The Interrelationships Among Acculturation, Social Support, and Postpartum Depression Symptoms Among Marriage-Based Immigrant Women in Taiwan: A Cohort Study

The global burden of perinatal common mental health disorders and substance use among migrant women: a systematic review and meta-analysis

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.

Relationship between family cohesion/adaptability and postpartum depressive symptoms: A single-center retrospective study

BACKGROUND

Depression is the most common mental illness in postpartum mothers, and the etiology of postpartum depression remains poorly understood. Over the past several decades, studies have reported that postpartum depression is caused by multiple factors, such as genetic, psychological, pregnancy, and environmental factors, with the family environment being an important environmental factor. The theory of family cohesion and adaptability put forward by Olson is a classic model that describes the level of family function. However, to date, this model has not been examined regarding its applicability to patients with postpartum depression.

AIM

To investigate the relationship between family cohesion and adaptability and the risk of postpartum depressive symptoms.

METHODS

We retrospectively analyzed 1446 patients admitted to the postpartum healthcare clinic of the Affiliated Foshan Maternity and Child Healthcare Hospital from April 2021 to December 2021. Patients were grouped according to whether postpartum depression symptoms were reported (symptoms, n = 454; no symptoms, n = 992). All patients completed the Edinburgh Postpartum Depression Scale and the Chinese version of the Family Cohesion and Adapt-ability Assessment Scale II. Baseline and clinical data were compared between groups. Univariate regression analysis was used to investigate the association between different types of family cohesion and postpartum depressive symptoms and the association between different family adaptability types and postpartum depressive symptoms.

RESULTS

After adjusting for age, education, occupation, gravidity, parity, and mode of delivery, disengaged [adjusted odds ratio (AOR) = 3.36, 95%CI: 1.91–5.91], and separated (AOR = 1.97, 95%CI: 1.34–2.90) family cohesion types showed a higher risk of postpartum depression than the connection type, whereas the enmeshed type (AOR = 0.38, 95%CI: 0.28–0.51) protected against postpartum depressive symptoms. Rigid (AOR = 4.41, 95%CI: 3.02–6.43) and structured families (AOR = 1.88, 95%CI: 1.34–2.63) had a higher risk of postpartum depressive symptoms than flexible families, whereas chaotic families (AOR = 0.35, 95%CI: 0.24–0.51) protected against postpartum depressive symptoms.

CONCLUSION

Family cohesion and adaptability are influencing factors for postpartum depressive symptoms, with higher family cohesion and adaptability being associated with a lower risk of postpartum depressive symptoms.

Support Needs for Anxiety among Pregnant Women in Japan: A Qualitative Pilot Study

Support needs for pregnancy-related anxiety among low-risk pregnant women remain unclear. This study aimed to clarify the kinds of support for anxiety that women seek during pregnancy in Japan. Data were collected in a semi-structured focus group interview involving five pregnant women who were not in specific risk groups, recruited from three facilities in Tokyo. We generated themes using inductive thematic analysis. This paper adhered to the consolidated criteria for reporting qualitative research. From the data on support needs for anxiety during pregnancy, three themes were derived: (1) seeking tailored professional support; (2) seeking continuous support within informal relationships; and (3) seeking others’ success stories in the same situation. These three types of support gave participants a sense of reassurance or raised concern, depending on the situation. We proposed a model comprising the three derived themes using social cognitive theory. We discussed how these three types of support influenced pregnant women’s self-efficacy, which is the core concept of the social cognitive theory. Our findings may help to plan theory-based research and effective interventions to provide support for women’s anxiety during pregnancy using a population approach. Our results also demonstrated the importance of collaboration with pregnant women in developing further research and interventions.

Bi-dimensional acculturation and social support on perinatal depression in marriage-based immigrant women

BACKGROUND

Sociocultural factors play critical roles in the mental health of marriage-based immigrant women. However, the effect of bi-dimensional acculturation ("adaptation to host culture" and "maintenance of heritage culture") and social support on perinatal depression across time was unknown among them.

OBJECTIVE

To examine the effect of bi-dimensional acculturation and social support on perinatal depression among marriage-based immigrant women in Taiwan.

METHODS

This longitudinal study recruited 310 immigrant mothers to complete structured questionnaires during pregnancy and postpartum periods. Depression was assessed using the Edinburgh Postnatal Depression Scale. Bi-dimensional acculturation was measured using the Bi-dimensional Acculturation Scale for Marriage-Based Immigrant Women. Social support was measured by a three-subscale instrument, namely emotional, instrumental, and informational support.

