Background: Postnatal psychiatric disorders are a major global public health concern, and refugee women may be more susceptible to postpartum depression and anxiety due to pre and post migration risk factors. Presently, there are no large-scale studies examining postnatal mental health of refugee women across specific subpopulations. This study examined the prevalence of depression, anxiety and associated factors among newly arrived refugee women during the postpartum period.

Methods: During domestic health screenings conducted in California between October 1, 2014 and December 31, 2019, sociodemographic, health, and mental health data was collected for refugee mothers who had given birth within 2 years prior to their arrival to the United States (N=3715) and compared to refugee women with no reported births (N=4098). Risk of depression and anxiety were measured using the Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2) Scales respectively. Bivariate analyses and multivariate logistic regression were performed to identify risk factors associated with postpartum depression and anxiety. Chi square tests were used to determine statistical differences.

Results: The combined prevalence of depression and anxiety among refugee mothers two years postpartum was higher than women with no reported births (8.6% vs 7.6%, respectively). Refugee mothers born in Afghanistan had significantly higher prevalence rates of mental health (depression and anxiety) compared to Non-Afghan mothers (9.9% vs 6.9%; p<.01). Among this subgroup, women who reported having at least one postpartum condition (depression or anxiety) were more likely to be under the age of 30 (54.3%, p<.01) or to have completed a secondary or higher level education (61.5%).

Conclusion: Our findings suggest that refugee women are at greater risk for symptoms of depression and anxiety during the postpartum period, and that these risks vary by country of birth, age and education. Targeted efforts should be made to address postnatal mental health of refugee women. Lastly, early screening and identification of depression and anxiety during postpartum period is imperative such that preventive interventions may be implemented.

background: Promoting maternal mental health during the perinatal and postpartum periods may foster women’s well-being and promote healthy childhood outcomes, including impacts on growth and development. Disentangling the effects of maternal mental health during one period versus accumulation over time is critical to inform the development of targeted interventions that are delivered at the most optimal time. The primary objective of this study was to investigate associations between pre- and post-natal maternal stress and depression and childhood obesity at 5- and 8-years of age.

methods: The Growing Up in New Zealand longitudinal cohort study provided information on 5,839 pregnant women and their children to assess this objective. These data represent a nationally representative and multi-ethnic sample (58.6% New Zealand European, 13.0% Māori, 12.1% Pacific, and 13.1% Asian). To date, there have been five waves of data collection (e.g. prenatal, 9-months, 2-years, 5-years) and data from the most recent wave (8-years) will be available in the Summer of 2020. Path model analysis was used to investigate if pre- and post-natal maternal exposure to a composite of nine external stressors (e.g. government-subsidized housing) and depression (Edinburgh Postnatal Depression Scale) were direct predictors of early childhood body mass index (BMI) at 5-year of age (data on 8-years of age pending) and if these pathways varied by exposure during the pre- versus the post-natal period.

results: Higher stress exposure during pregnancy was significantly associated with a .15 increase in BMI z-score at 5-years (p<.01), after controlling for covariates, including ethnicity. Individuals who experienced stress both pre- and post-natally had children with significantly higher BMI at 5-years than individuals who experienced stress at neither or only one time point (p<.01). Results related to pre- and post-natal depression and childhood BMI at 8-years of age are pending and will be available by the Summer of 2020.

conclusions: Findings inform the most critical periods for routine screening of maternal mental health and subsequent interventions and/or treatment. For example, it may be that the persistence of symptoms over time, rather than a singular critical period, is the key feature of maternal mental health regarding childhood development.

Background:

Maternal depression is a major mental health problem affecting health and quality of living among women of reproductive age, particularly in the low and middle-income countries (LMICs) where women have suboptimal access to maternal and mental health care. Meta-epidemiological evidence is essential for evidence-based policymaking addressing the burden of maternal depression in those countries. The objective of this umbrella review was to evaluate the evidence on the prevalence and associated risk factors of maternal depression in LMICs to inform future research, policymaking, and practice.

Methods:

We searched eight major databases and additional sources to retrieve systematic reviews and meta-analyses published as peer-reviewed articles that reported prevalence or risk factors of maternal depression in any LMICs listed by the World Bank. We extracted epidemiological data from respective reviews and synthesized the same using the Joanna Briggs Institute (JBI) methodology for umbrella review.

Results:

Among 651 citations, 20 evidence-based reviews met the criteria for this review. The prevalence rates of antepartum and postpartum depression ranged from 9.18% to 65% and 5% to 65%, respectively. Reviews reported several risk factors of maternal depression in LMICs. These factors included low socioeconomic status, lack of family and social support, son preference, marital conflicts, domestic violence, lack of education and employment, unwanted pregnancy, complications during pregnancy, inadequate antenatal care, suboptimal delivery care, congenital and other child health problems, history of previous mental disorders, co-occurring diseases, and other psychosocial problems during prenatal, perinatal, and postnatal phases.

Conclusion:

This umbrella review found a high prevalence of maternal depression in LMICs, which necessitate multilevel interventions, including strengthening mental health systems and services in LMICs. Moreover, the synthesized evidence on risk factors of maternal depression informs the development of targeted clinical and psychosocial interventions addressing the same. Furthermore, there is a critical gap in evidence from many African and Asian countries, which should be addressed in future research and evidence synthesis on maternal depression in those contexts.

Background: South African women experience some of the highest rates of antenatal and postnatal depression globally due to complex underlying determinants, yet there remains a large mental health treatment during the perinatal period. Screening for perinatal mood and anxiety disorders has recently been integrated into general and antenatal care in South Africa through a locally-validated ultra-short screening tool to identify those who might need referral, yet many healthcare providers face significant barriers which prevent them from routinely screening and referring women for additional mental health assessment. This lack of screening and referral has potential to limit the ability for women to receive necessary care, further contributing to the mental health treatment gap in South Africa.

Methods: This study included in-depth semi-structured interviews with 20 key informants based in South Africa. The key informants included nurses, midwives, doctors, and psychologists, which had experience providing physical or mental health care during pregnancy and/or postpartum and insight into screening and referral processes. We used purposive sampling to identify key informants. Interviews were recorded and then transcribed verbatim and analyzed using a thematic content approach.

Findings: Key barriers we identified to perinatal mental health screening and referral in South Africa included: lack of functional referral networks, projection of provider’s own mental health issues onto patients; lack of sufficient training on importance of antenatal and postpartum mental health; and lack time for mental health screening as part of their workload.

Conclusion: The key barriers we identified influence the ability for women to access needed mental health care services, and ultimately impacts the quality of mental health promotion and care for women. One of the primary underlying challenges to addressing barriers was the absence of provider training and support to integrate systems of care to better address perinatal mental health. We found key insights and promising innovative training approaches to address these issues, and we provide lessons learned and best practices in provider training for perinatal mental health education. These successful models demonstrate potential in South Africa and other LMIC settings for improving perinatal mental health education and reduction of screening and referral related barriers.