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Winter AK, Due C, Ziersch A. Wellbeing Outcomes and Risk and Protective Factors for Parents with Migrant and Refugee Backgrounds from the Middle East in the First 1000 Days: A Systematic Review. J Immigr Minor Health 2024; 26:395-408. [PMID: 37410193 PMCID: PMC10937786 DOI: 10.1007/s10903-023-01510-4] [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: 05/31/2023] [Indexed: 07/07/2023]
Abstract
The First 1000 Days (the period from conception to a child's second birthday) is an important developmental period. However, little is known about experiences of parents with refugee and migrant backgrounds during this period. A systematic review was conducted according to PRISMA guidelines. Publications were identified through searches of the Embase, PsycINFO, PubMed, and Scopus databases, critically appraised, and synthesised using thematic analysis. A total of 35 papers met inclusion criteria. Depressive symptomatology was consistently higher than global averages, however maternal depression conceptualisations differed across studies. Several papers reported changes in relationship dynamics as a result of having a baby post-migration. Consistent relationships were found between social and health support and wellbeing. Conceptualisations of wellbeing may differ among migrant families. Limited understanding of health services and relationships with health providers may impede help-seeking. Several research gaps were identified, particularly in relation to the wellbeing of fathers, and of parents of children over 12 months old.
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Affiliation(s)
- Amelia Kate Winter
- School of Psychology, The University of Adelaide North Terrace, Adelaide, 5005, Australia.
| | - Clemence Due
- School of Psychology, The University of Adelaide North Terrace, Adelaide, 5005, Australia
| | - Anna Ziersch
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, 5001, Australia
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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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SantiÁ P, de Montgomery CJ, Pedersen TP, Marti-Castaner M. Differences in postpartum mental healthcare among women with identified needs: The role of migration status. Scand J Public Health 2023:14034948231178337. [PMID: 37837218 DOI: 10.1177/14034948231178337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
AIMS The aim of this study was to examine the association between women's migrant status (majority, immigrant, descendant) and use of postpartum mental healthcare and investigate whether migration characteristics are associated with mental healthcare use. METHODS Retrospective cohort study. We included all mothers of children born between 2002 and 2018 in 34 municipalities of Denmark who had an identified mental health need as clinically assessed by a child health visitor (CHV) or by a score of 11 or more on the Edinburgh Postpartum Depression Scale (EPDS). Women were followed until the first mental healthcare received 2 years' postpartum, death or emigration. Using Cox regression models, we estimated the time to mental healthcare by migrant status and explored the role of migration characteristics. RESULTS A total of 29% of women (n = 45,573) had a mental health need identified by the CHV, and 7% (n = 4968) had an EPDS ⩾ 11. Immigrants accounted for 19.5%, and descendants for 4.7% of the sample. Immigrants were at lower risk of using mental healthcare than the majority group (CHV: hazard ratio adjusted (HRa) 0.75 (0.70-0.79), EPDS: HRa 0.67 (0.58-0.78)), as were descendants (CHV: HRa 0.77 (0.70-0.86), EPDS: HRa 0.69 (0.55-0.88)). Among migrants, those not refugees, newly arrived, whose partners were immigrants or descendants, and those originally from Africa showed a lower risk of using postpartum mental healthcare. CONCLUSIONS Our findings emphasize the need to strengthen access to mental healthcare for immigrants and descendants experiencing postpartum mental health concerns and consider migration characteristics as indicators of potential inequalities in access to maternal mental healthcare.
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Affiliation(s)
- Paula SantiÁ
- Preventive Medicine and Public Health Training Unit PSMar-UPF-ASPB (Parc de Salut Mar-Pompeu Fabra University-Agència de Salut Pública de Barcelona), Barcelona, Spain
| | - Christopher Jamil de Montgomery
- Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health (MESU), University of Copenhagen, Copenhagen K, Denmark
| | - Trine Pagh Pedersen
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Maria Marti-Castaner
- Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health (MESU), University of Copenhagen, Copenhagen K, Denmark
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Grundy A, Ng E, Rank C, Quinlan J, Giovinazzo G, Viau R, Ponka D, Garner R. Mental health and neurocognitive disorder-related hospitalization rates in immigrants and Canadian-born population: a linkage study. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:692-704. [PMID: 36809592 PMCID: PMC10348999 DOI: 10.17269/s41997-023-00740-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 01/05/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVES Mental health and neurocognitive conditions are important causes of hospitalization among immigrants, though patterns may vary by immigrant category, world region of origin, and time since arrival in Canada. This study uses linked administrative data to explore differences in mental health hospitalization rates between immigrants and individuals born in Canada. METHODS Hospital records from the Discharge Abstract Database and the Ontario Mental Health Reporting System for 2011 to 2017 were linked to the 2016 Longitudinal Immigrant Database and to Statistics Canada's 2011 Canadian Census Health and Environment Cohort. Age-standardized hospitalization rates for mental health-related conditions (ASHR-MHs) were derived for immigrants and the Canadian-born population. ASHR-MHs overall and for leading mental health conditions were compared between immigrants and the Canadian-born population, stratified by sex and selected immigration characteristics. Quebec hospitalization data were not available. RESULTS Overall, immigrants had lower ASHR-MHs compared to the Canadian-born population. Mood disorders were leading causes of mental health hospitalization for both cohorts. Psychotic, substance-related, and neurocognitive disorders were also leading causes of mental health hospitalization, although there was variation in their relative importance between subgroups. Among immigrants, ASHR-MHs were higher among refugees and lower among economic immigrants, those from East Asia, and those who arrived in Canada most recently. CONCLUSION Differences in hospitalization rates among immigrants from various immigration streams and world regions, particularly for specific types of mental health conditions, highlight the importance of future research that incorporates both inpatient and outpatient mental health services to further understand these relationships.
