. Sources of evidence published in English between January 2011 and the present will be assessed for inclusion. Two independent reviewers will screen titles and abstracts using the inclusion criteria for study selection. The reviewers will critically appraise methodological quality and rigor. Data will be extracted on facilitators and barriers among perinatal refugee women accessing mental health care services and social supports. Synthesis will involve aggregation of these findings to generate a set of statements based on their meaning similarity. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42021245240.
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Affiliation(s)
- Joyce O'Mahony
- School of Nursing, Thompson Rivers University, Kamloops, BC, Canada University of Victoria (UVic) Centre for Evidence-Informed Nursing and Healthcare (CEiNHC): A JBI Centre of Excellence, Victoria, BC, Canada School of Nursing, Faculty of Human and Social Development, University of Victoria, Victoria, BC, Canada
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Liu C, Butwick A, Sand A, Wikström AK, Snowden JM, Stephansson O. The association between postpartum hemorrhage and postpartum depression: A Swedish national register-based study. PLoS One 2021; 16:e0255938. [PMID: 34379698 PMCID: PMC8357098 DOI: 10.1371/journal.pone.0255938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 07/27/2021] [Indexed: 11/30/2022] Open
Abstract
Background Postpartum hemorrhage is an important cause of maternal death and morbidity. However, it is unclear whether women who experience postpartum hemorrhage are at an increased risk of postpartum depression. Objectives To examine whether postpartum hemorrhage is associated with postpartum depression. Methods We conducted a national register-based cohort study of 486,476 Swedish-born women who had a singleton livebirth between 2007 and 2014. We excluded women with pre-existing depression or who filled a prescription for an antidepressant before childbirth. We classified postpartum depression up to 12 months after giving birth by the presence of an International Classification of Diseases, version 10 (ICD-10) diagnosis code for depression or a filled outpatient prescription for an antidepressant. We used Cox proportional hazard models, adjusting for maternal sociodemographic and obstetric factors. Results Postpartum depression was identified in 2.0% (630/31,663) of women with postpartum hemorrhage and 1.9% (8601/455,059) of women without postpartum hemorrhage. In our unadjusted analysis, postpartum hemorrhage was not associated with postpartum depression (unadjusted hazard ratio (HR) = 1.06, 95% confidence interval (CI) 0.97–1.15). After adjusting for maternal age, parity, education, cohabitation status, maternal smoking status, and early pregnancy maternal BMI, gestational age, and birthweight, the association did not appreciably change, with confidence intervals overlapping the null (adjusted HR = 1.08, 95% CI 0.99, 1.17). Conclusions Within a population-based cohort of singleton women in Sweden with no prior history of depression, postpartum hemorrhage was not associated with postpartum depression.
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Affiliation(s)
- Can Liu
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- * E-mail:
| | - Alexander Butwick
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Anna Sand
- Department of Women’s Health, Karolinska University Hospital, Stockholm, Sweden
| | - Anna-Karin Wikström
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Jonathan M. Snowden
- School of Public Health, Oregon Health & Science University–Portland State University, Portland, Oregon, United States of America
| | - Olof Stephansson
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Women’s Health, Karolinska University Hospital, Stockholm, Sweden
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Hamwi S, Lorthe E, Barros H. Language Proficiency and Migrant-Native Disparities in Postpartum Depressive Symptoms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094782. [PMID: 33947149 PMCID: PMC8125143 DOI: 10.3390/ijerph18094782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 01/08/2023]
Abstract
Migrant women have a higher risk of developing postpartum depressive symptoms (PPDS) than do native women. This study aimed to investigate the role of host-country language proficiency in this disparity. We analysed the data of 1475 migrant and 1415 native women who gave birth at a Portuguese public hospital between 2017 and 2019 and were participants in the baMBINO cohort study. Migrants’ language proficiency was self-rated and comprised understanding, speaking, reading, and writing skills. PPDS were assessed using the Edinburgh Postnatal Depression Scale with a cut-off score of ≥10. Multivariable logistic regression models were fitted to estimate the association between language proficiency and PPDS. PPDS were experienced by 7.2% of native women and 12.4% among migrants (p < 0.001). Increasing proportions of PPDS were observed among decreasing Portuguese proficiency levels; 11% among full, 13% among intermediate, and 18% among limited proficiency women (ptrend < 0.001). Full (aOR 1.63 (95% CI 1.21–2.19)), intermediate (aOR 1.68 (95% CI 1.16–2.42)), and limited (aOR 2.55 (95% CI 1.64–3.99)) language proficiencies were associated with increasingly higher odds of PPDS among migrant women, compared to native proficiency. Prevention measures should target migrant women at high risk of PPDS, namely those with limited language skills, and promote awareness, early detection, and help-seeking, in addition to facilitating communication in their perinatal healthcare encounters.
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Affiliation(s)
- Sousan Hamwi
- EPIUnit–Instituto de Saúde Pública, Universidade do Porto, 4050-091 Porto, Portugal;
- Correspondence: ; Tel.: +351-22-206-1820
| | - Elsa Lorthe
- Unit of Population Epidemiology, Department of Primary Care, Geneva University Hospitals, 1205 Geneva, Switzerland;
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Université de Paris, F-75004 Paris, France
| | - Henrique Barros
- EPIUnit–Instituto de Saúde Pública, Universidade do Porto, 4050-091 Porto, Portugal;
- Departamento de Ciências de Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, 4200-450 Porto, Portugal
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Exploring the State of Gender-Centered Health Research in the Context of Refugee Resettlement in Canada: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207511. [PMID: 33076467 PMCID: PMC7602644 DOI: 10.3390/ijerph17207511] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 11/16/2022]
Abstract
Interdisciplinary health research that investigates gender as a relational process is necessary to facilitate a safe and healthy resettlement process for refugees in Canada. This scoping review explores the range, nature, and extent of published research examining gender in relation to refugee health during resettlement in Canada. An initial search of six databases yielded 7325 articles published before June 2019. A total of 34 articles published between 1988 and 2019 were included for in-depth review. Articles meeting inclusion criteria primarily focused on refugee women. Categories of focus included maternal health, social and emotional health, health impacts of sexual and gender-based violence and torture, access to health and social services, decision-making and health-seeking behavior, mental health, and sexual and reproductive health. Our thematic analysis identified connections between gender roles, expectations, ideals, and health through interactions and lived experiences within the family, community, and healthcare system. Review findings suggest that many refugee women are influenced by pervasive gender roles and expectations as well as exposed to gendered health systems and practices that may pose risks to health, particularly mental health and access to services. Further efforts should be made to understand processes and experiences of resilience and community building in countering negative impacts of gendered beliefs and practices on health during resettlement.
