Prevalence and Risk Factors of Major Depressive Disorder Among Women at Public Antenatal Clinics From Refugee, Conflict-Affected, and Australian-Born Backgrounds

Abstract

Key Points Question What is the prevalence and which risk factors are associated with major depressive disorder in women from conflict-affected backgrounds resettling in a high-income country, and does self-identification as a refugee signal a higher risk? Findings In this cross-sectional study of 1335 women (685 recruited from conflict-affected backgrounds and 650 from the host nation), the prevalence of major depressive disorder was 14.5% for women born in the host nation compared with 19.7% for women from conflict-affected backgrounds and 32.5% for women who identified as refugees. Meaning General and refugee-related traumatic events, intimate partner violence, low social support, and financial stress should be prioritized in resettlement policies and clinical settings to reduce major depressive disorder in women from conflict-affected backgrounds and those who identify as refugees.

The prevalence of mental illness in refugees and asylum seekers: A systematic review and meta-analysis

“…Nine studies mentioned the reliability or validity of the used instruments [ 23 , 35 , 36 , 39 , 41 , 44 – 46 , 51 ]. Thirteen studies conducted the assessment in the refugee’s native language [ 25 , 31 , 32 , 37 , 39 , 42 , 43 , 45 – 47 , 51 – 53 ]. Thirteen studies were conducted with assistance from interpreters [ 23 , 24 , 33 – 36 , 38 , 40 , 41 , 44 , 48 – 50 ].…”

“…Seventeen studies of depression were identified ( n = 3,877) [ 23 , 25 , 33 , 35 – 37 , 39 – 45 , 49 – 51 , 53 ]. Participants had a weighted mean age of 35.7 years and 48% were women.…”

“…All were observational, except one RCT from which we included baseline prevalence data [24]. Studies were undertaken in 15 countries: Australia (652 refugees) [33][34][35][36][37], Austria (150) [38], China (65) [32], Germany (1,104) [39][40][41][42][43][44], Italy (297) [39], Lebanon (646) [45,46], Nepal (574) [25], Norway (64) [23], South Korea (200) [47], Sweden (86) [48], Switzerland (164) [49,50], Turkey (238) [51], Uganda (77) [24], UK (420) [39,52], and the US (406) [31,53]. Participants were from four geographic regions: the Middle East (43%), Europe (29%), Asia (20%), and Africa (5%), with two studies reporting refugee samples coming from 18 different countries (3%) [26,41] (97% of total sample due to unreported countries of origin).…”

“…Thirteen studies were assigned a low risk of bias and determined to be of high quality [23,24,35,37,38,40,[45][46][47][48][49][50]53]. Nine studies demonstrated moderate risk of bias PLOS MEDICINE [25,33,34,36,39,41,44,51,52].…”

Gender competence and mental health promotion

“…They encompass, but are not limited to, female feticide, sexual abuse of girls, female genital mutilation, dowry‐related violence, sexual harassment and intimidation at work, trafficking, and violence perpetrated by an intimate partner. Women who are Indigenous or members of ethnic or religious minority groups, occupying low socio‐economic positions, or refugees or asylum‐seekers, are especially vulnerable. Experiencing or witnessing interpersonal violence, especially when it occurs within households, is always harmful to mental health.…”