Healthcare worker’s perceptions of barriers to care by immigrant women with postpartum depression: an exploratory qualitative study Original contribution First Online: 14 May 2007 Received: 22 June 2006 Accepted: 26 February 2007 DOI:
10.1007/s00737-007-0176-x Cite this article as: Teng, L., Robertson Blackmore, E. & Stewart, D. Arch Womens Ment Health (2007) 10: 93. doi:10.1007/s00737-007-0176-x Summary Objective: We interviewed healthcare workers working in Toronto, Canada, regarding their experience of providing care to recent immigrant women suffering from postpartum depression. The objective was two-fold: 1) to identify potential barriers to care that recent immigrant women may encounter as perceived by healthcare workers; and 2) to identify challenges healthcare workers felt that they faced as providers of care to this population. Methods: Qualitative semi-structured interviews were conducted with 16 key informants from various disciplines employed by healthcare agencies providing care to postpartum immigrant women in Toronto. Constant comparative analysis was used to analyze the data. Results: Two main categories of barriers to care for recent immigrant women were identified: ‘practical barriers’ and ‘culturally determined barriers’. Practical barriers included knowing where and how to access services, and language difficulties. Cultural barriers included fear of stigma and lack of validation of depressive symptoms by family and society. The challenges experienced by healthcare providers working with this population were organized into two other categories: ‘professional limitations’, and ‘social/cultural barriers’. ‘Professional limitations’ included fear of incompetence, language barriers, and inadequate assessment tools. ‘Social/cultural barriers’ included the experience of cultural uncertainty. Conclusions: The results suggest that not only are there important barriers to accessing postpartum care for recent immigrant women, but it can also be challenging for healthcare workers to deliver such needed care. Understanding some of these barriers and challenges from the perspective of healthcare providers is an important step to remedying gaps and obstacles in the service system. Keywords: Postpartum depression; barriers; recent immigrant women; healthcare providers. References Affonso, DD, De, AK, Horowitz, JA, Mayberry, LJ 2000 An international study exploring levels of postpartum depressive symptomatology J Psychosom Res 49 207 216 PubMed CrossRef Google Scholar Amankwaa, LC 2003 Postpartum depression among African-American women Issues Ment Health Nurs 24 297 316 PubMed CrossRef Google Scholar Arboleda-Florez, J 2003 Considerations on the stigma of mental illness Can J Psychiatry 48 645 650 PubMed Google Scholar Barclay, L, Kent, D 1998 Recent immigration and the misery of motherhood: A discussion of pertinent issues Midwifery 14 4 9 PubMed CrossRef Google Scholar Boath, E, Bradley, E, Henshaw, W 2004 Women’s views of antidepressants in the treatment of postnatal depression J Psychosom Obst Gynecol 25 221 233 CrossRef Google Scholar Cheung, FK, Snowden, KR 1990 Community mental health and ethnic minority populations Commun Ment Health J 26 277 291 CrossRef Google Scholar Cooper, P, Murray, L 1995 Course and recurrence of postnatal depression. Evidence for the specificity of the diagnostic concept Br J Psychiatry 166 191 195 PubMed CrossRef Google Scholar Cox, JL 1988 Childbirth as a life event: sociocultural aspects of postnatal depression Acta Psychiatr Scand 344 75 83 Google Scholar Danaci, AR, Dinc, G, Deveci, A, et al. 2002 Postnatal depression in turkey: epidemiological and cultural aspects Soc Psychiatry Psychiatr Epidemiol 37 125 129 PubMed CrossRef Google Scholar Dankner, R, Goldberg, RP, Fisch, RZ, Crum, RM 2000 Cultural elements of postpartum depression. A study of 327 Jewish Jerusalem women J Reprod Med 45 97 104 PubMed Google Scholar Dennis, C-LE, Janssen, PA, Singer, J 2004 Identifying women at-risk for postpartum depression in the immediate postpartum period Acta Psychiatr Scand 110 338 346 PubMed CrossRef Google Scholar Dennis, C-LE, Leinic, CL 2006 Postpartum depression help-seeking barriers and maternal treatment preference: A Qualitative Systematic Review Birth 33 323 331 PubMed CrossRef Google Scholar Edge, D, Baker, D, Rogers, A 2004 Perinatal depression among black Caribbean women Health Soc Care Community 12 430 438 PubMed CrossRef Google Scholar Glaser, B, Strauss, A 1967Discovery of grounded theory: Strategies for qualitative research Aldine New York Google Scholar Glasser, S, Barell, V, Shoham, A, Ziv, A, Boyko, V, Lusky, A, Hart, S 1998 Prospective study of postpartum depression in an Israeli cohort: Prevalence, incidence and demographic risk factors J Psychosom Obstet Gynecol 19 155 164 Google Scholar Holopainen, D 2002 The experience of seeking help for postnatal depression Aust J Adv Nurs 19 39 44 PubMed Google Scholar Katz, D, Gagnon, AJ 2002 Evidence of adequacy of postpartum care for immigrant women Can J Nurs Res 34 71 81 PubMed Google Scholar Kinnon, D 