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Haque S, Malebranche M. Impact of culture on refugee women's conceptualization and experience of postpartum depression in high-income countries of resettlement: A scoping review. PLoS One 2020; 15:e0238109. [PMID: 32870929 PMCID: PMC7462258 DOI: 10.1371/journal.pone.0238109] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 08/09/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The global refugee population has reached a staggering 25.9 million. Approximately 16% of global refugees resettle in high-income countries which are often culturally very different from their home countries. This can create cross-cultural challenges when accessing health services, leading to inappropriate assessments, diagnoses and treatments if cultural background is not factored in. The impact of culture on the conceptualization and experience of postpartum depression (PPD) amongst migrant women has received growing attention in recent years, however, a specific focus on refugee and asylum-seeking women is lacking. Given the unique mental health challenges refugee women face, it is hypothesized that the interplay between culture and postpartum depression amongst refugee women may differ from other migrant women. Therefore, a scoping review was conducted to characterize what is known about the impact of culture on the conceptualization and experience of PPD in refugee women resettled in high-income countries. METHODS AND FINDINGS This study was conducted as a scoping review in accordance with the Joanna Briggs Institute's Methodology for Scoping Reviews. A systematic search of studies addressing the relationship between culture and postpartum depression amongst refugee women (including asylum-seeking women) resettled in high-income countries was conducted across 6 databases including MEDLINE, PsycINFO and SOCINDEX between June 2018 and August 2019. A total of 637 articles were found. Studies were eligible if they focused on refugee women who had a pregnancy during forced migration or upon resettlement in a high-income country and focused on the impact of culture on women's conceptualization and/or experience of PPD. Eight studies met inclusion criteria and were included in the final analysis, the majority of which were qualitatively driven. Four key themes emerged: 1) there are diverse conceptualizations and experiences of postpartum depression amongst refugee women; 2) mental health stigma has a significant impact on women's conceptualizations and experiences of postpartum depression and help-seeking behaviors; 3) cultural traditions and social support play protective roles in postpartum mental wellbeing; and, 4) host culture has a significant influence on the pregnancy and postpartum experience of refugee women. The overall themes align with those seen in the literature on migrant women in general, however significant research gaps remain. CONCLUSION The studies identified through this scoping review provide a rich description of the significant impact culture has on the conceptualization and experience of postpartum depression among refugee women resettled in high-income countries. Though overall themes align with those seen in the literature on migrant women in general, further research is needed to better characterize how culture impacts refugee women's experiences of PPD as a distinct sub-group of migrant women.
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Affiliation(s)
| | - Mary Malebranche
- Department of Medicine, Cumming School Medicine, University of Calgary, Calgary, Alberta, Canada
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Bohr Y, Bimm M, Bint Misbah K, Perrier R, Lee Y, Armour L, Sockett-DiMarco N. The Crying Clinic: Increasing accessibility to Infant Mental Health services for immigrant parents at risk for peripartum depression. Infant Ment Health J 2020; 42:140-156. [PMID: 32644229 DOI: 10.1002/imhj.21879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Peripartum depression (PPD) is considered a major public health concern due to its profound impact on families, including infants. In this paper, we report on a pilot initiative designed to reduce barriers and stigma related to the use of traditional infant mental health services for immigrant parents deemed at high risk of PPD. The Crying Clinic (CC) is an innovative walk-in service offered in a culturally diverse Canadian community to support maternal well-being and healthy parent-infant relationships. The CC was designed to be a gateway to existing infant mental health services, through its emphasis on accessibility and cultural sensitivity. Support for concrete concerns, such as anxiety about normative infant behaviors like crying, is underscored in this approach to attract vulnerable families who would otherwise not access mental health support. A review of 44 users, utilization, plans for the use of additional services, and client evaluations suggests that the CC accomplished most of its goals. We conclude that gateway service models such as the CC have the potential to enhance traditional infant mental health programs by creatively addressing the challenge of engaging highly vulnerable parents from culturally diverse backgrounds.
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Affiliation(s)
- Y Bohr
- Department of Psychology, York University, Toronto, Canada
| | - M Bimm
- Department of Psychology, York University, Toronto, Canada
| | - K Bint Misbah
- Department of Psychology, York University, Toronto, Canada
| | - R Perrier
- Department of Psychology, University of Montreal, Montreal, Canada
| | - Y Lee
- Department of Psychology, York University, Toronto, Canada
| | - L Armour
- Aisling Discoveries Child and Family Centre, Scarborough, Canada
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Baiden D, Evans M. Black African Newcomer Women's Perception of Postpartum Mental Health Services in Canada. Can J Nurs Res 2020; 53:202-210. [PMID: 32551939 DOI: 10.1177/0844562120934273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY BACKGROUND The stress of immigrating, settling into Canada, and being a new mother, may place newcomer women at risk of mental health challenges. However, little is known on Black African newcomer women's perspectives of postpartum mental health care after experiencing childbirth in Canada. PURPOSE To explore sociocultural factors that impact Black African newcomer women's perception of mental health and mental health service utilization within a year after childbirth in Canada. METHODS This qualitative study, set in Southern Ontario, purposively sampled 10 African newcomer women who birthed a baby in Canada within the past year. Open-ended, semistructured interviews were conducted individually, transcribed and analyzed using thematic analysis. RESULTS Black African newcomer women rely on mental strength, nonmedical treatment preferences, spirituality, and spousal support for fostering postpartum mental health. Furthermore, cultural beliefs, racial discrimination, and temporary immigration status impact their decision making around postpartum mental health services utilization. CONCLUSION Our findings suggest that Black African newcomer women use mental strength to minimize maternal mental illness. Also, the spouses of Black African newcomer women are crucial in their postpartum mental health support. There is an urgent need for culturally safe interventions to meet the postpartum mental health needs of Black African newcomer mothers.
