Prevalence and risk of mental disorders in the perinatal period among migrant women: a systematic review and meta-analysis

Abstract

This study was conducted in order to evaluate the prevalence and risk of mental disorders in the perinatal period among migrant women. Six databases (including MEDLINE) were searched from inception to October 19th, 2015, in addition to citation tracking. Studies were eligible if mental disorders were assessed with validated tools during pregnancy and up to 1 year postpartum among women born outside of the study country. Of 3241 abstracts screened, 53 met the inclusion criteria for the review. Only three studies investigated a mental disorder other than depression. Unadjusted odds ratios were pooled using random effects meta-analysis for elevated depression symptoms during pregnancy (n = 12) and the postpartum (n = 24), stratified by study country due to heterogeneity. Studies from Canada found an increased risk for antenatal (OR = 1.86, 95% CIs 1.32–2.62) and postnatal elevated depression symptoms (OR = 1.98, 95% CIs 1.57–2.49) associated with migrant status. Studies from the USA found a decreased risk of antenatal elevated depression symptoms (OR = 0.71, 95% CIs 0.51–0.99), and studies from the USA and Australia found no association between migrant status and postnatal elevated depression symptoms. Low social support, minority ethnicity, low socioeconomic status, lack of proficiency in host country language and refugee or asylum-seeking status all put migrant populations at increased risk of perinatal mental disorders.Electronic supplementary materialThe online version of this article (doi:10.1007/s00737-017-0723-z) contains supplementary material, which is available to authorized users.

Prevalence and determinants of perinatal depression among labour migrant and refugee women on the Thai-Myanmar border: a cohort study

“…For moderate-severe perinatal depression, the main risk factors identified were psychosocial, including interpersonal violence (OR 4.5), a history of trauma (OR 2.4), a self-reported history of depression (OR 2.3), perceived insufficiency of social support (OR 2.1) and labour migrant (as opposed to refugee) status (OR 2.1). Low levels of social support have consistently been associated with perinatal depression across multiple and diverse settings, and it is unsurprising that this was one of the key factors associated with depression in our population [8,10,14]. In this context of geo-political tension, women often live in separation from family members who have remained in home towns or villages in Myanmar or resettled abroad.…”

“…Overall, 15.4% (95% CI 11. [8][9][10][11][12][13][14][15][16][17][18][19].6%) of women developed new-onset moderate-severe depression during the study period. Forty-two participants received treatment for depression.…”

“…Evidence consistently suggests that prevalence is higher in low-and middle-income countries (LMIC), with estimates ranging from 10. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25].3% in LMIC compared with 7.4-19.2% in high-income countries (HIC) [1,3,4]. Untreated perinatal depression has been associated with a number of significant adverse outcomes including negative health behaviours in pregnancy [1], subsequent chronic and recurrent depression [1,2], impaired ability to work and provide care, relationship breakdown [2,5] and suicidean important contributor to maternal deaths globally [6,7].…”

“…Meta-analyses have reported high pooled prevalence rates of perinatal depression ranging from 19 to 31% among migrant women [13,14]. However, these figures stem from research which has focused largely on migrants living in HIC destinations.…”

“…Few other studies have included different categories of migrants, and those that did have not always conducted comparative analyses [10]. Hard-toreach migrants including those with insecure legal status and those who do not speak the host country languagesuch as the women included in this studyhave rarely been included in research to date, and the importance of this group being represented has been emphasized [14]. The use of a diagnostic rather than screening instrument to identify women with depression constitutes a further strength, enabling greater accuracy and addressing a significant gap in the existing evidence, which relies heavily on screening tools [13].…”