Prevalence and Risk Factors of Major Depressive Disorder Among Women at Public Antenatal Clinics From Refugee, Conflict-Affected, and Australian-Born Backgrounds

• Published in: JAMA network open 2019-05, Vol.2 (5), p.e193442-e193442
• Main Authors: Rees, Susan J, Fisher, Jane R, Steel, Zachary, Mohsin, Mohammed, Nadar, Nawal, Moussa, Batool, Hassoun, Fatima, Yousif, Mariam, Krishna, Yalini, Khalil, Batoul, Mugo, Jok, Tay, Alvin Kuowei, Klein, Louis, Silove, Derrick
• Format: Article
• Language: English
• Subjects: Adult; Australia - epidemiology; Case-Control Studies; Cross-Sectional Studies; Depressive Disorder, Major - diagnosis; Depressive Disorder, Major - epidemiology; Domestic violence; Exposure to Violence - psychology; Exposure to Violence - statistics & numerical data; Female; Humans; Mental depression; Online Only; Original Investigation; Pregnancy; Psychiatry; Refugees; Refugees - psychology; Refugees - statistics & numerical data; Risk Factors; Womens health
• ISSN: 2574-3805; 2574-3805
• DOI: 10.1001/jamanetworkopen.2019.3442

Pregnancy may increase the risk of depression among women who self-identify as refugees and have resettled in high-income countries. To our knowledge, no large systematic studies among women with refugee backgrounds in the antenatal period have been conducted. To compare the prevalence of major depressive disorder (MDD), trauma exposure, and other psychosocial risk factors among women who identify as refugees, women from the same conflict-affected countries, and women from the host nation and to test whether self-identification as a refugee indicates greater likelihood of prevalence and risk. This cross-sectional study was undertaken in 3 public antenatal clinics in Sydney and Melbourne, Australia, between January 2015 and December 2016. Overall, 1335 women (685 consecutively enrolled from conflict-affected backgrounds and 650 randomly selected from the host nation) participated. Data analysis was undertaken between June and September 2018. One-hour interviews covering mental health, intimate partner violence, and other social measures. World Health Organization measure for intimate partner violence and the Mini-International Neuropsychiatric Interview from the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) for MDD. To make a diagnosis, 1 of 2 items relating to being consistently depressed for 2 weeks and 3 further symptoms that cause personal distress or psychosocial dysfunction were endorsed. Overall, 1335 women (84.8% overall response rate), comprising 685 (51.3%) from conflict-affected countries (women self-identifying as refugees: 289 [42.2%]) and 650 (48.7%) from the host nation, participated. The mean (SD) age was 29.7 (5.4) years among women from conflict-affected backgrounds and 29.0 (5.5) years among women born in the host nation. Conflict-affected countries included Iraq (260 [38.0%]), Lebanon (125 [18.2%]), Sri Lanka (71 [10.4%]), and Sudan (66 [9.6%]). Women who identified as refugees reported higher exposure to 2 to 3 (67 [23.2%]) and 4 or more (19 [6.6%]) general traumatic events compared with women from the host nation (103 [15.8%] and 21 [3.2%], respectively). Women who identified as refugees also reported higher exposure to 1 (147 [50.9%]) and 2 or more (97 [33.6%]) refugee-related traumatic events compared with women from the host nation (86 [13.2%] and 20 [3.1%], respectively). Women who identified as refugees reported higher rates of psychological intimate partner violence than women born in the host nation (124