The risk factors of perinatal mental illness in forced migrant women: a systematic review.

Background: Perinatal mental illness is a common complication of pregnancy and the post-partum period, with anxiety and depression being the most common disorders. Despite efforts to improve identifying women at risk, forced migrant women are often missed out leading to a higher prevalence of perinatal mental illness in this vulnerable group. This qualitative systematic review aimed to comprehensively review the literature on the risk factors for perinatal mental illness in forced migrant women to further understand their increased vulnerability. Methods: A comprehensive literature search was conducted on PubMed, CINAHL and PsycINFO (OVID), using keywords such as ‘perinatal’, ‘’antenatal’, ‘postnatal’, ‘migrant’, ‘refugee’, ‘asylum seeker’, ‘depression, ‘and ‘anxiety’ to identify studies published between 2013 and 2023. Following screening and critical appraisal, 21 papers were included in the systematic review. The papers selected then underwent thematic analysis. Results: Five themes emerged which identified pertinent risk factors for perinatal mental illness in forced migrant women. These were a: lack of social support, trauma and adverse events, poor emotional wellbeing, socioeconomic inequalities, and barriers to healthcare access. Forced migrant women were experiencing social isolation, stigma, marginalisation, and relationship distress which contributed to a poor social network. They were also exposed to traumatic experiences including violence which increased their level of fear during and after arrival to the host country. Consequently, this caused poor emotional wellbeing increasing the risk of suicide. Moreover, socioeconomic inequalities were significant in forced migrant women with low educational attainment, economic insecurity, and poor living conditions contributing to further marginalisation. In addition, communication challenges including poor language proficiency, produced barriers to healthcare access. All these risk factors were found to exacerbate perinatal mental illness and cause long term impacts both medically and socially. Conclusion: The risk factors identified were found to contribute to worsening perinatal mental illness with higher levels of anxiety and depression symptoms present in forced migrant women. However, the effects also included chronic health issues such as post- traumatic stress disorder, leading to maladaptive coping mechanisms such as smoking and substance misuse. The risk factors identified also contributed to wider societal impacts including unemployment, poor living conditions and increased violence, all of which promoted the socioeconomic inequalities already present. This led to continued marginalisation and poverty within forced migrant women. Although risk factors were established, further research is required to disentangle the complexity and understand the interplay of these factors to improving screening and provide effective interventions for forced migrant women.