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Rabia RA, Alfayumi-Zeadna S, Hendel T, Kagan I. Barriers to Adopting Healthy Lifestyle and Health Promotion among Ethnic Minority Bedouin Women in Southern Israel: A Qualitative Study. J Racial Ethn Health Disparities 2025; 12:1925-1936. [PMID: 38809466 DOI: 10.1007/s40615-024-02022-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/16/2024] [Accepted: 05/08/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND A healthy lifestyle is a crucial step in disease prevention and management, as well as a significant predictor of health promotion. Yet, despite an increase in chronic morbidity among Bedouin women in southern Israel, little research has been conducted on their health behaviors. Therefore, the aim of this study is to examine barriers to adopting a healthy lifestyle and health promotion among ethnic minority Bedouin women in southern Israel. METHODS This qualitative study was based on data collected through focus groups during June and July 2021. Participants included 44 Bedouin women aged 18-55. Focus groups were recorded and transcribed. Transcriptions were thematically analyzed and coded using the ecological model. RESULTS We found multiple barriers at various levels that prevent Bedouin women from adopting a healthy lifestyle and health promotion. At the individual level, such factors included the impact of financial limitations on healthful nutrition, as well as a lack of awareness or knowledge regarding healthy lifestyle and health promotion. At the organizational level, barriers include a lack of clinics, accessibility, and availability of health services and cultural incompatibility of the health services. At the community level, impediments to a healthy lifestyle include inaccessibility to sports facilities and suppression of physical activity. At the public policy level, participants, especially those living in unrecognized villages, described difficult living conditions related to environmental and social neglect as affecting their health status and ability to maintain a healthy lifestyle. CONCLUSION Study findings emphasize the need for policymaking and a systemic approach to address health disparities and ensure equal health promotion for the Bedouin population.
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Affiliation(s)
- Rasmiya Abu Rabia
- Nursing Department, School of Health Sciences, Ashkelon Academic College, 78211, Ashkelon, Israel
- Clalit Health Services, Southern Region, 84417, Be'er-Sheva, Israel
| | - Samira Alfayumi-Zeadna
- Nursing Department, School of Health Sciences, Ashkelon Academic College, 78211, Ashkelon, Israel.
| | - Tova Hendel
- Nursing Department, School of Health Sciences, Ashkelon Academic College, 78211, Ashkelon, Israel
| | - Ilya Kagan
- Nursing Department, School of Health Sciences, Ashkelon Academic College, 78211, Ashkelon, Israel
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Bonney RA, Opoku D, Mensah KA, Amuasi JH, Dassah E, Emikpe BO, Waitzberg R. Access barriers to healthcare services among the Fulani population in Ghana: a qualitative study in the Sissala East Municipality. BMC Health Serv Res 2025; 25:671. [PMID: 40346645 PMCID: PMC12065350 DOI: 10.1186/s12913-025-12839-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/02/2025] [Indexed: 05/11/2025] Open
Abstract
BACKGROUND Access to healthcare services is at the center of every health system. Research to understand access to healthcare services for the Fulani in Ghana is limited. Efforts have mainly focused on the confrontations between the Fulani herders and the communities. The study aimed to explore what access barriers exist among the Fulani vulnerable population in Ghana; this will contribute to the understanding of access to healthcare services for a vulnerable population, who are also prone to possible transmission of diseases from human-animal connections, and requiring global health interventions. METHODS This is an explorative study using qualitative methods to investigate how the Fulani population access healthcare services in the Sissala East Municipality, Ghana. From 17 to 30 September 2022, interviews were conducted using an interview guide among 11 individuals sampled purposively based on the criteria that, the individual is a Fulani or healthcare professional, resides in and around the study area, and is 18 years or older. Thematic content analysis was used for the analysis. RESULTS Contrary to the widely held view of the Fulani population being typically conservative, they displayed positive healthcare-seeking behavior and acceptance of modern healthcare services. And despite their nomadic lifestyle, physical accessibility of healthcare services has not been a challenge given that they can even reach a health facility via mobile phones (mHealth) as well as via other means of transport (e.g., motor bike). However, access barriers to healthcare are influenced mainly by financial constraints and gender roles. They rely on health insurance for healthcare coverage, but co-payments and difficulties in enrollment pose serious healthcare affordability challenges. They require access to health information to improve their knowledge on health-related issues as well. CONCLUSION This study reveals that the main barrier to healthcare access among the Fulani is affordability and gender-specific roles. However, they are also utilizing innovative mobile technologies to assist in seeking healthcare against the potential barrier of their nomadic lifestyle. Community engagement and policy measures to improve the coverage of the national health insurance scheme are required to improve healthcare access among the Fulani vulnerable population.
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Affiliation(s)
- Richard Abeiku Bonney
- eHealth Research Partner Group (eHRPG) at the Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany.
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Daniel Opoku
- eHealth Research Partner Group (eHRPG) at the Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany.
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
- German-West African Centre for Global Health and Pandemic Prevention, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Kofi Akohene Mensah
- eHealth Research Partner Group (eHRPG) at the Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - John Humphrey Amuasi
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- German-West African Centre for Global Health and Pandemic Prevention, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Bernhard Nocht Institute of Tropical Medicine, Hamburg, Germany
| | - Ebenezer Dassah
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Benjamin Obukowho Emikpe
- German-West African Centre for Global Health and Pandemic Prevention, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- School of Veterinary Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ruth Waitzberg
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
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Shibli H, Feder-Bubis P, Daoud N, Aharonson-Daniel L. Healthcare access barriers and utilization among the Arab Bedouin population in Israel: a cross-sectional study. Int J Equity Health 2025; 24:40. [PMID: 39930481 PMCID: PMC11808989 DOI: 10.1186/s12939-025-02398-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2024] [Accepted: 01/25/2025] [Indexed: 02/14/2025] Open
Abstract
BACKGROUND The Arab Bedouin Muslim minority in Israel, is one of the country's most vulnerable groups. They are residents of the Israeli geographical and social periphery. Bedouin's healthcare service utilization is shaped by its sociocultural and environmental characteristics. This study explores healthcare access barriers and utilization patterns among the Arab Bedouin population, focusing on two types of legal status locality: a legally recognized Bedouin town and the surrounding unrecognized villages. METHODS We conducted a cross-sectional study among Arab Bedouin adults (N = 246) residing in a Bedouin recognized town and unrecognized villages. Using an anonymous, self-administered questionnaire in Arabic. We collected information about healthcare visits, types of services accessed, access barriers and the factors influencing healthcare-seeking behavior. Multivariate linear regression was conducted to examine the predictors of healthcare services utilization. RESULTS Of the 246 participants, 60% resided in a recognized Bedouin town and 40% resided in unrecognized villages. Most participants were female (61%) and the mean age was 37.8 ± 13.9 years. The findings showed that barriers to seeking care differed based on the residence town's legal status. While residents of unrecognized villages face significant physical access barriers, they also show a notable reliance on cross-border healthcare providers, particularly in the Palestinian Authority. Chronic medical conditions (B = 1.147, p < 0.001), gender (B = -0.459, p < 0.01), and parental status (B = 0.667, p = 0.001) have been identified as strong predictors of healthcare service utilization. CONCLUSION This study offers new insights regarding the complexity of healthcare access and utilization in the Arab Bedouin population in Israel, emphasizing that barriers are not only structural but also deeply intertwined with cultural and linguistic factors. The study highlights the universal message of addressing both physical and systemic barriers to healthcare access, ensuring that healthcare services are culturally and linguistically tailored to the specific needs of marginalized populations locally and globally. These findings provide actionable insights for policymakers emphasizing the need to improve health equity by addressing the access barriers faced by the Arab Bedouin population, including structural, cultural, and linguistic challenges, and ensuring targeted interventions for marginalized communities both locally and globally.
