Pregnant migrant and refugee women’s perceptions of mental illness on the Thai-Myanmar border: a qualitative study

Abstract

BackgroundMental illness is a significant contributor to the global burden of disease, with prevalence highest in low- and middle-income countries. Rates are high in women of childbearing age, especially during pregnancy and the first year post-partum. Migrant and refugee populations are at risk of developing mental illness due to the multiple stressors associated with migration. The Thai-Myanmar border area is home to large populations of migrants and refugees as a result of long-standing conflict, poverty and unemployment in Myanmar. This study aims to explore perceptions of mental illness among pregnant migrants and refugees and antenatal clinic staff living and working along the Thai-Myanmar border.MethodsThirteen focus group discussions were conducted with pregnant migrants, pregnant refugees and antenatal clinic staff. Focus groups were held in one large refugee camp and two migrant health clinics along the Thai-Myanmar border. Thematic analysis was used to identify and code themes emerging from the data.ResultsA total of 92 pregnant women and 24 antenatal clinic staff participated. Discussions centered around five main themes: symptoms of mental illness; causes of mental illness; suicide; mental illness during pregnancy and the post-partum period; and managing mental illness. Symptoms of mental illness included emotional disturbances, somatic symptoms and socially inappropriate behavior. The main causes were described as current economic and family-related difficulties. Suicide was frequently attributed to shame. Mental illness was thought to be more common during and following pregnancy due to a lack of family support and worries about the future. Talking to family and friends, medication and hospitalization were suggested as means of helping those suffering from mental illness.ConclusionsMental illness was recognized as a concept by the majority of participants and there was a general willingness to discuss various aspects of it. More formal and systematic training including the development of assessment tools in the local languages would enable better ascertainment and treatment of mental illness in this population.

Beliefs and perception about mental health issues: a meta-synthesis

“…Similarly, Dow5 identified lacking direction and purpose in life as an important factor leading to mental health problems. In a similar fashion, Fellmeth et al41 attributed mental health problems to a lack of social support, familial conflicts, and economic problems. Challenging events, trauma, and everyday life stresses were also identified as some important factors for the development of mental health problems 2,15,40,41.…”

“…In a similar fashion, Fellmeth et al41 attributed mental health problems to a lack of social support, familial conflicts, and economic problems. Challenging events, trauma, and everyday life stresses were also identified as some important factors for the development of mental health problems 2,15,40,41. Stress is also believed to be a significant cause of mental health problems discussed in these studies.…”

“…Previous studies2,41,42 highlighted the behavioral symptoms of mental health issues. A pattern of consensus can be found in all these studies regarding the existence of deviant behavior specifically revealing irrelevant talk, inappropriate behavior, and self-talk, self-laughter, and crying as some major behaviors identified as abnormal.…”

“…Most of the studies, when discussing causes of mental health issues, described psychological factors such as unhappiness, low self-esteem, rejection, overthinking, self-downing and blaming, anxiety and worry, and conflicts in familial and other interpersonal relationships 2,15,41,44,48. Socioeconomic factors of poverty, lack of earning opportunities, unfulfilled basic and secondary needs,44 racial and ethnic discrimination,49 and economic injustice were also believed to be important factors resulting in mental health problems 45.…”

“…Mental disorders were interpreted as a result of the wrath of God, curses, and evil spirits 51. People attributing them to spirits was found in a number of studies 41,44,47,51,52. Within a spiritual and supernatural domain, there was some distinction as these aforementioned studies attributed mental health issues to negative forces or the result of the anger of God, while other studies revealed the beliefs of people attributing mental health problems to some blessings and spiritual connection with God and getting special attention from nature 44,53…”