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Affiliation(s)
- Deborah Baiden
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Marilyn Evans
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
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Khalil D, Giurgescu C, Misra DP, Templin T, Javanbakht A. Recruiting Immigrant and Refugee Arab American Mother-Father-Infant Triads Resettling in the United States: A Feasibility Study. Can J Nurs Res 2020; 52:139-148. [PMID: 32192379 DOI: 10.1177/0844562120910856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Recent Iraqi and Syrian immigrant families are exposed to stress, anxiety, and depressive symptoms due to civil war. Recruitment challenges specific to conducting research within this population include the lack of knowledge about research, stigma of mental illness, and mistrust. PURPOSES Among immigrant Iraqi and Syrian families: (1) evaluate the approach to recruitment and retention; and (2) evaluate the acceptability of the study procedures. METHODS This feasibility study was conducted based on the work of Orsmond and Cohn. It is focused on the evaluation of recruitment capability and resulting sample characteristics and evaluation of acceptability and suitability of the study procedures. Mother-father-infant triads were recruited from a community center. Parents completed questionnaires about stress and depressive symptoms. Buccal swab samples were obtained from the triads to measure telomere length, and infant hair samples were obtained to measure cortisol level. Telomere length and hair cortisol were utilized as measures of chronic stress. RESULTS Ten mother-father-infant triads were enrolled out of 11 approached. Challenges faced this study included inability to reach families by telephone and the effect of cultural norms where the husband's permission was needed before proceeding, resulting in a slow pace of recruitment. The study strategy and procedures appeared to be feasible as all of the families who participated completed all study protocols. CONCLUSION This study provides feasibility data to inform the launching of a larger study to examine the associations of family stress with infant stress and development. These findings from Iraqi and Syrian families may be generalizable to studies seeking to recruit these and other immigrant and refugee population families.
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Affiliation(s)
- Dalia Khalil
- College of Nursing, Wayne State University, Detroit, MI, USA
| | - Carmen Giurgescu
- College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Dawn P Misra
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Thomas Templin
- College of Nursing, Wayne State University, Detroit, MI, USA
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Henry J, Beruf C, Fischer T. Access to Health Care for Pregnant Arabic-Speaking Refugee Women and Mothers in Germany. QUALITATIVE HEALTH RESEARCH 2020; 30:437-447. [PMID: 31530252 DOI: 10.1177/1049732319873620] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Refugee women often encounter multiple barriers when accessing ante-, peri-, and postnatal care. The aim of this study was to investigate how premigration experiences, conceptions about pregnancy and childbirth, health literacy, and language skills influence access to health care, experiences of health care, and childbirth. A total of 12 semi-structured interviews with refugee women from Iraq, Syria, and Palestine were conducted in the city of Dresden. Content analysis was applied using Levesque's access model as a framework. Results indicate that conceptions of pregnancy and childbirth and premigration experiences influence women's behaviors and experiences of pregnancy and childbirth. They contribute to barriers in accessing health care and lead to negative health outcomes. In view of limited health literacy, poor language skills, lack of information, and missing translators, female relatives in countries of origin remain an important source of information. Improved access to services for refugee women is needed.
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Affiliation(s)
- Julia Henry
- Evangelische Hochschule Dresden, Dresden, Germany
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Ganann R, Sword W, Newbold KB, Thabane L, Armour L, Kint B. Influences on mental health and health services accessibility in immigrant women with post-partum depression: An interpretive descriptive study. J Psychiatr Ment Health Nurs 2020; 27:87-96. [PMID: 31444918 DOI: 10.1111/jpm.12557] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/27/2019] [Accepted: 08/22/2019] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN ABOUT THE SUBJECT?: Immigrant women in Canada are at greater risk for post-partum depression (PPD) than native-born women. Immigrant women are less likely to have their care needs met as they face multiple barriers to care at both individual and system levels. To date, most PPD research has focused on individual barriers to care, with limited research examining organizational and system level barriers and the uniqueness of immigrant women's post-partum health experiences. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This study provides unique insights into immigrant women's perceptions of what influences their post-partum mental health and ability to access services for PPD. Factors contributing to immigrant women's PPD included several social determinants of health, particularly a lack of social support and limited knowledge about PPD and available services. Most helpful services acknowledge women's concerns, build trust, enact cultural competence and help with system navigation. Assessment approaches and organizational wait times created barriers to accessing care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Relationship building by providers is foundational to effective care for immigrant women with PPD. Findings highlight the need for mental health practitioners to improve cultural competence when working with diverse ethno-cultural communities and for more effective assistance with system navigation, service integration and timely, flexible and accessible services. Findings have implications for the development of healthy public policy to address perinatal mental health issues amongst immigrant women. Abstract Introduction Immigrant women in Canada are at greater risk for post-partum depression (PPD) than native-born women yet face multiple barriers to care at individual and system levels. Aim To explore factors that contribute to PPD and health service accessibility, and the role of health services in supporting immigrant women with PPD. Methods A qualitative interpretive descriptive design was used. Individual interviews were conducted with 11 immigrant women who had delivered a baby within the previous year and had experienced PPD. Inductive thematic content analysis was conducted. Results Factors contributing to immigrant women's PPD included several social health determinants. Services were most helpful and accessible when providers acknowledged women's concerns, allowed time to build trust, provided culturally competent care and helped with navigating services. Assessment approaches and organizational wait times created barriers to care. Discussion Immigrant women with PPD see relationship building by providers as foundational to providing effective support, enhancing coping and facilitating access to services. Improved communication with diverse ethno-cultural communities and assistance with system navigation, service integration and timely, accessible services are needed. Implications for Practice Findings can inform health service delivery models and the development of healthy public policy to address perinatal mental health issues amongst immigrant women.
