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Pregnant Women With Refugee Status at Higher MDD Risk

May 10, 2019

By Anne Harding

NEW YORK—Pregnant women who identify themselves as refugees have higher rates of major depressive disorder (MDD), Australian researchers report.

"Simple screening questions, such as whether a woman perceives herself to be a refugee, may assist in distinguishing subpopulations at the greatest risk of psychosocial adversity and mental disorders such as MDD," Dr. Susan J. Rees of the University of New South Wales in Sydney and colleagues conclude in their May 3 report in JAMA Network Open.

About 2 billion people worldwide have been exposed to mass conflict, Dr. Rees and her team note. "Pregnant women have a higher prevalence of MDD, and this may be particularly true of those migrating from conflict-affected countries, given their exposure to trauma and related psychosocial difficulties," they add.

For their study, the authors enrolled 1,335 women treated at three prenatal clinics in Sydney and Melbourne in 2015-2016, including 685 from conflict-affected nations including Iraq, Lebanon, Sri Lanka and Sudan, plus 650 randomly chosen Australian-born women. Within the immigrant group, 289 self-identified as refugees.

Among the refugees, 23.2% reported being exposed to two or three traumatic events, and 6.6% to four or more, compared to 15.8% and 3.2%, respectively, of the Australian-born group. Refugees were more likely to report psychological intimate partner violence (42.9% vs. 20.5%), less likely to name at least five supportive family members or friends (12.5% vs. 45.7%), and more likely to have at least three financial stressors (22.5% vs. 6.3%) compared to women born in Australia.

Just under one-third of the refugee group had MDD, compared to 19.7% of women from conflict-affected countries who did not self-identify as refugees and 14.5% of women born in the host country.

"A novel finding is that a single self-identifying item defines a subpopulation of women at high risk of exposure to traumas (related to past conflict and intimate partner violence), psychosocial difficulties, and MDD," Dr. Rees and her team write. "In that sense, without a detailed inquiry into potentially sensitive information, front-line workers in antenatal clinics can use the refugee item as a signpost that may warrant referring women for further screening, for example by a social worker who can inquire into the trauma background, ongoing psychosocial status, and possible presence of MDD."


JAMA Netw Open 2019.

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