Pregnancy
Both antenatal and postpartum depression rates seem to be higher among immigrant mothers than among Canadian-born mothers (Vigod et al , 2016; Khanlou et al, 2017). The rates vary depending on length of time in Canada and intersecting variables (Ballantyne et al., 2013; Miszkurka et al., 2012a). The rates of depressive symptoms among immigrant, postpartum women seem to range widely depending on ethnic origins; around 20% of women from Europe and over 40% of women from Maghreb, South-Asian and Caribbean regions report symptoms of depression in the postpartum period (Miszkurka et al., 2010).
Canadian researchers are increasingly exploring the reasons for the higher rates of depression in pregnancy among immigrant and refugee mothers.
Postpartum depression
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Description
Postpartum depression is a depressive disorder that goes beyond the “baby blues.” It can impair a woman's ability to function both during pregnancy and after giving birth.
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Symptoms
The DSM-5 does not recognize peripartum (formerly postpartum) depression as a separate diagnosis from other depressive disorders. Rather, clients need to meet the criteria for a major depressive episode and the criteria for the peripartum-onset specifier. Peripartum depression is a major depressive episode with an onset in pregnancy or within four weeks of delivery (APA, 2013).
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Rates: Similarities and differences
Available evidence suggests that recent immigrant women have significantly higher rates of depressive symptoms at 16 weeks of pregnancy compared to Canadian-born women (12.2% vs. 25.6%, respectively) (Daoud & al, 2019). Another study showed that among immigrant women, asylum seekers have the highest rate of postpartum depression (14.3%), followed by refugee (11.5%) and immigrant women (5.1%) (Dennis et al., 2017). In addition, the prevalence of postpartum depression is higher for immigrant women compared to Canadian-born women, particularly in South-Asian immigrants (Close et al., 2016).
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Assessment
The Edinburgh Postnatal Depression Scale is the most widely used screening measure for women in the postpartum period across cultures (Kirmayer et al., 2011). The Patient Health Questionnaire-9 has also been validated as a screening tool for postpartum depression (Kirmayer et al., 2011).
Risk factors for postpartum depression and the role of the service provider
With Dr. Vanessa Reddit (Physician, The Crossroads Clinic, Women's College Hospital)
So I think that there are some studies that indicate there are higher rates of postpartum depression among newcomer women. And we can think of a lot of reasons that that may be the case. Many women may be very socially isolated during this period, they may not have the family and social supports that they normally would in raising a child and particularly during that very sleepless early stage of having an infant. They may actually be separated from their spouse or partner. It can be a very lonely, isolating time. Because women may be new to this context, they may be unfamiliar with the supports that are available. So I think as primary care providers or other health care providers, we have an opportunity when women are coming back for their well-baby visits and for their postpartum visits to ask women how they're doing and to see if they are experiencing any of the symptoms of postpartum depression or baby blues. Just inquiring about their emotional status at that time. And I think also normalizing that it can be a profoundly stressful period, particularly when you're all alone, and that many women experience these symptoms and that there are supports available. Even just saying that, it may open the door for someone to, maybe not at the first visit, but at a second visit, talk about how they're feeling. I think the second step is to then help to connect women to some of the community resources that are available. So there are nurse visiting programs. For example in Toronto, through Toronto Public Health, there's the Healthy Babies Healthy Children program that we can help connect women with during their pregnancy and that follows them through the prenatal period and postpartum. So that they can have nurses actually in their home, checking on them, supporting them with child care, but also really seeing how they're doing and making subsequent connections to other community resources. It might also be helping a woman to connect with infant parent programs where they're getting out to a library or recreation centre so that they're around other people and other infants and talking about how they're feeling or just not feeling so alone. That can be very helpful and, of course, in certain cases, connecting to counselling or psychiatry services may be helpful. And I think there's also a role to be cognizant of this during the prenatal period of someone who may be at a higher risk for developing postpartum depression, because of how they're emotionally feeling at that stage, and, if possible, connecting them to some resources during that time so that again they have that trusting relationship in the postpartum period if they're feeling worse.