Immigrant Women and Women with Learning Disabilities Have Complex Mental Health Needs and Service Use in the Perinatal Period

Perinatal mental disorders are important contributors to maternal morbidity and mortality globally,1–3 and are associated with adverse infant and child outcomes.4 There is clear evidence-based guidance on the detection and treatment of perinatal mental disorders in the general population,5 ,6 but little evidence on vulnerable subgroups who may have distinct clinical presentation and/or service needs. In the two selected studies, population-based regional Canadian data are used to investigate perinatal mental health among migrant women (focusing on their postnatal use of mental health services compared with non-migrant women),7 and among women with intellectual or developmental disabilities (IDD) (focusing on adverse maternal and neonatal outcomes among women with comorbid IDD and mental illness compared with women with IDD only).8 The WHO estimated that in 2015, 38 million migrant women were living in Europe,9 with migrant women representing a quarter to a third of recent live births in the UK and Canada.10 While in some contexts, migrants have better health than non-migrants (the so-called ‘healthy migrant’ effect), overall maternal and mental health are poorer in migrant women.9 ,11 Postnatal depression is around twice as common among migrant than non-migrant women, especially among ethnic minority migrant women living in poor households with limited social support and language barriers.12 However, little is known about psychiatric treatment and service use in this group. In the better researched maternal (obstetric) field, worse outcomes are in part explained by poorer access to high quality care—which is hampered by language and cultural barriers; poor patient knowledge of the healthcare system; structural or legal barriers for those with insecure migration status—and poor provider cultural understanding.9 Vigod's study is one of the first to investigate mental health service use among postnatal migrant women at the population level. As outlined …