1
|
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.
Collapse
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
| |
Collapse
|
2
|
Alnaji NA, Tippens JA, ElRayes W. Syrian Refugee Women's Maternal Mental Health Perceptions, Coping Strategies, and Help-Seeking Practices in Lebanon. J Transcult Nurs 2023; 34:270-278. [PMID: 37039470 DOI: 10.1177/10436596231163876] [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] [Indexed: 04/12/2023] Open
Abstract
INTRODUCTION Globally, 27 million female refugees of reproductive age are subjected to numerous socio-ecological factors that increase their risks of mental health issues, especially during the postpartum period. This study seeks to explore Syrian refugee mothers' experiences and perceptions of postpartum depression. METHODS We used a qualitative phenomenological approach to interview purposively sampled typical postpartum Syrian mothers living in informal camps in Lebanon to evaluate their maternal mental health perceptions, coping strategies, and help-seeking practices. RESULTS Results revealed three major themes: conceptualizing maternal depression as extraordinary and ordinary, cultural perceptions of mental health help-seeking, and coping with negative emotions. DISCUSSIONS Findings are critical to Lebanon and other Muslim refugee-hosting countries as they can inform future health policies, health care delivery models, and community interventions. Utilizing culturally and religiously appropriate frameworks in assessing and providing mental health services to this vulnerable group can substantially improve mental health services' acceptance, utilization, and impact.
Collapse
Affiliation(s)
| | | | - Wael ElRayes
- University of Nebraska Medical Center, Omaha, USA
| |
Collapse
|
3
|
Kassam S, Marcellus L. Creating safe relational space: Public health nurses work with mothering refugee women. Public Health Nurs 2022; 39:1280-1287. [PMID: 35689836 DOI: 10.1111/phn.13096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/29/2022] [Accepted: 05/04/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Exploring how public health nurses (PHNs) provide community-based support to women who are refugees and mothering. DESIGN A constructivist grounded theory (CGT) design was used where intersectionality as an analytical tool was applied. Varying data collection approaches including focus groups were used. SAMPLE Twelve PHNs from four public health units in Western Canada participated in this study. RESULTS Participants in this study described an overall process of creating safe relational space to address a basic social problem of establishing trust while managing structural forces. This overarching process was expressed through burning with passion, connecting while looking beyond, protecting from re-traumatization, and fostering independence. Findings reveal strategies PHNs used to enhance health equity. This study extends critical caring theory to include sociopolitical and economic influences on public health nursing practice. Consequences of these influences on the mothering refugee women population are also revealed. Implications include structural integration of trauma-and-violence-informed principles to support public health nursing practice. CONCLUSIONS This study adds to an emerging body of knowledge on PHNs work with complex populations. Innovative application of intersectionality is demonstrated as an effective approach to analyzing impacts of broad sociopolitical priorities on communities that are systemically marginalized.
