Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK; Institute of Reproductive and Developmental Biology, Imperial College London, London, UK; Institute of Health Informatics, University College London, London, UK.
National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Lancet Public Health. 2023 Mar;8(3):e203-e216. doi: 10.1016/S2468-2667(22)00342-5.
There are one billion migrants globally, of whom 82 million are forced migrants. Pregnant migrants face pre-migration stressors such as conflict, transit stressors including poverty, and post-migration stressors including navigating the immigration system; these stressors can make them vulnerable to mental illness. We aimed to assess the global prevalence of and risk factors for perinatal mental health disorders or substance use among women who are migrants.
In this systematic review and meta-analysis, we searched OVID MEDLINE, Embase, PsycINFO, CENTRAL, Global Health, Scopus, and Web of Science for studies published from database inception until July 8, 2022. Cohort, cross-sectional, and interventional studies with prevalence data for any mental illness in pregnancy or the postnatal period (ie, up to a year after delivery) or substance use in pregnancy were included. The primary outcome was the prevalence of perinatal common mental health disorders among women who are migrants, globally. Data for study quality and risk factors were also extracted. A random-effects meta-analysis was used to calculate pooled prevalence estimates, when appropriate. Sensitivity analyses were conducted according to study quality, sample representativeness, and method of outcome assessment. Risk factor data were synthesised narratively. This study is registered with PROSPERO, CRD42021226291.
18 650 studies were retrieved, of which 135 studies comprising data from 621 995 participants met the inclusion criteria. 123 (91%) of 135 studies were conducted in high-income host countries. Five (4%) of 135 studies were interventional, 40 (30%) were cohort, and 90 (66%) were cross-sectional. The most common regions of origin of participants were South America, the Middle East, and north Africa. Only 26 studies presented disaggregated data for forced migrants or economic migrants. The pooled prevalence of perinatal depressive disorders was 24·2% (range 0·5-95·5%; I 98·8%; τ 0·01) among all women who are migrants, 32·5% (1·5-81·6; 98·7%; 0·01) among forced migrants, and 13·7% (4·7-35·1; 91·5%; 0·01) among economic migrants (p<0·001). The pooled prevalence of perinatal anxiety disorders was 19·6% (range 1·2-53·1; I 96·8%; τ 0·01) among all migrants. The pooled prevalence of perinatal post-traumatic stress disorder (PTSD) among all migrant women was 8·9% (range 3·2-33·3; I 97·4%; τ 0·18). The pooled prevalence of perinatal PTSD among forced migrants was 17·1% (range 6·5-44·3; I 96·6%; τ 0·32). Key risk factors for perinatal depression were being a recently arrived immigrant (ie, approximately within the past year), having poor social support, and having a poor relationship with one's partner.
One in four women who are migrants and who are pregnant or post partum experience perinatal depression, one in five perinatal anxiety, and one in 11 perinatal PTSD. The burden of perinatal mental illness appears higher among women who are forced migrants compared with women who are economic migrants. To our knowledge, we have provided the first pooled estimate of perinatal depression and PTSD among women who are forced migrants. Interpreting the prevalence estimate should be observed with caution due to the very wide range found within the included studies. Additionally, 66% of studies were cross-sectional representing low quality evidence. These findings highlight the need for community-based routine perinatal mental health screening for migrant communities, and access to interventions that are culturally sensitive, particularly for forced migrants who might experience a higher burden of disease than economic migrants.
UK National Institute for Health Research (NIHR); March of Dimes European Preterm Birth Research Centre, Imperial College; Imperial College NIHR Biomedical Research Centre; and Nuffield Department of Population Health, University of Oxford.
全球有 10 亿移民，其中 8200 万是被迫移民。孕妇在移民前面临冲突等压力源，在移民过程中面临贫困等压力源，在移民后还面临融入移民系统等压力源，这些压力源可能使她们容易患上精神疾病。本研究旨在评估全球范围内移民孕妇的围产期心理健康障碍或物质使用的患病率和风险因素。
在这项系统评价和荟萃分析中，我们检索了 OVID MEDLINE、Embase、PsycINFO、CENTRAL、全球卫生、Scopus 和 Web of Science，以获取截至 2022 年 7 月 8 日发表的所有研究。包括在怀孕期间或产后（即分娩后一年）任何精神疾病患病率或物质使用患病率的队列研究、横断面研究和干预性研究。主要结局是全球移民孕妇的围产期常见精神健康障碍患病率。还提取了研究质量和风险因素的数据。适当情况下，使用随机效应荟萃分析计算汇总患病率估计值。根据研究质量、样本代表性和结局评估方法进行敏感性分析。风险因素数据以叙述性方式综合。本研究在 PROSPERO 注册，CRD42021226291。
共检索到 18650 项研究，其中 135 项研究包含了来自 621995 名参与者的数据，符合纳入标准。135 项研究中有 123 项（91%）在高收入东道国进行。5 项（4%）为干预性研究，40 项（30%）为队列研究，90 项（66%）为横断面研究。参与者的最常见原籍地为南美洲、中东和北非。只有 26 项研究提供了强制移民或经济移民的分类数据。所有移民孕妇的围产期抑郁障碍患病率为 24.2%（范围 0.5-95.5%；I 98.8%；τ 0.01），其中强制移民为 32.5%（1.5-81.6%；I 98.7%；τ 0.01），经济移民为 13.7%（4.7-35.1%；I 91.5%；τ 0.01）（p<0.001）。所有移民孕妇的围产期焦虑障碍患病率为 19.6%（范围 1.2-53.1%；I 96.8%；τ 0.01）。所有移民妇女围产期创伤后应激障碍（PTSD）患病率为 8.9%（范围 3.2-33.3%；I 97.4%；τ 0.18）。强制移民围产期 PTSD 患病率为 17.1%（范围 6.5-44.3%；I 96.6%；τ 0.32）。围产期抑郁的主要风险因素是最近移民（即大约在过去一年）、社会支持差和与伴侣关系差。
四分之一的移民孕妇在怀孕期间或产后患有围产期抑郁，五分之一患有围产期焦虑，十分之一患有围产期 PTSD。与经济移民相比，被迫移民的孕妇围产期精神疾病负担似乎更高。据我们所知，我们首次提供了关于被迫移民孕妇围产期抑郁和 PTSD 的汇总估计。由于纳入研究中发现的范围非常广泛，因此对患病率估计值的解释应谨慎。此外，66%的研究为横断面研究，代表的证据质量较低。这些发现强调了需要对移民社区进行基于社区的常规围产期心理健康筛查，并提供文化敏感的干预措施，特别是对于可能比经济移民负担更高疾病负担的被迫移民。
英国国家卫生研究院（NIHR）；March of Dimes 欧洲早产研究中心，帝国理工学院；帝国理工学院 NIHR 生物医学研究中心；牛津大学纳菲尔德人口健康系。