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Affiliation(s)
- Haneen Shibli
- Faculty of Health Sciences School of Public Health, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva, 8410501, Israel.
- PREPARED Centre for Emergency Response Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Paula Feder-Bubis
- PREPARED Centre for Emergency Response Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Health Policy and Management, Faculty of Health Sciences and Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Nihaya Daoud
- Faculty of Health Sciences School of Public Health, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva, 8410501, Israel
| | - Limor Aharonson-Daniel
- Faculty of Health Sciences School of Public Health, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva, 8410501, Israel
- PREPARED Centre for Emergency Response Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Qi W, Huang S, Zhao J, Cui X, Wei Z, Cui G, Guo Q, Hu J. The preventive effect of psychological and psychosocial interventions on postpartum depression: An overview of systematic reviews. J Psychiatr Res 2025; 182:21-33. [PMID: 39793268 DOI: 10.1016/j.jpsychires.2024.11.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 10/15/2024] [Accepted: 11/22/2024] [Indexed: 01/13/2025]
Abstract
BACKGROUND Postpartum depression is a prevalent issue that significantly impacts the mental health of women, placing a substantial burden on individuals, families, and society. With the increasing evidence of postpartum depression prevention, conducting comprehensive assessments becomes essential to facilitate future clinical practices. METHODS The systematic review and meta-analysis examined psychological and psychosocial interventions to prevent postpartum depression in perinatal women (antenatal and postnatal up to 12 months). In January 2022 and November 2023, nine English- and four Chinese-language databases were searched. Two authors independently carried out literature screening and data extraction. To assess the quality of methodological, reporting, and evidence of the included reviews, the AMSTAR-2 scale, PRISMA statement, and GRADE approach were employed by the two authors. RESULTS Twenty-eight eligible reviews were included, with medium-very low methodological quality. These reviews reported on 15 effective preventive interventions in four categories. However, due to inconsistent results across the studies, it was challenging to pinpoint the most beneficial interventions conclusively. LIMITATIONS Grey literature and unpublished articles were not searched, and the limitation on included reviews may result in biased results. In our narrative summary, data overlap in the original study was not considered. The low quality of the identified reviews further undermines the credibility of the evidence. CONCLUSIONS The study identified four promising aspects of preventive interventions, namely psychological, educational, support, and maternal-infant interventions. However, to draw more robust and reliable conclusions, future research must focus on higher-quality studies that directly compare the effectiveness of these different interventions.
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Affiliation(s)
- Weijing Qi
- Innovation Center of Humanistic Care and Health Management, School of Nursing, Hebei Medical University, Shijiazhuang, Hebei Province, China.
| | - Sha Huang
- Innovation Center of Humanistic Care and Health Management, School of Nursing, Hebei Medical University, Shijiazhuang, Hebei Province, China.
| | - Jinping Zhao
- School of Public Health, Hebei Medical University, Shijiazhuang, Hebei Province, China.
| | - Xuefei Cui
- Innovation Center of Humanistic Care and Health Management, School of Nursing, Hebei Medical University, Shijiazhuang, Hebei Province, China.
| | - Ziqi Wei
- Innovation Center of Humanistic Care and Health Management, School of Nursing, Hebei Medical University, Shijiazhuang, Hebei Province, China.
| | - Gaiying Cui
- Shijiazhuang Obstetrics and Gynecology Hospital, Shijiazhuang, China.
| | - Qing Guo
- Shijiazhuang Obstetrics and Gynecology Hospital, Shijiazhuang, China.
| | - Jie Hu
- Innovation Center of Humanistic Care and Health Management, School of Nursing, Hebei Medical University, Shijiazhuang, Hebei Province, China.
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Shibli H, Aharonson-Daniel L, Daoud N, Feder-Bubis P. Unpacking access barriers through the health providers' lens among the Arab Bedouin population in Israel. Soc Sci Med 2025; 364:117536. [PMID: 39603172 DOI: 10.1016/j.socscimed.2024.117536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Revised: 11/18/2024] [Accepted: 11/19/2024] [Indexed: 11/29/2024]
Abstract
The Arab Bedouin ethnic minority is considered one of the most vulnerable populations in Israel due to socio-cultural factors that affect their healthcare utilization patterns. By adopting the intersectionality perspective, this research aims to identify gaps and barriers to Bedouins' healthcare services (HCS) utilization, as perceived by healthcare professionals (HCP) serving this community. A qualitative study was conducted from June 2019 to January 2022, involving in-depth semi-structured interviews with thirty-two HPCs working in hospitals and community health centers/clinics in Bedouin villages and towns in Southern Israel. Reflective Thematic Analysis (RTA) was used to analyze the collected data, and trustworthiness was ensured through audit, reflexivity, and peer debriefing. Findings revealed that healthcare professionals noted gaps that hinder HCS accessibility and utilization. This study found that the intersection of physical, financial, language, health literacy, and gender barriers with issues of trust, stigma, and deep-rooted socio-cultural norms and beliefs affect Bedouin healthcare accessibility. Additionally, Bedouin women are particularly vulnerable subgroups who were impacted differently by these barriers. In conclusion, our research highlights the necessity of targeted interventions to improve healthcare access for Bedouin minority populations, particularly tailoring HCS to the women subgroup within the Bedouin community. Suggested interventions include health literacy-enhancing educational initiatives, addressing medication affordability, and approaches to mitigate cultural and gendered hindrances to HCS. These insights have broader relevance for shaping health policies and strategies that bridge healthcare disparities among global minority populations.
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Affiliation(s)
- Haneen Shibli
- Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel; PREPARED Centre for Emergency Response Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Limor Aharonson-Daniel
- Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel; PREPARED Centre for Emergency Response Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Nihaya Daoud
- Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Paula Feder-Bubis
- PREPARED Centre for Emergency Response Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Health Policy and Management, Faculty of Health Sciences and Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Sajjad A, Shah S, Abbas G, Aslam A, Randhawa F, Khurram H, Assiri A. Treatment gap and barriers to access mental healthcare among women with postpartum depression symptoms in Pakistan. PeerJ 2024; 12:e17711. [PMID: 39035151 PMCID: PMC11260416 DOI: 10.7717/peerj.17711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/18/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Postpartum depression (PPD) is prevalent among women after childbirth, but accessing mental healthcare for PPD is challenging. This study aimed to assess the treatment gap and barriers to mental healthcare access for women with PPD symptoms living in Punjab, Pakistan. METHODS A multicenter cross-sectional study was conducted in five populous cities of Punjab from January to June 2023 by administering the questionnaire to the women using stratified random sampling. A total of 3,220 women in first 6 months postpartum were screened using the Edinburgh Postnatal Depression Scale. Of them, 1,503 women scored thirteen or above, indicating potential depressive disorder. Interviews were conducted to explore help-seeking behavior and barriers to accessing mental healthcare. Descriptive statistics along with nonparametric tests (e.g., Kruskal-Wallis, Mann-Whitney U) were used and group differences were examined. Scatter plot matrices with fitted lines were used to explore associations between variables. Classification and regression tree methods were used to classify the importance and contribution of different variables for the intensity of PPD. RESULTS Only 2% of women (n = 33) with high PPD symptoms sought mental healthcare, and merely 5% of women (n = 75) had been in contact with a health service since the onset of their symptoms. 92.80% of women with PPD symptoms did not seek any medical attention. The majority of women, 1,215 (81%), perceived the need for mental health treatment; however, 91.23% of them did not seek treatment from healthcare services. Women who recently gave birth to a female child had higher mean depression scores compared to those who gave birth to a male child. Age, education, and birth location of newborn were significantly associated (p < 0.005) with mean barrier scores, mean social support scores, mean depression scores and treatment gap. The results of classification and regression decision tree model showed that instrumental barrier scores are the most important in predicting mean PPD scores. CONCLUSION Women with PPD symptoms encountered considerable treatment gap and barriers to access mental health care. Integration of mental health services into obstetric care as well as PPD screening in public and private hospitals of Punjab, Pakistan is critically needed to overcome the treatment gap and barriers.
