Nuffield Department of Population Health, University of Oxford, L0/14, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK.
Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 68/30 Bantung Road, Mae Sot, Tak, 63110, Thailand.
BMC Psychiatry. 2020 Apr 15;20(1):168. doi: 10.1186/s12888-020-02572-6.
Perinatal depression is a significant contributor to maternal morbidity and mortality globally. Migrant women, particularly those living in low- and middle-income settings, represent a particularly vulnerable group due to stressors experienced before, during and after migration. The vast majority of global migration flows occurring within and between low- and middle-income regions, yet existing evidence focuses predominantly on migrants in high-income destinations. This study aimed to redress this significant gap in the evidence by determining the prevalence and determinants of perinatal depression among migrant women on the Thai-Myanmar border.
A cohort of labour migrant and refugee women was followed-up from the first trimester of pregnancy to one month post-partum. Depression status was assessed in the first, second and third trimesters of pregnancy and at one month post-partum using the Structured Clinical Interview for the Diagnosis of DSM-IV Disorders. Women diagnosed with depression had immediate access to care. Data on potential demographic, social and clinical associated factors was collected using a questionnaire. Prevalence and incidence of any depressive disorder and moderate-severe depressive disorder was calculated. Univariable and multivariable logistic regression using complete case analysis was used to estimate odds ratios (OR) of association between exposure variables and depression status.
Five hundred sixty-eight women participated. Period prevalence (from first trimester of pregnancy to one month post-partum) of moderate-severe perinatal depression was 18.5% (95% CI 15.4-21.9%). Overall, 15.4% (95% CI 11.8-19.6%) of women developed new-onset moderate-severe depression during the study period. Forty-two participants received treatment for depression. Risk factors were interpersonal violence (OR 4.5; 95% CI 1.9-11.1); history of trauma (OR 2.4; 95% CI 1.4-4.3); self-reported history of depression (OR 2.3; 95% CI 1.2-4.2); labour migrant status (OR 2.1; 95% CI 1.1-4.0); low social support (OR 2.1; 95% CI 1.1-3.7); and maternal age (OR 1.1 per year; 95% CI 1.0-1.1). Limitations of the study include that culturally specific manifestations of depression may have been missed.
Perinatal depression represents a significant burden among migrant women on the Thai-Myanmar border. Programmes to address the determinants along with early case identification and effective treatment and referral systems are key to addressing perinatal depression in this low-resource setting.
围产期抑郁症是全球产妇发病率和死亡率的一个重要因素。移民妇女，尤其是那些生活在中低收入国家的移民妇女，由于在移民前、中、后经历的压力，成为一个特别脆弱的群体。绝大多数全球移民流动发生在中低收入国家之间和内部，但现有证据主要集中在高收入目的地的移民身上。本研究旨在通过确定泰国-缅甸边境移民妇女的围产期抑郁症的患病率和决定因素来纠正这一证据上的重大差距。
对一组劳工移民和难民妇女进行了随访，从妊娠第一 trimester 到产后一个月。在妊娠的第一、第二和第三 trimester 以及产后一个月，使用 DSM-IV 障碍的结构化临床访谈对抑郁状况进行了评估。被诊断为抑郁症的妇女立即获得了治疗。使用问卷收集了潜在的人口统计学、社会和临床相关因素的数据。计算了任何抑郁障碍和中重度抑郁障碍的患病率和发病率。使用完全病例分析的单变量和多变量逻辑回归估计了暴露变量与抑郁状况之间的关联的比值比 (OR)。
568 名妇女参加了研究。围产期抑郁症的现患率（从妊娠第一 trimester 到产后一个月）为 18.5%（95%CI 15.4-21.9%）。总体而言，15.4%（95%CI 11.8-19.6%）的妇女在研究期间出现了新的中重度抑郁障碍。42 名参与者接受了抑郁症治疗。危险因素包括人际暴力（OR 4.5；95%CI 1.9-11.1）；创伤史（OR 2.4；95%CI 1.4-4.3）；自述抑郁症史（OR 2.3；95%CI 1.2-4.2）；劳工移民身份（OR 2.1；95%CI 1.1-4.0）；社会支持度低（OR 2.1；95%CI 1.1-3.7）；和产妇年龄（OR 每年增加 1.1 岁；95%CI 1.0-1.1）。本研究的局限性包括可能遗漏了具有文化特异性的抑郁表现。
围产期抑郁症是泰国-缅甸边境移民妇女的一个重大负担。解决这些决定因素以及早期病例识别和有效的治疗及转诊系统是解决这一资源匮乏环境下围产期抑郁症的关键。
