Healthcare worker’s perceptions of barriers to care by immigrant women with postpartum depression: an exploratory qualitative study

  • L. Teng
  • E. Robertson Blackmore
  • D. E. Stewart
Original contribution

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

  1. Affonso, DD, De, AK, Horowitz, JA, Mayberry, LJ 2000An international study exploring levels of postpartum depressive symptomatologyJ Psychosom Res49207216PubMedCrossRefGoogle Scholar
  2. Amankwaa, LC 2003Postpartum depression among African-American womenIssues Ment Health Nurs24297316PubMedCrossRefGoogle Scholar
  3. Arboleda-Florez, J 2003Considerations on the stigma of mental illnessCan J Psychiatry48645650PubMedGoogle Scholar
  4. Barclay, L, Kent, D 1998Recent immigration and the misery of motherhood: A discussion of pertinent issuesMidwifery1449PubMedCrossRefGoogle Scholar
  5. Boath, E, Bradley, E, Henshaw, W 2004Women’s views of antidepressants in the treatment of postnatal depressionJ Psychosom Obst Gynecol25221233CrossRefGoogle Scholar
  6. Cheung, FK, Snowden, KR 1990Community mental health and ethnic minority populationsCommun Ment Health J26277291CrossRefGoogle Scholar
  7. Cooper, P, Murray, L 1995Course and recurrence of postnatal depression. Evidence for the specificity of the diagnostic conceptBr J Psychiatry166191195PubMedCrossRefGoogle Scholar
  8. Cox, JL 1988Childbirth as a life event: sociocultural aspects of postnatal depressionActa Psychiatr Scand3447583Google Scholar
  9. Danaci, AR, Dinc, G, Deveci, A,  et al. 2002Postnatal depression in turkey: epidemiological and cultural aspectsSoc Psychiatry Psychiatr Epidemiol37125129PubMedCrossRefGoogle Scholar
  10. Dankner, R, Goldberg, RP, Fisch, RZ, Crum, RM 2000Cultural elements of postpartum depression. A study of 327 Jewish Jerusalem womenJ Reprod Med4597104PubMedGoogle Scholar
  11. Dennis, C-LE, Janssen, PA, Singer, J 2004Identifying women at-risk for postpartum depression in the immediate postpartum periodActa Psychiatr Scand110338346PubMedCrossRefGoogle Scholar
  12. Dennis, C-LE, Leinic, CL 2006Postpartum depression help-seeking barriers and maternal treatment preference: A Qualitative Systematic ReviewBirth33323331PubMedCrossRefGoogle Scholar
  13. Edge, D, Baker, D, Rogers, A 2004Perinatal depression among black Caribbean womenHealth Soc Care Community12430438PubMedCrossRefGoogle Scholar
  14. Glaser, B, Strauss, A 1967Discovery of grounded theory: Strategies for qualitative researchAldineNew YorkGoogle Scholar
  15. Glasser, S, Barell, V, Shoham, A, Ziv, A, Boyko, V, Lusky, A, Hart, S 1998Prospective study of postpartum depression in an Israeli cohort: Prevalence, incidence and demographic risk factorsJ Psychosom Obstet Gynecol19155164Google Scholar
  16. Holopainen, D 2002The experience of seeking help for postnatal depressionAust J Adv Nurs193944PubMedGoogle Scholar
  17. Katz, D, Gagnon, AJ 2002Evidence of adequacy of postpartum care for immigrant womenCan J Nurs Res347181PubMedGoogle Scholar
  18. Kinnon, D 1999Canadian research on immigration and healthMinister of Public Works and Government Services CanadaOttawaGoogle Scholar
  19. Kumar, R 1994Postnatal mental illness: a transcultural perspectiveSoc Psychiatry Psychiatr Epidemiol29250264PubMedCrossRefGoogle Scholar
  20. Matthews, AK, Hughes, TL 2001Mental health service use by African American women: Exploration of subpopulation differencesCultur Divers Ethnic Minor Psychol77587PubMedCrossRefGoogle Scholar
  21. Mauthner, NS 1997Postnatal depression: How can midwifes help?Midwifery13163171PubMedCrossRefGoogle Scholar
  22. Mauthner, NS 1999“Feeling low and feeling really bad about feeling low”: Women’s experiences of motherhood and postpartum depressCan Psychol40143161Google Scholar
  23. Mayberry, LJ, Affonso, DD 1993Infant temperament and postpartum depression: A reviewHealth Care Women Int14201211PubMedCrossRefGoogle Scholar
  24. McIntosh, J 1993Postpartum depression: Women’s help-seeking behaviour and perceptions of causeJ Adv Nurs18178184PubMedCrossRefGoogle Scholar
  25. Murray, L, Fiori-Cowley, A, Hooper, R, Cooper, P 1996The impact of postnatal depression and associated adversity on early mother-infant interactions and later infant outcomeChild Dev6725122526PubMedCrossRefGoogle Scholar
  26. Oates, MR, Cox, JL, Neema, S, Asten, P, Glangeaud-Freudenthal, N, Figueiredo, B,  et al. 2004Postnatal depression across countries and cultures: a qualitative studyBr J Psychiatry1841016CrossRefGoogle Scholar
  27. O’Connor, KM, De Dreu, CKW, Schroth, H, Bruce, B, Lituchy, TR, Bazerman, MH 2002What we want to do versus what we think we should do: An empirical investigation of intrapersonal conflictJ Behav Decis Making15403418CrossRefGoogle Scholar
  28. O’Hara, MW 1994