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Affiliation(s)
- Anne Grundy
- Migration Health Branch, Immigration, Refugees and Citizenship Canada, 250 Tremblay Rd, Ottawa, ON, K1G 5P4, Canada.
| | - Edward Ng
- Health Analysis Division, Statistics Canada, Ottawa, ON, Canada
| | - Claudia Rank
- Migration Health Branch, Immigration, Refugees and Citizenship Canada, 250 Tremblay Rd, Ottawa, ON, K1G 5P4, Canada
| | - Jacklyn Quinlan
- Migration Health Branch, Immigration, Refugees and Citizenship Canada, 250 Tremblay Rd, Ottawa, ON, K1G 5P4, Canada
| | - George Giovinazzo
- Migration Health Branch, Immigration, Refugees and Citizenship Canada, 250 Tremblay Rd, Ottawa, ON, K1G 5P4, Canada
| | - Rachel Viau
- Migration Health Branch, Immigration, Refugees and Citizenship Canada, 250 Tremblay Rd, Ottawa, ON, K1G 5P4, Canada
| | - David Ponka
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Rochelle Garner
- Health Analysis Division, Statistics Canada, Ottawa, ON, Canada
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Mitchell KA, Haddock AJ, Husainy H, Walter LA, Rajapreyar I, Wingate M, Smith CH, Tita A, Sinkey R. Care of the Postpartum Patient in the Emergency Department: A Systematic Review with Implications for Maternal Mortality. Am J Perinatol 2023; 40:489-507. [PMID: 34327686 PMCID: PMC10961102 DOI: 10.1055/s-0041-1732455] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Approximately one-third of maternal deaths occur postpartum. Little is known about the intersection between the postpartum period, emergency department (ED) use, and opportunities to reduce maternal mortality. The primary objectives of this systematic review are to explore the incidence of postpartum ED use, identify postpartum disease states that are evaluated in the ED, and summarize postpartum ED use by race/ethnicity and payor source. STUDY DESIGN We searched PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), ClinicalTrials.gov, Cochrane CENTRAL, Social Services Abstracts, and Scopus from inception to September 19, 2019. Each identified abstract was screened by two authors; the full-text manuscripts of all studies deemed to be potential candidates were then reviewed by the same two authors and included if they were full-text, peer-reviewed articles in the English language with primary patient data reporting care of a female in the ED in the postpartum period, defined as up to 1 year after the end of pregnancy. RESULTS A total of 620 were screened, 354 records were excluded and 266 full-text articles were reviewed. Of the 266 full-text articles, 178 were included in the systematic review; of these, 108 were case reports. Incidence of ED use by postpartum females varied from 4.8 to 12.2% in the general population. Infection was the most common reason for postpartum ED evaluation. Young females of minority race and those with public insurance were more likely than whites and those with private insurance to use the ED. CONCLUSION As many as 12% of postpartum women seek care in the ED. Young minority women of lower socioeconomic status are more likely to use the ED. Since approximately one-third of maternal deaths occur in the postpartum period, successful efforts to reduce maternal mortality must include ED stakeholders. This study is registered with the Systematic Review Registration (identifier: CRD42020151126). KEY POINTS · Up to 12% of postpartum women seek care in the ED.. · One-third of maternal deaths occur postpartum.. · Maternal mortality reduction efforts should include ED stakeholders..
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Affiliation(s)
- Kellie A. Mitchell
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
- Center for Women’s Reproductive Health, Birmingham, Alabama
| | - Alison J. Haddock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Lauren A. Walter
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Indranee Rajapreyar
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Martha Wingate
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Catherine H. Smith
- Division of Library Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alan Tita
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
- Center for Women’s Reproductive Health, Birmingham, Alabama
| | - Rachel Sinkey
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
- Center for Women’s Reproductive Health, Birmingham, Alabama
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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] [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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Disparities in Emergency Department Utilization Among Women with Postpartum Mood Disorders (2006-2016). Matern Child Health J 2023; 27:158-167. [PMID: 36352280 DOI: 10.1007/s10995-022-03544-w] [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: 08/04/2021] [Revised: 08/17/2022] [Accepted: 09/09/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Postpartum mood disorders are associated with adverse outcomes for newborns and mothers and may require urgent evaluation. The emergency department is often a healthcare entry point, but factors associated with these emergency department visits are unknown. METHODS A longitudinal retrospective analysis using the Nationwide Emergency Department Sample to assess national estimates of emergency department visits by women ages 15-49 with primary diagnosis of a postpartum mood disorder between 2006 and 2016. Emergency department visit rates for postpartum mood disorders per 100,000 live births were calculated. RESULTS Emergency department visits related to postpartum mood disorders remained stable from 2006 to 2016 (5153 to 5390 respectively). Two-thirds of visits were by patients younger than 30. Approximately half of visits for postpartum mood disorders were funded by Medicaid (42.4-56.7%) compared to 27.4-41.2% funded by Medicaid for all other age-matched women. Of postpartum mood disorder visits 30.3% were by women from the lowest income quartile. The highest rate of emergency department visits occurred in the youngest patients (ages 15-19: 231 visits versus ages 35-49: 105 visits). Postpartum mood disorder admissions were higher than those for age-matched women with all other diagnoses (19.8% vs. 6.5%). DISCUSSION The high rate of women that are young and with public insurance visiting the emergency department for postpartum mood disorders demonstrates an increased risk for these disorders in these populations and an opportunity for targeted intervention by policymakers and providers. Higher admission rates for postpartum mood disorders compared to all other diagnoses reveals a chance to optimize outpatient screening and treatment.