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Affiliation(s)
- Rebecca Ganann
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Wendy Sword
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - K Bruce Newbold
- School of Geography & Earth Sciences, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Leigh Armour
- Aisling Discoveries Child and Family Centre, Toronto, ON, Canada
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Kassam S. Understanding Experiences of Social Support as Coping Resources among Immigrant and Refugee Women with Postpartum Depression: An Integrative Literature Review. Issues Ment Health Nurs 2019; 40:999-1011. [PMID: 31070499 DOI: 10.1080/01612840.2019.1585493] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Lack of social support increases the risk of postpartum depression (PPD), especially among immigrant and refugee women. In this integrative literature review, I aim to synthesize the current state of knowledge on social support experiences among immigrant and refugee women with PPD. Conceptualization of social support as coping resources occurs through Stewart's coping theory. Eleven primary sources were located using Whittemore and Knafl's review methods. These methods are philosophically underpinned by Racine's postcolonial feminist lens. In synthesizing literature located, themes were generated and include the following: maintaining cultural identity, connecting with a community, connecting with spirit (subtheme), relational space imparted by health care providers, and seeking and exchanging knowledge. Co-existing issues emerged from this review and capture broad determinants influential in shaping immigrant and refugee experiences of social support. These included: experience of poverty, connecting to maintain gender-driven roles, and experience of trauma and abuse. Interconnectedness of these themes and issues are depicted in a data display to demonstrate complexity. Drawing on these findings, I propose practice implications for nurses working in psychiatric and public health facilities. I also offer future research ideas and policy development recommendations based on the generated findings of this review.
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Affiliation(s)
- Shahin Kassam
- School of Nursing, University of Victoria, Victoria, Canada
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Identifying the critical time points for mental health of asylum seekers and refugees in high-income countries. Epidemiol Psychiatr Sci 2019; 29:e61. [PMID: 31576800 PMCID: PMC8061286 DOI: 10.1017/s204579601900057x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AIMS High heterogeneity was found in the prevalence rates of mental disorders in adult asylum seekers and refugees in high-income countries. This may be related to different problems. Among them, there is a changing exposure to risk and protective factors for mental health at different phases of these people's life before migration, and during the migratory journey and resettlement. This study aimed at identifying and distinguishing time points in which distinct risk and protective factors for the mental health of asylum seekers and refugees may occur. METHODS Systematic review and narrative synthesis. A systematic search was carried out for the period January 2017-August 2019, given the existence of systematic reviews of the evidence up to January 2017. RESULTS Two hundred and fifty-two studies were identified with our search and 31 studies were included. The critical time points identified are: (a) before the travel; (b) during the travel; (c) at initial settlement in the host country; (d) when attempting to integrate in the host country; (e) when the immigration status is challenged or revoked. Some factors such as sense of belonging in the host country can be risk factors or protective factors depending on the time point. CONCLUSIONS These five critical time points can guide the development and selection of well-timed preventive and treatment interventions. They could also be used to stratify samples in epidemiological studies and meta-analyses. At present, we know much more on risk factors than on protective factors. Knowing more about protective factors may inform the development of interventions to foster them.
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Li D, Li Y, Chen Y, Li H, She Y, Zhang X, Chen S, Chen W, Qiu G, Huang H, Zhang S. Neuroprotection of reduced thyroid hormone with increased estrogen and progestogen in postpartum depression. Biosci Rep 2019; 39:BSR20182382. [PMID: 31406011 PMCID: PMC6722490 DOI: 10.1042/bsr20182382] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/07/2019] [Accepted: 08/08/2019] [Indexed: 02/05/2023] Open
Abstract
Background: Postpartum depression (PPD) is a common serious mental health problem. Recent studies have demonstrated that hormone therapy serves as a promising therapeutic approach in managing PPD. The present study aims at exploring the role of thyroid hormone (TH), estrogen and progestogen in patients with PPD.Methods: Initially, PPD patients were enrolled and a PPD mouse model was established. The serum levels of estradiol (E2), progesterone (P), triiodothyronine (T3), thyroxine (T4), free triiodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) were subsequently measured. Next, in order to identify the effects of TH, estrogen and progestogen on PPD progression, mice were administrated with E2, P, contraceptives (CA), Euthyrox and methimazole (MMI). Besides, the body weight, activities, basolateral amygdala (BLA) neuron cell structure and the related gene expression of mice were analyzed.Results: The PPD patients and the mice showed elevated serum levels of T3, T4, FT3 and FT4 along with diminished E2, P and TSH levels. In the mice administered with a combination of E2, P, and MMI, decreased TH and increased estrogen and progestogen were detected, which resulted in increased body weight, normal activities, and BLA neuron cell structure. Moreover, brain-derived neurotrophic factor (BDNF) and cAMP-responsive element-binding protein (CREB) were both up-regulated in PPD mice administrated with a combination of E2, P, and MMI, which was accompanied by decreased TH and elevated estrogen and progestogen.Conclusion: Taken together, reduced TH combined with enhanced estrogen and progestogen confers neuroprotection in PPD, highlighting a potential target in prevention and treatment of PPD.