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Affiliation(s)
- Aqsa Sajjad
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Faisalabad, Pakistan
| | - Shahid Shah
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Faisalabad, Pakistan
| | - Ghulam Abbas
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Faisalabad, Pakistan
| | - Ayesha Aslam
- Department of Neurology, King Edward Medical University, Lahore, Pakistan
| | - Fawad Randhawa
- Department of Endocrinology, King Edward Medical University, Lahore, Pakistan
| | - Haris Khurram
- Department of Mathematics and Computer Science, Faculty of Science and Technology Prince of Songkla University, Pattani Campus, Thailand
- Department of Science and Humanities, National University of Computer and Emerging Science, Chiniot-Faisalabad Campus, Chiniot, Pakistan
| | - Abdullah Assiri
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
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Place JMS, Renbarger K, Van De Griend K, Guinn M, Wheatley C, Holmes O. Barriers to help-seeking for postpartum depression mapped onto the socio-ecological model and recommendations to address barriers. Front Glob Womens Health 2024; 5:1335437. [PMID: 38855482 PMCID: PMC11157017 DOI: 10.3389/fgwh.2024.1335437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 05/13/2024] [Indexed: 06/11/2024] Open
Abstract
Postpartum depression affects nearly a quarter of women up to a year after childbirth. Although it is treatable, significant barriers to help-seeking prevent women from being treated. This paper assesses key literature on the barriers for help-seeking among women with postpartum depression. The barriers identified have been mapped onto the socio-ecological model in addition to potential recommendations that professionals can use to address barriers on individual, interpersonal, organizational, community and societal levels. The recommendations provided are meant to serve as leverage points for professionals in efforts to create appropriate support and interventions. As such, this paper serves as a mapping tool for healthcare and public health professionals to assess obstacles to women's help-seeking and to guide multi-pronged interventions on various levels of the socio-ecological model that may increase help-seeking among women with postpartum depression. Holistically and comprehensively providing support to women will require significant effort throughout all sectors of society as opposed to isolated, siloed interventions.
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Affiliation(s)
- Jean Marie S. Place
- Department of Nutrition and Health Science, Ball State University, Muncie, IN, United States
| | - Kalyn Renbarger
- School of Nursing, Ball State University, Muncie, IN, United States
| | - Kristin Van De Griend
- Department of Community and Public Health, Idaho State University, Pocatello, ID, United States
| | - Maya Guinn
- Department of Biology, Ball State University, Muncie, IN, United States
| | - Chelsie Wheatley
- Medical Imaging, Idaho State University, Pocatello, ID, United States
| | - Olivia Holmes
- Department of Community and Public Health, Idaho State University, Pocatello, ID, United States
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Xiao M, Huang S, Liu Y, Tang G, Hu Y, Fu B, Lei J. Stigma and its influencing factors for seeking professional psychological help among pregnant women: A cross-sectional study. Midwifery 2024; 132:103973. [PMID: 38442529 DOI: 10.1016/j.midw.2024.103973] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 02/23/2024] [Accepted: 02/29/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Although the stigma associated with seeking professional psychological help has received significant attention, few studies have focused on the status and factors influencing this stigma among pregnant women, especially those with a Chinese cultural background. This study aimed to assess the status of stigma associated with seeking professional psychological help and its influencing factors. METHODS A total of 1325 pregnant women were recruited from Hunan Province, China. The Stigma for Seeking Professional Psychological Help questionnaire, Patient Health Questionnaire-9, Perceived Social Support Scale, Simplified Coping Style Questionnaire, and questionnaires on sociodemographic characteristics and pregnancy-related information were used. Descriptive, univariate, correlation, and multivariate linear regression analyses were used to investigate the status of stigma and identify its influencing factors. FINDINGS Pregnant Chinese women experienced a mild to moderate level of stigma associated with seeking professional psychological help, and self-stigma was more common than social stigma associated with seeking psychological help. The results of the multivariate analysis suggested that perceived social support, positive coping styles, negative coping styles, and depressive symptoms were the factors influencing self-stigma and social stigma associated with seeking professional psychological help. Advanced age and a low educational level were the only predictors associated with self-stigma, while a history of multiple pregnancies had an effect only on social stigma associated with seeking professional psychological help. CONCLUSION Chinese pregnant women experienced a mild to moderate level of stigma associated with seeking professional psychological help. Destigmatizing interventions focusing on self-stigma and social stigma should be designed according to maternal characteristics, social support, coping style, and depressive symptoms.
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Affiliation(s)
- Meili Xiao
- Department of Nursing, Hunan Normal University School of Medicine, 371 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China.
| | - Sasa Huang
- Nursing Department, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China; Xiang Ya Nursing School of Central South University, 172 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China
| | - Yongrong Liu
- Nursing Department, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China; Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China
| | - Guanxiu Tang
- Nursing Department, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China; Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China.
| | - Ying Hu
- Nursing Department, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China; Xiang Ya Nursing School of Central South University, 172 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China
| | - Bing Fu
- Nursing Department, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China; Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China
| | - Jun Lei
- Nursing Department, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China; Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China.
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Shitrit IB, Wang A, Ilan K, Agassi R, Freih SA, Vaynshtein J. Epidemiological, clinical, and pathological characteristics of invasive breast cancer in Bedouin and Jewish women in southern Israel: a retrospective comparative study. BMC Cancer 2024; 24:310. [PMID: 38448861 PMCID: PMC10916252 DOI: 10.1186/s12885-024-12051-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 02/25/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Invasive breast cancer (IBC) is a leading cause of cancer-related death among women in Israel, regardless of ethnicity. This study compared IBC epidemiological, clinical, and pathological characteristics in Bedouin and Jewish patients in southern Israel. METHODS Medical records of 1514 Jewish and 191 Bedouin women with IBC treated at Soroka University Medical Center between 2014 and 2021 were analyzed retrospectively. Baseline measures and tumor characteristics were compared between groups. Overall survival (OS) and disease-free survival (DFS) were analyzed using log-rank test. Multivariate analysis was performed using the Cox proportional hazard model. RESULTS Bedouin patients exhibited a significantly younger age at diagnosis (median 48 vs. 62 years, p < 0.001), larger tumor size (median 2.5 vs. 2.13 cm, p < 0.001), and higher metastasis rate (18.8% vs. 12.7%, p = 0.03) compared to Jewish patients. In early-stage (non-metastatic) disease, Jewish and Bedouin patients had comparable overall survival (OS) rates (127 vs. 126 months, p = 0.2), consistent across stages 1 to 3. However, among patients with metastatic disease, Bedouins exhibited significantly longer OS (76.6 vs. 37.8 months, p = 0.006). Disease-free survival (DFS) showed no ethnic differences (not reached vs. 122 months, p = 0.31). There were no significant differences in OS between Bedouin and Jewish patients undergoing various treatment modalities for early-stage disease: surgery, adjuvant radiotherapy, chemotherapy, and systemic neoadjuvant therapy. CONCLUSION Breast cancer among Bedouin women in southern Israel manifests at a younger age, with larger tumors and more advanced stages than in Jewish women. However, recent data indicate no differences in OS and DFS between the ethnic groups despite past disparities in prognosis.
