Abstract
Purpose
To examine the distribution of contextual risk factors for antenatal depression according to immigrant status and the length of stay in Canada, to assess the association between these risk factors and antenatal depression (AD) for Canadian-born and immigrant women, and to compare the vulnerability of Canadian-born and immigrant women to risk factors in relation to antenatal depression.
Methods
Women were recruited at routine ultrasound examinations (16–20 weeks), at antenatal blood sampling (8–12 weeks), or in antenatal care clinics. Cross-sectional analysis was performed on the baseline sample consisting of 5,162 pregnant women. CES-D scale was used to investigate depression. Levels of exposure to the selected risk factors according to immigrant status and length of stay were assessed using Chi-square-test or the t test. All measures of association were assessed using logistic regression. Multiplicative interaction terms were constructed between each of the risk factors and immigrant status to reveal differential vulnerability between Canadian-born and immigrant women.
Results
Prevalence of AD (CES-D ≥16 points) was higher in immigrants (32% [29.6–34.4]) than in Canadian-born women (22.8% IC 95% [21.4–24.1]). Immigrant women were significantly more exposed than Canadian-born women to adverse contextual risk factors such as high marital strain, lack of social support, poverty, and crowding. At the same level of exposure to risk factors, Canadian-born women presented higher vulnerability to AD when lacking social support (OR = 4.14 IC 95% [2.69; 6.37]) while immigrant women presented higher vulnerability to AD when lacking money for basic needs (OR = 2.98 IC 95% [2.06; 4.32]).
Conclusions
Important risk factor exposure inequalities exist between Canadian-born and immigrant pregnant women. Interventions should target poverty and social isolation. The observed high frequency of AD highlights the need to evaluate the effectiveness of preventive interventions of antenatal depression.
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References
Kaaya S, Mbwambo J, Kilonzo G, Van Den Borne H, Leshabari M, Fawzi M, Schaalma H (2010) Socio-economic and partner relationship factors associated with antenatal depressive morbidity among pregnant women in Dar es Salaam, Tanzania. Tanzan J Health Res 12(1):23–35
Melville J, Gavin A, Guo Y, Fan M, Katon W (2010) Depressive disorders during pregnancy: prevalence and risk factors in a large urban sample. Obstet Gynecol 116(5):1064–1070
Edwards B, Galletly C, Semmler-Booth T, Dekker G (2008) Antenatal psychosocial risk factors and depression among women living in socioeconomically disadvantaged suburbs in Adelaide, South Australia. Aust N Z J Psychiatry 42(1):45–50. doi:10.1080/00048670701732673
Bowen A, Muhajarine N (2006) Antenatal depression. Can Nurse 102(9):26–30
Koleva H, Stuart S, O’Hara M, Bowman-Reif J (2010) Risk factors for depressive symptoms during pregnancy. Arch Womens Ment Health 14(2):99–105
Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, Davis MM (2010) Risk factors for depressive symptoms during pregnancy: a systematic review. Am J Obstet Gynecol 202(1):5–14
Chui T, Tran K, Maheux H (2007) Immigration in Canada: a portrait of the foreign-born population, 2006 Census. Ottawa: Statistics Canada
Miszkurka M, Goulet L, Zunzunegui MV (2010) Contributions of immigration to depressive symptoms among pregnant women in Canada. Can J Public Health 101(5):358–364
Denton M, Prus S, Walters V (2004) Gender differences in health: a Canadian study of the psychosocial, structural and behavioural determinants of health. Soc Sci Med 58(12):2585–2600
Rogler Lloyd H (1994) International migrations. A framework for directing research. Am Psychol 49(8):701–708
Kramer MS, Goulet L, Lydon J, Séguin L, McNamara H, Dassa C, Platt RW, Chen MF, Gauthier H, Genest J, Kahn S, Libman M, Rozen R, Masse A, Miner L, Asselin G, Benjamin A, Klein J, Koren G (2001) Socio-economic disparities in preterm birth: causal pathways and mechanisms. Pediatr Perinat Epidemiol, suppl(2):104–123
Kramer MS, Wilkins R, Goulet L, Séguin L, Lydon J, Kahn SR, McNamara H, Dassa C, Dahhou M, Masse A, Miner L, Asselin G, Gauthier H, Ghanem A, Benjamin A, Platt RW (2009) Investigating socio-economic disparities in preterm birth: evidence for selective study participation and selection bias. Paediatr Perinat Epidemiol 23(4):301–309
Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1(3):385–401. doi:10.1177/014662167700100306
Roberts RE (1980) Reliability of the CES-D scale in different ethnic contexts. Psychiatry Res 2(2):125–134
Giovanni AF (1983) Assessing depressive symptoms across cultures: Italian validation of the CES-D self-rating scale. J Clin Psychol 39(2):249–251
Stahl D, Sum CF, Lum SS, Liow PH, Chan YH, Verma S, Chua HC, Chong SA (2008) Screening for depressive symptoms: validation of the Center for Epidemiologic Studies Depression Scale (CES-D) in a multiethnic group of patients with diabetes in Singapore. Diabetes Care 31(6):1118–1119. doi:10.2337/dc07-2019
Morton DJ, Schoenrock SA, Stanford EP, Peddecord KM, Molgaard CA (1989) Use of the CES-D among a community sample of older Mexican–Americans. J Cr Cultural Gerontol 4(4):289–306
Nguyen HT, Kitner-Triolo M, Evans MK, Zonderman AB (2004) Factorial invariance of the CES-D in low socioeconomic status African Americans compared with a nationally representative sample. Psychiatry Res 126(2):177–187
Vissandjee B, Carignan P, Bourdeau-Marchand M (1999) Les nouvelles immigrantes et la sante. L’infirmiere canadienne 95(4):35–41
Vissandjee B, Desmeules M, Cao Z, Abdool S, Kazanjian A (2004) Integrating ethnicity and migration as determinants of Canadian women’s health. BMC Women’s Health 4(Suppl 1):S32
Pearlin LI, Schooler C (1978) The structure of coping. J Health Soc Behav 19(1):2–21
Vega WA, Kolody B, Ramon V (1988) Marital strain, coping, and depression among Mexican–American women. J Marriage Fam 50(2):391–403
Osborne LN, Rhodes JE (2001) The role of life stress and social support in the adjustment of sexually victimized pregnant and parenting minority adolescents. Am J Community Psychol 29(6):833–849
Barrera M (1981) Social support in the adjustment of pregnant adolescents: assessment issues. In: Gottieb B (ed) Social network and social support. Sage, Beverly Hills, pp 69–96
Zelkowitz P, Schinazi J, Katofsky L, Saucier JF, Valenzuela M, Westreich R, Dayan J (2004) Factors associated with depression in pregnant immigrant women. Transcult Psychiatry 41(4):445–464. doi:10.1177/1363461504047929
Ehounoux NZ, Zunzunegui M-V, Seguin L, Nikiema B, Gauvin L (2009) Duration of lack of money for basic needs and growth delay in the Quebec longitudinal study of child development birth cohort. J Epidemiol Community Health 63(1):45–49. doi:10.1136/jech.2007.072157
Lobel M (1997) The prenatal life event scale (PLES). State University of New York at Stony Brook, Stony Brook
Lobel M, Dunkel-Schetter C, Scrimshaw SCM (1992) Prenatal maternal stress and prematurity: a prospective study of socioeconomically disadvantaged women. Health Psychol 11(1):32–40
Cuzick J (1985) A Wilcoxon-type test for trend. Stat Med 4(1):87–90
Zelkowitz P (1996) Childbearing and women’s mental health. Transcult Psychiatry 33(4):391–412. doi:10.1177/136346159603300402
Wu Z, Noh S, Kaspar V, Schimmele CM (2003) Race, ethnicity, and depression in Canadian society. J Health Soc Behav 44(3):426–441
Williams DR (2002) Racial/ethnic variations in women’s health: the social embeddedness of health. Am J Public Health 92(4):588–597
Fung K, Dennis C-L Postpartum depression among immigrant women. Curr Opin Psychiatry 23(4):342–348 310.1097/YCO.1090b1013e32833ad32721
Saunders RB, Robins E (1987) Changes in the marital relationship during the first pregnancy. Health Care Women Int 8(5–6):361–377. doi:10.1080/07399338709515800
Xie R-H, He G, Koszycki D, Walker M, Wen SW (2009) Prenatal social support, postnatal social support, and postpartum depression. Ann Epidemiol 19(9):637–643
Stewart DE, Gagnon A, Saucier JF, Wahoush O, Dougherty G (2008) Postpartum depression symptoms in newcomers. Can J Psych 53:121–124
Sword W, Watt S, Krueger P (2006) Postpartum health, service needs, and access to care experiences of immigrant and Canadian-born women. J Obstet Gynecol Neonatal Nurs 35(6):717–727. doi:10.1111/j.1552-6909.2006.00092.x
Lau Y, Keung Wong DF (2008) The role of social support in helping chinese women with perinatal depressive symptoms cope with family conflict. J Obstet Gynecol Neonatal Nurs 37(5):556–571. doi:10.1111/j.1552-6909.2008.00273.x
Rudnicki SR, Graham JL, Habboushe DF, Ross RD (2001) Social support and avoidant coping: correlates of depressed mood during pregnancy in minority women. Women Health 34(3):19–34
