Pregnant migrant and refugee women's perceptions of mental illness on the Thai-Myanmar border: a qualitative study.

Gracia Fellmeth,Prakaykaew Charunwatthana,Emma Plugge,François Nosten,Moo Kho Paw,Rose Mcgready

doi:10.1186/s12884-015-0517-0

Abstract

BackgroundMental illness is a significant contributor to the global burden of disease, with prevalence highest in low- and middle-income countries. Rates are high in women of childbearing age, especially during pregnancy and the first year post-partum. Migrant and refugee populations are at risk of developing mental illness due to the multiple stressors associated with migration. The Thai-Myanmar border area is home to large populations of migrants and refugees as a result of long-standing conflict, poverty and unemployment in Myanmar. This study aims to explore perceptions of mental illness among pregnant migrants and refugees and antenatal clinic staff living and working along the Thai-Myanmar border.MethodsThirteen focus group discussions were conducted with pregnant migrants, pregnant refugees and antenatal clinic staff. Focus groups were held in one large refugee camp and two migrant health clinics along the Thai-Myanmar border. Thematic analysis was used to identify and code themes emerging from the data.ResultsA total of 92 pregnant women and 24 antenatal clinic staff participated. Discussions centered around five main themes: symptoms of mental illness; causes of mental illness; suicide; mental illness during pregnancy and the post-partum period; and managing mental illness. Symptoms of mental illness included emotional disturbances, somatic symptoms and socially inappropriate behavior. The main causes were described as current economic and family-related difficulties. Suicide was frequently attributed to shame. Mental illness was thought to be more common during and following pregnancy due to a lack of family support and worries about the future. Talking to family and friends, medication and hospitalization were suggested as means of helping those suffering from mental illness.ConclusionsMental illness was recognized as a concept by the majority of participants and there was a general willingness to discuss various aspects of it. More formal and systematic training including the development of assessment tools in the local languages would enable better ascertainment and treatment of mental illness in this population.

Highlights

Mental illness is a significant contributor to the global burden of disease, with prevalence highest in low- and middle-income countries
This study focused on pregnant refugee and migrant women attending antenatal clinic (ANC) at Maela refugee camp (MLA), Mawker Tai (MKT) and Wang Pha (WPA) and the locally-trained staff providing their antenatal care
Twentyfour ANC staff participated in three focus groups, all of which were conducted in Karen

Summary

Introduction

Mental illness is a significant contributor to the global burden of disease, with prevalence highest in low- and middle-income countries. Mental illness and substance use represent the leading cause of years lived with disability and the fourth leading cause of overall disease burden as measured by disability adjusted life-years [1]. This burden is set to increase further due to the substantial co-morbidity of mental illness with other chronic conditions such as cancer, cardiovascular disease and diabetes which are becoming ever more prevalent [1,2]. Across low-income countries the treatment gap is estimated to be as high as 90% due to a lack of mental health resources and facilities, inequities in their distribution and inefficiencies in their use [1,4,5]

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