Abstract
This study assessed the prevalence, continuation, and identification of maternal depressive symptomatology over the first 16 weeks postpartum among refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women. A sample of 1125 women (143 refugees, 369 asylum-seekers, 303 non-refugee immigrant, and 310 Canadian-born) completed the Edinburgh Postnatal Depression Scale (EPDS) at 1 and 16 weeks postpartum. The sensitivity, specificity, and predictive power of the 1-week EPDS to identify women with elevated EPDS scores at 16 weeks were determined. The total number of women with EPDS scores >9 for each group at 1 and 16 weeks, respectively, was 26.6 and 18.2 % for refugees; 25.2 and 24.1 % for asylum-seekers; 22.4 and 14.2 % for non-refugee immigrants, and 14.8 and 7.4 % for Canadian-born. Using the cut-off score of 9/10, the 1-week EPDS accurately classified 77.6 % refugee, 73.4 % asylum-seeking, 76.6 % non-refugee immigrant, and 85.5 % Canadian-born women at 16 weeks with or without postpartum depressive symptomatology. The 1-week EPDS was significantly correlated to the 16-week EPDS (r = 0.46, p < 0.01). All groups were significantly more likely to exhibit depressive symptomatology at 16 weeks if they had EPDS scores >9 at 1 week postpartum: refugees (OR = 6.9, 95 % CI = 2.8–17.3), asylum-seekers (OR = 4.0, 95 % CI = 2.4–6.7), non-refugee immigrants (OR = 3.8, 95 % CI = 2.0–7.6), and Canadian-born women (OR = 8.0, 95 % CI = 3.3–19.8). Our findings suggest that refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women at risk of postpartum depression may be identified early in the postpartum period such that secondary preventive interventions may be implemented.
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References
Adserà A, Ferrer A (2013) The fertility of recent immigrants to Canada. Discussion Paper Series, Forschungsinstitut zur Zukunft der Arbeit
Affonso DD, De AK, Horowitz JA, Mayberry LJ (2000) An international study exploring levels of postpartum depressive symptomatology. J Psychosom Res 49:207–216
Beck CT (2001) Predictors of postpartum depression: an update. Nurs Res 50:275–285
Citizenship and Immigration Canada (2007) Facts and Figures 2006: Immigration overview-permanent and temporary residents. Minister of Public Works and Government Services Canada, Ottawa, ON
Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry 150:782–786
Cox JL, Murray D, Chapman G (1993) A controlled study of the onset, duration and prevalence of postnatal depression. Br J Psychiatry 163:27–31
Dennis C-L (2014) Psychosocial interventions for the treatment of perinatal depression. Best Pract Res Clin Obstet Gynaecol 28:97–111
Dennis CL, Ross LE (2006) Depressive symptomatology in the immediate postnatal period: identifying maternal characteristics related to true-and false-positive screening scores. Can J Psychiatr 51:265
Dennis CL, Hodnett E, Kenton L, Weston J, Zupancic J, Stewart DE, Kiss A (2009) Effect of peer support on prevention of postnatal depression among high risk women: multisite randomised controlled trial. BMJ 338:a3064
Dennis CL, Coghlan M, Vigod S (2013) Can we identify mothers at-risk for postpartum anxiety in the immediate postpartum period using the State-Trait Anxiety Inventory? J Affect Disord 150:1217–1220
England M, Sim L (2009) Depression in parents, parenting, and children: opportunities to improve identification, treatment, and prevention. The National Academics Press, Washington, DC
Falah-Hassani K, Shiri R, Vigod S, Dennis C-L (2015) Prevalence of postpartum depression among immigrant women: a systematic review and meta-analysis. J Psychiatr Res 70:67–82
Fletcher R, Fletcher S, Wagner E (1996) Clinical epidemiology: the essentials. Williams and Wilkins, Baltimore, MD
Gagnon AJ et al (2006) The childbearing health and related service needs of newcomers (CHARSNN) study protocol. BMC Pregnancy Childbirth 6:31
Gaynes B et al (2005) Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evidence Report/Technology Assessment No. 119. AHRQ publication no. 05-E006-2. Agency for Healthcare Research and Quality, Rockville, MD
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 Gynaecol 19:155–164
Hannah P, Adams D, Lee A, Glover V, Sandler M (1992) Links between early post-partum mood and post-natal depression. Br J Psychiatry 160:777–780