RESULTS

Depression scores increased from pregnancy to three months postpartum, and decreased from six to twelve months postpartum. The generalized estimating equation results showed that lower adaptation to host culture, emotional support, and informational support were associated with higher maternal depression scores over time. Maintaining heritage culture has both positive (from pregnancy to three months postpartum) and negative associations (from six to twelve months postpartum) with maternal depression, further, increased emotional support enhanced the protective effect of adaptation to host culture, but decreased the positive effect of maintenance of heritage culture on depression.

CONCLUSION

Strategies should be developed to assist perinatal immigrant women to adapt to the host culture, maintain their heritage culture, and resolve potential cultural conflicts to decrease their depression. Respect for immigrant mothers' heritage cultures should be accompanied by increased emotional support.

Bi-dimensional acculturation and depressive symptom trajectories from pregnancy to 1 year postpartum in marriage-based immigrant women in Taiwan

BACKGROUND

Childbirth may pose many challenges to the psychological well-being of marriage-based immigrant mothers in interracial marriages, who must negotiate bi-dimensional acculturation - adaptation to the host culture and maintenance of her own heritage culture. We examined the temporal relationships between bi-dimensional acculturation and depressive symptoms from pregnancy to 1 year postpartum among marriage-based immigrant mothers in Taiwan using the cross-lagged structural equation modeling.

METHODS

This study recruited 310 immigrant mothers, who were examined in the second and third trimesters, and again at 1 month, 3 months, 6 months, and 1 year postpartum from March 2013 to December 2015. Depressive symptoms and bi-dimensional acculturation were measured using the Edinburgh Postnatal Depression Scale and Bidimensional Acculturation Scale for Marriage-Based Immigrant Women, respectively.

RESULTS

The study found that adaptation to the host culture followed a downward linear trajectory, while maintenance of the mother's own heritage culture followed an upward linear trajectory from pregnancy to 1 year postpartum. All but one cross-lagged path between bi-dimensional acculturation and depressive symptoms was statistically insignificant, though almost all cross-sectional associations were significant. Adaptation to host culture was negatively associated with depressive symptoms at all time points. The association between maintenance of heritage culture and depressive symptoms reversed from positive to negative after 6 months postpartum.

CONCLUSIONS

Adaptation to the host culture and maintenance of the mother's heritage culture differed in their associations with maternal depressive symptoms. Health professionals should assist immigrant mothers in adapting to the host culture while supporting their heritage culture in the childbearing period.

Posttraumatic growth and postpartum depression in women after childbirth: The moderating role of postpartum negative life events

AIM

This study aimed to investigate the implications of postpartum negative life events on postpartum depression and posttraumatic growth in women after childbirth.

METHODS

A sample of 280 postpartum women at a level III hospital in China provided data on postpartum depression, negative life events, and posttraumatic growth with a cross-sectional design.

RESULTS

The scores of both postpartum depression and negative life events exhibited a quadratic correlation with posttraumatic growth in women after childbirth, and negative life events significantly moderated the associations between depression and overall posttraumatic growth and its three dimensions: personal strength, spirit change, and relating to others.

CONCLUSIONS

Women can experience positive psychological growth after childbirth, and this study provides new evidence of an interaction between postpartum depression and negative life events in the prediction of psychological growth, highlighting the moderating role of negative life events. This study could help direct mental health professionals to target interventions that provide more psychological support to reduce the impact of depression and negative life events, which will be conducive to improving women's psychological growth.

The psychometric properties of the Bidimensional Acculturation Scale for Marriage-Based Immigrant Women in Taiwan

Introduction

Marriage-based immigrant women are increasing around the world. Although bi-dimensional acculturation is important for immigrant women’s health, the existing scales have mainly been developed for immigrant women in Western countries and hence some items may not be suitable for Asian contexts. Thus, we developed and evaluated the Bidimensional Acculturation Scale for Marriage-Based Immigrant Women (BAS-MBIW) in Taiwan.

Methods

The BAS-MBIW was developed based on a literature review and clinical observations. Bi-dimensional acculturation involves “adaptation to host culture (acculturation)” and “maintenance of heritage culture (enculturation).” The initial scale included two 24-item subscales. The validation samples were 310 marriage-based immigrant women who were pregnant for at least twelve weeks in Taiwan. The BAS-MBIW was assessed and modified by experts. Data analyses included factor analysis, Pearson’s correlation, and Cronbach’s alpha coefficient.

