First-generation Nigerian mothers living in the UK and their experience of postnatal depression: an interpretative phenomenological analysis

Abstract

Objective: Previous studies emphasise the negative psychological and physical consequences of Postnatal Depression (PND) on mothers and children's health.In the UK, around 10-20% of women can be affected by perinatal mental health problems. Minority ethnic groups such as Black African mothers are considered to be at greater risk of developing PND and data estimates that immigrant mothers are twice more likely to develop PND than native mothers. The unique experiences and needs of this culturally diverse group remain little explored in the UK. To address this gap in the literature, this study aimed to explore the lived experiences of First-Generation Nigerian Mothers (FGNMs) who suffered PND, their coping behaviours and treatment experiences in the UK.Design: Six FGNMs with a previous diagnosis of PND and treatment experiences were purposefully recruited from GP practices and social groups attended by Nigerian mothers in the UK. Semi-structured interviews were analysed using Interpretative Phenomenological Analysis.Results: Three master and seven subordinate themes were identified: (i) Sociocultural factors (Inter-generational transmission; cultural perceptions: shame and stigma; transitions: adjusting to a new culture); (ii) What about me? The neglected nurturer (experiences of treatment; pretending to be OK); and (iii) Loneliness and coping (lack of support from partner; self-reliance). Conclusions:The study provides evidence about the difficulties encountered by FGNMs in relation to PND, including socio-cultural factors, neglect from family and healthcare professionals, and self-reliance as a coping strategy. Contrary to reports suggesting that Black ethnic groups do not seek help for their mental health needs, participants' accounts indicated that their attempts to engage with professionals were met with unsatisfactory responses. The findings of this study highlight the need to address barriers affecting access to services by fostering a patient-centred and culturally sensitive approach in healthcare teams to effectively engage mothers at an early stage in the detection pathway.

Mental health and mental health help-seeking behaviors among first-generation voluntary African migrants: A systematic review

“…In addition to conceptualization, four other dominant themes emerged on PND: (1) isolation–a lack of social, cultural support (i.e., lack of hands-on support for mother and child from immediate family and community), emotional support (i.e., having someone to talk to), and professional support (i.e., lack of on-going support from professional postpartum); (2) loss of identity, including loss of one’s old self and old life (mourning the loss of who they once were); (3) issues of trust—distrust in others due to fear of betrayal and fear of stigma (from community members); (4) relationships facilitate recovery–work and other activities are helpful distractors, better relationship with baby was helpful for recovery, maternal support services and groups help reduce distress and facilitate recovery. In a related study, Ling et al [ 41 ] assessed the lived experiences of Nigerian mothers in the UK who had experienced PND. Three main themes were identified, including seven sub-themes: (i) Socio-cultural factors (inter-generational expectation to conform to the strong Black woman identify; cultural perceptions of shame and stigma around PND made it difficult for women to open up; and transitions/adjusting to a new culture led to isolation and loss of community support); (ii) What about me?…”

“…Barriers were explored only in the studies, which investigated PND in migrant women of African origin [ 39 – 41 ]. Barriers identified included African cultural beliefs about mental health (e.g., bewitchment), cultural expectation to be a strong woman, cultural shame and stigma around mental health challenges, racial discrimination from health providers during maternal care, neglect from health visitors and midwives due to excessive focus on the child’s health and limited focus on the mother’s wellbeing, neglect from GPs, and GPs limited tendency to involve new mothers in treatment decisions, temporary immigration status (which often limits their accessibly to health care services), stress of navigating the health system [ 39 , 41 , 42 ], lack of support from partner, and lack of trust of others in community due to fear of stigma and profiling [ 40 , 41 ]. Facilitators of help-seeking behaviors reported in the other studies were proficiency in the English language ( p = 0.010) and a higher level of education ( p = 0.002)- in the USA migrant group [ 35 ]; sensitizing migrant women about maternal mental health and postpartum mental health services, reaching out to immigrant women, providing services that protest their confidentiality (e.g., online services) [ 39 ], and having access to health professionals that could provide a safe space for confidential conversations–in new-born mothers with PND [ 40 ].…”

“…This review also included four studies exploring perceptions [ 39 , 42 ] and lived experience [ 40 , 41 ] of PND in first-generation voluntary African migrant women, all of whom emigrated from sub-Saharan Africa. Falah-Hassani et al [ 22 ] reported that migrant women are twice as likely to experience PND compared to non-migrant women, highlighting a greater vulnerability in this group.…”

“…This highlights a fundamental difference in conceptualization and the need to understand this condition and the care needs of these women from a culturally sensitive perspective. Factors perceived to influence risk of PND across studies included isolation due to lack of social, cultural, emotional support and on-going professional support; loss of self and identity; lack of trust in community due to fear of stigma and betrayal [ 40 , 41 ]; ability to nurture their child and home; their infant’s state of wellbeing; worry over family’s financial status; lack of spousal support [ 39 ], inter-generational expectation to conform to the strong Black woman identify; cultural perceptions of shame and stigma around PND; transitions/adjusting to a new culture leading to isolation and loss of access to community; tendency to be self-reliant due to lack of support [ 41 ] breastfeeding (due to associated pain and discomfort); infant’s temperament (e.g., sleep problems); and accommodation problems (e.g., limited space) [ 42 ].…”

Unequal Care: Examining the intersection of multifactorial factors contributing to suboptimal perinatal outcomes: A scoping review and implications for perinatal services in the UK

“…First-generation Nigerian mothers living in the UK 45 encountered di culties with post-natal depression, including neglect from family and healthcare professionals, and self-reliance as a coping strategy. Contrary to reports suggesting that black ethnic groups do not seek help for their mental health needs 44 , mothers reported that their attempts to engage with professionals were met with unsatisfactory responses 45 . Black Caribbean women appeared invisible in mainstream mental health services and associated research.…”