- Asian, Middle Eastern and African respondents may report somatic symptoms to express depression rather than emotional symptoms. Consequently PND in non-Western women may not be detected in maternity settings (Klainin & Arthur 2009).
- The relevance of a diagnosis of depression relies on an individual’s interpretation of unhappiness, sadness, loss, misery and other depression-like emotional states.
- In non-western cultural groups many of the key psychiatric symptoms of depression have entirely different meanings compared to western concepts (Jackson, 2006).
- Women may express emotions and distress in culturally specific ways and language, and report distress in interpersonal rather than individualistic terms (Morrow et al., 2008).
- Cross-cultural research shows that collectivist cultures commonly view depressive symptoms as social problems or emotional reactions to situations, particularly as a response to harsh circumstances such as refugee flight and resettlement in an alien culture (Kokanovic et al., 2009).
- In cultures where stigmatisation of mental illness exists, women are hesitant to describe their experiences in those terms.
- Mothers may resist a mental health diagnosis because of the negative cultural associations with weakness when there is cultural validation for strong, stoic motherhood in the face of hardship and ‘imperatives to normalise distress’ (Kokanovic et al., 2012).
- Migrant and refugee-background mothers may be more vulnerable to PND because of the disruption to traditional practices of maternal support for the new mother.
- While migrant women attribute postpartum unhappiness and distress similarly to non-migrant women, their situations are more difficult due to the lack of family support and barriers to formal supports (Dennis & Chung-Lee 2006).
- Migrant mothers may be conflicted because of the way that their culture views the role of mothers and of appropriate mothering; and the host society’s views and attitudes of mothering, for example, co-sleeping with their baby.
- Migrant and refugee background women are faced with unfamiliar standards and pressures from the host society, for example norms about breastfeeding in public, which leads to distress (Morrow et al 2008).
