Pregnant immigrant women have greater depression risk

Immigrant women are at far greater risk for depression during pregnancy and the postpartum period than Canadian- born women, a Montreal team of researchers has found.

An alarming 42 per cent of 120 pregnant immigrant women scored above the cut-off point for depression in a screening test, according to a study published recently in the journal Transcultural Psychiatry.

If they were evaluated by a mental health professional, the likelihood is that at least half would receive a diagnosis of depression, said Phyllis Zelkowitz, director of research in the psychiatry department at Montreal's Jewish General Hospital, and lead author of the study.

By contrast, studies of depression during pregnancy have reported rates of about 12 per cent in the general population.

The depressed pregnant women, the study found, reported a lack of social support, as well as more stressful life events and marital problems than women who were not depressed.

Immigrant women who had been in the country for less than five years were more likely to be depressed -- and stress associated with the move, such as problems with housing and discrimination, was more common among women who scored high on the screening test.

Those who reported more symptoms of depression had fewer relatives and friends and people from their own ethnic group.

In their countries of origin, the study suggests, support and assistance from other women -- relatives as well as friends -- would have been available.

Depression during pregnancy puts women at greater risk for postpartum depression, part of a spectrum of postpartum psychiatric disorders that affects 10 to 15 per cent of mothers. A history of mental health problems before pregnancy is the single most important risk factor for depression during pregnancy and after, Zelkowitz said in an interview.

But health-care professionals don't always recognize the problem, she told delegates to a conference on women's health issues at the Jewish General recently, and the difference between blues and depression is not always clear cut. Postpartum depression can be persistent, and the risk is that postpartum depression can be the first episode in a recurring pattern of depression, she said.

And although it is eminently treatable, women are unlikely to seek help because they're ashamed or embarrassed or simply not aware of the condition, which affects the whole family -- from a couple's intimacy and companionship to the baby. Mothers with postpartum depression don't speak to their babies in "motherese" -- that high- pitched tone important for babies' social and cognitive development, Zelkowitz said.

Infant behaviour is also affected. Babies are more irritable, and problems can endure: A study of 18-month-olds whose mothers had postpartum depression found more sleep and behaviour problems. Cognitive development may be affected through middle childhood.

That's why screening for the condition is important, Zelkowitz said.

"We should let them know and say that having a baby could be more stressful for them," she said.

"If we know people are at risk, we should be helping them to prepare, helping them to mobilize, to communicate -- and just make them feel aware."

It's known that immigrants are less likely than Canadian-born people to seek help for mental health issues, so outreach programs could be especially important for this group.

Such services as child care, baby furniture, clothing and diapers, as well as emotional support, could help this group, the study concluded.