Language Proficiency and Migrant-Native Disparities in Postpartum Depressive Symptoms.

Sousan Hamwi,Elsa Lorthe,Henrique Barros

doi:10.3390/ijerph18094782

Abstract

Migrant women have a higher risk of developing postpartum depressive symptoms (PPDS) than do native women. This study aimed to investigate the role of host-country language proficiency in this disparity. We analysed the data of 1475 migrant and 1415 native women who gave birth at a Portuguese public hospital between 2017 and 2019 and were participants in the baMBINO cohort study. Migrants’ language proficiency was self-rated and comprised understanding, speaking, reading, and writing skills. PPDS were assessed using the Edinburgh Postnatal Depression Scale with a cut-off score of ≥10. Multivariable logistic regression models were fitted to estimate the association between language proficiency and PPDS. PPDS were experienced by 7.2% of native women and 12.4% among migrants (p < 0.001). Increasing proportions of PPDS were observed among decreasing Portuguese proficiency levels; 11% among full, 13% among intermediate, and 18% among limited proficiency women (ptrend < 0.001). Full (aOR 1.63 (95% CI 1.21–2.19)), intermediate (aOR 1.68 (95% CI 1.16–2.42)), and limited (aOR 2.55 (95% CI 1.64–3.99)) language proficiencies were associated with increasingly higher odds of PPDS among migrant women, compared to native proficiency. Prevention measures should target migrant women at high risk of PPDS, namely those with limited language skills, and promote awareness, early detection, and help-seeking, in addition to facilitating communication in their perinatal healthcare encounters.

Highlights

We investigated the association between language proficiency and an Edinburgh Postnatal Depression Scale (EPDS) score ≥10 using univariate and multivariable logistic regression models and reported the results as crude (OR) and adjusted odds ratios with their 95% confidence intervals (CI)
There were no significant differences in terms of their migrant status, having twin pregnancy, complications during pregnancy, or adverse neonatal outcomes (Table S1)
We found increasing means of log-transformed EPDS scores with decreasing language proficiency, with the lowest value being for native women and the highest for migrants with limited Portuguese competence (1.02, 1.19, 1.21, and 1.29 for native, full, intermediate, and limited language skills, respectively)

Summary

Introduction

Prevention measures should target migrant women at high risk of PPDS, namely those with limited language skills, and promote awareness, early detection, and help-seeking, in addition to facilitating communication in their perinatal healthcare encounters. A meta-analysis showed that the risk of experiencing postpartum depressive symptoms (PDDS) is 1.5–2 times higher among migrant women than among natives [14]. Reasons behind this difference are likely to be of a complex nature, including unfamiliarity with the host-country and migration-related stress, poor marital adjustment or abuse, low socioeconomic status, lack of social support, and reduced access to health and social services [14,15]

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