Collapse
Affiliation(s)
- Shahin Kassam
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - Lenora Marcellus
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| |
Collapse
|
4
|
Chrzan-Dętkoś M, Rodríguez-Muñoz MF, Krupelnytska L, Morozova-Larina O, Vavilova A, López HG, Murawaska N, Radoš SN. Good Practices in Perinatal Mental Health for Women during Wars and Migrations: A Narrative Synthesis from the COST Action Riseup-PPD in the Context of the War in Ukraine. CLÍNICA Y SALUD 2022. [DOI: 10.5093/clysa2022a14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
|
5
|
Ewesesan R, Chartier MJ, Nickel NC, Wall-Wieler E, Urquia ML. Psychosocial and behavioral health indicators among immigrant and non-immigrant recent mothers. BMC Pregnancy Childbirth 2022; 22:612. [PMID: 36008777 PMCID: PMC9413808 DOI: 10.1186/s12884-022-04937-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Perinatal risk factors can vary by immigration status. We examined psychosocial and behavioral perinatal health indicators according to immigration status and immigrant characteristics. METHODS We conducted a population-based cross-sectional study of 33,754 immigrant and 172,342 non-immigrant childbearing women residents in Manitoba, Canada, aged 15-55 years, who had a live birth and available data from the universal newborn screen completed within 2 weeks postpartum, between January 2000 and December 2017. Immigration characteristics were from the Canadian federal government immigration database. Logistic regressions models were used to obtain Odds Ratios (OR) with 95% confidence intervals (CI) for the associations between immigration characteristics and perinatal health indicators, such as social isolation, relationship distress, partner violence, depression, alcohol, smoking, substance use, and late initiation of prenatal care. RESULTS More immigrant women reported being socially isolated (12.3%) than non-immigrants (3.0%) (Adjusted Odds Ratio (aOR): 6.95, 95% CI: 6.57 to 7.36) but exhibited lower odds of depression, relationship distress, partner violence, smoking, alcohol, substance use, and late initiation of prenatal care. In analyses restricted to immigrants, recent immigrants (< 5 years) had higher odds of being socially isolated (aOR: 9.04, 95% CI: 7.48 to 10.94) and late initiation of prenatal care (aOR: 1.50, 95% CI: 1.07 to 2.12) compared to long-term immigrants (10 years or more) but lower odds of relationship distress, depression, alcohol, smoking and substance use. Refugee status was positively associated with relationship distress, depression, and late initiation of prenatal care. Secondary immigrants, whose last country of permanent residence differed from their country of birth, had lower odds of social isolation, relationship distress, and smoking than primary migrants. There were also differences by maternal region of birth. CONCLUSION Immigrant childbearing women had a higher prevalence of social isolation but a lower prevalence of other psychosocial and behavioral perinatal health indicators than non-immigrants. Health care providers may consider the observed heterogeneity in risk to tailor care approaches for immigrant subgroups at higher risk, such as refugees, recent immigrants, and those from certain world regions.
Collapse
Affiliation(s)
- Roheema Ewesesan
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Mariette J Chartier
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Nathan C Nickel
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Elizabeth Wall-Wieler
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Marcelo L Urquia
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada. .,Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
6
|
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.
Collapse
|
7
|
Firth A, Haith-Cooper M, Dickerson J, Hart A. Perinatal depression: Factors affecting help-seeking behaviours in asylum seeking and refugee women. A systematic review. J Migr Health 2022; 6:100128. [PMID: 36110501 PMCID: PMC9467873 DOI: 10.1016/j.jmh.2022.100128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/30/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Amanda Firth
- University of Huddersfield, Queensgate, Huddersfield, West Yorkshire HD1 3DH, UK
- Corresponding author.
| | | | - Josie Dickerson
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford Institute for Health Research, UK
| | | |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
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.
Collapse
|
10
|
Frank GD, Fox D, Njue C, Dawson A. The maternity experiences of women seeking asylum in high-income countries: a meta-ethnography. Women Birth 2021; 34:531-539. [PMID: 33414082 DOI: 10.1016/j.wombi.2020.12.012] [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: 07/29/2020] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Abstract
PROBLEM The maternity care experiences and perinatal outcomes of women seeking asylum in high-income countries (HICs) are poorer than the general population of pregnant women in that HIC. There is a paucity of literature on the maternity experiences of women seeking asylum in HICs. BACKGROUND There is an increasing number of women seeking asylum in HICs due to escalating violence and human rights abuses. Asylum-seeking women are a distinct group whom are likely to have different needs to refugees or migrants as a result of their undocumented status. AIM This literature review aimed to explore the emotional, physical and health information needs of women seeking asylum in the perinatal period in HICs, to provide insights to better address their maternity needs. METHOD A meta-ethnography described by Noblit and Hare, was applied to analyse the studies, to reflect the voices of women seeking asylum, hosted in HICs in their perinatal period. FINDINGS Eight studies were included in the review. The overarching theme was 'just having to survive.' Four sub-themes were revealed which highlighted the vulnerability of asylum-seeking women. They included: 'I was never sure if I had understood', 'feeling ignored and alone', 'ongoing dislocation and recurrent relocation' and 'knowing there's someone who cares for you'. DISCUSSION Improved maternity care for women seeking asylum requires culturally appropriate respectful maternity care and supportive strategies such as consistent access to language services. CONCLUSION It is recommended that future research is targeted to explore the maternity experience of women seeking asylum in HICs, such as Australia.