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Affiliation(s)
- Itamar Ben Shitrit
- Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer- Sheva, Israel.
- Clinical Research Center, Faculty of Health Sciences, Soroka University Medical Center, Ben- Gurion University of the Negev, Beer-Sheva, Israel.
| | - Ao Wang
- Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer- Sheva, Israel
| | - Karny Ilan
- Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer- Sheva, Israel
| | - Ravit Agassi
- Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer- Sheva, Israel
| | - Sofyan Abu Freih
- Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer- Sheva, Israel
| | - Julie Vaynshtein
- Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer- Sheva, Israel
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Glasser S, Uziel M, Wagman S, Zaworbach H, Ferber Y, Levinson D, Lerner-Geva L. The first three years: The association of early postpartum depressive symptoms with infant and toddler development. Public Health Nurs 2024; 41:274-286. [PMID: 38131107 DOI: 10.1111/phn.13272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/19/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The influence of postpartum depression (PPD) on child development has been a source of professional interest and practical relevance. OBJECTIVE This study investigated the association of early PPD symptoms with developmental domains. DESIGN AND METHOD This historical cohort study included 574,282 children attending Mother Child Healthcare Centers in Israel from January 1, 2014 to July 31, 2020, who underwent at least one developmental screening examination by public health nurses up to age 36 months, and whose mothers completed the Edinburgh Postnatal Depression Scale (EPDS) postnatally. Developmental milestone tasks included four domains: fine and gross motor, language/communication, and social/behavioral. RESULTS The rate of failure to complete age-appropriate tasks was higher among children whose mothers had scored ≥ 10 on the EPDS on the majority of tasks in every domain. DISCUSSION This large population-based study has demonstrated the association between early maternal postnatal depressive symptoms and failure to meet developmental milestones across domains, until three years. Recommendations for practice focus on the mother, the child, and health policy.
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Affiliation(s)
- Saralee Glasser
- Women and Children's Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, affiliated with Tel Aviv University, Ramat Gan, Israel
| | - Moshe Uziel
- Big Data Department, TIMNA Initiative, Ministry of Health, Jerusalem, Israel
| | - Shir Wagman
- Public Health Services, Ministry of Health, Jerusalem, Israel
| | - Hani Zaworbach
- Big Data Department, TIMNA Initiative, Ministry of Health, Jerusalem, Israel
| | - Yona Ferber
- Public Health Services, Ministry of Health, Jerusalem, Israel
| | - Daphna Levinson
- Mental Health Services, Ministry of Health, Jerusalem, Israel
| | - Liat Lerner-Geva
- Women and Children's Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, affiliated with Tel Aviv University, Ramat Gan, Israel
- School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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11
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Wei A, Zhang YB, Robertson E, Steen J, Mushquash C, Wekerle C. Global Indigenous gender concepts, gender-based violence and resilience: A scoping review. CHILD ABUSE & NEGLECT 2024; 148:106185. [PMID: 37087390 DOI: 10.1016/j.chiabu.2023.106185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/23/2023] [Accepted: 03/30/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND & OBJECTIVE The legacy of colonialism includes ongoing trauma and disruption of traditional teachings on relationality, which has contributed to Indigenous populations being disproportionately exposed to gender-based violence (GBV). GBV in Indigenous populations is explored to consider gender-specific findings and points of resilience in relational networks. PARTICIPANTS & SETTING Included articles sampled Indigenous groups in Canada, US, Mexico, Guatemala, and Israel. All participants self-identified as Indigenous, and were either GBV survivors or service providers working in GBV contexts. METHODS A scoping review was conducted in OVID Medline, Embase, APA Psycinfo, and Informit Indigenous Collection, using keywords for Indigenous peoples, gender concepts, and GBV. Articles were screened and extracted by two reviewers; a third reviewer resolved conflicts. RESULTS Our search yielded one mixed-method study and seven qualitative studies, all published since 2016. North American studies identified colonial, patriarchal disruptions (e.g. residential schools) to positive pre-contact gender norms (e.g. non-hierarchical roles) that contribute to emerging GBV. Studies conducted in Guatemala and Israel also described local patriarchal cultures contributing to GBV. Lack of understanding of the Two-Spirit identity (i.e. supra-binary gender identity used by Indigenous persons) led to harmful attitudes and stigma. Interpersonal support and return to traditional matriarchal practices were identified as key resilience processes. CONCLUSIONS There is limited literature on Indigenous gender concepts and GBV, particularly regarding GBV against males and Two-Spirit persons. Colonization-related violence and/or patriarchal gender norms were identified as precursors for GBV. Decolonization processes should be further explored to address GBV in Indigenous populations.
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Affiliation(s)
- Angela Wei
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
| | - Yang Bo Zhang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Emma Robertson
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jeremy Steen
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Christopher Mushquash
- Department of Psychology and Northern Ontario School of Medicine, Lakehead University, Thunder Bay, Ontario, Canada
| | - Christine Wekerle
- Department of Pediatrics, Faculty of Health Sciences, and Department of Psychiatry and Behavioral Neuroscience, Faculty of Science, McMaster University, Hamilton, Ontario, Canada; Optentia Research Unit, North-West University, South Africa
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12
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Kwon H, Kim J. Effect of Postpartum Depression on Infant Safety Practices in Korea. J Obstet Gynecol Neonatal Nurs 2023; 52:491-500. [PMID: 37659433 DOI: 10.1016/j.jogn.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 09/04/2023] Open
Abstract
OBJECTIVE To describe the prevalence of postpartum depression in a sample of Korean women and to examine the effect of postpartum depression on their adoption of safety practices for their infants. DESIGN Secondary, cross-sectional. SETTING South Korea. PARTICIPANTS A total of 3,127 women who gave birth in 2020. METHODS We applied a complex sample design analysis using the national survey data on postpartum care in South Korea. We analyzed the data using weighted multivariate logistic regression to determine the association between postpartum depression and the adoption of five safety practices for infants. RESULTS A total 42.7% (n = 1,319) of our participants had symptoms of postpartum depression during the initial 7 days after birth. Participants who had postpartum depression were less likely to engage in certain safety practices for infants. CONCLUSION We propose a proactive approach to promote an improved policy for postpartum depression screening alongside a comprehensive program that offers guidance and education to mothers suffering with postpartum depression. The primary objective is to empower these mothers with essential skills that can effectively ensure the safety of their infants.
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Elshamy F, Hamadeh A, Billings J, Alyafei A. Mental illness and help-seeking behaviours among Middle Eastern cultures: A systematic review and meta-synthesis of qualitative data. PLoS One 2023; 18:e0293525. [PMID: 37883515 PMCID: PMC10602270 DOI: 10.1371/journal.pone.0293525] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 10/15/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Western literature has long explored help-seeking behaviours related to mental health issues. However, this has been relatively neglected in the Middle East despite an increase in mental health needs in the region. The purpose of this review was to conduct a systematic review and qualitative meta-synthesis exploring help-seeking behaviours related to mental health issues in the Middle East. METHODS We conducted a systematic review and meta-synthesis to gain a comprehensive overview of what is known about mental health and help-seeking behaviours in the Middle East from published qualitative research in the Middle Eastern region. A search of electronic databases (MEDLINE, Embase, CINAHL, PsycINFO and QScience) was carried out from inception to July 2022. The quality of the included studies was assessed using the Critical Appraisal Skills Programme tool, and the review protocol was pre-registered with PROSPERO (Ref: CRD42022311494). RESULTS We identified 16 qualitative studies exploring mental health-seeking behaviours in Middle East countries. Facilitators and barriers to help-seeking were captured under six overarching themes. Across all studies, we identified negative attitudes towards seeking help for mental health issues, economic and structural barriers to accessing mental healthcare, and misconceptions surrounding religious beliefs, all of which had a critical role in impacting decisions to seek mental healthcare services. Many sought help from alternative sources, such as traditional healers or family members before consulting a healthcare professional. The role of the family and cultural norms was also identified as key contributors to people's help-seeking behaviours. CONCLUSIONS This meta-synthesis indicates the existence of many challenges surrounding mental health-seeking in the Middle East, including public and internalizing stigmas. This suggests an urgent need for an increase in psychoeducation and mental health awareness in the region.
