Improving Mental Health in Pregnancy for Refugee Women: Protocol for the Implementation and Evaluation of a Screening Program in Melbourne, Australia

Abstract

Background Identifying mental health disorders in migrant and refugee women during pregnancy provides an opportunity for interventions that may benefit women and their families. Evidence suggests that perinatal mental health disorders impact mother-infant attachment at critical times, which can affect child development. Postnatal depression resulting in suicide is one of the leading causes of maternal mortality postpartum. Routine screening of perinatal mental health is recommended to improve the identification of depression and anxiety and to facilitate early management. However, screening is poorly implemented into routine practice. This study is the first to investigate routine screening for perinatal mental health in a maternity setting designed for refugee women. This study will determine whether symptoms of depression and anxiety are more likely to be detected by the screening program compared with routine care and will evaluate the screening program’s feasibility and acceptability to women and health care providers (HCPs). Objective The objectives of this study are (1) to assess if refugee women are more likely to screen risk-positive for depression and anxiety than nonrefugee women, using the Edinburgh Postnatal Depression Scale (EPDS); (2) to assess if screening in pregnancy using the EPDS enables better detection of symptoms of depression and anxiety in refugee women than current routine care; (3) to determine if a screening program for perinatal mental health in a maternity setting designed for refugee women is acceptable to women; and (4) to evaluate the feasibility and acceptability of the perinatal mental health screening program from the perspective of HCPs (including the barriers and enablers to implementation). Methods This study uses an internationally recommended screening measure, the EPDS, and a locally developed psychosocial questionnaire, both administered in early pregnancy and again in the third trimester. These measures have been translated into the most common languages used by the women attending the clinic and are administered via an electronic platform (iCOPE). This platform automatically calculates the EPDS score and generates reports for the HCP and woman. A total of 119 refugee women and 155 nonrefugee women have been recruited to evaluate the screening program’s ability to detect depression and anxiety symptoms and will be compared with 34 refugee women receiving routine care. A subsample of women will participate in a qualitative assessment of the screening program’s acceptability and feasibility. Health service staff have been recruited to evaluate the integration of screening into maternity care. Results The recruitment is complete, and data collection and analysis are underway. Conclusions It is anticipated that screening will increase the identification and management of depression and anxiety symptoms in pregnancy. New information will be generated on how to implement such a program in feasible and acceptable ways that will improve health outcomes for refugee women. International Registered Report Identifier (IRRID) DERR1-10.2196/13271

Mental Health Screening Approaches for Resettling Refugees and Asylum Seekers: A Scoping Review

“…Three publications described two mental health screening programs specifically for refugee women of reproductive age [ 47 , 69 , 104 ]. The report by Boyle and colleagues is a protocol for a screening program [ 47 ] whose acceptability and feasibility has been evaluated [ 104 ], but whose effectiveness (outcome) data are not yet available.…”

“…Three publications described two mental health screening programs specifically for refugee women of reproductive age [ 47 , 69 , 104 ]. The report by Boyle and colleagues is a protocol for a screening program [ 47 ] whose acceptability and feasibility has been evaluated [ 104 ], but whose effectiveness (outcome) data are not yet available. Boyle et al conducted their study in a Refugee Antenatal Clinic in Australia [ 47 ], while Johnson-Agbakwu et al conducted their study in a Refugee Women’s Health Clinic in the United States [ 69 ].…”

“…The report by Boyle and colleagues is a protocol for a screening program [ 47 ] whose acceptability and feasibility has been evaluated [ 104 ], but whose effectiveness (outcome) data are not yet available. Boyle et al conducted their study in a Refugee Antenatal Clinic in Australia [ 47 ], while Johnson-Agbakwu et al conducted their study in a Refugee Women’s Health Clinic in the United States [ 69 ]. Both studies screened for mental health conditions post-arrival in a clinic specifically aimed at assessing and treating refugee women.…”

“…Both studies screened for mental health conditions post-arrival in a clinic specifically aimed at assessing and treating refugee women. Boyle et al screened pregnant women in the perinatal and postnatal period at their first appointment, with screening repeated in the third trimester [ 47 ]. Johnson-Agbakwu et al recruited women seeking obstetric and/or gynaecological care, not differentiating between pregnant and non-pregnant women [ 69 ].…”

Introducing and Integrating Perinatal Mental Health Screening: Development of an Equity-informed Evidence-based Approach

“…We used a case study approach [23] to describe how the perinatal mental health screening program was designed and implemented. The protocol for the evaluation of this program has been published elsewhere [24], but in summary, the study was conducted at a public antenatal clinic located in a large teaching hospital within south-eastern Melbourne, Australia. The area is home to a large multicultural and refugee population.…”