Collapse
Affiliation(s)
- Glenys D Frank
- University of Technology (UTS), Sydney, PO Box 123, Broadway, NSW, 2007, Australia.
| | - Deborah Fox
- University of Technology (UTS), Sydney, PO Box 123, Broadway, NSW, 2007, Australia
| | - Carolyne Njue
- University of Technology (UTS), Sydney, PO Box 123, Broadway, NSW, 2007, Australia
| | - Angela Dawson
- University of Technology (UTS), Sydney, PO Box 123, Broadway, NSW, 2007, Australia
| |
Collapse
|
11
|
Kassam S, Marcellus L, Butcher D. Experiences of nurses caring for maternal immigrant and refugee women: a qualitative systematic review protocol. JBI Evid Synth 2020; 18:2416-2424. [PMID: 32813433 DOI: 10.11124/jbisrir-d-19-00222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This review will focus on studies inquiring into nurses working across diverse health care settings and their experiences of caring for immigrant and refugee women who are pregnant or mothering. Within this review, diverse terminologies used to conceptualize "nurse," immigrant," and "refugee" will also be captured. INTRODUCTION Immigrant and refugee women who are pregnant or mothering experience poorer health than non-displaced women. Nurses are pivotal in providing care to this population. Understanding nursing experiences can reveal structural barriers and facilitators to equitable care provision. INCLUSION CRITERIA Peer-reviewed, qualitative studies that include nurses working across diverse health care settings and providing care to involuntary immigrant and refugee maternal women will be considered. Studies where nurses are described as being educated within a basic and generalized nursing program and have been authorized by a regulatory organization to practice nursing in their country will be included. METHODS Key information sources searched include CINAHL, PsycINFO, MEDLINE, Google Scholar, Web of Science, and PubMed. Search terms will be adapted for each information source. Study selection includes screening titles and abstracts by two independent reviewers against the inclusion criteria. These reviewers will then critically appraise for methodological quality and begin data extraction to understand experiences of nurses and diverse understandings of "nurse," "immigrant," and "refugee." Synthesis includes assembling and categorizing findings on the basis of meaning similarity. A set of statements will be generated representing this synthesis. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42019137922.
Collapse
Affiliation(s)
- Shahin Kassam
- School of Nursing, Victoria, BC, Canada
- The University of Victoria (UVic) Centre for Evidence-Informed Nursing and Healthcare (CEiNHC): A JBI Affiliated Group, Victoria, BC, Canada
| | - Lenora Marcellus
- School of Nursing, Victoria, BC, Canada
- The University of Victoria (UVic) Centre for Evidence-Informed Nursing and Healthcare (CEiNHC): A JBI Affiliated Group, Victoria, BC, Canada
| | - Diane Butcher
- The University of Victoria (UVic) Centre for Evidence-Informed Nursing and Healthcare (CEiNHC): A JBI Affiliated Group, Victoria, BC, Canada
- Employment & Social Development Canada, Victoria, BC, Canada
| |
Collapse
|
12
|
Exploring the State of Gender-Centered Health Research in the Context of Refugee Resettlement in Canada: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207511. [PMID: 33076467 PMCID: PMC7602644 DOI: 10.3390/ijerph17207511] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 11/16/2022]
Abstract
Interdisciplinary health research that investigates gender as a relational process is necessary to facilitate a safe and healthy resettlement process for refugees in Canada. This scoping review explores the range, nature, and extent of published research examining gender in relation to refugee health during resettlement in Canada. An initial search of six databases yielded 7325 articles published before June 2019. A total of 34 articles published between 1988 and 2019 were included for in-depth review. Articles meeting inclusion criteria primarily focused on refugee women. Categories of focus included maternal health, social and emotional health, health impacts of sexual and gender-based violence and torture, access to health and social services, decision-making and health-seeking behavior, mental health, and sexual and reproductive health. Our thematic analysis identified connections between gender roles, expectations, ideals, and health through interactions and lived experiences within the family, community, and healthcare system. Review findings suggest that many refugee women are influenced by pervasive gender roles and expectations as well as exposed to gendered health systems and practices that may pose risks to health, particularly mental health and access to services. Further efforts should be made to understand processes and experiences of resilience and community building in countering negative impacts of gendered beliefs and practices on health during resettlement.
