title: Predictors of Postpartum Depression Among Immigrant Women in the Year After Childbirth.
abstract: BACKGROUND
  Immigrant women are at increased risk for postpartum depression (PPD). The factors that influence PPD among immigrant women are poorly understood. The purpose of this study was to identify individual- and community-level factors predictive of PPD among immigrant women living in a large Ontario city at 6 weeks, 6 months, and 1 year postpartum.
  
  
  METHODS
  The study involved a secondary analysis of a prospective cohort study, The Ontario Mother and Infant Study 3. This study included 519 immigrant women who were recruited from two hospitals in one urban city and delivered full-term singleton infants. Women completed a written questionnaire in hospital, followed by structured telephone interviews at 6 weeks, 6 months, and 1 year after hospital discharge. Generalized estimating equations were used to explore factors associated with PPD, measured using the Edinburgh Postnatal Depression Scale (EPDS) and two thresholds for depression (≥12 and ≥9).
  
  
  RESULTS
  Rates of PPD at all time points were 8%-10% for EPDS scores of ≥12. For EPDS scores of ≥9, rates of PPD more than doubled at all time points. A lack of social support was strongly associated with PPD in all analyses. Living in Canada for ≤2 years, poor perceptions of health, and lower mental health functioning were other important predictors of PPD. Living in communities with a high prevalence of immigrants and low income also was associated with PPD.
  
  
  CONCLUSIONS
  Complex individual and community-level factors are associated with PPD in immigrant women. Understanding these contextual factors can inform a multifaceted approach to addressing PPD.
authors.affiliation: 1 School of Nursing, McMaster University , Hamilton, Canada .
authors.forename: Rebecca
authors.initials: R
authors.lastname: Ganann
authors.affiliation: 2 School of Nursing, University of Ottawa , Ottawa, Canada .
authors.forename: Wendy
authors.initials: W
authors.lastname: Sword
authors.affiliation: 3 Department of Clinical Epidemiology and Biostatistics, McMaster University , Hamilton, Canada .
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.affiliation: 4 School of Geography and Earth Sciences, McMaster University , Hamilton, Canada .
authors.forename: Bruce
authors.initials: B
authors.lastname: Newbold
authors.affiliation: 1 School of Nursing, McMaster University , Hamilton, Canada .
authors.forename: Margaret
authors.initials: M
authors.lastname: Black
mesh_terms: D000293:Adolescent; D000328:Adult; D003153:Community Health Services / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D019052:Depression, Postpartum / Q000175:diagnosis / Q000208:ethnology*; D054242:Emigrants and Immigrants / Q000523:psychology*; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D009035:Mothers / Q000523:psychology*; D009864:Ontario / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012111:Residence Characteristics; D012307:Risk Factors; D012944:Social Support; D012959:Socioeconomic Factors