Results

Expert reviews and factor analysis indicated that the scale had acceptable content and construct validity. The validated scale includes two 19-item subscales, encompassing six domains: language, media, food preference, cultural heritage, social interaction, and shopping and merchandise preference, with good internal consistencies (Cronbach’s alpha coefficient is 0.88 for acculturation and 0.83 for enculturation). Acculturation was positively related to local language ability and duration of immigration but negatively related to age at immigration, stress, and depression; whereas enculturation was positively related to age at immigration, stress, and depression but negatively related to duration of immigration, indicating convergent validity.

Conclusions

The BAS-MBIW offers reliable and valid assessments of pregnant immigrant women’s level of acculturation and enculturation in Taiwan. The BAS-MBIW could be used to assess bi-dimensional acculturation among marriage-based immigrant women.

Prevalence and associated factors of postpartum depression among immigrant women in Guangzhou, China

Background

Although there has been mounting research on postpartum depression (PPD), the impact of immigration on PPD has remained quite unexplored. The purpose of this study is to investigate the prevalence and associated factors of PPD among immigrant women living in Guangzhou at 6 weeks postpartum.

Methods

A cross-sectional study was conducted involving 1230 immigrant women in a tertiary hospital of Guangzhou from December 2016 to December 2017 at 6 weeks postpartum. The Chinese version of Edinburgh Postnatal Depression Scale and a structured questionnaire regarding associated factors were administered to all participants. Multivariate logistic regression was used to determine factors that were significantly associated with PPD.

Results

The prevalence of PPD among immigrant women at 6 weeks postpartum was 34.0%. A multivariate logistic regression model identified significant obstetric and social factors as: living in Guangzhou for less than 2 years, insufficient family income, poor social support and marital relationship.

Conclusion

Prevalence of PPD among immigrant women from Guangzhou at 6 weeks postpartum is high. The development of PPD among immigrant women is associated with individual and social factors. There’s an urgent need for healthcare providers to take a more active role in engaging immigrant women in their psychological needs.

Acculturation and Postpartum Depression Among Immigrant Women of Arabic Descent

Acculturation has been related to risk of postpartum depression (PPD) among immigrant women globally. The purpose of this study was to examine the relationship between acculturation and PPD symptoms among U.S. immigrant women of Arabic descent. A cross-sectional study was conducted with 115 postpartum immigrant women of Arabic descent. Women completed questionnaires including measures of acculturation [attraction to Arabic culture (AArC), attraction to American culture (AAmC), marginalization] and PPD symptoms (Edinburgh Postnatal Depression Scale-EPDS) between 1 and 12 months postpartum. Twenty-five percent of women (n = 29) had EPDS scores ≥ 10 that represent PPD symptoms. Women with higher marginalization reported more PPD symptoms (r = .25, p = .008). None of the acculturation factors correlated with PPD symptoms after adjustment for maternal sociodemographic and health characteristics. Higher education (p = .001), lower gestational age at birth (p < .05), and antenatal anxiety (p < .05) were correlated with PPD symptoms in multivariate analyses. Health care providers should identify and assess immigrant women of Arabic descent for antenatal anxiety as this may identify women at risk for development of PPD symptoms. Future studies need to examine acculturation in relation to mental health among immigrant women of Arabic descent.

A systematic review of prevalence and risk factors of postpartum depression in Chinese immigrant women

BACKGROUND

As the number of immigrants grows, the health of Chinese immigrant women, especially their perinatal health, has gradually attracted public attention. Our review has two main purposes. First, estimate the prevalence of postpartum depressive symptoms in Chinese immigrant women, and then determine risk factors for postpartum depressive symptoms among these women.

METHODS

The following databases: MEDLINE, Embase, Scopus, Web of Science, PsycINFO and PubMed were used in literature search from their commencements until November 21st 2017. The Joanna Briggs Institute (JBI) Critical Appraisal instruments were used to evaluate the quality of the article. Four studies met the inclusion criteria, contributed to our review and meta-analysis.

RESULT

The prevalence of postpartum depression is high in Chinese immigrant women. Risk factors for postpartum depression in Chinese immigrant women were defined as lack of social support, unstable economic status, and acculturation.

