Refugee and Immigrant Women’s Experience of Postpartum Depression: A Meta-Synthesis

Abstract

The aim of this work is to synthesize qualitative research on refugee and immigrant women's experiences of postpartum depression (PPD) to gain insight into the unique needs of this group of women. This population is more at risk of developing PPD due to a complexity of issues including pre- and postmigratory stressors; however, there is currently little research on this topic available to health care providers and policy makers. Thirteen articles met inclusion criteria, and five themes emerged from the meta-synthesis: (a) suffering in solitude, (b) the invisible illness, (c) cultural conceptualizations, (d) barriers to help seeking, and (e) facilitators of help seeking. Conclusions suggest immigrant women with PPD may lack understanding of their condition, are often isolated, are alone, fear stigmatization, and risk being considered an unfit mother. Raising awareness with health care providers of the meaning of PPD for immigrant women is key to the provision of effective care.

What enables or prevents women with depressive symptoms seeking help in the postnatal period?

“…"I think that [PND] As this review identifies (along with Dennis and Chung-Lee, 2006;Hadfield and Wittkowski, 2017;Tobin et al, 2018), the attitudes of HCPs and their relationship with women influence a woman's choice to seek help. With HCPs facing pressures from a number of sources in practice, such as time constraints and lack of continuity, it is possible that professionals are struggling to build a relationship with the women they see.…”

“…They reported complex and interrelated themes relating to the process of help, relationships with HCPs and the importance of continuity of care as well as education for HCPs regarding PND. Tobin et al's (2018) review investigated refugee and immigrant women's experiences of PND with barriers and facilitators to help-seeking being two of the identified themes.…”

“…The findings are largely consistent with other reviews; this review therefore suggests that changes such as introduction of routine assessment have not (yet) fundamentally changed barriers and facilitators to help-seeking.One of the most consistent findings here and in the wider literature(Dennis and Chung-Lee, 2006;Button et al, 2017;Hadfield and Wittkowski, 2017) is the barriers presented by the (in)accessibility and availability of services, highlighting the need for change. Another common finding is the significance of the environment, and its ability to enable women to talk and to help them recognise their symptoms(Button et al, 2017;Hadfield & Wittkowski, 2017;Tobin et al, 2018); referred to elsewhere as the 'context of disclosure'(Darwin et al, 2016). National investment in maternal mental health services is underway (National Maternity Review, 2016) but likely to focus on number of services and geographical location, without addressing factors such as length of appointment and time available for discussing mental health in greater depth (Maternal Mental Health Alliance, 2013).…”

Access to and interventions to improve maternity care services for immigrant women: a narrative synthesis systematic review

“…For example, an integrative review of the literature examining the potential influence of HCPs' attitudes and behaviours on health-care disparities 80 used a 'broad definition' and included all groups that, owing to ethnicity, place of birth, citizenship, residence status or the related variables, have minority status in the country in which they reside. The same approach is taken by a meta-synthesis 81 undertaken on refugee and immigrant women's experience of postpartum depression in three major European countries with high levels of immigration (Germany, Italy and the UK). The authors of this aforementioned meta-synthesis noted that there is inconsistency in the use of the term immigrant and thus 'extended the inclusion criteria to all articles, where research had been undertaken on "ethnic minorities", "migrants", "refugees" and "asylum seekers" in the given country'.…”

“…The authors of this aforementioned meta-synthesis noted that there is inconsistency in the use of the term immigrant and thus 'extended the inclusion criteria to all articles, where research had been undertaken on "ethnic minorities", "migrants", "refugees" and "asylum seekers" in the given country'. 81 It is observed that 'nationality' is also used in maternity care-related research to classify immigrant women. For example, acknowledging the challenge of categorising immigrant and ethnic minority women, Jentsch et al 82 used 'overseas nationals' in their study.…”