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Machado S, Wiedmeyer ML, Watt S, Servin AE, Goldenberg S. Determinants and Inequities in Sexual and Reproductive Health (SRH) Care Access Among Im/Migrant Women in Canada: Findings of a Comprehensive Review (2008-2018). J Immigr Minor Health 2022; 24:256-299. [PMID: 33811583 PMCID: PMC8487436 DOI: 10.1007/s10903-021-01184-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 02/03/2023]
Abstract
Given growing concerns of im/migrant women's access to sexual and reproductive health (SRH) services, we aimed to (1) describe inequities and determinants of their engagement with SRH services in Canada; and (2) understand their lived experiences of barriers and facilitators to healthcare. Using a comprehensive review methodology, we searched the quantitative and qualitative peer-reviewed literature of im/migrant women's access to SRH care in Canada from 2008 to 2018. Of 782 studies, 38 met inclusion criteria. Ontario (n = 18), British Columbia (n = 6), and Alberta (n = 6) were primary settings represented. Studies focused primarily on maternity care (n = 20) and sexual health screenings (n = 12). Determinants included health system navigation and service information; experiences with health personnel; culturally safe and language-specific care; social isolation and support; immigration-specific factors; discrimination and racialization; and gender and power relations. There is a need for research that compares experiences across diverse groups of racialized im/migrants and a broader range of SRH services to inform responsive, equity-focused programs and policies.
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Affiliation(s)
- Stefanie Machado
- Centre for Gender and Sexual Health Equity, c/o St Paul's Hospital, 1081 Burrard, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Mei-Ling Wiedmeyer
- Centre for Gender and Sexual Health Equity, c/o St Paul's Hospital, 1081 Burrard, Vancouver, BC, V6Z 1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Sarah Watt
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Argentina E Servin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA
| | - Shira Goldenberg
- Centre for Gender and Sexual Health Equity, c/o St Paul's Hospital, 1081 Burrard, Vancouver, BC, V6Z 1Y6, Canada.
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA.
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Hirani SAA, Wagner J. Impact of COVID-19 on Women Who Are Refugees and Mothering: A Critical Ethnographic Study. Glob Qual Nurs Res 2022; 9:23333936221121335. [PMID: 36105717 PMCID: PMC9465568 DOI: 10.1177/23333936221121335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 06/30/2022] [Accepted: 07/07/2022] [Indexed: 11/21/2022] Open
Abstract
Refugee women often experience trauma and social disconnection in a new
country and are at risk of experiencing reduced physical, mental, and
emotional well-being. Globally, COVID-19 has affected the health and
well-being of the population at large. This critical ethnographic
study aimed to explore the effects of COVID-19 on women who are
refugees and mothering in Saskatchewan, Canada. In-depth interviews
were undertaken with 27 women who are refugees and mothering young
children aged 2 years and under. This study suggests that during
COVID-19, refugee women are at high risk of experiencing add-on
stressors due to isolation, difficulty in accessing health care,
COVID-19-related restrictions in hospitals, limited follow-up care,
limited social support, financial difficulties, and compromised
nutrition. During COVID-19, collaborative efforts by nurses, other
health-care professionals, and governmental and non-governmental
organizations are essential to provide need-based mental health
support, skills-building programs, nutritional counseling, and
follow-up care to this vulnerable group.
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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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Mahajan S, Meyer SB, Neiterman E. Identifying the impact of social networks on mental and emotional health seeking behaviours amongst women who are refugees from Syria living in Canada. Glob Public Health 2021; 17:700-716. [PMID: 33460363 DOI: 10.1080/17441692.2021.1872679] [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: 12/11/2022]
Abstract
Between 2015 and 2017, over 24,000 Syrian women came to Canada as refugees. Refugees are two to three times more likely than native Canadians to suffer from depression and other mental health challenges. A qualitative approach was taken to understand roles of social networks in shaping the mental and emotional health resource-seeking behaviours of twelve Syrian women who are refugees. Semi-structured telephone interviews were conducted in both English and Arabic. Interviews were audio-recorded, transcribed, and thematically coded using NVivo 12. Findings reveal that (1) families play large roles in teaching and providing information about Canada's health system, including mental health services; (2) Social networks influence assumptions about mental and physical health services; (3) women feel more welcomed into social networks in Canada than in countries of first asylum; and (4) social networks act as alternatives to seeking formal mental and emotional health care. Through first-hand stories and experiences of Syrian women's transitions into Canada, this study identifies the ways in which social networks may help or hinder engagement with mental and emotional health services.