    Postpartum depression: identification and measurement in a cross-cultural context

    Cox, JHolden, J eds. Perinatal psychiatry: The use and misuse of the Edinburgh Postnatal Depression ScaleGaskellLondon145168
    Google Scholar
  29. O’Hara, MW, Swain, AM 1996Rates and risk of postpartum depression-a meta analysisInt Rev Psychiatry83754Google Scholar
  30. Parvin, A, Jones, CE, Hull, SA 2004Experiences and understandings of social and emotional distress in the postnatal period among Bangladeshi women living in Tower HamletsFam Pract21254260PubMedCrossRefGoogle Scholar
  31. Phan, T 2000Investigating the use of services for Vietnamese with mental illnessJ Commun Health25411425CrossRefGoogle Scholar
  32. Prieto, LR, McNeill, BW, Walls, RG, Gomez, SP 2001Chicanas/os and Mental Health Services: An overview of utilization, counselor preferences, and assessment IssuesCouns Psychol291854CrossRefGoogle Scholar
  33. Robertson, E, Grace, S, Wallington, T, Stewart, DE 2004Antenatal risk factors for postpartum depression: A synthesis of recent literatureGen Hosp Psychiatry26289295PubMedCrossRefGoogle Scholar
  34. Robinson, GE, Stewart, DE 2001

    Postpartum disorders

    Stotland, NLStewart, DE eds. Psychological aspects of women’s healthcareAmerican Psychiatric PublishingWashington DC117139
    Google Scholar
  35. Ross, LE, Campbell, VL, Dennis, CL, Robertson Blackmore, E 2006Demographic characteristics of participants in studies of risk factors, prevention and treatment of postpartum depressionCan J Psychiatry51704710PubMedGoogle Scholar
  36. Shakespeare, J, Blake, F, Garcia, J 2003A qualitative study of the acceptability of routine screening of postnatal women using the Edinburg Postnatal Depression ScaleBr J Gen Pract53614619PubMedGoogle Scholar
  37. Statistics Canada (2001) Longitudinal survey of immigrants to Canada. http://www.statcan.ca/. Accessed December 20, 2006.
  38. Stocky, A, Lynch, J 2000Acute psychiatric disturbance in pregnancy and the puerperiumBaillieres Best Pract Res Clin Obstet Gynaecol147387PubMedCrossRefGoogle Scholar
  39. Tammentie, T, Paavilaninen, E, Astedt-Kurki, P, Tarkka, MT 2004Family dynamics of postnatally depressed mothers-discrepancy between expectations and realityJ Clin Nurs136574PubMedCrossRefGoogle Scholar
  40. Templeton, I, Velleman, R, Persaud, A, Milner, P 2003The experience of postnatal depression in women from black and minority ethnic communities in Wiltshire, U.KEthn Health8207221PubMedCrossRefGoogle Scholar
  41. Thome, M 2003Severe postpartum depression in Icelandic mothers with difficult infants. A follow-up study on their healthcareScand J Caring Sci17104112PubMedCrossRefGoogle Scholar
  42. Ugarriza, DN 2004Group therapy and its barriers for women suffering from postpartum depressionArch Psychiat Nurs183948CrossRefGoogle Scholar
  43. Warner, R, Appleby, L, Whitton, A, Faragher, B 1996Demographic and obstetric risk factors for postnatal psychiatric morbidityBr J Psychiatry168607611PubMedGoogle Scholar
  44. Willig, C 2001Introducing qualitative research in psychology: Adventures in theory and methodOpen University PressBuckinghamGoogle Scholar
  45. Zelkowitz, P, Schinazi, J, Katofsky, L, Saucier, JF, Valenzuela, M, Westreich, R, Dayan, J 2004Factors associated with depression in pregnant immigrant womenTranscult Psychiatry41445464PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • L. Teng
    • 1
  • E. Robertson Blackmore
    • 2
  • D. E. Stewart
    • 3
  1. 1.University of TorontoTorontoCanada
  2. 2.Department of PsychiatryUniversity of Rochester Medical CenterNew YorkU.S.A.
  3. 3.University Health Network and University of TorontoTorontoCanada

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