Collapse
|
13
|
Haque S, Malebranche M. Impact of culture on refugee women's conceptualization and experience of postpartum depression in high-income countries of resettlement: A scoping review. PLoS One 2020; 15:e0238109. [PMID: 32870929 PMCID: PMC7462258 DOI: 10.1371/journal.pone.0238109] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 08/09/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The global refugee population has reached a staggering 25.9 million. Approximately 16% of global refugees resettle in high-income countries which are often culturally very different from their home countries. This can create cross-cultural challenges when accessing health services, leading to inappropriate assessments, diagnoses and treatments if cultural background is not factored in. The impact of culture on the conceptualization and experience of postpartum depression (PPD) amongst migrant women has received growing attention in recent years, however, a specific focus on refugee and asylum-seeking women is lacking. Given the unique mental health challenges refugee women face, it is hypothesized that the interplay between culture and postpartum depression amongst refugee women may differ from other migrant women. Therefore, a scoping review was conducted to characterize what is known about the impact of culture on the conceptualization and experience of PPD in refugee women resettled in high-income countries. METHODS AND FINDINGS This study was conducted as a scoping review in accordance with the Joanna Briggs Institute's Methodology for Scoping Reviews. A systematic search of studies addressing the relationship between culture and postpartum depression amongst refugee women (including asylum-seeking women) resettled in high-income countries was conducted across 6 databases including MEDLINE, PsycINFO and SOCINDEX between June 2018 and August 2019. A total of 637 articles were found. Studies were eligible if they focused on refugee women who had a pregnancy during forced migration or upon resettlement in a high-income country and focused on the impact of culture on women's conceptualization and/or experience of PPD. Eight studies met inclusion criteria and were included in the final analysis, the majority of which were qualitatively driven. Four key themes emerged: 1) there are diverse conceptualizations and experiences of postpartum depression amongst refugee women; 2) mental health stigma has a significant impact on women's conceptualizations and experiences of postpartum depression and help-seeking behaviors; 3) cultural traditions and social support play protective roles in postpartum mental wellbeing; and, 4) host culture has a significant influence on the pregnancy and postpartum experience of refugee women. The overall themes align with those seen in the literature on migrant women in general, however significant research gaps remain. CONCLUSION The studies identified through this scoping review provide a rich description of the significant impact culture has on the conceptualization and experience of postpartum depression among refugee women resettled in high-income countries. Though overall themes align with those seen in the literature on migrant women in general, further research is needed to better characterize how culture impacts refugee women's experiences of PPD as a distinct sub-group of migrant women.
Collapse
Affiliation(s)
| | - Mary Malebranche
- Department of Medicine, Cumming School Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
14
|
Pregnant and undocumented: taking work into account as a social determinant of health. INTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE 2020. [DOI: 10.1108/ijmhsc-04-2019-0046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PurposeIt is well understood that women’s work situations are critical to their well-being during pregnancy and in terms of potential risks to the fetus. It has also long been known that undocumented women workers face particularly difficult work conditions and being undocumented precludes access to key social benefits (i.e. public health insurance, paid maternity leave, child benefits and subsidized daycare) that support pregnant women and new mothers. Yet, this paper aims to write about the intersection of undocumented women’s pregnancy with work experiences.Design/methodology/approachDrawing on the results of a broader qualitative study that was focussed on access to healthcare for undocumented (and therefore, uninsured) women who were pregnant and gave birth in Montreal, Canada, the authors begin this paper with a review of the relevant literature for this topic related to the work conditions of undocumented women, how work exacerbates barriers to accessing healthcare and the resulting health outcomes, particularly in relation to pregnancy. The authors highlight the social determinants of health human rights framework (Solar and Irwin, 2010), before presenting methodology. In conclusion, the authors discuss how an understanding of undocumented women’s work situations sheds light on their pregnancy experiences.FindingsThe authors then present participants’ work conditions before becoming pregnant, working conditions while pregnant and employment options and pressures after giving birth.Originality/valueThe authors emphasize that attention to undocumented pregnant women’s work situations might help health and social service practitioners to better serve their needs at this critical point in a woman’s life and at the beginning of the life of their children, born as full citizens.