CONCLUSION

There have been few studies on postpartum depression among Chinese immigrant women. Existing studies have shown a high prevalence of postpartum depression in Chinese immigrant women. Moreover, there is an urgent need for studies on postpartum depression among Chinese immigrant women informing better understanding, programs of care and improving the perinatal health status of Chinese immigrant women.

Ethnic Drinking Culture, Acculturation, and Enculturation in Relation to Alcohol Drinking Behavior Among Marriage-Based Male Immigrants in Taiwan

Drinking behavior among immigrants could be influenced by drinking-related cultural norms in their country of origin and host country. This study examined the association of ethnic drinking culture, acculturation, and enculturation with alcohol drinking among male immigrants in Taiwan. This cross-sectional survey recruited 188 male immigrants. Ethnic drinking culture was divided into dry and wet according to per capita alcohol consumption and abstinent rate in the countries of origin in reference to that in Taiwan. A scale, Bidimensional Acculturation Scale for Marriage-Based Immigrants, was developed to measure acculturation (adaptation to the host culture) and enculturation (maintenance of the original culture). Drinking patterns (abstinent, low-risk drinking, and hazardous drinking) were determined by scores on the Alcohol Use Disorder Identification Test. There was a significant interaction between ethnic drinking culture and enculturation/acculturation on drinking patterns. Multinomial logistic regression models identified that for those from dry ethnic drinking cultures, a high level of acculturation was associated with increased low-risk drinking, while a high level of enculturation was associated with decreased low-risk drinking. For those from wet ethnic drinking cultures, a low level of acculturation and high level of enculturation were associated with increased hazardous drinking. High family socioeconomic status was associated with increased drinking, while perceived insufficient family income was positively associated with hazardous use. To prevent hazardous use of alcohol, health education should be targeted at immigrant men who drink, especially among those who have economic problems, are from wet ethnic drinking cultures, and demonstrate low adaptation to the host culture.

Economic and Health Predictors of National Postpartum Depression Prevalence: A Systematic Review, Meta-analysis, and Meta-Regression of 291 Studies from 56 Countries

BACKGROUND

Postpartum depression (PPD) poses a major global public health challenge. PPD is the most common complication associated with childbirth and exerts harmful effects on children. Although hundreds of PPD studies have been published, we lack accurate global or national PPD prevalence estimates and have no clear account of why PPD appears to vary so dramatically between nations. Accordingly, we conducted a meta-analysis to estimate the global and national prevalence of PPD and a meta-regression to identify economic, health, social, or policy factors associated with national PPD prevalence.

METHODS

We conducted a systematic review of all papers reporting PPD prevalence using the Edinburgh Postnatal Depression Scale. PPD prevalence and methods were extracted from each study. Random effects meta-analysis was used to estimate global and national PPD prevalence. To test for country level predictors, we drew on data from UNICEF, WHO, and the World Bank. Random effects meta-regression was used to test national predictors of PPD prevalence.

FINDINGS

291 studies of 296284 women from 56 countries were identified. The global pooled prevalence of PPD was 17.7% (95% confidence interval: 16.6-18.8%), with significant heterogeneity across nations (Q = 16,823, p = 0.000, I2 = 98%), ranging from 3% (2-5%) in Singapore to 38% (35-41%) in Chile. Nations with significantly higher rates of income inequality (R2 = 41%), maternal mortality (R2 = 19%), infant mortality (R2 = 16%), or women of childbearing age working ≥40 h a week (R2 = 31%) have higher rates of PPD. Together, these factors explain 73% of the national variation in PPD prevalence.

INTERPRETATION

The global prevalence of PPD is greater than previously thought and varies dramatically by nation. Disparities in wealth inequality and maternal-child-health factors explain much of the national variation in PPD prevalence.

Prevalence, Incidence, and Persistence of Postpartum Depression, Anxiety, and Comorbidity among Chinese Immigrant and Nonimmigrant Women: A Longitudinal Cohort Study

OBJECTIVE

Our objectives were to examine the prevalence and incidence of postpartum depressive, anxiety, and comorbid symptoms over the first postpartum year; the persistence of these symptoms; and the prevalence stratified by immigration status.

METHOD

We conducted a longitudinal cohort study in Ontario, Canada. Participants were 571 Chinese recent immigrant, nonrecent immigrant, and Canadian-born women with live births in 2011 to 2014. Participants were assessed at 4, 12, and 52 weeks postpartum for the presence of possible and high depressive symptomatology (Edinburgh Postnatal Depression Scale [EPDS] >9 and >12, respectively), anxiety symptomatology (State-Trait Anxiety Inventory [STAI] >40), and comorbid symptomatology (EPDS >9 and STAI >40). Prevalence and incidence with 95% confidence intervals were calculated.