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Affiliation(s)
- Shreya Mahajan
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Samantha B Meyer
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Elena Neiterman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
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McKnight A, Vigod SN, Dennis CL, Wanigaratne S, Brown HK. Association Between Chronic Medical Conditions and Acute Perinatal Psychiatric Health-Care Encounters Among Migrants: A Population-Based Cohort Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:854-864. [PMID: 33167692 PMCID: PMC7658421 DOI: 10.1177/0706743720931231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To examine the relationship between prepregnancy chronic medical conditions (CMCs) and the risk of acute perinatal psychiatric health-care encounters (i.e., psychiatric emergency department visits, hospitalizations) among refugees, nonrefugee immigrants, and long-term residents in Ontario. METHODS We conducted a population-based study of 15- to 49-year-old refugees (N = 29,189), nonrefugee immigrants (N = 187,430), and long-term residents (N = 641,385) with and without CMC in Ontario, Canada, with a singleton live birth in 2005 to 2015 and no treatment for mental illness in the 2 years before pregnancy. Modified Poisson regression was used to estimate the relative risk of a psychiatric emergency department visit or hospitalization from conception until 1 year postpartum among women with versus without CMC, stratified by migrant status. An unstratified model with an interaction term between CMC and migrant status was used to test for multiplicativity of effects. RESULTS The association between CMC and risk of a psychiatric emergency department visit or hospitalization was stronger among refugees (adjusted relative risk [aRR] = 1.87; 95% confidence interval [CI], 1.36 to 2.58) compared to long-term residents (aRR = 1.39; 95% CI, 1.30 to 1.48; interaction P = 0.047). The strength of the association was no different in nonrefugee immigrants (aRR = 1.26; 95% CI, 1.05 to 1.51) compared to long-term residents (interaction P = 0.45). CONCLUSION Our study identifies refugee women with CMC as a high-risk group for acute psychiatric health care in the perinatal period. Preventive psychosocial interventions may be warranted to enhance supportive resources for all women with CMC and, in particular refugee women, to reduce the risk of acute psychiatric health care in the perinatal period.
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Affiliation(s)
- Anthony McKnight
- Dalla Lana School of Public Health, 7938University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Simone N Vigod
- ICES, Toronto, Ontario, Canada.,Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Cindy-Lee Dennis
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada
| | - Susitha Wanigaratne
- Manitoba Centre for Health Policy, 8664University of Manitoba, Winnipeg, Manitoba, Canada
| | - Hilary K Brown
- Dalla Lana School of Public Health, 7938University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Interdisciplinary Centre for Health & Society, 33530University of Toronto Scarborough, Scarborough, Ontario, Canada
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Canadian Refugee Women Are at Increased Risk of Postpartum Depression: How Can We Help? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:1391-1393. [PMID: 32718870 DOI: 10.1016/j.jogc.2020.03.023] [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] [Received: 01/20/2020] [Revised: 03/27/2020] [Accepted: 03/29/2020] [Indexed: 11/24/2022]
Abstract
Refugee women in Canada are at increased risk of postpartum depression (PPD) compared with Canadian-born women. Physicians specializing in women's health are in a unique position to intervene with refugee women experiencing PPD. Although there are common contributors to the development of PPD in both Canadian-born and refugee women, refugee women face a number of additional barriers to treatment. These can include factors unique to the refugee experience (e.g., family separation, uncertainty regarding legal status, social mores of the new country) as well as social determinants of health (e.g., poverty, language barriers, barriers to accessing health care). Some authors have argued that all recent immigrant women who are pregnant should be considered at risk for developing PPD and have stressed the importance of early intervention with this group. This commentary argues that effective strategies to address the needs of women refugees who are pregnant focus on the following areas: early identification of women at risk, advocacy efforts, and mitigation of broader relevant social factors (e.g., food insecurity, poverty, lack of social supports). In addition to these strategies, more research is needed to identify how factors interact to increase the risk of PDD in women refugees and to identify factors that protect against the development of PPD in this group.
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Saunders NR, Chiu M, Lebenbaum M, Chen S, Kurdyak P, Guttmann A, Vigod S. Suicide and Self-Harm in Recent Immigrants in Ontario, Canada: A Population-Based Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:777-788. [PMID: 31234643 PMCID: PMC6882076 DOI: 10.1177/0706743719856851] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To estimate the rates of suicide and self-harm among recent immigrants and to determine which immigrant-specific risk factors are associated with these outcomes. METHODS Population-based cohort study using linked health administrative data sets (2003 to 2017) in Ontario, Canada which included adults ≥18 years, living in Ontario (N = 9,055,079). The main exposure was immigrant status (long-term resident vs. recent immigrant). Immigrant-specific exposures included visa class and country of origin. Outcome measures were death by suicide or emergency department visit for self-harm. Cox proportional hazards estimated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). RESULTS We included 590,289 recent immigrants and 8,464,790 long-term residents. Suicide rates were lower among immigrants (n = 130 suicides, 3.3/100,000) than long-term residents (n = 6,354 suicides, 11.8/100,000) with aHR 0.3, 95% CI, 0.2 to 0.3. Male-female ratios in suicide rates were attenuated in immigrants. Refugees had 2.1 (95% CI, 1.3 to 3.6; rate 6.1/100,000) and 2.8 (95% CI, 2.5 to 3.2) times the likelihood of suicide and self-harm, respectively, compared with nonrefugee immigrants. Self-harm rate was lower among immigrants (n = 2,256 events, 4.4/10,000) than long-term residents (n = 68,039 events, 9.7/10,000 person-years; aHR 0.3; 95% CI, 0.3 to 0.3). Unlike long-term residents, where low income was associated with high suicide rates, income was not associated with suicide among immigrants and there was an attenuated income gradient for self-harm. Country of origin-specific analyses showed wide ranges in suicide rates (1.4 to 9.9/100,000) and self-harm (1.8 to 14.9/10,000). CONCLUSION Recent immigrants have lower rates of suicide and self-harm and different sociodemographic predictors compared with long-term residents. Analysis of contextual factors including immigrant class, origin, and destination should be considered for all immigrant suicide risk assessment.