Collapse
|
15
|
Kassam S. Understanding Experiences of Social Support as Coping Resources among Immigrant and Refugee Women with Postpartum Depression: An Integrative Literature Review. Issues Ment Health Nurs 2019; 40:999-1011. [PMID: 31070499 DOI: 10.1080/01612840.2019.1585493] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Lack of social support increases the risk of postpartum depression (PPD), especially among immigrant and refugee women. In this integrative literature review, I aim to synthesize the current state of knowledge on social support experiences among immigrant and refugee women with PPD. Conceptualization of social support as coping resources occurs through Stewart's coping theory. Eleven primary sources were located using Whittemore and Knafl's review methods. These methods are philosophically underpinned by Racine's postcolonial feminist lens. In synthesizing literature located, themes were generated and include the following: maintaining cultural identity, connecting with a community, connecting with spirit (subtheme), relational space imparted by health care providers, and seeking and exchanging knowledge. Co-existing issues emerged from this review and capture broad determinants influential in shaping immigrant and refugee experiences of social support. These included: experience of poverty, connecting to maintain gender-driven roles, and experience of trauma and abuse. Interconnectedness of these themes and issues are depicted in a data display to demonstrate complexity. Drawing on these findings, I propose practice implications for nurses working in psychiatric and public health facilities. I also offer future research ideas and policy development recommendations based on the generated findings of this review.
Collapse
Affiliation(s)
- Shahin Kassam
- School of Nursing, University of Victoria, Victoria, Canada
| |
Collapse
|
16
|
Winn A, Hetherington E, Tough S. Caring for pregnant refugee women in a turbulent policy landscape: perspectives of health care professionals in Calgary, Alberta. Int J Equity Health 2018; 17:91. [PMID: 29940958 PMCID: PMC6019511 DOI: 10.1186/s12939-018-0801-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 06/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Female refugees can be a vulnerable population, often having suffered through traumatic events that pose risks to their health, especially during pregnancy. Pregnancy can be an entry point into the health care system, providing health care professionals the opportunity to gain women's trust, connect refugees with resources, and optimize the health of mother and child. Policies surrounding the provision and funding of health care services to refugees can impact access to and quality of care. The aim of our study was to understand the experiences of health care professionals caring for pregnant refugee women in Calgary, AB, taking into consideration recent contextual changes to the refugee landscape in Canada. METHODS We conducted ten semi-structured interviews with health care professionals who provided regular care for pregnant refugee women at a refugee health clinic and major hospital in Calgary, Alberta. Interviews were recorded, transcribed, and analyzed using an interpretive description methodology. RESULTS Health care providers described several barriers when caring for pregnant refugees, including language barriers, difficulty navigating the health care system, and cultural barriers such as managing traditional gender dynamics, only wanting a female provider and differences in medical practices. Providers managed these barriers through strategies including using a team-based approach to care, coordinating the patient's care with other services, and addressing both the medical and social needs of the patient. The federal funding cuts added additional challenges, as many refugees were left without adequate health coverage and the system was complicated to understand. Health care providers developed creative strategies to maximize coverage for their patients including paying out of pocket or relying on donations to care for uninsured refugees. Finally, the recent Syrian refugee influx has increased the demand on service providers and further strained already limited resources. CONCLUSION Health care providers caring for pregnant refugee women faced complex cultural and system-level barriers, and used multiple strategies to address these barriers. Additional system strains add extra pressure on health care professionals, requiring them to quickly adjust and accommodate for new demands.