RESULTS

Prevalence rates were highest at 4 weeks and decreased across time, with possible depressive symptomatology most prevalent at most time points. Incidence rates at 12 and 52 weeks were generally similar. Of those with possible symptomatology at 4 weeks, 42.0% or less continued to have symptomatology at 12 weeks and 17.4% or less at 52 weeks. There were no differences in prevalence of any type of symptomatology between immigrant and Canadian-born Chinese women at 4 weeks, but at 12 and 52 weeks, most types of symptomatology were more common among recent and nonrecent immigrants.

CONCLUSION

Our findings suggest that Chinese immigrant women are a high-risk group for postpartum depressive and anxiety symptomatology. Future research should identify cultural and psychosocial factors associated with immigration that could be addressed in the system of care for postpartum immigrant women.

Venous thromboembolism risk and postpartum lying-in: Acculturation of Indian and Chinese women

OBJECTIVE

many cultures have a set time of traditional rest in the postpartum period. There is limited information on how this activity may potentially increase the risk of venous thromboembolism (VTE). We aimed to investigate VTE risk by determining the prevalence of the cultural practice of postpartum "lying-in", quantifying activity and determining the factors that influence this tradition in women from China and the Indian subcontinent (India, Bangladesh, Pakistan and Sri Lanka) at an Australian tertiary referral hospital.

DESIGN

we surveyed a prospective cohort of 150 women aged ≥ 18 years who self-identified culturally as from the Indian subcontinent or Chinese, at baseline (≥ 32 weeks gestation) and at follow-up (six to eight weeks postpartum). Demographic details collected included VTE risk factors such as caesarean section, lack of graduated compression stockings (GCS), postpartum haemorrhage greater than 1000mL, comorbidities and immobility. We quantified postpartum activities and investigated factors that might influence inactivity.

RESULTS

there were 100 women identifying as from the Indian subcontinent and 50 women identifying as Chinese recruited at the baseline of over 32 weeks' gestation. Most of the study participants (85%) rested in the postpartum period for cultural reasons. Of the women surveyed, 51% rested in bed as much as possible in the postpartum period. We found a significant correlation between increased number of children and decreased overall immobility or rest (P = 0.03). Overall, 91% of participants had relative live-in help, and this significantly increased the risk of immobility by more than six-fold (odds ratio [OR], 6.17; 95% CI, 1.6-23.5; P = 0.008). Furthermore, a vaginal compared to a caesarean birth increased immobility risk by almost 3.5 times (OR, 3.4; 95% CI, 1.20-9.4; P = 0.021).

CONCLUSIONS

acculturation is highly individualised, however postpartum rest remains prevalent in women who identify themselves culturally as from the Indian subcontinent or as Chinese. Inactivity and comorbidities compounded the impact of cultural postpartum rest, and put women at increased risk for VTE.

IMPLICATIONS FOR PRACTICE

targeted, culturally appropriate, postnatal education should include VTE-prevention information to women who intend to practise postpartum rest.

Risk factors, cross-cultural stressors and postpartum depression among immigrant Chinese women in Japan

The purpose of this mixed-method design study was to examine factors contributing to depression among immigrant Chinese women (primipara and multipara) (n = 22) delivering a child for the first time in Japan. Data were obtained just after hospital discharge by using the Edinburgh Postnatal Depression Scale (EPDS), the Social Support Scale, a new scale to measure cross-cultural stressors in the postpartum setting and a visual analogue scale for stress and a demographic survey. The average EPDS score was 9.0 (SD ± 3.7) at 1-3 weeks postpartum; yet, more than half of the subjects (n = 12; 54.5%) were high risk for depression (EPDS ≥ 10). Low household income and primiparous status were associated with depression scores. New mothers with depression also reported more general stress and more cross-cultural stress in the postpartum setting, although social support appeared to mediate cross-cultural stressors. Semi-structured interviews were held with two immigrant women at high risk for depression; these new mothers described additional stress because they could not follow Zuoyuezi, an important postpartum Chinese tradition, in the Japanese hospital. These findings suggest that immigrant Chinese women are at higher risk for postpartum depression when they give birth for the first time in Japan.

