title: Pregnant migrant and refugee women's perceptions of mental illness on the Thai-Myanmar border: a qualitative study.
abstract: BACKGROUND
  Mental illness is a significant contributor to the global burden of disease, with prevalence highest in low- and middle-income countries. Rates are high in women of childbearing age, especially during pregnancy and the first year post-partum. Migrant and refugee populations are at risk of developing mental illness due to the multiple stressors associated with migration. The Thai-Myanmar border area is home to large populations of migrants and refugees as a result of long-standing conflict, poverty and unemployment in Myanmar. This study aims to explore perceptions of mental illness among pregnant migrants and refugees and antenatal clinic staff living and working along the Thai-Myanmar border.
  
  
  METHODS
  Thirteen focus group discussions were conducted with pregnant migrants, pregnant refugees and antenatal clinic staff. Focus groups were held in one large refugee camp and two migrant health clinics along the Thai-Myanmar border. Thematic analysis was used to identify and code themes emerging from the data.
  
  
  RESULTS
  A total of 92 pregnant women and 24 antenatal clinic staff participated. Discussions centered around five main themes: symptoms of mental illness; causes of mental illness; suicide; mental illness during pregnancy and the post-partum period; and managing mental illness. Symptoms of mental illness included emotional disturbances, somatic symptoms and socially inappropriate behavior. The main causes were described as current economic and family-related difficulties. Suicide was frequently attributed to shame. Mental illness was thought to be more common during and following pregnancy due to a lack of family support and worries about the future. Talking to family and friends, medication and hospitalization were suggested as means of helping those suffering from mental illness.
  
  
  CONCLUSIONS
  Mental illness was recognized as a concept by the majority of participants and there was a general willingness to discuss various aspects of it. More formal and systematic training including the development of assessment tools in the local languages would enable better ascertainment and treatment of mental illness in this population.
authors.affiliation: Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, UK. gracia.fellmeth@dph.ox.ac.uk.
authors.forename: Gracia
authors.initials: G
authors.lastname: Fellmeth
authors.affiliation: Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Old Road Campus, Headington, Oxford, UK. emma.plugge@ndm.ox.ac.uk.
authors.forename: Emma
authors.initials: E
authors.lastname: Plugge
authors.affiliation: Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand. mookhopaw@shoklo-unit.com.
authors.forename: Moo Kho
authors.initials: MK
authors.lastname: Paw
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. jib@tropmedres.a.
authors.forename: Prakaykaew
authors.initials: P
authors.lastname: Charunwatthana
authors.affiliation: Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand. francois@tropmedres.a.|Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. francois@tropmedres.a.|Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK. francois@tropmedres.a.
authors.forename: François
authors.initials: F
authors.lastname: Nosten
authors.affiliation: Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand. rose@shoklo-unit.com.|Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. rose@shoklo-unit.com.|Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK. rose@shoklo-unit.com.
authors.forename: Rose
authors.initials: R
authors.lastname: McGready
mesh_terms: D000328:Adult; D005195:Family Relations / Q000523:psychology; D005260:Female; D017144:Focus Groups; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008427:Maternal Health Services; D001523:Mental Disorders / Q000453:epidemiology / Q000209:etiology / Q000523:psychology*; D002052:Myanmar; D049590:Postpartum Period / Q000523:psychology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000209:etiology / Q000523:psychology*; D037841:Pregnant People / Q000523:psychology*; D015995:Prevalence; D036301:Qualitative Research; D012036:Refugees / Q000523:psychology*; D012752:Shame; D012944:Social Support; D012959:Socioeconomic Factors; D013785:Thailand; D014171:Transients and Migrants / Q000523:psychology*; D055815:Young Adult