Infants born to first-time mothers with a refugee background faced an increased risk of regulatory problems

AIM

This study investigated the association between mothers' migration background and infant regulatory problems and analysed the mediating role of maternal mental health. We also explored whether the child's sex, parity and length of residence moderated the effect of a maternal migrant background.

METHODS

Child health surveillance data from the Danish home visiting programme were used. Community health nurses followed infants from birth to 12 months of age. The source population comprised 103 813 infants born between 1 January 2008 and 31 December 2018. The final sample comprised 62 964 infants, including 3.4% with a refugee background. A maternal migrant background was the primary exposure. The results are presented as risk ratios (RR) and 95% confidence intervals (CI).

RESULTS

A maternal refugee background increased the risk of regulatory problems in offspring (RR 1.34, 95% CI: 1.18-1.51). The effect was partially mediated by maternal postpartum mental health concerns. The association between maternal refugee background and infant regulatory problems was more pronounced in first-time mothers (RR 1.80, 95% CI: 1.51-2.15).

CONCLUSION

The risk of infant regulatory problems was higher in the first-born children of refugee mothers. First-time refugee parents may need tailored support to identify mental health needs and infants with regulatory problems.

Universal screening for postpartum depression? Inequalities and barriers among immigrant mothers

Background

Postpartum depression (PPD) is a serious public health concern affecting 12% of women globally. Early detection is necessary to provide timely support. In Scandinavian countries, universal screening is recommended. However, migrant women, who are at increased risk of PPD, seem to be screened less often. Still, there is limited knowledge about 1) how acculturation relates to screening, and 2) how healthcare providers navigate PDD screening with migrant women.

Aims and methods

We used a mixed-methods approach to explore whether and why inequalities in PPD screening using the Edinburgh postpartum depression scale (EPDS) may exist in the context of universal PPD screening within the free home-visiting program in Denmark. Data from 77,694 infants and their mothers participating in the Danish home-visiting program (2015-2018) was used to examine the prevalence of participation in PPD screening and its association with migrant status and acculturation factors. We interviewed 16 health visitors to examine qualitatively challenges and strategies used when assessing PPD among immigrant mothers.

Results

Immigrant women were 80% more likely to lack screening (adj. RR 1.81-1.90). All factors indicating lower acculturation, such as shorter length of residence, older age at migration, and having studied abroad were independently associated with increased risk of lack of screening. Thematic analysis of qualitative data showed how cultural and linguistic differences and organizational constraints limit health visitors’ ability to assess immigrant women's mental health needs. Although health visitors often used EPDS as an opener to talk about mental health, they did not use it as an ‘assessment’.

Conclusions

This study shows inequalities in PPD screening than may result in reduced use of mental health services among immigrant women. The experiences of health visitors shed light on how to improve the identification of PPD among immigrant mothers.

Key messages

• Migrant women in Denmark, even those who have migrated as children, are at risk of being left out of PPD screening programs.

• Limited organizational support and cultural competences makes PPD screening among immigrant women not feasible for maternal health visitors.

Disparities in postpartum depression screening participation between immigrant and Danish-born women

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.

Prolonged family separation is associated with increased risk of mental disorders among refugee fathers

Background

Refugees resettled in Western countries experience long periods of family separation due to waiting first for asylum, and then for family reunification. This study aimed to examine if family separation is associated with psychiatric disease among refugee fathers.

Methods

We traversed full-population Danish administrative data since 1986 to establish a cohort of refugee fathers from nuclear families in which the father was the first to arrive and resettled alone during 1995-2015, and where the mother and children were later family reunified. We followed these fathers for up to 24 years from the day their residence permit was issued until their first psychiatric diagnosis, emigration, death, or study end, whichever came first. Using Cox proportional hazard regression, we estimated the temporary and longer-term risks of psychiatric disorders for i) the total family separation period, and ii) the family separation decomposed into time waiting for, respectively, asylum and family reunification.

Results

6176 fathers were included in the study. The HR assessing the temporary risk of psychiatric disorders was 2.23[95% CI: 1.72-2.89] for separated fathers compared with those who were already family reunified. As to the longer-term risk, compared with fathers separated for 0-9 months, the HR of psychiatric disorders was 1.54[1.08-2.21] after +9-12 months of separation, increasing to 1.84[1.29-2.62] after +24 months of separation. The decomposition analysis revealed that +6 months of waiting increased the risk of any psychiatric disorder by approximately 40% for both time waiting for asylum and time waiting for family reunification.

Conclusions

Strong evidence supports that fathers waiting for their wives and children face an increased risk of psychiatric disease. Countries receiving refugees should be aware that delayed family reunification can lead to adverse mental health effects.

Key messages

Family separation is associated with an increased risk of psychiatric disease among refugee fathers—both while the fathers are separated from their families and after family reunification. The risk of psychiatric disease is more than double among refugee fathers still separated from their family compared with those who have been family reunified.