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Mental health stressors and possible psychological reactions in migrant and refugee women

Maternal Health for CALD Women Resource

eCALD Supplementary Resources

Gaining an understanding of the context and impact of the woman’s migrant or refugee resettlement experience is important. Challenging and traumatic experiences impact on women’s coping skills and resilience as new mothers.

Mental health stressors and possible psychological reactions
(Adapted from Queensland Health- Multicultural Services, 2009)

Mental Health Stressors Possible Psychological Reactions
Pre-migration and refugee experiences
  • Psychological issues related to the experience of civil war, refugee flight, displacement, rape, torture, survival in refugee camps, death of close relatives.
  • Post-traumatic stress disorder (fear, nightmares, lack of control of situation, depression, hopelessness).
  • Powerlessness over decision to migrate.
Adjustment
  • Stress related to the loss of a job, housing, financial problems, lack of English language skills, lack of knowledge and skills for everyday activities, lack of knowledge of services.
Wellbeing of overseas family
  • Feelings of guilt for not contributing enough to family overseas.
  • Family members may be missing or living in difficult or dangerous circumstances.
Lack of knowledge of the Lead Maternity Carer system and NZ birthing practices
  • Fear of difference in health care and birthing practices in New Zealand.
  • Inability to navigate the health system due to language and cultural barriers.
Traditional beliefs
  • Fear of illness due to not following traditional practices.
  • Fear of being cursed by overseas relatives.
  • Fear of displeasing relatives and/or ancestral spirits.
  • Conflict between traditional and western health practices.
Female Genital Mutilation
  • Stigma, feeling different from others, fear of potential procedures, lack of voice.
  • Confusion. Some women feel proud of being circumcised but in western societies may feel different or incomplete and this may impact on mental health.
  • Women may feel a loss of cultural or religious identity, and pressure from parents or grandmothers to continue the practice of FGM
Antenatal testing, genetic counselling
  • Fear of tests, lack of choice about continuing or terminating a pregnancy due to religious beliefs.
Sex preference
  • Negative emotions linked to having a female fetus, lack of choice about continuing or terminating a pregnancy due to family pressure.
Arranged/early marriage, unwanted/unplanned pregnancy
  • Hopelessness, lack of personal voice, lack of choice about continuing or terminating pregnancy, lack of choice about remaining married, or separation or divorce, due to family pressure and religious beliefs.
  • Fear of abuse from partner’s family
  • Loss of trust with her own family if she was coerced into early marriage
Family Violence
  • Partner and/or in-law or other family members’ abuse resulting in injuries, post- traumatic stress disorder, depression and anxiety, insomnia, chronic pain, drug abuse or addiction, suicidal ideation or attempts, somatic symptoms.
Lack of support
  • Loneliness, isolation, lack of extended family support in NZ, burden of caring for newborn alone, nostalgia for traditional supports.
Lack of knowledge and skills to care for new born child
  • Fear that the baby might die due to inadequate care, anxiety and fear that something is not right with the baby, self-blame for inadequate care.
Breastfeeding problems
  • Stress related to increased pressure from extended family members to supplement with formula due to baby crying/unsettled periods.

Postnatal Depression: Practical Advice
(Ministry of Health, 2013b; Queensland Health- Multicultural Services, 2009)

  • Be sensitive to cultural differences in understanding or relating to mental health issues. While providing your explanation of postnatal depression, replace terms such as “mental illness” or “postnatal depression” with “pregnancy-related psychological condition” or “birth-related emotional condition”.
  • Acknowledge and explain to the woman the role of various factors that may contribute to postnatal depression. Women from collective cultures may be reluctant to disclose their issues to other family members. Talk to the woman on her own. Carefully consider what information should be shared and with whom. Discuss visiting the local Plunket Family Centre (or other Well Child/Tamariki Ora provider). Well Child/Tamariki Ora providers, for example Plunket can offer support and information (http://www.plunket.org.nz/your-child/welcome-to-parenting/postnatal-depression/where-can-i-find-support-and-advice/).
  • Phone the GP, Maternal Mental Health Service or Community Mental Health Service for advice.
  • Reassure the woman that prenatal and postnatal depression is common.
  • Discuss the potential consequences of postnatal depression with the woman.
  • Provide reassurance that the woman will get better but that she will need extra care and support for a time.
  • Provide printed information about postnatal depression, preferably in the woman’s first language. An Australian booklet Emotional Health during Pregnancy and Early Childbirth, which has been translated into several languages, is available for download from the beyondblue website at: www.beyondblue.org.au/index.aspx?link_id=102.944.
  • Arrange early contact with the Well Child/Tamariki Ora provider. The Well Child/Tamariki Ora Provider will explain any value added services they provide such as the Plunket Family Centre.
  • Offer phone support available from PlunketLine 0800 933 922. PlunketLine is a toll-free parent helpline and advice service available for all with children under five regardless of which Well Child/Tamariki Ora Provider they have chosen. It is a 24 hours a day, seven days a week service. Interpreting services are available.
  • Encourage early contact with the general practitioner to explore options for care.
  • Discuss the community support available including: postnatal depression groups, community mental health services, home help assistance and counselling.
  • Try to elicit potential reasons for refusing psychological support.
  • Where available, refer the woman to the maternal mental health service provided by your DHB.

This video presents how a Plunket nurse manage the cultural issues presented by an Indian woman, assessed with postpartum depression symptoms, in a culturally appropriate manner.

 

An Expert Panel Discussion responding to:

What are some of the most common factors that can lead to mental health issues for CALD women during the perinatal period?
How can practitioners best support CALD women during this period to help prevent mental health issues developing?
Can you suggest any culturally appropriate tools that practitioners can use to assess mental health needs during the perinatal period?