Key considerations: perinatal mental health

he Growing up in New Zealand study shows that being a migrant or refugee woman and being without extended family support exposes women who are mothers to maternal depression (Morton et al., 2015). As well, being less integrated in the community, and having no support outside the immediate family is an indicator for maternal depression (Morton et al., 2015, p.44).

Approaches to psychosocial / cultural assessment (beyondblue, 2011a)

Women from culturally and linguistically diverse backgrounds may be particularly vulnerable to antenatal and postnatal depression during the perinatal period due to:

• Communication difficulties with their healthcare provider.
• Not having a female interpreter provided.
• A lack of information including psycho-education due to low or no literacy in English.
• The unacceptability of maternal health services.
• Extreme stigma regarding mental health problems or disorders, particularly in the maternal role.
• The cultural value placed on the gender of the infant.
• Lack of usual female family and peer support systems.
• Conflict between traditional practices around birth and postnatal care and mainstream health services.
• A lack of cultural competency among mainstream health professionals.
• A history of grief, loss and trauma, in addition to migration, particularly for women from refugee backgrounds.

Women who have resettled in New Zealand as part of the refugee quota

• Women from refugee backgrounds are likely to have experienced repeated traumatic events.
• Families who have been forced to flee from their country of origin may have been subject to multiple traumas, including sexual violence; and disrupted attachments, including the loss of family members and/or separation from extended family and community.
• Prolonged periods in unsafe refugee camps.
• The challenges of the resettlement process can be overwhelming. These include adapting to an alien society, learning a new language, limited income support, changes in family roles, concern for family members still overseas, and the pressure to provide financial support.
• Refugees may also experience posttraumatic stress disorder, and multiple loss and grief.
• For these women, the increased stress associated with the perinatal period can add to an already difficult and challenging situation. An unfamiliar environment, language difficulties, absence of support and the absence of traditional pregnancy and birth rites and rituals, may place new mothers at a higher risk of perinatal depression (State Perinatal Reference Group 2008).

Checklist: Having systems in place to ensure appropriate care for women

• Communicating with non-English speaking women:
  • Use qualified interpreters.
  • Accessing cultural support where available and appropriate: Develop networks with health professionals who may be able to assist in the care of women from CALD backgrounds (eg CALD cultural caseworkers).
  • Use language matched health professionals if appropriate; NGOs such as the Chinese Wellbeing Charitable Trust).
• Assess social context:
  • Gain a full understanding of a woman’s situation by exploring her exposure to the social factors that may increase the likelihood of mental health problems including partner and in-law abuse; immigration issues; housing and income issues; and social isolation.
• Take a family-centred approach:
  • Take a family-centred approach.
  • Ask women who they would like to be involved in their care and, with the woman’s consent, seek this involvement early.
  • Be aware of the emotional wellbeing of significant others and offer support if needed.
• Have appropriate information available:
  • Promote awareness of depression and related disorders in the perinatal period.
  • Have available translated information that is suitable for women and their families in your community.
  • When appropriate services are not available locally seek alternative means of accessing care, explore models of care that have worked in your community.
• Consider complexity:
  • For women with a co-occurring mental health or ongoing sociocultural or psychosocial stressors, explore options for case planning by a multidisciplinary team.
• Consider risk of harm to woman or infant:
  • In all contacts with women in the perinatal period, regard should be given to the wellbeing and safety of the woman and infant.
• Develop referral pathways:
  • Develop a local plan, identifying appropriate health professionals (eg GPs, community health workers, mental health nurses) and support groups that are accessible to women in your area.
  • Have processes in place to follow-up on referrals.
• Develop a professional support network:
  • Identify health professionals and resources that may assist you to support women and their significant others, through specialist advice and support.