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Affiliation(s)
- Natasha Ruth Saunders
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada.,These authors contributed equally, acting as co-first authors
| | - Maria Chiu
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada.,These authors contributed equally, acting as co-first authors
| | - Michael Lebenbaum
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
| | | | - Paul Kurdyak
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Astrid Guttmann
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada
| | - Simone Vigod
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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Saunders NR, Gill PJ, Holder L, Vigod S, Kurdyak P, Gandhi S, Guttmann A. Use of the emergency department as a first point of contact for mental health care by immigrant youth in Canada: a population-based study. CMAJ 2019; 190:E1183-E1191. [PMID: 30301742 DOI: 10.1503/cmaj.180277] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Emergency department visits as a first point of contact for people with mental illness may reflect poor access to timely outpatient mental health care. We sought to determine the extent to which immigrants use the emergency department as an entryway into mental health services. METHODS We used linked health and demographic administrative data sets to design a population-based cohort study. We included youth (aged 10-24 yr) with an incident mental health emergency department visit from 2010 to 2014 in Ontario, Canada (n = 118 851). The main outcome measure was an emergency department visit for mental health reasons without prior mental health care from a physician on an outpatient basis. The main predictor of interest was immigrant status (refugee, non-refugee immigrant and non-immigrant). Immigrant-specific predictors included time since migration, and region and country of origin. We used Poisson models to estimate adjusted rate ratios (aRRs) and 95% confidence intervals (CIs). RESULTS The cohort included 2194 (1.8%) refugee, 6680 (5.6%) non-refugee immigrant and 109 977 (92.5%) nonimmigrant youth. Rates of first mental health contact in the emergency department were higher among refugee (61.3%) and non-refugee immigrant youth (57.6%) than non-immigrant youth (51.3%) (refugee aRR 1.17, 95% CI 1.13-1.21; non-refugee immigrant aRR 1.10, 95% CI 1.08-1.13). Compared with non-refugee immigrants, refugees had a higher rate of first mental health contact in the emergency department (aRR 1.06, 95% CI 1.02-1.11). We also observed higher rates among recent versus longer-term immigrants (aRR 1.10, 95% CI 1.05-1.16) and immigrants from Central America (aRR 1.17, 95% CI 1.08-1.26) and Africa (aRR 1.15, 95% CI 1.06-1.24) versus from North America and Western Europe. INTERPRETATION Immigrant youth are more likely to present with a first mental health crisis to the emergency department than non-immigrants, with variability by region of origin and time since migration. Immigrants may face barriers to access and use of outpatient mental health services from a physician. Efforts are needed to reduce stigma and identify mental health problems early, before crisis, among immigrant populations.
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Affiliation(s)
- Natasha Ruth Saunders
- The Hospital for Sick Children (Saunders, Gill, Guttmann); Department of Pediatrics (Saunders, Gill, Guttmann), University of Toronto; ICES (Saunders, Holder, Vigod, Kurdyak, Gandhi, Guttmann); Child Health Evaluative Sciences (Saunders, Guttmann), SickKids Research Institute; Institute of Health Policy, Management and Evaluation (Saunders, Vigod, Kurdyak, Guttmann), University of Toronto; Women's College Research Institute (Vigod), Women's College Hospital; Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont.
