The postnatal experiences of resettled Syrian refugee women: Access to healthcare and social support in Nova Scotia, Canada

Exploring prenatal depression and postpartum depression: Findings from a prospective cohort study at University Hospital Obstetrics in Damascus

The perinatal period is crucial for both mother and newborn, and mental health, including prenatal and postpartum depression (PPD), is a significant aspect. Screening for these disorders allows for early treatment and helps prevent risks to both mother and child. This prospective cohort study was carried out at University Hospital Obstetrics in Damascus City. The first phase was during the third trimester of pregnancy and the second phase involved a follow-up assessment after 6 weeks of delivery. The Arabic-validated version of the Edinburgh Postnatal Depression Scale questionnaire (EPDS) was used. A cutoff of 13 or higher was used to determine the presence of probable depression in both assessments. Of 347 pregnant women, 38.6% had prenatal depression (PND). 295 patients have achieved the second assessment, of which 30.2% had PPD. Furthermore, 42.6% who had PND developed PPD on follow-up. Binary logistic regression indicated that PND was predicted by non-Syrian nationality, paternal absence, poor financial status, number of previous pregnancies, and a history of depression independent of pregnancy. PPD was predicted by a history of PPD, and work status. Findings underscore potential value of early screening for depressive symptoms as a predictive measure. It is recommended that women with a history of depression receive heightened attention and care, irrespective of the timing of their depressive episodes.

Effect of food insecurity on depression, anxiety, and stress among resettled Syrian refugees in Ontario

Food insecurity has been linked to adverse health outcomes, particularly among vulnerable populations such as refugees. The aim of this study was to assess the prevalence of food insecurity and its association with depression, anxiety, and stress among resettled Syrian refugee parents in Ontario. This was a cross-sectional study with a total of 540 Syrian refugee parents who resided in Ontario for an average of four years and had at least one child less than 18 years who were interviewed. Information about food insecurity was collected based on the question "During the past year, did you ever eat less because there was not enough food or money for food?". Levels of depression, anxiety, and stress were assessed using the Depression Anxiety Stress Scales (DASS-21). Multiple linear regression analyses were performed to evaluate the relationship between food insecurity and depression, anxiety, and stress after adjusting for sociodemographic, migration-, and health-related factors. 44.6% of respondents reported experiencing food insecurity. Of participants, 7.6%, 8.9%, and 8.5% reported severe to extremely severe levels of depression, anxiety, and stress, respectively. Results of the multiple linear regression analysis showed that food insecurity was significantly associated with higher levels of depression (Adjβ = 2.00, p = 0.008), anxiety (Adjβ = 1.53, p = 0.013), and stress (Adjβ = 1.87, p = 0.019). Implementation of effective government interventions and frameworks are essential to reduce food insecurity among resettled Syrian refugees to ultimately improve their mental health outcomes and overall well-being.

Looking through the lens: a photovoice study examining access to services for newcomer children

PURPOSE

Canadian new immigrant families (also known as newcomers) encounter challenges navigating systems when trying to access programmes critical for their children's healthy development. The purpose of this study is to understand how newcomer families find and use early childhood programmes and services from the perspective of families and early childhood educators (ECEs) working within a settlement organization.

METHODS

Using photovoice methodology, newcomer family members (n = 8) with young children and ECEs (n = 6) participated in a series of virtual workshops to share photos and reflect on their experiences.

RESULTS

Participants discussed the systemic barriers that obstructed newcomer families' access to services for young newcomer children. Financial challenges due to unemployment/underemployment, language and cultural differences were emphasized. Despite these barriers and challenges, participants shared how culturally responsive programmes enhanced their connections to programmes and services. Both groups of participants discussed the critical role of social networks in supporting newcomers to use programmes by helping families become aware of available services and assistance with various processes such as registration.

CONCLUSIONS

This research illustrates the lived experiences of newcomer families and identifies opportunities to address inequities, improve early childhood programmes, and enhance families' access to programmes and services.

Factors Associated with the Prevalence of Postpartum Anxiety Disorder and Depression in Syrian Migrant Women Living in Turkey: A Cross-Sectional Study

The global migration trend has brought attention to the mental health of immigrant populations, especially postpartum women. The prevalence of postpartum anxiety and depression among these populations remains a growing concern. This study aimed to explore the factors associated with postpartum anxiety and depression among immigrant women, with a special emphasis on Syrian migrants in Turkey. A cross-sectional design was employed, enrolling postpartum women who visited the Strengthened Migrant Health Center in Istanbul between July and December 2022. Data were collected using a three-part questionnaire comprising sociodemographic details and scores from the Edinburgh Postpartum Depression Scale (EPDS) and Beck Anxiety Scale (BAI). The average age of participants was 25.73 years. The mean EPDS and BAI scores were low at 1.27 and 3.85, respectively. Notably, 97.1% of women scored below the EPDS cut-off point of 13. EPDS scores showed a significant relationship between income levels and COVID-19 vaccination status, while BAI scores were significantly associated with educational levels. There was an inverse correlation between EPDS scores and the number of cohabitants in a household. The observed low rates of postpartum depression and anxiety could be attributed to the accessible health services and psychosocial support for immigrants in Turkey. It would be useful to conduct multicenter and comprehensive epidemiological studies on migrant puerperas.