Prevalence and risk of mental disorders in the perinatal period among migrant women: a systematic review and meta-analysis

This study was conducted in order to evaluate the prevalence and risk of mental disorders in the perinatal period among migrant women. Six databases (including MEDLINE) were searched from inception to October 19th, 2015, in addition to citation tracking. Studies were eligible if mental disorders were assessed with validated tools during pregnancy and up to 1 year postpartum among women born outside of the study country. Of 3241 abstracts screened, 53 met the inclusion criteria for the review. Only three studies investigated a mental disorder other than depression. Unadjusted odds ratios were pooled using random effects meta-analysis for elevated depression symptoms during pregnancy (n = 12) and the postpartum (n = 24), stratified by study country due to heterogeneity. Studies from Canada found an increased risk for antenatal (OR = 1.86, 95% CIs 1.32-2.62) and postnatal elevated depression symptoms (OR = 1.98, 95% CIs 1.57-2.49) associated with migrant status. Studies from the USA found a decreased risk of antenatal elevated depression symptoms (OR = 0.71, 95% CIs 0.51-0.99), and studies from the USA and Australia found no association between migrant status and postnatal elevated depression symptoms. Low social support, minority ethnicity, low socioeconomic status, lack of proficiency in host country language and refugee or asylum-seeking status all put migrant populations at increased risk of perinatal mental disorders.

Effect of Health Care as the "Home Visiting" on Postpartum Depression: A Controlled Clinical Trial

Background:

Postpartum depression is considered as a major health complication of women after delivery. It is necessary to find an essential approach for the prevention of its serious consequences on mothers’ and infants’ health. The aim of this study was to investigate the effect of home visiting on postpartum depression.

Methods:

The first stage of study was the design of postpartum package. According to the package, a clinical trial was performed for 276 mothers who had delivered in affiliated hospitals of Shahid Beheshti University in 2013 and were divided into two groups, i.e., control group and intervention group. Intervention group received health care by home visiting, and control group had no intervention. Mothers were supposed to fill up Edinburgh Postnatal Depression Scale before and 60 days after delivery, and the results were compared. The data were analyzed by SPSS version 18 software and t-test, Chi-square, and logistic regression test.

Results:

The mean ages of participants were 27.03 ± 5.2 standard deviation (SD) in intervention group and 27.37 ± 5.4 SD in control group. Occurrence of depression was 7.6% in intervention group and 19% in control group, and there was a significant difference between two groups (P < 0.05). The logistic regression results indicate that groups (intervention and control) (P = 0.087, odds ratio [OR] =2.1); planned and unplanned pregnancy (P = 0.028, OR = 2.5) and the infant nutrition (P = 0.025, OR = 2.2) are significantly associated with the postpartum depression.

Conclusions:

Providing postpartum home visiting can influence postpartum depression in a positive way and could improve mothers’ and infants’ health.

Migration and perinatal mental health in women from low- and middle-income countries: a systematic review and meta-analysis

BACKGROUND

Migrant women are at risk of perinatal mental disorders due to stressors experienced before, during and after migration.

OBJECTIVES

This systematic review and meta-analysis summarises the prevalence, associated factors and interventions for perinatal mental disorders in migrant women from low- and middle-income countries (LMIC).

SEARCH STRATEGY

We systematically searched nine electronic databases and the grey literature using a predefined search strategy.

SELECTION CRITERIA

Studies were included if they assessed pregnant or postpartum migrants from LMIC, used a structured tool and a case-control, cross-sectional, cohort or intervention study design.

DATA COLLECTION AND ANALYSIS

Data was double-extracted. We calculated pooled prevalence of depression and weighted mean anxiety and depression scores. We calculated crude odds ratios from risk factor studies and summarised intervention studies descriptively.

MAIN RESULTS

Forty studies were identified from 10 123 references. Pooled prevalence was 31% [95% condidence interval (CI) 23%-40%] for any depressive disorder and 17% (95% CI 12-23%) for major depressive disorder. Previous depression and lower social support were associated with perinatal depression. There were insufficient data to assess the burden of anxiety, post-traumatic stress disorder or psychosis in this population.

CONCLUSIONS

One in three migrant women from LMIC experiences symptoms of perinatal depression. Social support is an important protective factor. Evidence on LMIC women relocating to other LMIC is lacking. Given the adverse consequences of perinatal mental illness on women and their children, further research in low-resource settings is a priority.

TWEETABLE ABSTRACT

One in three migrant women from low- and middle-income countries has symptoms of perinatal depression.