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Affiliation(s)
- Dan Li
- Gynaecology and Obstetrics, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515031, P.R. China
| | - Yangyao Li
- Department of Pharmacy, Cancer Hospital of Shantou University Medical College, Shantou 515031, P.R. China
| | - Yun Chen
- Department of Pharmacy, Guangzhou Red Cross Hospital Affiliated of Ji-Nan University Medical College, Guangzhou 510220, P.R. China
| | - Haiyan Li
- Department of Nursing, Guangzhou Red Cross Hospital Affiliated of Ji-Nan University Medical College, Guangzhou 510220, P.R. China
| | - Yuqi She
- Department of Pharmacy, Cancer Hospital of Shantou University Medical College, Shantou 515031, P.R. China
| | - Xialan Zhang
- Gynaecology and Obstetrics, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515031, P.R. China
| | - Shuang Chen
- Department of Pharmacy, Cancer Hospital of Shantou University Medical College, Shantou 515031, P.R. China
| | - Wanying Chen
- Department of Pharmacy, Cancer Hospital of Shantou University Medical College, Shantou 515031, P.R. China
| | - Guodong Qiu
- Department of Pharmacy, Cancer Hospital of Shantou University Medical College, Shantou 515031, P.R. China
| | - Haiqing Huang
- Department of Ultrasound, Cancer Hospital of Shantou University Medical College, Shantou 515031, P.R. China
| | - Shuyao Zhang
- Department of Pharmacy, Guangzhou Red Cross Hospital Affiliated of Ji-Nan University Medical College, Guangzhou 510220, P.R. China
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Daoud N, O'Brien K, O'Campo P, Harney S, Harney E, Bebee K, Bourgeois C, Smylie J. Postpartum depression prevalence and risk factors among Indigenous, non-Indigenous and immigrant women in Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2019; 110:440-452. [PMID: 30767191 PMCID: PMC6964473 DOI: 10.17269/s41997-019-00182-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/16/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The social position of different minority groups in contemporary societies suggests different risk factors for postpartum depression (PPD). In this study, we used two cut-offs of the Edinburgh Postpartum Depression Scale (EPDS) to examine prevalence and risk factors for PPD among mothers participating in the Canadian Maternity Experiences Survey (MES), and to compare Indigenous, Canadian-born non-Indigenous and immigrant mothers. METHODS We used cross-sectional nationwide data from the 2006 MES (unweighted N = 6237, weighted N = 74,231) and conducted multivariate logistic regression models for EPDS ≥ 10 and EPDS ≥ 13 to explore risk factors for the total sample of mothers and in each study group. RESULTS Prevalence (%, 95 % CI) of EPDS ≥ 10 and EPDS ≥ 13 was significantly higher among immigrant (12.2 %, 10.2-14.2 and 24.1 %, 21.5-26.7) and Indigenous (11.1 %, 7.5-14.7 and 21.2 %, 16.5-25.9) compared to Canadian-born non-Indigenous mothers (5.6 %, 4.9-6.3 and 12.9 %, 11.9-13.9). Multivariate analysis of the total sample showed similar risk factors for EPDS ≥ 10 and EPDS ≥ 13 (ethnicity, low education, ≥ low income cut-off, taking antidepressants, experiencing abuse, low social support). Stratification by study group revealed differing risk factors in each group for EPDS ≥ 10 and EPDS ≥ 13. Indigenous mothers had the most distinct risk factors, followed by immigrant mothers. Non-indigenous Canadian-born mothers had risk factors most similar to the total sample. CONCLUSION Differing prevalence and risk factors for PPD within and across study groups suggest that instead of a universal approach, tailored programs and services to prevent PPD in Indigenous, immigrant and non-Indigenous Canadian-born groups could better protect the mental health of Canadian mothers.
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Affiliation(s)
- Nihaya Daoud
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, 84015, Beer Sheva, Israel.
| | - Kristen O'Brien
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
| | - Patricia O'Campo
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
- Dalla Lana School of Public Health, Toronto, Canada
| | - Sarah Harney
- Native Women's Association of Canada (NWAC), Ottawa, Canada
| | - Evelyn Harney
- National Aboriginal Council of Midwives (NACM), Montréal, Canada
| | - Kerry Bebee
- National Aboriginal Council of Midwives (NACM), Montréal, Canada
| | | | - Janet Smylie
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada
- Dalla Lana School of Public Health, Toronto, Canada
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King L, Feeley N, Gold I, Hayton B, Zelkowitz P. The healthy migrant effect and predictors of perinatal depression. Women Birth 2019; 32:e341-e350. [DOI: 10.1016/j.wombi.2018.07.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/22/2018] [Accepted: 07/23/2018] [Indexed: 12/20/2022]
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Ganann R, Sword W, Newbold K, Thabane L, Armour L, Kint B. Provider Perspectives on Facilitators and Barriers to Accessible Service Provision for Immigrant Women With Postpartum Depression: A Qualitative Study. Can J Nurs Res 2019; 51:191-201. [DOI: 10.1177/0844562119852868] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background Immigrant women are at greater risk for postpartum depression than native-born women and face multiple barriers to accessing services. Service providers themselves face challenges in delivering accessible care for immigrant women with postpartum depression. Purpose This research explored provider perspectives on facilitators and barriers providers faced in terms of providing accessible services. Methods The study used an interpretive descriptive design, shaped by an integrated knowledge user–researcher partnership. Fourteen health and social service providers participated in individual in-depth interviews. Using a socioecological framework as an organizing structure, an inductive thematic content analysis was conducted. Results Providers identified attributes that foster relationship building, including building trust, addressing power dynamics, understanding women’s experiences, enacting cultural competence, involving family members, providing adequate time, and facilitating system navigation. Organizational features shaping accessibility included assessment and treatment approaches, wait times, gate keeping, and the ability to address social health determinants. Different organizational approaches could facilitate or discourage service coordination across organizations. Finally, providers believed that health and immigration system mechanisms could work more effectively for optimal postpartum depression support. Conclusion Health service providers are critical in supporting immigrant women with postpartum depression and facilitating service accessibility. Organizational and system gaps restrict optimal postpartum depression service provision and integration.
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Affiliation(s)
- R. Ganann
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - W. Sword
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - K.B. Newbold
- School of Geography & Earth Sciences, McMaster University, Hamilton, ON, Canada
| | - L. Thabane
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
| | - L. Armour
- Aisling Discoveries Child and Family Centre, Toronto, ON, Canada
| | - B. Kint
- Toronto Public Health, Toronto, ON, Canada
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Skoog M, Berggren V, Hallström IK. ‘Happy that someone cared’—Non-native-speaking immigrant mothers’ experiences of participating in screening for postpartum depression in the Swedish child health services. J Child Health Care 2019; 23:118-130. [PMID: 29804463 PMCID: PMC7324125 DOI: 10.1177/1367493518778387] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Immigrant mothers who have immigrated during the last ten years and do not speak the language of the new country are found to be at particular risk of being affected by postpartum depression (PPD). Still they choose to participate to a lesser extent in screening for PPD and are not screened out as frequently as can be expected. In this study, non-native-speaking immigrant mothers' experiences of participating in screening for PPD in the Swedish Child Health Services were elucidated. Thirteen qualitative interviews were performed with the help of an interpreter and analysed using latent content analysis. The possibility to participate in screening was appreciated by the mothers even though the concept of PPD in general was unclear. Cultural beliefs about mental ill health, negative expectations connected to their perceived value as a woman, shame at not being grateful enough for their new life and negative experience of the interaction during the screening challenged them in speaking about their mood. To facilitate the screening procedure for this vulnerable group of mothers, it is important to be aware of possible challenges when speaking about their mood and to strive for a trusting clinical interview with the assistance of a female interpreter on-site.
