title: Prevalence, nature and determinants of postpartum mental health problems among women who have migrated from South Asian to high-income countries: a systematic review of the evidence.
abstract: BACKGROUND
  Women of reproductive age constitute a significant proportion of immigrants from South Asia to high-income countries. Pregnancy, childbirth and the postpartum period place increased demands on women׳s psychological resources and relationships. The aim of this review was to evaluate the available evidence about the prevalence, nature and determinants of postpartum mental health problems among South Asian women who have migrated to high-income countries.
  
  
  METHODS
  Using a systematic strategy, CINAHL, Medline, PsychInfo and Web of Science databases were searched.
  
  
  RESULTS
  Fifteen studies conducted in different high-income countries met inclusion criteria. Prevalence estimates of clinically significant symptoms of postpartum depression (CSS-PPD) varied widely (1.9-52%): the most common estimates ranged from 5 to 20%. Five studies found approximately a two-fold increase in risk of CSS-PPD (Odds Ratios 1.8-2.5) among overseas born women with a South Asian subgroup. The most common determinants appeared to be social factors, including social isolation and quality of relationship with the partner. Barriers to accessing health care included lack of English language proficiency, unfamiliarity with local services and lack of attention to mental health and cultural factors by health care providers.
  
  
  CONCLUSIONS
  The settings, recruitment strategies, inclusion and exclusion criteria, representative adequacy of the samples and assessment measures used in these studies varied widely. Many of these studies did not use formally validated tools or undertake specific subgroup analyses.
  
  
  CONCLUSIONS
  Reductions in postpartum depression could be achieved by increasing awareness of available services and ensuring health care professionals support the mental health of women from diverse cultural and linguistic backgrounds.
authors.affiliation: Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Ground Floor, 89 Commercial Road, Prahran, Melbourne, VIC 3004, Australia; Ministry of Health, Sri Lanka, 385, Rev. Baddegama Wimalawansa Thero Mawatha, Colombo 10, Sri Lanka. Electronic address: irosha.nilaweera@monash.edu.
authors.forename: Irosha
authors.initials: I
authors.lastname: Nilaweera
authors.affiliation: School of Health and Human Sciences, Southern Cross University, P.O. Box 157, Lismore, NSW 2480, Australia.
authors.forename: Frances
authors.initials: F
authors.lastname: Doran
authors.affiliation: Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Ground Floor, 89 Commercial Road, Prahran, Melbourne, VIC 3004, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Fisher
mesh_terms: D000328:Adult; D001210:Asia, Southeastern; D003466:Cultural Characteristics; D019052:Depression, Postpartum / Q000453:epidemiology* / Q000523:psychology*; D019049:Developed Countries; D054242:Emigrants and Immigrants / Q000523:psychology* / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008603:Mental Health; D011247:Pregnancy; D015995:Prevalence; D012934:Social Isolation
keywords: Immigrants; Mental health; Postpartum; South Asia