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Affiliation(s)
- Farah Elshamy
- Division of Psychiatry, University College London, London, United Kingdom
| | - Ayah Hamadeh
- Division of Psychiatry, University College London, London, United Kingdom
| | - Jo Billings
- Division of Psychiatry, University College London, London, United Kingdom
| | - Aisha Alyafei
- Division of Psychiatry, University College London, London, United Kingdom
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Bashkin O, Suisa A, Levi S. Higher Education in Public Health as a Tool to Reduce Disparities: Findings from an Exploratory Study among the Bedouin Community in Israel. Eur J Investig Health Psychol Educ 2023; 13:2082-2094. [PMID: 37887148 PMCID: PMC10606249 DOI: 10.3390/ejihpe13100147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/28/2023] Open
Abstract
The Bedouin community is a minority disadvantaged population in Israel that suffers from a variety of health and socioeconomic disparities and limited access to higher education. The current study aimed to examine perceptions, successes, and challenges experienced by Bedouin students during their studies and to assess an internship program developed on the principles of a community-based participatory research approach to public health. In-depth interviews were conducted with 34 Bedouin students studying in the public health academic track between January and April 2023. Grounded Theory was used to analyze the data. Three main themes emerged from the analysis: (1) facilitators for the decision to pursue higher education in public health, (2) challenges and coping strategies, and (3) experiences of success. The internship program included eleven Bedouin students who conducted six community intervention projects covering a range of topics with different target Bedouin populations. Higher education is crucial for empowering minorities, producing leadership, and reducing socioeconomic and health gaps. The field internship enabled the necessary alignment between academia and public health practice. It is important to further reflect on the integration of minority groups in public health studies and its role in decreasing health inequity.
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Affiliation(s)
- Osnat Bashkin
- Department of Public Health, Ashkelon Academic College, Ben-Tzvi 12, Ashkelon 78211, Israel
| | - Avia Suisa
- Department of Public Health, Ashkelon Academic College, Ben-Tzvi 12, Ashkelon 78211, Israel
| | - Sharon Levi
- Department of Public Health, Ashkelon Academic College, Ben-Tzvi 12, Ashkelon 78211, Israel
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Hu Y, Huang S, Xiao M, Fu B, Tang G, Lommel L, Lei J. Barriers and facilitators of psychological help-seeking behaviors for perinatal women with depressive symptoms: A qualitative systematic review based on the Consolidated Framework for Implementation Research. Midwifery 2023; 122:103686. [PMID: 37119670 DOI: 10.1016/j.midw.2023.103686] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 03/22/2023] [Accepted: 04/08/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE To identify barriers and facilitators related to psychological help-seeking behaviors of perinatal depression from all related stakeholders (e.g., perinatal women, family members, mental health care providers, and policymakers). DESIGN A literature search of six English-language databases (PubMed, Web of Science, Embase, PsycINFO, the Cochrane Library, CINAHL) and three Chinese-language databases (China National Knowledge Infrastructure, Wan Fang, Chinese Biomedical Literature Databases). Studies published in English or Chinese using qualitative or mixed methods to explore the psychological help-seeking behaviors of women with perinatal depression were included. Data extraction was synthesized for common themes based on the Consolidated Framework for Implementation Research. The Joanna Briggs Institute Qualitative Assessment and Review Instrument was used to appraise methodologic quality. PARTICIPANTS AND SETTINGS Perinatal women with depression, mental health care providers (e.g., pediatricians/nurses, social workers, nurse-midwives, perinatal psychiatrists, community health workers, and administrators), partners and informal caregivers (e.g., community birth attendants, elderly mothers, and men of reproductive age) based in high, middle and low income countries. FINDINGS Forty-three articles were included in this review and presented according to the Consolidated Framework for Implementation Research domains (in parentheses). The most common barriers to help seeking were stigma (individual characteristics), misconceptions (individual characteristics), cultural beliefs (inner setting), and lack of social support (outer setting). The most common facilitators were providing adequate support (outer setting) and perinatal health care professional training on how to detect, manage and discuss depression; establishing supportive relationships with mental health care providers; and eroding stigma (all three implementation processes). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE This systematic review could serve as a reference framework for health authorities to develop diverse strategies for improving the psychological help-seeking behaviors of women with perinatal depression. More high-quality studies focused on the Consolidated Framework for Implementation Research characteristics of available interventions, and implementation processes are needed in future research.
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Affiliation(s)
- Ying Hu
- Department of Nursing, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China; Xiang Ya Nursing School of Central South University, 172 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China
| | - Sasa Huang
- Department of Nursing, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China; Xiang Ya Nursing School of Central South University, 172 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China
| | - Meili Xiao
- Department of Nursing, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China; Xiang Ya Nursing School of Central South University, 172 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China; Department of Nursing, Hunan Normal University School of Medicine, 371 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China.
| | - Bing Fu
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China
| | - Guanxiu Tang
- Department of Geriatrics, the Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China
| | - Lisa Lommel
- University of California, San Francisco, 1001 Potrero Ave, San Francisco, San Francisco, California 94110, United States
| | - Jun Lei
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China.
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16
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Experiences and needs of women from ethnic minorities in maternity healthcare: A qualitative systematic review and meta-aggregation. Women Birth 2023; 36:30-38. [PMID: 35717372 DOI: 10.1016/j.wombi.2022.06.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/13/2022] [Accepted: 06/08/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To consolidate the available evidence around ethnic minority women's experiences and needs when accessing maternity care. METHODS A qualitative systematic review and meta-aggregation of qualitative data were conducted. Nine electronic databases were searched for qualitative or mixed-methods studies from the inception of each database until January 2022. Using the Nested-Knowledge software, meta-aggregation was conducted according to the Joanna Briggs Institute (JBI) data synthesis approach to identify all potential intersections between different themes. Methodological quality of included studies was assessed using the JBI Qualitative Assessment and Review Instrument (JBI-QARI) and the mixed-methods appraisal tool (MMAT) checklists for qualitative and mixed-methods studies, respectively. RESULTS Twenty-two studies (nineteen qualitative and three mixed-methods) were included. All studies were of good methodological quality. An overarching theme 'the struggles and fears of ethnic minority women' was identified. The negative experiences with maternity care were attributed to barriers including ineffective communication, cultural and religious insensitivity, inattentiveness and disregard for women's needs, and isolation-related impact due to the COVID pandemic. CONCLUSIONS Overall, our review highlighted several significant gaps between the care provided and the expected care among ethnic minority women accessing maternity care services. This mismatch between their expectations and care resulted in negative experiences, as the women reported being discriminated against and disrespected. There is an urgent need to develop and implement maternity care policies that are inclusive of needs of the ethnic minority women to optimize their maternity care experience.