Collapse
Affiliation(s)
- Anika Winn
- Department of Health and Science Education, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Erin Hetherington
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
- Owerko Centre, Child Development Centre, #355, 3820- 24 Avenue NW, Calgary, AB T3B2X9 Canada
| | - Suzanne Tough
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
- Owerko Centre, Child Development Centre, #355, 3820- 24 Avenue NW, Calgary, AB T3B2X9 Canada
| |
Collapse
|
17
|
Ahmed A, Bowen A, Feng CX. Maternal depression in Syrian refugee women recently moved to Canada: a preliminary study. BMC Pregnancy Childbirth 2017; 17:240. [PMID: 28738869 PMCID: PMC5525250 DOI: 10.1186/s12884-017-1433-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 07/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Refugee women are almost five times more likely to develop postpartum depression than Canadian-born women. This can be attributed to various difficulties they faced before coming to Canada as well as during resettlement. Moreover, refugee women usually face many obstacles when accessing health services, including language and cultural barriers, as well as unique help-seeking behaviors that are influenced by various cultural and practical factors. There has been a recent, rapid influx of Syrian refugees to Canada, and many of them are childbearing women. However, little is known about the experiences that these women have encountered pre- and post-resettlement, and their perceptions of mental health issues. Thus, there is an urgent need to understand refugee women's experiences of having a baby in Canada from a mental health perspective. METHODS A mixed methods research design included 12 Syrian refugee women who migrated to Saskatoon in 2015-16 and who were either pregnant or 1 year postpartum. The data were collected during a single focus group discussion and a structured questionnaire. RESULTS Our results showed that more than half of participants have depressive symptoms, half of them have anxiety symptoms, and one sixth have PTSD symptoms. Three major themes emerged from the qualitative data: 1) Understanding of maternal depression; 2) Protective factors for mental health; and 3) Barriers to mental health services. CONCLUSIONS Maternal depression is an important feature in Syrian refugee women recently resettled in Canada. Reuniting these women with their families and engaging them in culturally appropriate support programs may improve their mental health outcomes.
Collapse
Affiliation(s)
- Asma Ahmed
- School of Public Health, University of Saskatchewan, Saskatoon, Canada
| | - Angela Bowen
- College of Nursing, University of Saskatchewan, 104 Clinic Place, Health Sciences Building, Room 4246, Saskatoon, SK, S7N 2Z4, Canada.
| | - Cindy Xin Feng
- School of Public Health, University of Saskatchewan, 104 Clinic Place, Health Sciences Building, Room 3338, Saskatoon, SK, S7N 2Z4, Canada
| |
Collapse
|
18
|
Vigod SN, Bagadia AJ, Hussain-Shamsy N, Fung K, Sultana A, Dennis CLE. Postpartum mental health of immigrant mothers by region of origin, time since immigration, and refugee status: a population-based study. Arch Womens Ment Health 2017; 20:439-447. [PMID: 28378153 DOI: 10.1007/s00737-017-0721-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 03/22/2017] [Indexed: 01/09/2023]
Abstract
Immigrant women are at high risk for postpartum mental disorders. The purpose of this study was to understand how rates of postpartum mental health contact differ among immigrant women by region of origin, time since immigration, and refugee status. We conducted a population-based cohort study of immigrant mothers in Ontario, Canada, with children born from 2008 to 2012 (N = 123,231). We compared risk for mental health contact (outpatient, emergency department, inpatient hospitalization) in the first postpartum year by region of origin, time since immigration, and refugee status, generating adjusted odds ratios (aOR) and 95% confidence intervals (CI). Immigrants from North Africa and the Middle East were more likely to have outpatient mental health contact than a referent group of immigrants from North America or Europe (aOR 1.07, 95% CI 1.01-1.14); those from East Asia and the Pacific, Southern Asia, and Sub-Saharan Africa were less likely (0.64, 0.61-0.68; 0.78, 0.74-0.83; 0.88, 0.81-0.94). Refugees were more likely to have contact than non-refugees (1.10, 1.04-1.15); those in Canada <5 years were less likely than longer-term immigrants (0.83, 0.79-0.87). Refugees were more likely to have an emergency department visit (1.81, 1.50-2.17) and a psychiatric hospitalization than non-refugees (1.78, 1.31-2.42). These findings have implications for targeted postpartum mental health service delivery targeting certain immigrant groups and particularly refugees.
