title: Prevalence, continuation, and identification of postpartum depressive symptomatology among refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women: results from a prospective cohort study.
abstract: This study assessed the prevalence, continuation, and identification of maternal depressive symptomatology over the first 16 weeks postpartum among refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women. A sample of 1125 women (143 refugees, 369 asylum-seekers, 303 non-refugee immigrant, and 310 Canadian-born) completed the Edinburgh Postnatal Depression Scale (EPDS) at 1 and 16 weeks postpartum. The sensitivity, specificity, and predictive power of the 1-week EPDS to identify women with elevated EPDS scores at 16 weeks were determined. The total number of women with EPDS scores >9 for each group at 1 and 16 weeks, respectively, was 26.6 and 18.2 % for refugees; 25.2 and 24.1 % for asylum-seekers; 22.4 and 14.2 % for non-refugee immigrants, and 14.8 and 7.4 % for Canadian-born. Using the cut-off score of 9/10, the 1-week EPDS accurately classified 77.6 % refugee, 73.4 % asylum-seeking, 76.6 % non-refugee immigrant, and 85.5 % Canadian-born women at 16 weeks with or without postpartum depressive symptomatology. The 1-week EPDS was significantly correlated to the 16-week EPDS (r = 0.46, p < 0.01). All groups were significantly more likely to exhibit depressive symptomatology at 16 weeks if they had EPDS scores >9 at 1 week postpartum: refugees (OR = 6.9, 95 % CI = 2.8-17.3), asylum-seekers (OR = 4.0, 95 % CI = 2.4-6.7), non-refugee immigrants (OR = 3.8, 95 % CI = 2.0-7.6), and Canadian-born women (OR = 8.0, 95 % CI = 3.3-19.8). Our findings suggest that refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women at risk of postpartum depression may be identified early in the postpartum period such that secondary preventive interventions may be implemented.
authors.affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St., Toronto, Ontario, M5T 1P8, Canada. cindylee.dennis@utoronto.ca.|Women's College Research Institute Toronto, Toronto, Canada. cindylee.dennis@utoronto.ca.
authors.forename: Cindy-Lee
authors.initials: CL
authors.lastname: Dennis
authors.affiliation: School of Nursing, University of Ottawa, Ottawa, Canada. lisa.merry@mail.mcgill.ca.|Ingram School of Nursing, McGill University, Montreal, Canada. lisa.merry@mail.mcgill.ca.
authors.forename: Lisa
authors.initials: L
authors.lastname: Merry
authors.affiliation: Department of Psychiatry, University of Toronto, University Health Network, Toronto, Canada.|Toronto General Research Institute, Toronto, Canada.
authors.forename: Donna
authors.initials: D
authors.lastname: Stewart
authors.affiliation: Ingram School of Nursing, McGill University, Montreal, Canada.|Research Institute, McGill University Health Centre, Montreal, Canada.
authors.forename: Anita J
authors.initials: AJ
authors.lastname: Gagnon
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D019052:Depression, Postpartum / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D042241:Early Diagnosis; D061345:Early Medical Intervention; D054242:Emigrants and Immigrants / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D020380:Needs Assessment; D044382:Population Groups / Q000523:psychology / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011247:Pregnancy; D015995:Prevalence; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D012036:Refugees / Q000523:psychology* / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity
keywords: Edinburgh Postnatal Depression Scale (EPDS); Migrant women; Postpartum depression screening; Predictive validity; Sensitivity and specificity