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17
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Huang S, Hu Y, Fu B, Tang G, Chen Z, Zhang L, Xiao M, Lei J. Help-Seeking Intentions for Depression and Associated Factors among Chinese Perinatal Women: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2288. [PMID: 36767654 PMCID: PMC9916212 DOI: 10.3390/ijerph20032288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
A low help-seeking intention for depression is an important reason for the low number of women with perinatal depression who have sought professional help. However, evidence of help-seeking intentions for depression is still lacking in Chinese perinatal women. We aimed to investigate the help-seeking intention for depression and its associated factors among Chinese perinatal women. Participants were recruited from three comprehensive hospitals in Changsha. A total of 874 perinatal women were included in the study. The score for the help-seeking intention for depression in Chinese perinatal women was 3.65 ± 0.79, with about half of participants (58.3%) reporting that they were "likely" and "strongly likely" to seek professional help if they suffered from depression during the perinatal period. Favorable help-seeking attitudes and sufficient knowledge of mental illness help-seeking resources were positively associated with help-seeking intentions for depression. However, self-stigma decreased the help-seeking intention for depression. Chinese perinatal women had relatively positive help-seeking intentions for depression. Reducing the stigma of mental illness and help-seeking, enhancing mental health literacy, and improving attitudes toward professional psychological help-seeking of perinatal women may be the potential key components of interventions to encourage perinatal women to actively seek professional psychological help.
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Affiliation(s)
- Sasa Huang
- Nursing Department, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, China
- Xiang Ya Nursing School, Central South University, 172 Tongzipo Road, Yuelu District, Changsha 410013, China
| | - Ying Hu
- Nursing Department, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, China
- Xiang Ya Nursing School, Central South University, 172 Tongzipo Road, Yuelu District, Changsha 410013, China
| | - Bing Fu
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, China
| | - Guanxiu Tang
- Department of Geriatrics, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, China
| | - Zhihong Chen
- Department of Pediatric Intensive Care Unit, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, China
| | - Lijuan Zhang
- Department of Emergency Pediatrics, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, China
| | - Meili Xiao
- Nursing Department, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, China
- Xiang Ya Nursing School, Central South University, 172 Tongzipo Road, Yuelu District, Changsha 410013, China
| | - Jun Lei
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha 410013, China
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Alfayumi-Zeadna S, O’Rourke N, Azbarga Z, Froimovici M, Daoud N. Temporal Stability of Responses to the Edinburgh Postpartum Depression Scale by Bedouin Mothers in Southern Israel. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13959. [PMID: 36360839 PMCID: PMC9656510 DOI: 10.3390/ijerph192113959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/23/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
The detection and treatment of mental illness during pregnancy and postpartum are essential for the well-being of both mother and child. For this study, we set out to estimate the prevalence of perinatal depression among Bedouin mothers in southern Israel and determine if the latent structure of responses to the Edinburgh Postpartum Depression Scale (EPDS)-including depression, anxiety, and anhedonia-previously reported also applies to this population. A total of 332 women completed the EPDS during pregnancy (26-38 weeks) and again 2-4 months postpartum. Confirmatory factor analyses were performed to determine if first-order factors were correlated, or instead measure a second- or higher-order latent construct. We next performed temporal invariance analyses to compare the latent structure of EPDS responses over time. When pregnant, 35% of women provided EPDS responses suggestive of elevated depressive symptomology; this decreased to 23% postpartum. At both points, each EPDS factor significantly measures a higher-order, latent construct. The EPDS appears to measure three factors, labeled sadness, anxiety, and anhedonia. This latent structure appears stable (i.e., during pregnancy and postpartum). Further research is needed to validate EPDS responses versus structured clinical interviews. The construct validity of EPDS factors should be examined across other at-risk groups and over time.
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Affiliation(s)
- Samira Alfayumi-Zeadna
- Center for Women’s Health Studies and Promotion, Ben-Gurion University of the Negev, Be’er Sheva 84417, Israel
- Nursing Department, School of Health Sciences, Ashkelon Academic College, Ashkelon 78682, Israel
- MAP Centre for UrbanHealth Solutions, Li Ka Shing Knowledge Institute, Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada
| | - Norm O’Rourke
- Multidisciplinary Center for Research on Aging, Ben-Gurion University of the Negev, Be’er Sheva 84417, Israel
- Department of Psychology, Ben-Gurion University of the Negev, Be’er Sheva 84417, Israel
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva 84417, Israel
| | - Zuya Azbarga
- Clalit Health Services, Southern Region, Be’er-Sheva 84417, Israel
| | - Miron Froimovici
- Clalit Health Services, Southern Region, Be’er-Sheva 84417, Israel
| | - Nihaya Daoud
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva 84417, Israel
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19
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A Non-Randomized Controlled Trial for Reducing Postpartum Depression in Low-Income Minority Women at Community-Based Women's Health Clinics. Matern Child Health J 2022; 26:1689-1700. [PMID: 35445883 DOI: 10.1007/s10995-022-03434-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To analyze an intervention that delivered tailored clinic staff training on postpartum depression (PPD) followed by awareness raising and social support aimed at lowering PPD among low-income Bedouin women in southern Israel. METHODS We conducted a non-randomized controlled trial at two women's health clinics. The study included 332 of the 384 eligible women recruited at baseline (intervention = 169, control = 163), who completed two face-to-face interviews, one at 26-38 weeks of pregnancy (Time 1) and one 2-4 months postpartum (Time 2). PPD was measured by the Edinburgh Postnatal Depression Scale (EPDS) and dichotomized using a ≥ 10 score cutoff. We calculated EPDS change (rate difference of dichotomous EPDS from Time 1 to Time 2) (no change, positive change, or negative change), and compared EPDS changes in a control clinic vs. an intervention clinic. RESULTS The intervention group showed a greater decrease in dichotomous EPDS ≥ 10 between times 1 and 2 (38.5% to 17.2%) than the control group (31.9% to 29.4%, PV = 0.008). Multinomial logistic regression showed that high PPD awareness significantly contributed to positive EPDS change in the intervention group (PV = 0.003) and high social support significantly protected against negative EPDS change in both groups, intervention (PV = 0.001) and control (PV = 0.003). CONCLUSIONS In low-income women, an intervention focusing on increasing PPD awareness and social support following staff training was associated with reduced EPDS and positive EPDS change following the intervention. Similar interventions should be implemented in women's clinics during pregnancy. CLINICAL TRIAL REGISTRY ClinicalTrials.gov NCT02862444.
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20
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Alfayumi-Zeadna S, Bina R, Levy D, Merzbach R, Zeadna A. Elevated Perinatal Depression during the COVID-19 Pandemic: A National Study among Jewish and Arab Women in Israel. J Clin Med 2022; 11:jcm11020349. [PMID: 35054043 PMCID: PMC8778708 DOI: 10.3390/jcm11020349] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 12/10/2022] Open
Abstract
This study assessed prevalence of perinatal depression symptoms (PNDS) during the COVID-19 pandemic among Arab and Jewish women in Israel and identified COVID-19-related risk factors for PNDS, while comparing Arab and Jewish women. Sample included 730 perinatal women (604 Jewish and 126 Arab) aged 19-45 years, who filled out an online self-report questionnaire. The questionnaire assessed several areas: perinatal experiences and exposure to COVID-19, social support, and financial and emotional impact. PNDS was measured by the Edinburgh Postnatal Depression Scale (EPDS). Prevalence of PNDS (EPDS ≥ 10) in the entire study population was 40.0%. Prevalence among Arab women was significantly higher compared to Jewish women (58% vs. 36%, PV < 0.001). Higher PNDS were significantly associated with anxiety symptoms (GAD ≥ 10) (PV < 0.001), stress related to COVID-19 (PV < 0.001), adverse change in delivery of healthcare services (PV = 0.025), and unemployment (PV = 0.002). PNDS has elevated more than twofold during COVID-19 in Israel. Such high rates of PNDS may potentially negatively impact women, and fetal and child health development. This situation requires special attention from public health services and policy makers to provide support and mitigation strategies for pregnant and postpartum women in times of health crises.