Antonucci TC (1994) A life-span view of women’s social relations. In: Turner BF, Troll LE (eds) Women Growing Older Sage Publications Thousand Oaks, CA, pp 239–269
Fuhrer R, Stansfeld SA, Chemali J, Shipley MJ (1999) Gender, social relations and mental health: prospective findings from an occupational cohort (Whitehall II study). Soc Sci Med 48(1):77–87
Westdahl CMS, Magriples U, Kershaw TS, Rising SS, Ickovics JR (2007) Social support and social conflict as predictors of prenatal depression. Obstet Gynecol 110(1):134–140
House JS (2001) Social isolation kills, but how and why? Psychosom Med 63(2):273–274
Mechakra-Tahiri S, Zunzunegui MV, Seguin L (2007) Self-rated health and postnatal depressive symptoms among immigrant mothers in Quebec. Women Health 45:1–17
Van Hulst A, Séguin L, Zunzunegui MV, Vélez MP, Nikiéma B (2011) The influence of poverty and social support on the perceived health of children born to minority migrant mothers. Ethn Health 16(3):185–200
Tang T, Oatley K, Toner B (2007) Impact of life events and difficulties on the mental health of chinese immigrant women. J Immigr Minority Health 9(4):281–290
Reitz J (2007) Immigrant employment success in Canada, Part I: individual and contextual causes. J Int Migr Integr 8(1):11–36
Lawrence E, Nylen K, Cobb RJ (2007) Prenatal expectations and marital satisfaction over the transition to parenthood. J Fam Psychol 21(2):155–164
Lawrence E, Rothman AD, Cobb RJ, Rothman MT (2008) Marital satisfaction across the transition to parenthhood. J Fam Psychol 22(1):41–50
Mchale SM, Huston T (1985) The effect of the transition to parenthood on the marriage relationship: a longitudinal study. J Fam Issues 6(4):409–433
Records K, Rice M (2007) Psychosocial correlates of depression symptoms during the third trimester of pregnancy. J Obstet Gynecol Neonatal Nurs 36(3):231–242
Ding H, Hargraves L (2009) Stress-associated poor health among adult immigrants with a language barrier in the United States. J Immigr Minority Health 11(6):446–452. doi:10.1007/s10903-008-9200-0
Rubertsson C, Wickberg B, Gustavsson P, Rådestad I (2005) Depressive symptoms in early pregnancy, two months and one year postpartum-prevalence and psychosocial risk factors in a national Swedish sample. Arch Women’s Ment Health 8(2):97–104. doi:10.1007/s00737-005-0078-8
Stewart M, Anderson J, Beiser M, Mwakarimba E, Neufeld A, Simich L, Spitzer D (2008) Multicultural meanings of social support among immigrants and refugees. Int Migr 46(3):123–159
Hoffman S, Hatch MC (1996) Stress, social support and pregnancy outcome: a reassessment based on recent research. Paediatr Perinat Epidemiol 10(4):380–405. doi:10.1111/j.1365-3016.1996.tb00063.x
MacArthur C, Winter HR, Bick DE, Lilford RJ, Lancashire RJ, Knowles H, Braunholtz DA, Henderson C, Belfield C, Gee H (2003) Redesigning postnatal care: a randomised controlled trial of protocol-based midwifery-led care focused on individual women’s physical and psychological health needs. Health Technol Assess 7(37):1–98
Mallikarjun PK, Oyebode F (2005) Prevention of postnatal depression. J Royal Soc Promotion Health 125(5):221–226. doi:10.1177/146642400512500514
Beck CT (2001) Predictors of postpartum depression: an update. Nurs Res 50(5):275–285
Harvey ST, Pun PKK (2007) Analysis of positive Edinburgh depression scale referrals to a consultation liaison psychiatry service in a two-year period. Int J Ment Health Nurs 16(3):161–167
Leigh B, Milgrom J (2008) Risk factors for antenatal depression, postnatal depression and parenting stress. BMC Psychiatry 8(1):24
Murray L, Cooper PJ (1997) Effects of postnatal depression on infant development. Arch Dis Child 77:99–101
Hollins K (2007) Consequences of antenatal mental health problems for child health and development. Curr Opin Obstet Gynecol 19(6):568–572
Acknowledgments
Supported by the Perinatal Epidemiological Research Initiative Program Grant No. 20-FYO4-38 from the March of Dimes Birth Defects Foundation, and by the Canadian Institutes of Health Research (CIHR).
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Miszkurka, M., Goulet, L. & Zunzunegui, M.V. Antenatal depressive symptoms among Canadian-born and immigrant women in Quebec: differential exposure and vulnerability to contextual risk factors. Soc Psychiatry Psychiatr Epidemiol 47, 1639–1648 (2012). https://doi.org/10.1007/s00127-011-0469-2
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DOI: https://doi.org/10.1007/s00127-011-0469-2