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Affiliation(s)
- Malin Skoog
- Centre of Excellence for Child Health Services, Region Skåne, Malmö, Sweden,Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden,Malin Skoog, Centre of Excellence for Child Health Services, Ängelholmsgatan 1C, 205 02 Malmö, Sweden.
| | - Vanja Berggren
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Postpartum depression and social support in a racially and ethnically diverse population of women. Arch Womens Ment Health 2019; 22:105-114. [PMID: 29968129 PMCID: PMC6800248 DOI: 10.1007/s00737-018-0882-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 06/22/2018] [Indexed: 01/07/2023]
Abstract
Lack of social support is an important risk factor for postpartum depression (PPD), whereas the presence of social support can buffer against PPD. However, the relationship between social support and PPD in racial/ethnic minority women is still largely unknown. Our purpose was to examine the role of social support in a large, diverse population of PPD cases and controls. Participants (N = 1517) were recruited at the routine 6-week postpartum visit (± 1-2 weeks) from four different outpatient clinics in North Carolina. Case status was determined using the MINI International Neuropsychiatric Interview. Social support was measured using the Medical Outcomes Social (MOS) Support survey and the Baby's Father Support Scale (DAD). We found that higher levels of social support had a strong protective association against PPD (MOS total score OR, 0.23; 95% CI, 0.19-0.27; p = 6.92E-90; DAD total score OR, 0.89; 95% CI, 0.88-0.92; p = 1.69E-29), and the effects of social support did not differ when accounting for race/ethnicity. Additionally, PPD symptom severity is significantly and negatively correlated with the degree of social support. Our findings suggest that multi-dimensional aspects of social support may be protective for racial/ethnic minority women. We believe this study is currently the largest and most robust characterizing PPD case status and its association with social support in a diverse cohort of mothers. Future work is required to understand how best to implement culturally sensitive interventions to increase social support in minority perinatal women.
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Refugee women's experiences negotiating motherhood and maternity care in a new country: A meta-ethnographic review. Int J Nurs Stud 2018; 90:31-45. [PMID: 30583266 DOI: 10.1016/j.ijnurstu.2018.10.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 10/02/2018] [Accepted: 10/02/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this meta-ethnographic review was to examine refugee women's experiences negotiating motherhood and maternity services in a new country with a view to identifying the specific needs of refugee women accessing maternity care in high income countries. DESIGN A meta-ethnographic synthesis of qualitative research. DATA SOURCES Five databases were searched for papers published in English between January 2000 and January 2017. REVIEW METHODS The synthesis process was guided by the seven steps of meta-ethnography. The quality of included studies was assessed using the COREQ tool. RESULTS One overarching theme and three major themes emerged from the synthesis. The overarching theme "Living between two cultures" conveyed women's experience of feeling "in between" cultures and described refugee women's experience of striving to maintain a strong cultural identity from their country of origin while simultaneously adapting to their new context and country. This theme permeated the following three major themes: 1) "Constructing maternal identity across cultures" which discusses the cultural conflict experienced by refugees accessing maternity services in their host country; 2) "Understanding in practice" which describes reciprocal issues in communication between women and health professionals; and 3) "Negotiating care" which illustrates a mix of coping mechanisms which refugee women utilise to navigate health services in the context of high income countries. CONCLUSION Liminality is a ubiquitous experience for refugee women seeking maternity care in high income countries. It impacts feelings of belonging and connection to services and society. It is often a challenging experience for many women and a time in which they reformulate their identity as a citizen and a mother. This review found that the experience of liminality could be perpetuated by social factors, and inequality of healthcare provision, where communication and cultural barriers prevented women accessing care that was equal, accessible, and meaningful. Findings revealed both positive and negative experiences with maternity care. Continuity, culturally appropriate care, and healthcare relationships played an important role in the positive experiences of women. The review also revealed the damaging effects of disparities in care experienced by refugee women.
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Mohammad KI, Abu Awad D, Creedy DK, Gamble J. Postpartum depression symptoms among Syrian refugee women living in Jordan. Res Nurs Health 2018; 41:519-524. [PMID: 30431160 DOI: 10.1002/nur.21919] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 10/06/2018] [Indexed: 11/08/2022]
Abstract
Postpartum depression (PPD) is recognized as a common maternal health problem, but few studies have investigated the postpartum mental health of refugee women. In this cross-sectional study, we investigated the prevalence of PPD symptoms and associated factors among Syrian refugee women living in north Jordan. Women (N = 365) were recruited from four health care centers in Ramtha and Jarash, cities in northern Jordan. Participants completed a demographic data form, the Edinburgh Postnatal Depression Scale (EPDS), and the Maternal Social Support Scale at 6-8 weeks postpartum. Half (49.6%; n = 181) of the Syrian refugee women scored >12 on the EPDS. PPD symptoms were significantly associated with low social support, low monthly income, and recent immigration (less than 2 years). There is a high level of PPD symptoms among Syrian refugee women, many of whom are living in poverty and with limited social support. The results highlight the need for immediate action by governments to support childbearing refugee women with early screening for psychosocial risk and respond to women's physical and mental health, and social needs through interservice collaboration. Social support programs would meet an important need for these women, as would ongoing assessment by health professionals and early intervention for women who screen positive for PPD.