| | - Peter J Gill
- The Hospital for Sick Children (Saunders, Gill, Guttmann); Department of Pediatrics (Saunders, Gill, Guttmann), University of Toronto; ICES (Saunders, Holder, Vigod, Kurdyak, Gandhi, Guttmann); Child Health Evaluative Sciences (Saunders, Guttmann), SickKids Research Institute; Institute of Health Policy, Management and Evaluation (Saunders, Vigod, Kurdyak, Guttmann), University of Toronto; Women's College Research Institute (Vigod), Women's College Hospital; Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont
| | - Laura Holder
- The Hospital for Sick Children (Saunders, Gill, Guttmann); Department of Pediatrics (Saunders, Gill, Guttmann), University of Toronto; ICES (Saunders, Holder, Vigod, Kurdyak, Gandhi, Guttmann); Child Health Evaluative Sciences (Saunders, Guttmann), SickKids Research Institute; Institute of Health Policy, Management and Evaluation (Saunders, Vigod, Kurdyak, Guttmann), University of Toronto; Women's College Research Institute (Vigod), Women's College Hospital; Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont
| | - Simone Vigod
- The Hospital for Sick Children (Saunders, Gill, Guttmann); Department of Pediatrics (Saunders, Gill, Guttmann), University of Toronto; ICES (Saunders, Holder, Vigod, Kurdyak, Gandhi, Guttmann); Child Health Evaluative Sciences (Saunders, Guttmann), SickKids Research Institute; Institute of Health Policy, Management and Evaluation (Saunders, Vigod, Kurdyak, Guttmann), University of Toronto; Women's College Research Institute (Vigod), Women's College Hospital; Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont
| | - Paul Kurdyak
- The Hospital for Sick Children (Saunders, Gill, Guttmann); Department of Pediatrics (Saunders, Gill, Guttmann), University of Toronto; ICES (Saunders, Holder, Vigod, Kurdyak, Gandhi, Guttmann); Child Health Evaluative Sciences (Saunders, Guttmann), SickKids Research Institute; Institute of Health Policy, Management and Evaluation (Saunders, Vigod, Kurdyak, Guttmann), University of Toronto; Women's College Research Institute (Vigod), Women's College Hospital; Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont
| | - Sima Gandhi
- The Hospital for Sick Children (Saunders, Gill, Guttmann); Department of Pediatrics (Saunders, Gill, Guttmann), University of Toronto; ICES (Saunders, Holder, Vigod, Kurdyak, Gandhi, Guttmann); Child Health Evaluative Sciences (Saunders, Guttmann), SickKids Research Institute; Institute of Health Policy, Management and Evaluation (Saunders, Vigod, Kurdyak, Guttmann), University of Toronto; Women's College Research Institute (Vigod), Women's College Hospital; Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont
| | - Astrid Guttmann
- The Hospital for Sick Children (Saunders, Gill, Guttmann); Department of Pediatrics (Saunders, Gill, Guttmann), University of Toronto; ICES (Saunders, Holder, Vigod, Kurdyak, Gandhi, Guttmann); Child Health Evaluative Sciences (Saunders, Guttmann), SickKids Research Institute; Institute of Health Policy, Management and Evaluation (Saunders, Vigod, Kurdyak, Guttmann), University of Toronto; Women's College Research Institute (Vigod), Women's College Hospital; Centre for Addiction and Mental Health (Kurdyak), Toronto, Ont
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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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Vigod SN, Arora S, Urquia ML, Dennis CL, Fung K, Grigoriadis S, Ray JG. Postpartum self-inflicted injury, suicide, assault and homicide in relation to immigrant status in Ontario: a retrospective population-based cohort study. CMAJ Open 2019; 7:E227-E235. [PMID: 30979727 PMCID: PMC6461543 DOI: 10.9778/cmajo.20180178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Intentional injury, including suicide and assault, is a leading cause of maternal morbidity and mortality. We aimed to determine whether immigrant and nonimmigrant women differ in their 1-year risk of intentional injury after birth. METHODS This population-based retrospective cohort study used administrative data from Ontario from 2002 to 2012. Risk of self-inflicted injury (self-harm or suicide), and injury inflicted by others (assault or homicide), were each analyzed within 1 year after delivery of a live-born infant for immigrant and nonimmigrant mothers. Relative risks (RRs) were adjusted for maternal age, parity, income, resource utilization and psychiatric history. RESULTS The study included 327 279 immigrant and 942 502 nonimmigrant mothers. Risk of self-inflicted injury was similar among immigrants and nonimmigrants (adjusted RR 0.91, 95% confidence interval [CI] 0.78-1.04), with no variation by duration of residence or refugee status. Immigrants were at lower risk than nonimmigrants for injury inflicted by others (adjusted RR 0.57, 95% CI 0.51-0.64); that risk was higher among refugees than among nonrefugee immigrants (adjusted RR 1.79, 95% CI 1.33-2.41), and it was higher among long-term (adjusted RR 2.27, 95% CI 1.76-2.91) and medium-term (adjusted RR 1.58, 95% CI 1.19-2.11) immigrants than among recent immigrants. Variability by country of origin was observed for both injury types. INTERPRETATION Immigrant mothers have a reported risk for self-inflicted injury after birth similar to that of their Canadian-born counterparts. The extent to which selective underreporting of intentional injury in immigrant women might explain our findings is a key consideration for future research.
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Affiliation(s)
- Simone N Vigod
- Women's College Hospital and Research Institute (Vigod, Arora); ICES (Vigod, Urquia, Fung); Department of Psychiatry (Vigod, Grigoriadis, Ray), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Urquia), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Li Ka Shing Knowledge Institute (Dennis, Ray), St. Michael's Hospital; Faculty of Nursing (Dennis), University of Toronto; Department of Psychiatry (Grigoriadis), Sunnybrook Health Sciences Centre; Department of Medicine (Ray), University of Toronto, Toronto, Ont.