Use of participatory action research to support Syrian refugee mothers in the resettlement period in Canada: A longitudinal study

Research has shown that refugees in a foreign country often experience physical and mental health challenges upon resettlement (Ahmad et al., 2021; Salam et al., 2022). In Canada, refugee women experience a range of physical and mental barriers, including poor access to interpreter services and transportation, and a lack of accessible childcare, all of which can negatively affect their successful integration (Stirling Cameron et al., 2022). Social factors that support Syrian refugees to settle successfully in Canada have been unexplored systematically. This study examines these factors from the perspectives of Syrian refugee mothers living in the province of British Columbia (BC). Framed by principles of intersectionality and community-based participatory action research (PAR), the study draws on Syrian mothers' perspectives of social support in early, middle, and later phases of resettlement. A qualitative longitudinal design consisting of a sociodemographic survey, personal diaries, and in-depth interviews was used to gather information. Descriptive data were coded, and theme categories were assigned. Six themes emerged from data analysis: (1) Steps in the Migration Journey; (2) Pathways to Integrated Care; (3) Social Determinants of Refugee Health; (4) COVID-19 Pandemic Impacts and Ongoing Resettlement; (5) Strength-Based Capabilities of Syrian mothers; (6) Peer Research Assistant's Research (PRAs) Experience. Results from themes 5 and 6 are published separately. Data obtained in this study contribute to the development of support services that are culturally appropriate and accessible to refugee women living in BC. Our objectives are to promote the mental health and improve the quality of life of this female population, and to enable it to access healthcare services and resources in a timely manner.

Teetering on the Edge: A Third Grounded Theory Modification of Postpartum Depression

Reported prevalence rates of elevated postpartum depressive symptoms in immigrant and refugee women range from 24% to 82%. A third modification of Teetering on the Edge, a grounded theory of postpartum depression, was conducted to extend this midrange theory to address immigrant and refugee women. Data from 13 qualitative studies that specifically focused on this vulnerable population were included in this modification. Two categories were added to the third stage of Teetering on the Edge: Barriers to Sources of Support and Battling Self and Culture. These new categories shed light on the struggles of immigrant and refugee mothers.

Breastfeeding practices among Syrian refugees in Turkey

Background

We evaluated (a) opinion of Syrian and Turkish healthcare workers (HCWs), and perceptions and attitudes of Syrian refugee mothers, pregnant women, fathers and grandmothers on age-appropriate breastfeeding, (b) the effect of cultural characteristics, migration and pandemics on Syrian’s infant nutrition, and (c) the suggestions of HCWs and Syrian family members to improve breastfeeding practices in the Syrian refugee society in a qualitative study.

Methods

The qualitative study consisting of structured focus group discussions (FGDs) was held in four provinces in Turkey where Syrian refugees live intensely in September and October 2020. Seven different types of online FGDs were held with Turkish HCWs working in maternity hospitals, Syrian HCWs working in Refugee Health Centers (RHCs), Syrian pregnant women, mothers, fathers, and grandmothers. In total, we carried out 46 FGDs with 335 individuals. Thematic analysis of the transcripts in a deductive-inductive fashion was carried out with MAXQDA 11.

Results

Most Syrian HCWs did not get any training on breastfeeding counseling. The short duration of breastfeeding in Syrian refugees was seen to be related to the cultural characteristics, and migration. Some cultural characteristics can be summarized as “believing that breastfeeding harms mother’s health”, “adolescent marriages”, “wanting to have as many children as possible”, “giving anise to infants and not breastfeeding at night”, “prelacteal feeding”, “believing that milk is not enough”, “over controlling mother–child interaction by grandmothers, which limits the interaction”, “short pregnancy intervals”, and “not using modern family planning techniques”. We found out that migration increased the tendency for adolescent pregnancies, deepened the poverty, and decreased family social support. We did not observe any change in breastfeeding practices during pandemics.

Conclusions

Breastfeeding counseling programs should be designed in consideration of cultural characteristics of Syrian HCWs and family members. Continuing health education programs for family members with socially appropriate interventions to prevent adolescent marriages are important.

"COVID affected us all:" the birth and postnatal health experiences of resettled Syrian refugee women during COVID-19 in Canada

BACKGROUND

Prior to COVID-19, postnatal resettled refugee women in Canada reported barriers to healthcare and low levels of social support, contributing to maternal health morbidities. The COVID-19 pandemic appears to be further exacerbating health inequities for marginalized populations. The experiences of resettled refugee women are not fully known.

AIM

To understand Syrian refugee women's experiences accessing postnatal healthcare services and supports during the COVID-19 pandemic.

METHODS

Semi-structured, virtual interviews were conducted with eight resettled Syrian refugee women living in Nova Scotia (Canada) who were postnatal between March and August 2020. Data analysis was informed by constructivist grounded theory.

FINDINGS

Three themes emerged: "the impacts of COVID-19 on postnatal healthcare;" "loss of informal support;" and "grief and anxiety." Women experienced difficult healthcare interactions, including socially and physically isolated deliveries, challenges accessing in-person interpreters, and cancelled or unavailable in-home services (e.g., public health nurse and doula visits). Increased childcare responsibilities and limited informal supports due to pandemic restrictions left women feeling overwhelmed and exhausted. Stay-at-home orders resulted in some women reporting feelings of isolation and loss, as they were unable to share in person postnatal moments with friends and family, ultimately impacting their mental wellness.

CONCLUSIONS

COVID-19 and associated public health restrictions had significant impacts on postnatal Syrian refugee women. Data presented in this study demonstrated the ways in which the pandemic environment and related restrictions amplified pre-existing barriers to care and postnatal health inequalities for resettled refugee women-particularly a lack of postnatal informal supports and systemic barriers to care.