Correlates of Postpartum Depression in First Time Mothers Without Previous Psychiatric Contact

Background

Postpartum depression (PPD) is a common disorder after childbirth. The strongest known predictors are a history of depression and/or a history of PPD. However, for a significant proportion of women, PPD constitutes their first depressive episode. This study aimed to gain further insight into the risk factors for PPD in first time mothers without previous psychiatric contact.

Methods

Women delivering in Uppsala University Hospital, Sweden, from May 2006 to June 2007, were asked to participate and filled out questionnaires five days and six weeks postpartum, containing inter alia the Edinburgh Postnatal Depression Scale (EPDS). Univariate logistic regression models, as well as a path analysis, were performed to unveil the complex interplay between the study variables.

Results

Of the 653 participating primiparas, 10.3% and 6.4% reported depressive symptoms (EPDS ≥ 12 points) five days and six weeks postpartum, respectively. In the path analysis, a positive association between anxiety proneness and depressive symptoms at five days and six weeks postpartum was identified. For depressive symptoms six weeks after delivery, additional risk factors were detected, namely depressive symptoms five days postpartum and subjective experience of problems with the baby. Caesarean section and assisted vaginal delivery were associated with fewer depressive symptoms at 6 six weeks postpartum.

Conclusions

Identification of anxiety proneness, delivery mode and problems with the baby as risk factors for self-reported depressive symptoms postpartum in this group of primiparas can be important in helping health care professionals identify women at increased risk of affective disorders in the perinatal period, and provide a base for early intervention.

Differences between native and immigrant women in Taiwan in factors associated with caesarean section: A prospective observational study

This study aimed to examine the association of social support, social factors, and maternal complications with caesarean deliveries in native and immigrant women, and to explore the association between acculturation and caesarean deliveries in immigrant women in Taiwan. This prospective panel study was conducted from August 2012 through April 2014 and included 222 native and 147 immigrant pregnant women in Taiwan. Caesarean rates did not differ significantly between native and immigrant women, including the overall caesarean rate (28.8%, 32.0%), medically indicated caesarean (22.5%, 24.5%), and caesarean without medical indications (6.3%, 7.5%). Results of multiple logistic regression models revealed that maternal complications and household activity support were positively associated with caesarean deliveries. Both native and immigrant women with high levels of informational support were less likely to receive caesareans. Immigrant women who were older than 35 years, had a middle level socioeconomic status, and perceived a high level of acceptance of caesarean in Taiwan were more likely to have caesarean deliveries. Informational support was a protective factor for caesarean delivery, whereas household activity support offered by the family was positively associated with caesarean delivery. Perceived acceptance level in mainstream society could affect immigrant women's use of caesarean delivery.

Depression and Social Support Trajectories During 1 Year Postpartum Among Marriage-Based Immigrant Mothers in Taiwan

OBJECTIVES

This panel study examined the trajectories of depression and social support during the first year postpartum among marriage-based immigrant mothers in Taiwan, and the effect of social support on depression.

METHODS

This panel study recruited South-Asia immigrant mothers (mean age: 27years) to complete structured questionnaire at 1month, 6month, and 1year postpartum. A total of 203 immigrant mothers completed structured questionnaires at 1 and 6months, and 163 completed the questionnaires at 1year postpartum. Postpartum depression was measured using the Edinburgh Postpartum Depression Scale. Social support was composed of 3 subscales, emotional, instrumental, and informational support. Hierarchical linear modeling was used to examine the relationships between trajectories and factors associated with depression.

RESULTS

Depression and instrumental support followed downward curvilinear trajectories, while emotional and informational support followed upward curvilinear trajectories. Depression was highest at 1month, decreased sharply until 6months, and then leveled off between 6 and 12months. Emotional and instrumental support negatively covaried with postpartum depression over time. When the three-dimensional supports were considered together, only emotional support retained its significance.

CONCLUSIONS

Our results demonstrated that depression was highest at 1month, then decreased, and then leveled off during 1year postpartum, though further study may be needed to confirm the trajectory. The 3 types of social support differed in postpartum trajectory, suggesting the needs to consider them separately in future studies. To decrease postpartum depression among immigrant mothers, strategies should be developed to increase emotional and instrumental support during postpartum period.

