In our quantitative study, we used data from the Child Health Database and National registries to investigate the effects of maternal mental health on infant development among refugee families in comparison to non-immigrants. First, our analysis showed that compared to Danish-born women, immigrant women, including refugees, were between 80-90% more likely to lack a postpartum depression screening using the Edinburgh postpartum depression scale (EPDS), pointing out problems in screening practices. In our subsequent analysis focused on community health nurses (CHN) records of maternal mental health problems, which were based on CHN and mothers’ conversations about mental health problems. Second, in a sample of 62964 infants (of which 3,4% had a refugee background), we showed that infants born to first-time refugee mothers had a higher risk to have late regulatory problems at 8-11 months than their counterparts. These differences in infant development were in part explained by refugee mothers’ increased postpartum mental health burden. Last, an analysis focusing on the group of refugee mothers showed that postpartum mental health problems increased infants’ odds of having regulatory, motor, and communication problems. The negative effects of postpartum mental health problems were mediated by challenges in the mother-child relationship (described as parents’ ability to respond to infants' needs).
Our phenomenological qualitative study was based on interviews with 12 health nurses and 9 refugee mothers that participated in the enhanced home visiting program. Drawing from the Resource-Based Model of refugee adaptation (Ryan et al. 2008) our thematic analysis showed how by creating a safe space for sharing about one’s life and hopes, offering respectful knowledge about parenting, focusing on families’ strengths, and ‘hand-holding’ families in interactions with Danish welfare services, health nurses facilitate mothers’ gain of new cultural, social, and psychological resources to respond to the daily challenges of mothering in exile. The emotional connection between mothers and health nurses, which often substituted lost social supports, served as the foundation of such resource gain and facilitated a process of gaining confidence and control in parenting abroad while feeling cared for and supported. These findings point towards the potential of this home-visiting model to promote the psycho-social well-being of refugee women. Whether this approach can prevent postpartum mental health problems needs to be further investigated. In our analysis of qualitative data, we also identified some of the dilemmas and challenges that health nurses experience when caring for refugee women that experience mental health challenges and the importance of taking a systems perspective to improve the mental health care of refugee women.
These findings have been disseminated at the European Public Health conference, the Nordic Marce Conference, the 21st Nordic Migration Research Conference, and the COST Action RISEUP-PPD international conference. Our first open-access article has been recently published: Marti-Castaner M at al., (2022). Disparities in postpartum depression screening participation between immigrant and Danish-born women. European journal of public health, 32(1), 41-48. More peer-review articles will follow in the upcoming months in open-access formats.
Our exploitation strategies included presenting the findings at the Danish Health Nurse Board and at the National Institute for Public Health and to stakeholders from international organizations (Danish Refugee Council, Red Cross, Danish Refugee Council). Findings have also been presented to practitioners, municipalities, and stakeholders in Denmark to plan the preparation for Ukrainian refugees arriving in Denmark.