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Affiliation(s)
- Samira Alfayumi-Zeadna
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada
- Correspondence:
| | - Rena Bina
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan 5290002, Israel; (R.B.); (D.L.); (R.M.)
| | - Drorit Levy
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan 5290002, Israel; (R.B.); (D.L.); (R.M.)
| | - Rachel Merzbach
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan 5290002, Israel; (R.B.); (D.L.); (R.M.)
| | - Atif Zeadna
- Fertility and IVF Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410402, Israel;
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21
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Shibli H, Aharonson-Daniel L, Feder-Bubis P. Perceptions about the accessibility of healthcare services among ethnic minority women: a qualitative study among Arab Bedouins in Israel. Int J Equity Health 2021; 20:117. [PMID: 33964946 PMCID: PMC8106134 DOI: 10.1186/s12939-021-01464-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/29/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Access to healthcare services has major implications for vulnerable populations' health. Socio-cultural and gender characteristics shape the utilization and access of healthcare services among ethnic minorities worldwide. One such vulnerable ethnic minority is the Arab Bedouin women in Israel. As women, they are marginalized in their community, where women do not have full equity and they experience multiple barriers to healthcare services The main objective of this study is to provide a nuanced, experiential, emic description of healthcare accessibility issues among Bedouin women in Israel. Identifying the barriers, they face in accessing healthcare may help healthcare policymakers make changes based on and tailored to Bedouin women's needs. METHODS A qualitative study included in-depth semi-structured interviews with 21 Arab Bedouin village residents, consisting of 14 women and 7 men. Eligible participants were Arab Bedouins over 18 years of age and who used healthcare services at least once in the last 5 years. The interviews were carried out in Arabic-Bedouin dialect and included demographic questions, open-ended questions that asked about participants' perceptions regarding their experiences with healthcare services, including the factors that helped and hindered them in accessing these services and questions regarding suggestions for improving the accessibility of healthcare services based on the identified needs. Data collected were analyzed using thematic analysis. Study trustworthiness was ensured using audit, reflexivity, and peer debriefing. RESULTS Arab Bedouin women experienced varied barriers while accessing healthcare services. This study uncovered how language, cultural and gender barriers intersect with other disadvantages ingrained in social norms, values and beliefs and affect the access of a minority women subgroup to healthcare services. The participants identified subgroups of Bedouin women (e.g. elderly Bedouin women) affected differently by these barriers. CONCLUSION Taking into consideration the identified needs and the Arab Bedouin women's unique characteristics, along with adopting the intersectional approach should help improve access to healthcare services among such a vulnerable subgroup and other subgroups within minorities worldwide.
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Affiliation(s)
- Haneen Shibli
- School of Public Health, Faculty of Health Sciences, Faculty of Health Sciences, PREPARED Center for Emergency Response Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Limor Aharonson-Daniel
- School of Public Health, Faculty of Health Sciences, Faculty of Health Sciences, PREPARED Center for Emergency Response Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Paula Feder-Bubis
- School of Public Health, Faculty of Health Sciences, Faculty of Health Sciences, PREPARED Center for Emergency Response Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Health Systems Management, Faculty of Health Sciences & Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Alfayumi-Zeadna S, Froimovici M, Rourke NO, Azbarga Z, Okby-Cronin R, Salman L, Alkatnany A, Grotto I, Daoud N. Direct and indirect determinants of prenatal depression among Arab-Bedouin women in Israel: The role of stressful life events and social support. Midwifery 2021; 96:102937. [PMID: 33667825 DOI: 10.1016/j.midw.2021.102937] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/30/2021] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Prenatal depression (PND) negatively affects the health and well-being of both mother and child. The aim of this study was to identify the direct and indirect determinants of prenatal depression symptoms (PNDS) among Arab-Bedouin women in southern Israel. DESIGN Data collection was conducted in two women's health centers from October 2017 to February 2018. SETTING Participants were recruited during visits to women's health centers in southern Israel. PARTICIPANTS We recruited 376 Arab-Bedouin women as part of a larger study of perinatal health and well-being. We recruited 376 Arab-Bedouin women as part of a larger study of perinatal health and well-being. All women were 18+ years of age and 26-38 weeks of gestational age. MEASUREMENTS PNDS were measured by an Arabic version of the Edinburgh Postnatal Depression Scale. We computed path analyses to identify direct and indirect determinants of PND and estimated the contribution of stressful life events and social support. RESULTS Positive direct associations emerged between stressful life events, history of depression and gestational age, and PNDS; direct inverse associations were found between social support, PND awareness, and education, and PNDS. History of depression was the single strongest direct predictor of PNDS yet when considering combined direct and indirect effects, the contribution of stressful life events is greater. Stressful life events (via history of depression and PND awareness) and education (via PND awareness) had both direct and indirect effects on PNDS. Age of the mother indirectly affects PNDS via education and PND awareness. Polygamy emerged as neither a direct nor indirect predictor of PNDS. CONCLUSIONS PNDS in the underserved and understudied Bedouin women has serval direct and indirect predictors. Interventions aiming at reducing stress and increasing social support, via PND awareness might be successful in reducing PND and possibly future postpartum depression.
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Affiliation(s)
- Samira Alfayumi-Zeadna
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.
| | | | - Norm O' Rourke
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel; Multidisciplinary Center for Research on Aging, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | | | | | | | | | - Itmar Grotto
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel; Israeli Ministry of Health, Jerusalem, Israel
| | - Nihaya Daoud
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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23
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Savitsky B, Radomislensky I, Frid Z, Gitelson N, Glasser S, Hendel T. Ethnic disparities in receiving benefits for disability following postpartum mental illness during first two years after delivery: an Israeli nationwide study. Isr J Health Policy Res 2020; 9:63. [PMID: 33168058 PMCID: PMC7650171 DOI: 10.1186/s13584-020-00407-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 09/16/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Despite relatively high rates of Postpartum Depression (PPD), little is known about the granting of social security benefits to women who are disabled as a result of PPD or of other postpartum mood and anxiety disorders (PMAD). This study aims to identify populations at risk for underutilization of social security benefits due to PMAD among Israeli women, with a focus on ethnic minorities. METHODS This retrospective cohort study is based on the National Insurance Institute (NII) database. The study population included a simple 10% random sample of 79,391 female Israeli citizens who gave birth during 2008-2016 (these women delivered a total of 143,871 infants during the study period), and who had not been eligible for NII mental health disability benefits before 2008. The dependent variable was receipt of Benefit Entitlement (BE) due to mental illness within 2 years following childbirth. Maternal age at delivery, population group, Socio-Economic Status (SES), family status, employment status of the mother and her spouse, and infant mortality were the independent variables. Left truncation COX proportional hazard model with time-dependent variables was used, and birth number served as a time discrete variable. RESULTS Bedouin and Arab women had significantly lower likelihood of BE (2.6 times lower and twice lower) compared with other ethnic groups (HR = 0.38; 95% CI: 0.26-0.56; HR = 0.47; 95% CI: 0.37-0.60 respectively). The probability of divorced or widowed women for BE was significantly higher compared to those living with a spouse (HR = 3.64; 95% CI: 2.49-5.33). Lack of employment was associated with higher likelihood of BE (HR = 1.54; 95% CI: 1.30-1.82). Income had a dose-response relationship with BE in multivariable analysis: lower income was associated with the nearly four-fold greater probability compared to the highest income quartile (HR = 3.83; 95% CI: 2.89-5.07). CONCLUSIONS Despite the exceptionally high prevalence of PMAD among ethnic minorities, Bedouins and Arabs had lowest likelihood of Benefit Entitlement. In addition to developing programs for early identification of postpartum emotional disorders among unprivileged ethnic groups, awareness regarding entitlement to a mental health disability allowance among ethnic minorities should be improved.