Prevalence of postpartum depression among immigrant women: A systematic review and meta-analysis

The aims of this systematic review and meta-analysis were threefold: to estimate the prevalence of postpartum depressive symptoms in immigrant women, compare this prevalence to non-immigrant women, and determine risk factors for postpartum depressive symptoms in immigrant women. Literature searches were conducted in PubMed, Embase, PsycINFO, Web of Science, Scopus, ResearchGate and Google Scholar databases from 1950 until October 2014. Twenty-four studies met the inclusion criteria of which 22 (12 cross-sectional and 10 prospective cohort) contributed data for meta-analyses. Heterogeneity and publication bias were assessed. The prevalence of postpartum depressive symptoms in immigrant women was 20% (95% confidence interval [CI] 17-23%, 18 studies, N = 13,749 women). Immigrant women were twice more likely to experience depressive symptoms in the postpartum period than non-immigrant women (pooled unadjusted odds ratio [OR] = 2.10 [95% CI 1.62-2.73, 15 studies, N = 50,519 women] and adjusted OR = 2.18 [95% CI 1.60-2.96, 7 studies, N = 35,557 women]). There was, however, evidence of publication bias with the pooled adjusted OR reduced to 1.63 (95% CI 1.22-2.17) after adjustment for bias. Risk factors associated with postpartum depressive symptoms among immigrant women included shorter length of residence in the destination country, lower levels of social support, poorer marital adjustment, and perceived insufficient household income. This study suggests that postpartum depression is a common condition among immigrant women. Moreover, immigrant women are at higher risk of postpartum depression than non-immigrant women. Further prospective studies on the risk factors of postpartum depression among immigrant women verified by a clinical diagnosis are needed.

Magnitude and risk factors for postpartum symptoms: a literature review

BACKGROUND

The prevalence of postpartum depression worldwide varies from 0.5% to 60.8% in the first 12 months postpartum using self-reported questionnaire. This review aims to update the current magnitude of postpartum depression based on self-reported questionnaire and clinical interview and explore its associated factors in developed and developing countries.

METHODS

A literature search conducted between 2005 and 2014 identified 203 studies, of which 191 used self-reported questionnaire in 42 countries and 21 used structured clinical interview in 15 countries. Nine studies used a combination of self-reported questionnaire and clinical interview.

RESULT

The prevalence of postpartum depression varies from 1.9% to 82.1% in developing countries and from 5.2% to 74.0% in developed countries using self-reported questionnaire. Structured clinical interview shows a much lower prevalence range from 0.1% in Finland to 26.3% in India. Antenatal depression and anxiety, previous psychiatric illness, poor marital relationship, stressful life events, negative attitude towards pregnancy, and lack of social support are significant contributors to postpartum depression.

LIMITATION

All studies are included irrespective of the methodological quality, such as small sample size and their inclusion could affect the generalizability of the results.

CONCLUSION

The current prevalence of postpartum depression is much higher than that previously reported, and similar risk factors are documented. A culturally sensitive cut-off score with adequate psychometric properties of the screening instruments should be available. In future studies, examining the physical, biological, and cultural factors in qualitative studies and in those with adequate methodological qualities is recommended.

Peripartum depression and anxiety as an integrative cross domain target for psychiatric preventative measures

Exposure to high levels of early life stress has been identified as a potent risk factor for neurodevelopmental delays in infants, behavioral problems and autism in children, but also for several psychiatric illnesses in adulthood, such as depression, anxiety, autism, and posttraumatic stress disorder. Despite having robust adverse effects on both mother and infant, the pathophysiology of peripartum depression and anxiety are poorly understood. The objective of this review is to highlight the advantages of using an integrated approach addressing several behavioral domains in both animal and clinical studies of peripartum depression and anxiety. It is postulated that a greater focus on integrated cross domain studies will lead to advances in treatments and preventative measures for several disorders associated with peripartum depression and anxiety.

A structural model of the influence of immigrant mothers' depressive symptoms and home environment on their children's early developmental outcomes in Taiwan

In this cross-sectional study of 61 immigrant mothers and their 6- to 24-month-old children in Taiwan, we examined the structure of relationships among maternal depressive symptoms, quality of the child-rearing home environment, and child development using a partial least squares approach. Maternal depressive symptoms as measured by the Edinburgh Postnatal Depression Scale had a direct and negative effect on the quality of the home environment as measured by the IT-HOME, which in turn had a direct and positive effect on child development as measured by the Comprehensive Developmental Inventory for Infants and Toddlers. Maternal depressive symptoms did not directly affect child development, suggesting that the quality of the home environment mediated the relationship between maternal depressive symptoms and child development.