Perinatal mental health screening for women of refugee background: Addressing a major gap in pregnancy care

• Published in: Birth (Berkeley, Calif.) Vol. 51; no. 1; pp. 229 - 241
• Main Authors: Willey, Suzanne M., Gibson, Melanie E., Blackmore, Rebecca, Goonetilleke, Liyasha, McBride, Jacqueline, Highet, Nicole, Ball, Natahl, Gray, Kylie M., Melvin, Glenn, Boyd, Leanne M., East, Christine E., Boyle, Jacqueline A.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-03-2024
• Subjects: Background; Clinical assessment; Depressive personality disorders; Health needs; Medical referrals; Medical screening; Mental depression; Mental disorders; Mental health; Mental health care; Perinatal care; perinatal mental health; Postpartum depression; Postpartum period; Pregnancy; Prenatal care; psychiatric status rating scales; Psychological assessment; Psychosocial assessment; Psychosocial factors; Refugees; screening; Women; Womens health; screening; psychiatric status rating scales; refugees; perinatal mental health; women
• ISSN: 0730-7659; 1523-536X
• DOI: 10.1111/birt.12782

Background
Perinatal mental health disorders affect up to 20% of all women. Women of refugee background are likely to be at increased risk, yet little research has explored this. This study aimed to assess if women of refugee background are more likely to screen risk positive for depression and anxiety than non‐refugee women, using the Edinburgh Postnatal Depression Scale (EPDS); and if screening in pregnancy using the EPDS enables better detection of depression and anxiety symptoms in women of refugee background than routine care.
Methods
This implementation study was conducted at an antenatal clinic in Melbourne, Australia. Women of refugee and non‐refugee backgrounds were screened for depression using English or translated versions of the EPDS and a psychosocial assessment on a digital platform. The psychosocial assessment records of 34 women of refugee background receiving routine care (no screening) were audited.
Results
Overall, 274 women completed the EPDS; 43% of refugee background. A similar proportion of women of refugee and non‐refugee backgrounds had EPDS scores of ≥9 (39% vs. 40% p = 0.93). Women receiving the combined EPDS and psychosocial screening were more likely to receive a referral for further support than women receiving routine care (41% vs. 18%, p = 0.012).
Conclusion
Similarly, high proportions of women of refugee and non‐refugee backgrounds were at increased risk of experiencing a current depressive disorder in early pregnancy, suggesting pregnancy care systems should acknowledge and respond to the mental health needs of these women. Screening appeared to facilitate the identification and referral of women compared to routine care.
In this study, we used translated versions of the Edinburgh Postnatal Depression Scale and a psychosocial assessment on a digital platform and found high proportions of women of refugee and non‐refugee background were at increased risk of experiencing a current depressive disorder in early pregnancy. We suggest pregnancy care systems should acknowledge and respond to the mental health needs of these women.