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Affiliation(s)
- Khitam I Mohammad
- Maternal and Child Health and Midwifery Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Doaa Abu Awad
- Maternal and Child Health Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Debra K Creedy
- Maternal, Newborn and Families Research Collaborative, Menzies Institute of Health Queensland, Griffith University, Brisbane, Australia
| | - Jenny Gamble
- Maternal, Newborn and Families Research Collaborative, Menzies Institute of Health Queensland, Griffith University, Brisbane, Australia
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Maternal violence experiences and risk of postpartum depression: A meta-analysis of cohort studies. Eur Psychiatry 2018; 55:90-101. [PMID: 30445371 DOI: 10.1016/j.eurpsy.2018.10.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/16/2018] [Accepted: 10/18/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Most of original studies indicated maternal violence experiences is associated with adverse obstetric outcomes, to date, but it is not clear that the association of maternal violence experiences and the risk of postpartum depression (PPD). We aimed to assess the association between maternal violence experiences and risk of developing PPD by performing a meta-analysis of cohort studies. METHODS PubMed, Google Scholar, Cochrane Libraries and Chinese databases were searched through December 2017 to identify studies that assessed the association between violence and PPD. Meta-analysis was conducted by the RevMan software and Stata software. Potential heterogeneity source was explored by subgroup analysis and potential publication bias was assessed by Begg's funnel plots and Egger's linear regression test. RESULTS Overall, women experiencing any violence events compared with the reference group were at a higher risk of developing PPD (odds ratio [OR] = 2.04; 95% confidence interval [CI]: 1.72-2.41). Additionally, different types of violence events such as sexual (OR = 1.56; 95%CI: 1.35-1.81), emotional (OR = 1.75; 95%CI: 1.61-1.89), and physical violence (OR = 1.90; 95%CI: 1.36-2.67), as well as domestic (OR = 2.05; 95%CI: 1.50-2.80) or childhood violence (OR = 1.59; 95%CI: 1.34-1.88) also increased the risk of developing PPD. Relevant heterogeneity moderators have been identified by subgroup analysis. Sensitivity analysis yielded consistent results. CONCLUSIONS Maternal violence experiences are significantly associated with risk of developing PPD. These finding highlight the necessary to protect women from any types of violence and formulate preventive strategies to promote the maternal mental health.
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Saad M. Examining the Social Patterning of Postpartum Depression by Immigration Status in Canada: an Exploratory Review of the Literature. J Racial Ethn Health Disparities 2018; 6:312-318. [DOI: 10.1007/s40615-018-0526-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/23/2018] [Accepted: 09/04/2018] [Indexed: 11/29/2022]
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Kingsbury DM, Bhatta MP, Castellani B, Khanal A, Jefferis E, Hallam JS. Factors Associated with the Presence of Strong Social Supports in Bhutanese Refugee Women During Pregnancy. J Immigr Minor Health 2018; 21:837-843. [PMID: 30027506 DOI: 10.1007/s10903-018-0790-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Social support may mitigate stress related to the refugee experience, including during resettlement. For refugee women, social support can play an important role during pregnancy. In-depth interviews were conducted within a sample of 45 Bhutanese refugee women. Perceived social support was measured using the Norbeck Social Support Questionnaire. Averaged social support scores are reported to account for personal network size. Participants were identified as "low support" and "high support" based on their reported score. The mean social support score reported was 18.9. Participants experiencing a secondary resettlement within the U.S. were 4.52 (95% CI 1.19-17.15) times as likely to report a "high support" network compared to participants who resettled directly from Nepal. Personal social networks are an important source of support for resettled refugee women during pregnancy in the U.S.. Refugee women who experience secondary resettlement may perceive stronger support from their personal connections.
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Affiliation(s)
- Diana M Kingsbury
- College of Public Health, Kent State University, Kent, OH, USA. .,Northeast Ohio Medical University, 4209 State Route 44, P.O. Box 95, Rootstown, OH, 44272, USA.
| | - Madhav P Bhatta
- College of Public Health, Kent State University, Kent, OH, USA
| | | | - Aruna Khanal
- College of Public Health, Kent State University, Kent, OH, USA
| | - Eric Jefferis
- College of Public Health, Kent State University, Kent, OH, USA
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Wanigaratne S, Shakya Y, Gagnon AJ, Cole DC, Rashid M, Blake J, Dastoori P, Moineddin R, Ray JG, Urquia ML. Refugee maternal and perinatal health in Ontario, Canada: a retrospective population-based study. BMJ Open 2018; 8:e018979. [PMID: 29643152 PMCID: PMC5898303 DOI: 10.1136/bmjopen-2017-018979] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES Immigrants are thought to be healthier than their native-born counterparts, but less is known about the health of refugees or forced migrants. Previous studies often equate refugee status with immigration status or country of birth (COB) and none have compared refugee to non-refugee immigrants from the same COB. Herein, we examined whether: (1) a refugee mother experiences greater odds of adverse maternal and perinatal health outcomes compared with a similar non-refugee mother from the same COB and (2) refugee and non-refugee immigrants differ from Canadian-born mothers for maternal and perinatal outcomes. DESIGN This is a retrospective population-based database study. We implemented two cohort designs: (1) 1:1 matching of refugees to non-refugee immigrants on COB, year and age at arrival (±5 years) and (2) an unmatched design using all data. SETTING AND PARTICIPANTS Refugee immigrant mothers (n=34 233), non-refugee immigrant mothers (n=243 439) and Canadian-born mothers (n=615 394) eligible for universal healthcare insurance who had a hospital birth in Ontario, Canada, between 2002 and 2014. PRIMARY OUTCOMES Numerous adverse maternal and perinatal health outcomes. RESULTS Refugees differed from non-refugee immigrants most notably for HIV, with respective rates of 0.39% and 0.20% and an adjusted OR (AOR) of 1.82 (95% CI 1.19 to 2.79). Other elevated outcomes included caesarean section (AOR 1.04, 95% CI 1.00 to 1.08) and moderate preterm birth (AOR 1.08, 95% CI 0.99 to 1.17). For the majority of outcomes, refugee and non-refugee immigrants experienced similar AORs when compared with Canadian-born mothers. CONCLUSIONS Refugee status was associated with a few adverse maternal and perinatal health outcomes, but the associations were not strong except for HIV. The definition of refugee status used herein may not sensitively identify refugees at highest risk. Future research would benefit from further refining refugee status based on migration experiences.
