“If you don’t ask … you don’t tell”: Refugee women’s perspectives on perinatal mental health screening

Willey, Suzanne; Blackmore, Rebecca; Gibson-Helm, Melanie; Ali, Razia; Boyd, Leanne; McBride, Jacqueline; Boyle, Jacqueline

doi:10.1016/j.wombi.2019.10.003

Cited by 29 publications

(125 citation statements)

References 36 publications

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“…If screening can be provided with simple and validated measures, such as the EDPS, then a major barrier to improving access to mental health care will be addressed. Perinatal mental health screening has been shown to be acceptable and supported by women of refugee background (Willey et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Validation of a Dari translation of the Edinburgh Postnatal Depression Scale among women of refugee background at a public antenatal clinic

Blackmore

Gibson-Helm

Melvin

et al. 2021

Aust N Z J Psychiatry

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Objective: Identifying women at risk of depression and anxiety during pregnancy provides an opportunity to improve health outcomes for women and their children. One barrier to screening is the availability of validated measures in the woman’s language. Afghanistan is one of the largest source countries for refugees yet there is no validated measure in Dari to screen for symptoms of perinatal depression and anxiety. The aim of this study was to assess the screening properties of a Dari translation of the Edinburgh Postnatal Depression Scale. Methods: This cross-sectional study administered the Edinburgh Postnatal Depression Scale Dari version to 52 Dari-speaking women at a public pregnancy clinic in Melbourne, Australia. A clinical interview using the depressive and anxiety disorders modules from the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) was also conducted. Interview material was presented to an expert panel to achieve consensus diagnoses. The interview and diagnostic process was undertaken blind to Edinburgh Postnatal Depression Scale screening results. Results: Cronbach’s alpha coefficient for the Edinburgh Postnatal Depression Scale Dari version was good (α = 0.79). Criterion validity was assessed using the receiver operating characteristics curve and generated excellent classification accuracy for depression diagnosis (0.90; 95% confidence interval [0.82, 0.99]) and for anxiety diagnosis (0.94; 95% confidence interval [0.88, 1.00]). For depression, a cut-off score of 9, as recommended for culturally and linguistically diverse groups, demonstrated high sensitivity (1.00; 95% confidence interval [0.79, 1.00]) and specificity (0.88; 95% confidence interval [0.73, 0.97]). For anxiety, a cut-off score of ⩾5 provided the best balance of sensitivity (1.00; 95% confidence interval [0.72, 1.00]) and specificity (0.80; 95% confidence interval [0.65, 0.91]). Conclusion: These results support the use of this Edinburgh Postnatal Depression Scale Dari version to screen for symptoms of depression and anxiety during pregnancy as well as the use of a lowered cut-off score.

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Section: Discussionmentioning

confidence: 99%

Validation of a Dari translation of the Edinburgh Postnatal Depression Scale among women of refugee background at a public antenatal clinic

Blackmore

Gibson-Helm

Melvin

et al. 2021

Aust N Z J Psychiatry

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“…Implementation of perinatal mental health screening has historically been limited due to a number of health service and individual barriers. There is support for screening from both women of refugee background and health professionals with both groups acknowledging the necessity and importance (18,25,26). With the provision of access to digital screening together with this development of the iCOPE digital screening platform.…”

Section: Discussionmentioning

confidence: 99%

“…The acceptability and feasibility of the perinatal mental health screening program in the antenatal period was evaluated from the both the perspective of the health professionals as well as women of refugee background and these results have been published elsewhere [25,26] In summary, a mixed methods approach was undertaken whereby health professionals completed an online survey (n = 38), focus groups (n = 2, 13 participants), and semi-structured interviews (n = 8, 11 participants). The evaluation was guided by the Normalization Process Theory (NPT) [27].…”

Section: Implementation Strategy Developmentmentioning

confidence: 99%

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Introducing and Integrating Perinatal Mental Health Screening: Development of an Equity-informed Evidence-based Approach