| | - Serena Arora
- Women's College Hospital and Research Institute (Vigod, Arora); ICES (Vigod, Urquia, Fung); Department of Psychiatry (Vigod, Grigoriadis, Ray), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Urquia), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Li Ka Shing Knowledge Institute (Dennis, Ray), St. Michael's Hospital; Faculty of Nursing (Dennis), University of Toronto; Department of Psychiatry (Grigoriadis), Sunnybrook Health Sciences Centre; Department of Medicine (Ray), University of Toronto, Toronto, Ont
| | - Marcelo L Urquia
- Women's College Hospital and Research Institute (Vigod, Arora); ICES (Vigod, Urquia, Fung); Department of Psychiatry (Vigod, Grigoriadis, Ray), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Urquia), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Li Ka Shing Knowledge Institute (Dennis, Ray), St. Michael's Hospital; Faculty of Nursing (Dennis), University of Toronto; Department of Psychiatry (Grigoriadis), Sunnybrook Health Sciences Centre; Department of Medicine (Ray), University of Toronto, Toronto, Ont
| | - Cindy-Lee Dennis
- Women's College Hospital and Research Institute (Vigod, Arora); ICES (Vigod, Urquia, Fung); Department of Psychiatry (Vigod, Grigoriadis, Ray), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Urquia), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Li Ka Shing Knowledge Institute (Dennis, Ray), St. Michael's Hospital; Faculty of Nursing (Dennis), University of Toronto; Department of Psychiatry (Grigoriadis), Sunnybrook Health Sciences Centre; Department of Medicine (Ray), University of Toronto, Toronto, Ont
| | - Kinwah Fung
- Women's College Hospital and Research Institute (Vigod, Arora); ICES (Vigod, Urquia, Fung); Department of Psychiatry (Vigod, Grigoriadis, Ray), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Urquia), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Li Ka Shing Knowledge Institute (Dennis, Ray), St. Michael's Hospital; Faculty of Nursing (Dennis), University of Toronto; Department of Psychiatry (Grigoriadis), Sunnybrook Health Sciences Centre; Department of Medicine (Ray), University of Toronto, Toronto, Ont
| | - Sophie Grigoriadis
- Women's College Hospital and Research Institute (Vigod, Arora); ICES (Vigod, Urquia, Fung); Department of Psychiatry (Vigod, Grigoriadis, Ray), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Urquia), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Li Ka Shing Knowledge Institute (Dennis, Ray), St. Michael's Hospital; Faculty of Nursing (Dennis), University of Toronto; Department of Psychiatry (Grigoriadis), Sunnybrook Health Sciences Centre; Department of Medicine (Ray), University of Toronto, Toronto, Ont
| | - Joel G Ray
- Women's College Hospital and Research Institute (Vigod, Arora); ICES (Vigod, Urquia, Fung); Department of Psychiatry (Vigod, Grigoriadis, Ray), University of Toronto, Toronto, Ont.; Department of Community Health Sciences (Urquia), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Li Ka Shing Knowledge Institute (Dennis, Ray), St. Michael's Hospital; Faculty of Nursing (Dennis), University of Toronto; Department of Psychiatry (Grigoriadis), Sunnybrook Health Sciences Centre; Department of Medicine (Ray), University of Toronto, Toronto, Ont
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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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Green JC, BeLue R, Boakye EA, Choi E, Vaughn MG. Armed Conflict in Central America and Immigrant Health in the United States. Ann Glob Health 2018. [PMID: 30779514 PMCID: PMC6748293 DOI: 10.29024/aogh.2373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND While many researchers document the immediate and localized health effects of armed conflicts on combatants are well documented in the literature, less is known about the effects of armed conflict on individuals who have subsequently migrated elsewhere. Objective: This study aims to estimate associations between pre-migration armed conflict in Central America and post-migration health in the United States. METHODS We created a new dataset that combines information on armed conflicts in Central America and immigrant health in the United States. We used ordered probit regressions to estimate age-adjusted associations between pre-migration armed conflict and post-migration health. FINDINGS The study sample of Central American immigrants included 15,563 females and 16,236 males between the ages 15 and 69. The mean age was 37.2 years (standard deviation, 11.6 years) for females and 35.5 years (standard deviation, 11.2 years) for males. After adjusting for age, pre-migration armed conflict was associated with a 8.6 percentage point decrease in excellent health for females (95% confidence interval, 6.0 to 11.1), and a 7.3 percentage point decrease for males (95% confidence interval, 4.0 to 10.7). Each decade of pre-migration armed conflict was associated a 2.9-percentage point decrease in excellent health for females (95% confidence interval, 2.0 to 3.8) and a 1.6-percentage point decrease for males (95% confidence interval, 0.6 to 2.6). For those individuals exposed to armed conflict, each decade since the most recent armed conflict was associated with a 1.5 percentage point increase in excellent health for females (95% confidence interval, 0.4 to 2.5). For males, the average marginal effect of decades since last conflict was not statistically significant (95% confidence interval, -0.001 to 0.002). CONCLUSIONS Pre-migration armed conflict in Central America is associated with decreases in excellent post-migration health in the United States. The effects of armed conflict are cumulative and fade over time for females.
