The Perinatal Mental Health of Indigenous Women: A Systematic Review and Meta-Analysis

Abstract

Objective: Although Indigenous women are exposed to high rates of risk factors for perinatal mental health problems, the magnitude of their risk is not known. This lack of data impedes the development of appropriate screening and treatment protocols, as well as the proper allocation of resources for Indigenous women. The objective of this systematic review and meta-analysis was to compare rates of perinatal mental health problems among Indigenous and non-Indigenous women. Methods: We searched Medline, EMBASE, PsycINFO, CINAHL, and Web of Science from their inceptions until February 2019. Studies were included if they assessed mental health in Indigenous women during pregnancy and/or up to 12 months postpartum. Results: Twenty-six articles met study inclusion criteria and 21 were eligible for meta-analysis. Indigenous identity was associated with higher odds of mental health problems (odds ratio [ OR] 1.62; 95% confidence interval [CI], 1.25 to 2.11). Odds were higher still when analyses were restricted to problems of greater severity ( OR 1.95; 95% CI, 1.21 to 3.16) and young Indigenous women ( OR 1.86; 95% CI, 1.51 to 2.28). Conclusion: Indigenous women are at increased risk of mental health problems during the perinatal period, particularly depression, anxiety, and substance misuse. However, resiliency among Indigenous women, cultural teachings, and methodological issues may be affecting estimates. Future research should utilize more representative samples, adapt and validate diagnostic and symptom measures for Indigenous groups, and engage Indigenous actors, leaders, and related allies to help improve the accuracy of estimates, as well as the well-being of Indigenous mothers, their families, and future generations. Trial Registration: PROSPERO-CRD42018108638.

Risk and resilience: a mixed methods investigation of Aboriginal Australian women’s perinatal mental health screening assessments

“…Our findings advance the argument that traditional mainstream approaches to perinatal mental health screening which focus exclusively on symptoms and risk factors are not sufficient in responding to the needs of Aboriginal Australian women [14,18,19]. We have found that while certain risk factors are more indicative of psychological distress the actual significance of a risk factor can only be understood in the unique context of a woman's overall risk and resiliency.…”

“…For Indigenous women such as Aboriginal Australian women colonisation, marginalisation, dispossession and racism create environments in which clusters of risk factors form [15][16][17][18]. International Indigenous experiences of perinatal mental ill health emphasise cultural disconnectedness, sociodemographic vulnerability, family and/or intimate partner violence, intergenerational trauma, limited social supports, substance abuse and limited expressions of self-efficacy [14,19]. Despite high levels of risk factors [20], most Indigenous women also have protective factors which may reduce their risk of developing perinatal mental health disorders.…”

“…Despite high levels of risk factors [ 20 ], most Indigenous women also have protective factors which may reduce their risk of developing perinatal mental health disorders. There is a paucity of knowledge, however, about the role these protective factors play in Indigenous women’s overall perinatal mental health [ 14 , 19 ].…”

A systematic review of EPDS cultural suitability with Indigenous mothers: a global perspective

“…Reciprocal cultural consultation and shared cultural wisdom between reference groups and conversations with community-based Indigenous women was key in facilitating trusted relationships and partnerships with the researchers (Campbell et al 2008 ; Carlin et al 2019a ; Hayes et al 2005 ; Kotz et al 2016 ; Marley et al 2017 ). There was general agreement that without trusting collaboration and allies, Indigenous participants and communities will continue to view research as culturally unsafe and as another form of loss of control and ownership (Owais et al 2020 ). If trust is hard to gain, and could be even harder to gain when quantitative methods are applied, perhaps qualitative methods could be the preferred path.…”

Moving Toward Indigenous-Centred Perinatal Care in Urban Quebec

“…The perinatal phase is viewed as a critical time for individual and collective healing, and cultural and community rebuilding (Gerlach et al, 2017). Research shows that Indigenous mothers are more likely to experience mental health problems during pregnancy and postpartum than non-Indigenous mothers (Owais et al, 2019). Indeed, mainstream maternal and child health care services have focused on the management of women's pregnancies and their infants' health and development, with little support and care for the rest of the family and their lives and well-being (McCalman et al, 2017).…”