Harris B, Huckle P, Thomas R, Johns S, Fung H (1989) The use of rating scales to identify post-natal depression. Br J Psychiatry 154:813–817
Hilder L, Zhichao Z, Parker M, Jahan S, Chambers GM (2014) Australia’s mothers and babies 2012. Perinatal statistics series no. 30. Cat. no. PER 69. Australian Institute of Health and Welfare (AIHW), Canberra
Lane A, Keville R, Morris M, Kinsella A, Turner M, Barry S (1997) Postnatal depression and elation among mothers and their partners: prevalence and predictors. Br J Psychiatry 171:550–555
Lanes A, Kuk JL, Tamim H (2011) Prevalence and characteristics of postpartum depression symptomatology among Canadian women: a cross-sectional study. BMC Public Health 11:302
Mechakra-Tahiri S, Zunzunegui MV, Seguin L (2007) Self-rated health and postnatal depressive symptoms among immigrant mothers in Quebec. Women Health 45:1–17
Merry L, Gagnon AJ, Hemlin I, Clarke H, Hickey J (2011) Cross-border movement and women’s health: how to capture the data. Int J Equity Health 10:56
Murray L, Carothers AD (1990) The validation of the Edinburgh post-natal depression scale on a community sample. Br J Psychiatry 157:288–290
O’Hara MW, McCabe JE (2013) Postpartum depression: current status and future directions. Annu Rev Clin Psychol 9:379–407
Office for National Statistics (2014) Births in England and Wales by parents’ country of birth, 2013
Pearlstein T, Howard M, Salisbury A, Zlotnick C (2009) Postpartum depression. Am J Obstet Gynecol 200:357–364
Ruppenthal L, Tuck J, Gagnon AJ (2005) Enhancing research with migrant women through focus groups. West J Nurs Res 27:735–754
Sobotka T (2008) Overview Chapter 7: the rising importance of migrants for childbearing in Europe. Demogr Res 19:225–248
Stewart DE, Gagnon A, Saucier J, Wahoush O (2008) Postpartum depression symptoms in newcomers. Can J Psychiatr 53:121
Strohschein FJ, Merry L, Thomas J, Gagnon AJ (2010) Strengthening data quality in studies of migrants not fluent in host languages: a Canadian example with reproductive health questionnaires. Res Nurs Health 33:369–379
Teissèdre F, Chabrol H (2004) Detecting women at risk for postnatal depression using the Edinburgh postnatal depression scale at 2 to 3 days postpartum. Can J Psychiatr 49:51–54
UN General Assembly (1951) Convention relating to the status of refugees, 28 July 1951, United Nations, Treaty Series, vol. 189, p. 137. Available at: http://www.refworld.org/docid/3be01b964.html
United Nations Department of Economic and Social Affairs Population Division (2013) International Migration Report 2013. United Nations, New York
Yamashita H, Yoshida K, Nakano H, Tashiro N (2000) Postnatal depression in Japanese women: detecting the early onset of postnatal depression by closely monitoring the postpartum mood. J Affect Disord 58:145–154
Yoshida K, Marks M, Kibe N, Kumar R, Nakano H, Tashiro N (1997) Postnatal depression in Japanese women who have given birth in England. J Affect Disord 43:69–77
Zelkowitz P, Milet TH (1995) Screening for post-partum depression in a community sample. Can J Psychiatr 40:80–86
Zelkowitz P, Saucier J-F, Wang T, Katofsky L, Valenzuela M, Westreich R (2008) Stability and change in depressive symptoms from pregnancy to two months postpartum in childbearing immigrant women. Arch Womens Ment Health 11:1–11
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This study was funded by the Canadian Institutes of Health Research (CIHR), Immigration et métropoles (Center of Excellence in Immigration Studies - Montreal) and the Réseau de recherche en santé des populations du Québec (RRSPQ).
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Prior to recruitment, ethical approval was obtained from all participating hospitals and from the ethics review boards of two affiliated universities.
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Dennis, CL., Merry, L., Stewart, D. et al. Prevalence, continuation, and identification of postpartum depressive symptomatology among refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women: results from a prospective cohort study. Arch Womens Ment Health 19, 959–967 (2016). https://doi.org/10.1007/s00737-016-0633-5
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DOI: https://doi.org/10.1007/s00737-016-0633-5