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Affiliation(s)
- Jeremy C Green
- Saint Louis University, Department of Health Management and Policy, US
| | - Rhonda BeLue
- Saint Louis University, Department of Health Management and Policy, US
| | - Eric A Boakye
- Saint Louis University, Center for Outcomes Research, US
| | - Esther Choi
- University of Maryland, Department of Behavioral and Community Health, US
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Green JC, BeLue R, Boakye EA, Choi E, Vaughn MG. Armed Conflict in Central America and Immigrant Health in the United States. Ann Glob Health 2018; 84:654-662. [PMID: 30779514 DOI: 10.9204/aogh.2373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND While many researchers document the immediate and localized health effects of armed conflicts on combatants are well documented in the literature, less is known about the effects of armed conflict on individuals who have subsequently migrated elsewhere. Objective: This study aims to estimate associations between pre-migration armed conflict in Central America and post-migration health in the United States. METHODS We created a new dataset that combines information on armed conflicts in Central America and immigrant health in the United States. We used ordered probit regressions to estimate age-adjusted associations between pre-migration armed conflict and post-migration health. FINDINGS The study sample of Central American immigrants included 15,563 females and 16,236 males between the ages 15 and 69. The mean age was 37.2 years (standard deviation, 11.6 years) for females and 35.5 years (standard deviation, 11.2 years) for males. After adjusting for age, pre-migration armed conflict was associated with a 8.6 percentage point decrease in excellent health for females (95% confidence interval, 6.0 to 11.1), and a 7.3 percentage point decrease for males (95% confidence interval, 4.0 to 10.7). Each decade of pre-migration armed conflict was associated a 2.9-percentage point decrease in excellent health for females (95% confidence interval, 2.0 to 3.8) and a 1.6-percentage point decrease for males (95% confidence interval, 0.6 to 2.6). For those individuals exposed to armed conflict, each decade since the most recent armed conflict was associated with a 1.5 percentage point increase in excellent health for females (95% confidence interval, 0.4 to 2.5). For males, the average marginal effect of decades since last conflict was not statistically significant (95% confidence interval, -0.001 to 0.002). CONCLUSIONS Pre-migration armed conflict in Central America is associated with decreases in excellent post-migration health in the United States. The effects of armed conflict are cumulative and fade over time for females.
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Affiliation(s)
- Jeremy C Green
- Saint Louis University, Department of Health Management and Policy, US
| | - Rhonda BeLue
- Saint Louis University, Department of Health Management and Policy, US
| | - Eric A Boakye
- Saint Louis University, Center for Outcomes Research, US
| | - Esther Choi
- University of Maryland, Department of Behavioral and Community Health, US
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O'Mahony J, Clark N. Immigrant Women and Mental Health Care: Findings from an Environmental Scan. Issues Ment Health Nurs 2018; 39:924-934. [PMID: 30273096 DOI: 10.1080/01612840.2018.1479903] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Immigrant women's mental health is a growing public health policy issue. New immigrant mothers may be particularly vulnerable to less than optimal mental health following childbirth given the cultural and geographic isolation, socioeconomic factors, gender roles, and language difficulties that influence their postpartum experiences. The purpose of this environmental scan was to increase understanding of immigrant women's perinatal mental health care services within the interior of a western Canadian province. Four interrelated themes emerged to impact postpartum health of immigrant women: (i) community capacity building, (ii) facilitators of mental health support and care, (iii) barriers of mental health promotion and support, and (iv) public policy and postpartum depression. Knowledge gained from this study contributes to healthy public policy and practices that promote mental health and support among immigrant women.
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Affiliation(s)
- Joyce O'Mahony
- a School of Nursing , Thompson Rivers University , Kamloops , BC , Canada
| | - Nancy Clark
- b Faculty of Human and Social Development, School of Nursing , University of Victoria , Victoria , BC , Canada
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Knapp C, Honikman S, Wirsching M, Husni-Pascha G, Hänselmann E. Adapting a perinatal empathic training method from South Africa to Germany. Pilot Feasibility Stud 2018; 4:101. [PMID: 29946478 PMCID: PMC6007011 DOI: 10.1186/s40814-018-0292-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 05/09/2018] [Indexed: 01/05/2023] Open
Abstract
Background Maternal mental health conditions are prevalent across the world. For women, the perinatal period is associated with increased rates of depression and anxiety. At the same time, there is widespread documentation of disrespectful care for women by maternity health staff. Improving the empathic engagement skills of maternity healthcare workers may enable them to respond to the mental health needs of their clients more effectively. In South Africa, a participatory empathic training method, the “Secret History” has been used as part of a national Department of Health training program with maternity staff and has showed promising results. For this paper, we aimed to describe an adaptation of the Secret History empathic training method from the South African to the German setting and to evaluate the adapted training. Methods The pilot study occurred in an academic medical center in Germany. A focus group (n = 8) was used to adapt the training by describing the local context and changing the materials to be relevant to Germany. After adapting the materials, the pilot training was conducted with a mixed group of professionals (n = 15), many of whom were trainers themselves. A pre-post survey assessed the participants’ empathy levels and attitudes towards the training method. Results In adapting the materials, the focus group discussion generated several experiences that were considered to be typical interpersonal and structural challenges facing healthcare workers in maternal care in Germany. These experiences were crafted into case scenarios that then formed the basis of the activities used in the Secret History empathic training pilot. Evaluation of the pilot training showed that although the participants had high levels of empathy in the pre-phase (100% estimated their empathic ability as high or very high), 69% became more aware of their own emotional experiences with patients and the need for self-care after the training. A majority, or 85%, indicated that the training was relevant to their work as clinicians and trainers, that it reflected the German situation, and that it may be useful ultimately to address emotional distress in mothers in the perinatal phase. Conclusions Our study suggests that it is possible to adapt an empathic training method developed in a South African setting and apply it to a German setting, and that it is well received by participants who may be involved in healthcare worker training. More research is needed to assess adaptations with other groups of healthcare workers in different settings and to assess empathic skill outcomes for participants and women in the perinatal period.
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Affiliation(s)
- Caprice Knapp
- 1Department of Health Policy and Administration, Pennsylvania State University, State College, USA
| | - Simone Honikman
- 3Perinatal Mental Health Project, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Michael Wirsching
- 2Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Gidah Husni-Pascha
- 2Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Eva Hänselmann
- 2Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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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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