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Affiliation(s)
- Bella Savitsky
- Department of Nursing, Ashkelon Academic College, School of Health Sciences, Yitshak Ben Zvi 12, Ashkelon, Israel
| | - Irina Radomislensky
- Gertner Institute for Epidemiology and Public Health Policy, Sheba Medical Center Tel-Hashomer, Ramat Gan, Israel
| | - Zhanna Frid
- The National Insurance Institute of Israel, Research Center, Sderot Weizmann 13, Jerusalem, Israel
| | - Natalia Gitelson
- The National Insurance Institute of Israel, Research Center, Sderot Weizmann 13, Jerusalem, Israel
| | - Saralee Glasser
- Women & Children’s Health Research Unit Gertner, Institute for Epidemiology and Public Health Policy, Sheba Medical Center Tel-Hashomer, Ramat Gan, Israel
| | - Tova Hendel
- Department of Nursing, Ashkelon Academic College, School of Health Sciences, Yitshak Ben Zvi 12, Ashkelon, Israel
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Zhang L, Yang X, Zhao J, Zhang W, Cui C, Yang F, Ma R, Jia Y. Prevalence of Prenatal Depression Among Pregnant Women and the Importance of Resilience: A Multi-Site Questionnaire-Based Survey in Mainland China. Front Psychiatry 2020; 11:374. [PMID: 32435211 PMCID: PMC7218063 DOI: 10.3389/fpsyt.2020.00374] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 04/15/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Prenatal depression is associated with adverse maternal and fetal health consequences, yet it has not raised sufficient concerns in China. Psychological worries and stress may lead to prenatal depression, but resilience could relieve some of the negative effects of worries and stress and mitigate prenatal depression. AIMS This study aimed to assess the prevalence of prenatal depression and explore its associated factors. METHOD A multisite cross-sectional study was conducted that included 605 pregnant women from three hospitals in two provincial capitals (Shenyang and Zhengzhou) and one municipality (Chongqing). A smartphone questionnaire was employed to assess prenatal depression using the Center for Epidemiologic Studies Depression Scale (CES-D). Multivariate logistic regression analysis was performed to explore factors associated with prenatal depression. RESULTS The prevalence of prenatal depression (CES-D≥16) among Chinese pregnant women was 28.4%. Logistic regression analyses revealed that prenatal depression was positively associated with worries about appearance (odds ratio [OR] 1.666, 95% confidence interval [CI] 1.043-2.661) and perceived stress (OR 1.156, 95% CI 1.104-1.211) and negatively associated with monthly income, relationship with mother (OR 0.287, 95% CI 0.103-0.796), and resilience (OR 0.935, 95% CI 0.918-0.953). CONCLUSION These findings revealed that Chinese pregnant women suffered from high levels of prenatal depression (28.4%). Worries about appearance and perceived stress were risk factors for prenatal depression, whereas a pregnant woman's harmonious relationship with her own mother and resilience could relieve the negative impacts of pregnancy that can lead to prenatal depression. Improving resilience and maintaining harmonious relationships with mothers should be emphasized in order to reduce the detrimental effects of pregnancy and improve the mental well-being of pregnant women.
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Affiliation(s)
- Lijuan Zhang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaoshi Yang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, China
| | - Jinfeng Zhao
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Weiyu Zhang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, China
| | - Can Cui
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, China
| | - Fengzhi Yang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, China
| | - Ruqing Ma
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, China
| | - Yajing Jia
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, China
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25
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Daoud N, Ali Saleh-Darawshy N, Meiyin Gao, Sergienko R, Sestito SR, Geraisy N. Multiple forms of discrimination and postpartum depression among indigenous Palestinian-Arab, Jewish immigrants and non-immigrant Jewish mothers. BMC Public Health 2019; 19:1741. [PMID: 31881953 PMCID: PMC6935055 DOI: 10.1186/s12889-019-8053-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 12/09/2019] [Indexed: 12/16/2022] Open
Abstract
Background While discrimination takes multiple forms, racial or ethnic discrimination is a root cause of this health-damaging social phenomenon. We drew on intersectionality theory, which offers an account of discrimination’s multiple effects, to consider associations between women’s experiences of discrimination and postpartum depression (PPD) using four measures: single forms of discrimination (SFD); multiple forms of discrimination (MFD); ethnic discrimination combined with MFD (E-MFD); and a composite MFD that interacted with women’s identity (C-MFD). Methods We interviewed a stratified sample of 1128 mothers face to face in 2014–2015 during mothers’ visits to maternal and child health clinics. The mothers belonged to three groups in Israel: Palestinian-Arab minority, Jewish immigrant, and non-immigrant Jewish. We conducted unadjusted and adjusted logistic regressions for PPD, measured on the Edinburgh Postnatal Depression Scale, in associations with SFD (experiencing discrimination based on any of the following: age, sex, class, ethno-national identity, religiosity level and skin color); MFD (experiencing 0,1, 2 or ≥ 3 of SFD); E-MFD (ethnic discrimination combined with other MFD); and finally, C-MFD (interaction between MFD and women’s identity). Results Palestinian-Arab mothers had higher PPD and reported higher SFD (based on ethnicity, religiosity level, and socioeconomic status), as well as higher MFD and E-MFD. This was followed by Jewish immigrant mothers, and lastly by non-immigrant Jewish mothers. However, both MFD and E-MFD had a strong association with PPD among non-immigrant Jewish mothers reporting 2MFD and ≥ 3MFD, and Palestinian-Arab mothers reporting ≥3MFD, but no significant association among immigrant Jewish mothers. When we used C-MFD, we found a dose-response association in which Palestinian-Arab mothers experiencing more MFD (2MFD and ≥ 3MFD) were more likely to experience PPD. This was followed by immigrant Jewish mothers (reporting 2MFD and ≥ 3MFD), and lastly by non-immigrant Jewish mothers. Conclusions MFD should be considered in relation to women’s identity (being part of a minority, immigrant, or non-immigrant majority group) in maternal mental health research and practice. Otherwise, we risk underestimating the effects of MFD on PPD, especially in minority and immigrant mothers, who are more likely to face interlocking forms of discrimination.
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Affiliation(s)
- Nihaya Daoud
- Department of Public Health, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, 84015, Beer Sheva, Israel.
| | - Neveen Ali Saleh-Darawshy
- Department of Public Health, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, 84015, Beer Sheva, Israel
| | - Meiyin Gao
- Critical Care Services Ontario, LuCliff Place, 700 Bay Street, Suite 1400, Toronto, ON, M5G 1Z6, Canada
| | - Ruslan Sergienko
- Department of Public Health, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, 84015, Beer Sheva, Israel
| | - Stephanie Ruth Sestito
- School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.28 Box 653,, 84015, Beer Sheva, Israel
| | - Nabil Geraisy
- Department of Psychiatry, Nazareth Hospital, E.M.M.S, Nazareth, Israel
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