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Affiliation(s)
- Susitha Wanigaratne
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Yogendra Shakya
- Access Alliance Multicultural Health and Community Services, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Anita J Gagnon
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Donald C Cole
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Meb Rashid
- Crossroads Medical Clinic, Women’s College Hospital, Toronto, Ontario, Canada
| | - Jennifer Blake
- Society of Obstetricians and Gynaecologists of Canada, Ottawa, Ontario, Canada
| | - Parisa Dastoori
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
- Access Alliance Multicultural Health and Community Services, Toronto, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Joel G Ray
- Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Keenan Research Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Marcelo L Urquia
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
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Giallo R, Riggs E, Lynch C, Vanpraag D, Yelland J, Szwarc J, Duell-Piening P, Tyrell L, Casey S, Brown SJ. The physical and mental health problems of refugee and migrant fathers: findings from an Australian population-based study of children and their families. BMJ Open 2017; 7:e015603. [PMID: 29151045 PMCID: PMC5702027 DOI: 10.1136/bmjopen-2016-015603] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 10/06/2017] [Accepted: 10/18/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The aim of this study was to report on the physical and mental health of migrant and refugee fathers participating in a population-based study of Australian children and their families. DESIGN Cross-sectional survey data drawn from a population-based longitudinal study when children were aged 4-5 years. SETTING Population-based study of Australian children and their families. PARTICIPANTS 8137 fathers participated in the study when their children were aged 4-5 years. There were 131 (1.6%) fathers of likely refugee background, 872 (10.7%) fathers who migrated from English-speaking countries, 1005 (12.4%) fathers who migrated from non-English-speaking countries and 6129 (75.3%) Australian-born fathers. PRIMARY OUTCOME MEASURES Fathers' psychological distress was assessed using the self-report Kessler-6. Information pertaining to physical health conditions, global or overall health, alcohol and tobacco use, and body mass index status was obtained. RESULTS Compared with Australian-born fathers, fathers of likely refugee background (adjusted OR(aOR) 3.17, 95% CI 2.13 to 4.74) and fathers from non-English-speaking countries (aOR 1.79, 95%CI 1.51 to 2.13) had higher odds of psychological distress. Refugee fathers were more likely to report fair to poor overall health (aOR 1.95, 95% CI 1.06 to 3.60) and being underweight (aOR 3.49, 95% CI 1.57 to 7.74) compared with Australian-born fathers. Refugee fathers and those from non-English-speaking countries were less likely to report light (aOR 0.25, 95% CI 0.15 to 0.43, and aOR 0.30, 95% CI 0.24 to 0.37, respectively) and moderate to harmful alcohol use (aOR 0.04, 95% CI 0.10 to 0.17, and aOR 0.14, 95% CI 0.10 to 0.19, respectively) than Australian-born fathers. Finally, fathers from non-English-speaking and English-speaking countries were less likely to be overweight (aOR 0.62, 95% CI 0.51 to 0.75, and aOR 0.84, 95% CI 0.68 to 1.03, respectively) and obese (aOR 0.43, 95% CI 0.32 to 0.58, and aOR 0.77, 95% CI 0.61 to 0.98, respectively) than Australian-born fathers. CONCLUSION Fathers of refugee background experience poorer mental health and poorer general health than Australian-born fathers. Fathers who have migrated from non-English-speaking countries also report greater psychological distress than Australian-born fathers. This underscores the need for primary healthcare services to tailor efforts to reduce disparities in health outcomes for refugee populations that may be vulnerable due to circumstances and sequelae of forced migration and to recognise the additional psychological stresses that may accompany fatherhood following migration from non-English-speaking countries. It is important to note that refugee and migrant fathers report less alcohol use and are less likely to be overweight and obese than Australian-born fathers.
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Affiliation(s)
- Rebecca Giallo
- Healthy Mothers Healthy Families Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Royal Children’s Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Elisha Riggs
- Healthy Mothers Healthy Families Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria, Australia
| | - Claire Lynch
- Healthy Mothers Healthy Families Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Dannielle Vanpraag
- Healthy Mothers Healthy Families Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Jane Yelland
- Healthy Mothers Healthy Families Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria, Australia
| | - Josef Szwarc
- The Victorian Foundation for Survivors of Torture, Brunswick, Australia
| | | | - Lauren Tyrell
- The Victorian Foundation for Survivors of Torture, Brunswick, Australia
| | - Sue Casey
- The Victorian Foundation for Survivors of Torture, Brunswick, Australia
| | - Stephanie Janne Brown
- Healthy Mothers Healthy Families Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Royal Children’s Hospital, The University of Melbourne, Parkville, Victoria, Australia
- Department of General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria, Australia
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Corbani IE, Rucci P, Iapichino E, Quartieri Bollani M, Cauli G, Ceruti MR, Gala C, Bassi M. Comparing the prevalence and the risk profile for antenatal depressive symptoms across cultures. Int J Soc Psychiatry 2017; 63:622-631. [PMID: 28805152 DOI: 10.1177/0020764017725543] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Although several studies have analyzed the risk factors of antenatal and post-partum depression, evidence on the prevalence and the risk profile for antenatal depressive symptoms (ADS) between native-born and different groups of non-native born women living in the same country is scant. The aim of this article is to compare the prevalence and the risk profile for ADS across geographical areas in women recruited from two large hospitals of North-western Italy. METHOD The presence of ADS was defined as an Edinburgh Post-natal Depression Scale (EPDS) score ≥12 or a Beck Depression Inventory, Short Form (BDI-SF) score ≥9 or the presence of suicidal ideation/behavior. Crude and adjusted odds ratios (ORs) of ADS were calculated using logistic regression models. RESULTS The prevalence of ADS was 12.4% among Italian women and ranged from 11.4% in other European to 44.7% in North-African women. Crude ORs of ADS were OR = 3.3 (95% confidence interval (CI), 1.2-8.8) for Asian, 3.3 (95% CI, 1.9-5.6) for South-American and 5.7 (95% CI, 3.4-9.6) for North-African women. Marital problems, at-risk pregnancy, past psychiatric history, pharmacological treatment, psychological treatment, financial problems, change in residence and number of children were significantly associated with ADS in multivariate analyses, regardless of women's origin. After adjusting for these variables, the OR of ADS remained significant for South-American and North-African women. CONCLUSION Our results demonstrate that the risk of ADS varies across geographical areas of origin and is highest among North-African women. The risk factors identified should be assessed in routine obstetric care to inform decisions about interventions to prevent post-partum depression and its consequences on the mothers and the newborns.
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Affiliation(s)
- Irene E Corbani
- 1 Division of Psychiatry, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Paola Rucci
- 2 Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | | | | | - Mara R Ceruti
- 1 Division of Psychiatry, Niguarda Ca' Granda Hospital, Milan, Italy
| | | | - Mariano Bassi
- 1 Division of Psychiatry, Niguarda Ca' Granda Hospital, Milan, Italy
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