Collapse
Affiliation(s)
- Simone N Vigod
- Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, Canada. .,University of Toronto, 27 King's College Circle, Toronto, ON, Canada. .,Institute for Clinical Evaluative Sciences, Veterans Hill Trail, 2075 Bayview Avenue G1 06, Toronto, ON, Canada.
| | - Ashlesha J Bagadia
- Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, Canada
| | - Neesha Hussain-Shamsy
- Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, Canada
| | - Kinwah Fung
- Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Veterans Hill Trail, 2075 Bayview Avenue G1 06, Toronto, ON, Canada
| | - Anjum Sultana
- University of Toronto, 27 King's College Circle, Toronto, ON, Canada
| | - Cindy-Lee E Dennis
- Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, Canada.,University of Toronto, 27 King's College Circle, Toronto, ON, Canada
| |
Collapse
|
19
|
Hansotte E, Payne SI, Babich SM. Positive postpartum depression screening practices and subsequent mental health treatment for low-income women in Western countries: a systematic literature review. Public Health Rev 2017; 38:3. [PMID: 29450075 PMCID: PMC5809911 DOI: 10.1186/s40985-017-0050-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/18/2017] [Indexed: 11/10/2022] Open
Abstract
Problem statement and significance Left undiagnosed and/or untreated, the short-and long-term sequelae of postpartum depression may negatively impact both mother and child. In Western countries, access to mental health care is influenced by socioeconomic factors. The objective of this systematic literature review is to compile factors that hinder and improve access to postpartum depression treatment in low-income women after a positive screen for postpartum depression. The key question of focus is: what are the characteristics associated with access to mental health treatment for low-income women with a positive postpartum depression screen in Western countries? Methods A PRISMA-based systematic literature review was conducted of studies published in English before February 2016 that looked at treatment for postpartum depression in low-income women who had been identified with the condition. PubMed and EBSCO databases were searched using MESH and key terms and found 100 articles that met the selection criteria. After review by two independent researchers, 18 studies with 17 unique populations were included in the literature review. Results Two independent abstractors searched the included articles for themes surrounding impediments and advantages for low-income women identified with postpartum depression in obtaining mental health treatment. Characteristics of successful mental health treatment included studies that employed the use of a home visitor and those that separated outcomes for women with previous mental health treatment. Themes that emerged as treatment obstacles included cultural barriers, physical barriers, systemic health care barriers, and social barriers. Implications for practice This review will help to better inform screening and treatment priorities for those in the medical field who may encounter women experiencing postpartum depression and are not aware of the various barriers to care specific to low-income women. This review will also help policymakers identify specific obstacles that are not addressed in postpartum screening mandate policies which can affect the implementation of these policies.
Collapse
Affiliation(s)
- Elinor Hansotte
- 1Department of Health Policy and Management, Indiana University Richard M Fairbanks School of Public Health at IUPUI, 1050 Wishard Blvd, Indianapolis, IN 46202 USA
| | - Shirley I Payne
- 2Department of Applied Health Science, Indiana University School of Public Health, 1025 E. 7th Street, Suite 111, Bloomington, IN 47405 USA
| | - Suzanne M Babich
- 1Department of Health Policy and Management, Indiana University Richard M Fairbanks School of Public Health at IUPUI, 1050 Wishard Blvd, Indianapolis, IN 46202 USA
| |
Collapse
|
20
|
The Association Between Postnatal Depression, Acculturation and Mother–Infant Bond Among Eritrean Asylum Seekers in Israel. J Immigr Minor Health 2016; 18:1232-1236. [DOI: 10.1007/s10903-016-0348-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|