1999Canadian research on immigration and health Minister of Public Works and Government Services Canada Ottawa Google Scholar Kumar, R 1994 Postnatal mental illness: a transcultural perspective Soc Psychiatry Psychiatr Epidemiol 29 250 264 PubMed CrossRef Google Scholar Matthews, AK, Hughes, TL 2001 Mental health service use by African American women: Exploration of subpopulation differences Cultur Divers Ethnic Minor Psychol 7 75 87 PubMed CrossRef Google Scholar Mauthner, NS 1997 Postnatal depression: How can midwifes help? Midwifery 13 163 171 PubMed CrossRef Google Scholar Mauthner, NS 1999 “Feeling low and feeling really bad about feeling low”: Women’s experiences of motherhood and postpartum depress Can Psychol 40 143 161 Google Scholar Mayberry, LJ, Affonso, DD 1993 Infant temperament and postpartum depression: A review Health Care Women Int 14 201 211 PubMed CrossRef Google Scholar McIntosh, J 1993 Postpartum depression: Women’s help-seeking behaviour and perceptions of cause J Adv Nurs 18 178 184 PubMed CrossRef Google Scholar Murray, L, Fiori-Cowley, A, Hooper, R, Cooper, P 1996 The impact of postnatal depression and associated adversity on early mother-infant interactions and later infant outcome Child Dev 67 2512 2526 PubMed CrossRef Google Scholar Oates, MR, Cox, JL, Neema, S, Asten, P, Glangeaud-Freudenthal, N, Figueiredo, B, et al. 2004 Postnatal depression across countries and cultures: a qualitative study Br J Psychiatry 184 10 16 CrossRef Google Scholar O’Connor, KM, De Dreu, CKW, Schroth, H, Bruce, B, Lituchy, TR, Bazerman, MH 2002 What we want to do versus what we think we should do: An empirical investigation of intrapersonal conflict J Behav Decis Making 15 403 418 CrossRef Google Scholar O’Hara, MW 1994 Postpartum depression: identification and measurement in a cross-cultural context Cox, J Holden, J eds. Perinatal psychiatry: The use and misuse of the Edinburgh Postnatal Depression Scale Gaskell London 145 168 Google Scholar O’Hara, MW, Swain, AM 1996 Rates and risk of postpartum depression-a meta analysis Int Rev Psychiatry 8 37 54 Google Scholar Parvin, A, Jones, CE, Hull, SA 2004 Experiences and understandings of social and emotional distress in the postnatal period among Bangladeshi women living in Tower Hamlets Fam Pract 21 254 260 PubMed CrossRef Google Scholar Phan, T 2000 Investigating the use of services for Vietnamese with mental illness J Commun Health 25 411 425 CrossRef Google Scholar Prieto, LR, McNeill, BW, Walls, RG, Gomez, SP 2001 Chicanas/os and Mental Health Services: An overview of utilization, counselor preferences, and assessment Issues Couns Psychol 29 18 54 CrossRef Google Scholar Robertson, E, Grace, S, Wallington, T, Stewart, DE 2004 Antenatal risk factors for postpartum depression: A synthesis of recent literature Gen Hosp Psychiatry 26 289 295 PubMed CrossRef Google Scholar Robinson, GE, Stewart, DE 2001 Postpartum disorders Stotland, NL Stewart, DE eds. Psychological aspects of women’s healthcare American Psychiatric Publishing Washington DC 117 139 Google Scholar Ross, LE, Campbell, VL, Dennis, CL, Robertson Blackmore, E 2006 Demographic characteristics of participants in studies of risk factors, prevention and treatment of postpartum depression Can J Psychiatry 51 704 710 PubMed Google Scholar Shakespeare, J, Blake, F, Garcia, J 2003 A qualitative study of the acceptability of routine screening of postnatal women using the Edinburg Postnatal Depression Scale Br J Gen Pract 53 614 619 PubMed Google Scholar
Statistics Canada (2001) Longitudinal survey of immigrants to Canada.
. Accessed December 20, 2006.
Stocky, A, Lynch, J 2000 Acute psychiatric disturbance in pregnancy and the puerperium Baillieres Best Pract Res Clin Obstet Gynaecol 14 73 87 PubMed CrossRef Google Scholar Tammentie, T, Paavilaninen, E, Astedt-Kurki, P, Tarkka, MT 2004 Family dynamics of postnatally depressed mothers-discrepancy between expectations and reality J Clin Nurs 13 65 74 PubMed CrossRef Google Scholar Templeton, I, Velleman, R, Persaud, A, Milner, P 2003 The experience of postnatal depression in women from black and minority ethnic communities in Wiltshire, U.K Ethn Health 8 207 221 PubMed CrossRef Google Scholar Thome, M 2003 Severe postpartum depression in Icelandic mothers with difficult infants. A follow-up study on their healthcare Scand J Caring Sci 17 104 112 PubMed CrossRef Google Scholar Ugarriza, DN 2004 Group therapy and its barriers for women suffering from postpartum depression Arch Psychiat Nurs 18 39 48 CrossRef Google Scholar Warner, R, Appleby, L, Whitton, A, Faragher, B 1996 Demographic and obstetric risk factors for postnatal psychiatric morbidity Br J Psychiatry 168 607 611 PubMed Google Scholar Willig, C 2001Introducing qualitative research in psychology: Adventures in theory and method Open University Press Buckingham Google Scholar Zelkowitz, P, Schinazi, J, Katofsky, L, Saucier, JF, Valenzuela, M, Westreich, R, Dayan, J 2004 Factors associated with depression in pregnant immigrant women Transcult Psychiatry 41 445 464 PubMed CrossRef Google Scholar