Blackmore

Boyle

Gray

et al. 2021

Preprint

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Background: Pregnancy is a time of increased risk for developing or re-experiencing mental illness. Perinatal mental health screening for all women is recommended in many national guidelines but a number of systems-level and individual barriers often hinder policy implementation. These barriers result in missed opportunities for detection and early intervention, and are likely to be experienced disproportionately by women from culturally and linguistically diverse backgrounds, including women of refugee backgrounds. The objectives of this study were to develop a theory-informed, evidence-based guide for introducing and integrating perinatal mental health screening across health settings; and to synthesise the learnings from an implementation initiative and multi-sectoral partnership between the Centre of Perinatal Excellence (COPE), and a university-based research centre. COPE is a peak body in perinatal mental health and Non-Governmental Organization commissioned to update the Australian national perinatal mental health guidelines, train health professionals and rollout innovative digital screening across healthcare settings. Methods: In this case study, barriers to implementation were prospectively identified and strategies to overcome them were developed. A pilot perinatal screening program with a strong health equity focus was implemented and evaluated at a large public maternity service delivering care to a culturally diverse population of women in metropolitan Melbourne, Australia, including women of refugee background. Strategies identified pre-implementation and post-evaluation were mapped to theoretical frameworks. An implementation guide was developed to support future policy, planning and decision-making by healthcare organisations. Results: Using a behavioural change framework (COM-B), the key barriers, processes, and outcomes are described for a real-world example designed to maximise accessibility, feasibility, and acceptability. A program logic model was developed to demonstrate the relationships of the inputs, which included stakeholder consultation, resource development, and a digital screening platform, with the outcomes of the program. A seven-stage implementation guide is presented for use in a range of healthcare settings. Conclusions: These findings describe an equity-informed, evidence-based approach that can be used by healthcare organisations to address common systems and individual level barriers to implement perinatal mental health screening guidelines.

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“…Infants born to migrant mothers are at increased risk of stillbirth [ 14 – 17 ], preterm birth, congenital anomalies [ 5 ], and admission to neonatal care units [ 12 , 18 , 19 ]. Women who are refugees or seeking asylum are often particularly vulnerable, due to prior exposure to violence and trauma [ 20 , 21 ], and are more likely to experience mental health issues, including post-traumatic stress and perinatal depression [ 22 – 26 ].…”

Section: Introductionmentioning

confidence: 99%

Cross Cultural Workers for women and families from migrant and refugee backgrounds: a mixed-methods study of service providers perceptions

et al. 2021

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Background Women from migrant and refugee backgrounds who live in high-income countries are at increased risk of adverse perinatal outcomes, including mental health issues, preterm birth and maternal and infant mortality. There is a need to implement and evaluate models of care to meet their specific needs in order to improve health outcomes, their experiences of care, and overcome barriers to access. In Sydney, Australia, a unique model of care was implemented to support women and families from migrant and refugee backgrounds to access health and community-based services through the continuum of pregnancy to the early parenting period. This model of care is known as the Cross Cultural Workers (CCWs) in Maternity and Child and Family Health Service (the CCW Service). The aim of this study was to explore the perceptions of service providers regarding the CCW Service and identify recommendations for improvement. Methods A mixed-methods study was conducted consisting of surveys and face to face semi-structured interviews. Service providers were recruited from hospital-based maternity and community-based services. Survey data were analysed descriptively. Interviews were analysed using qualitative content analysis. Results Sixty-nine service providers completed surveys and 19 were interviewed. The CCW Service was highly regarded by service providers who perceived it to be critical in improving care for women from migrant and refugee backgrounds. The overarching theme from the interviews was the ability of the CCW Service to act as a ‘bridge to health’ through the provision of culturally responsive care. There were three main categories; supporting access to health and community-based services, improving the healthcare experience, and organisational factors, including part-time hours, capacity, heavy workloads and confusion/lack of clarity regarding the CCW role, which affected CCWs’ capacity to optimally support service providers in providing culturally responsive care. These limitations meant CCWs were not able to meet demand, and fully operationalise the model. Conclusion Service providers perceived the CCW model to be a culturally responsive model of care tailored to the needs of women and families from migrant and refugee backgrounds, that reduces barriers to access, and has the potential to improve perinatal outcomes, and women's experience and satisfaction with care.

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“If you don’t ask … you don’t tell”: Refugee women’s perspectives on perinatal mental health screening

Cited by 29 publications

References 36 publications

Validation of a Dari translation of the Edinburgh Postnatal Depression Scale among women of refugee background at a public antenatal clinic

Validation of a Dari translation of the Edinburgh Postnatal Depression Scale among women of refugee background at a public antenatal clinic

Introducing and Integrating Perinatal Mental Health Screening: Development of an Equity-informed Evidence-based Approach

Cross Cultural Workers for women and families from migrant and refugee backgrounds: a mixed-methods study of service providers perceptions

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