Contributions of Immigration to Depressive Symptoms among Pregnant Women in Canada
Miszkurka, Malgorzata, Goulet, Lise, Zunzunegui, Maria Victoria, Canadian Journal of Public Health
Objectives: Immigrant women present high prevalence of depressive symptoms during pregnancy, the early postpartum period and as mothers of young children. We compared mental health of immigrant and Canadian native-born women during pregnancy according to length of stay and region of origin, and we assessed the role of economics and social support in antenatal depressive symptomatology.
Methods: Data originated from the Montreal study on socio-economic differences in prematurity; 3,834 Canadian-born and 1,495 foreign-born women attending Montreal hospitals for antenatal care were evaluated for depression at 24-26 weeks of pregnancy using the Center for Epidemiologic Studies Depression scale by fitting logistic regressions with staggered entry of possible explanatory variables.
Results: Immigrant women had a higher prevalence of depressive symptomatology independently of time since immigration. Region of origin was a strong predictor of depressive symptomatology: women from the Caribbean, South Asia, Maghreb, Sub-Saharan Africa and Latin America had the highest prevalence of depressive symptomatology compared to Canadian-born women. The higher depression odds in immigrant women are attenuated after adjustment for lack of social support and money for basic needs. Time trends of depressive symptoms varied across origins. In relation to length of stay, depressive symptoms increased (European, Southeast Asian), decreased (Maghrebian, Sub-Saharan African, Middle Eastern, East Asian) or fluctuated (Latin American, Caribbean).
Conclusion: Depression in minority pregnant women deserves more attention, independently of their length of stay in Canada. Social support favouring integration and poverty reduction interventions could reduce this risk of antenatal depression.
Key words: Pregnancy; depression; immigration; socio-economic factors; social support; region of origin
La traduction du résumé se trouve à la fin de l'article. Can J Public Health 2010;101(5):358-64.
Approximately 20% of childbearing women present a high risk of depression. Antenatal depression (AD) is the strongest predictor of postnatal depression with important consequences for the outcome of pregnancy.1,2 Immigration effects on mental health may be particularly strong during pregnancy, a period of increased vulnerability to depression. Studies show that immigrant women present a high prevalence of depressive symptoms during pregnancy, the early postpartum period and as mothers of young children.1,3-7
Immigration impacts cultural identity, social support and socioeconomic status and this, in turn, is likely to have effects on immigrant mental health.8-10 European studies of immigrant mental health have shown that risk factors for depression, such as poor health and discrimination, have particularly strong effects under conditions of poverty and lack of social support.11 Moreover, time since immigration and ethnicity may influence individual social and socio-economic characteristics, having an impact on mental health.12 In addition, pregnancy may be a period of vulnerability to depression.13We argue that the vulnerability to depression could be particularly exacerbated by lack of money and support, especially in immigrant women.
While ethnic disparities in depressive symptomatology (DS) during pregnancy have been described abroad,3,14,15 length of stay and region of origin are rarely assessed in a combined fashion in studies of immigrant health in Canada. Studies of pregnant women lack comparisons with Canadian-born women, and their sample size is often insufficient to disentangle the effect of region of origin and length of stay on mental health.4,16
Our aims are threefold: to estimate the prevalence of antenatal DS in Canada's immigrants with respect to length of stay and region of origin, and to compare this to the prevalence in Canadian-born women; to examine the role of lack of money and social support in depression in this population; and to evaluate the interplay of length of stay and region of origin as determinants of antenatal DS. …