Psychological Distress during Pregnancy in a Multi-Ethnic Community: Findings from the Born in Bradford Cohort Study

Purpose Antenatal anxiety and depression are predictive of future mental distress, which has negative effects on children. Ethnic minority women are more likely to have a lower socio-economic status (SES) but it is unclear whether SES is an independent risk factor for mental health in pregnancy. We described the association between maternal mental distress and socio-demographic factors in a multi-ethnic cohort located in an economically deprived city in the UK. Methods We defined eight distinct ethno-language groups (total N = 8,454) and classified a threshold of distress as the 75th centile of within-group GHQ-28 scores, which we used as the outcome for univariate and multivariate logistic regression for each ethnic group and for the sample overall. Results Financial concerns were strongly and independently associated with worse mental health for six out of the eight ethnic groups, and for the cohort overall. In some groups, factors such as working status, education and family structure were associated with worse mental health, but for others these factors were of little importance. Conclusions The diversity between and within ethnic groups in this sample underlines the need to take into consideration individual social, migration and economic circumstances and their potential effect on mental health in ethnically diverse areas.

[1]  K. Hunt,et al.  Has psychological distress among UK South Asians been under-estimated? A comparison of three measures in the west of Scotland population. , 1997, Ethnicity & health.

[2]  L. Kooistra,et al.  Validation of the Edinburgh Depression Scale during pregnancy. , 2011, Journal of psychosomatic research.

[3]  S. Shah,et al.  Prevalence of antenatal depression: comparison between Pakistani and Canadian women. , 2011, JPMA. The Journal of the Pakistan Medical Association.

[4]  S. Stuart,et al.  Risk factors for depressive symptoms during pregnancy , 2011, Archives of Women's Mental Health.

[5]  H. Flynn,et al.  Risk factors for depressive symptoms during pregnancy: a systematic review. , 2010, American journal of obstetrics and gynecology.

[6]  F. Creed,et al.  Adverse social circumstances and depression in people of Pakistani origin in the UK , 1997, British Journal of Psychiatry.

[7]  M. Prince,et al.  Understanding the effect of ethnic density on mental health: multi-level investigation of survey data from England , 2010, BMJ : British Medical Journal.

[8]  D. Bhugra,et al.  Cross-cultural validity of the Amritsar Depression Inventory and the General Health Questionnaire amongst English and Punjabi primary care attenders , 2000, Social Psychiatry and Psychiatric Epidemiology.

[9]  M. Kutner,et al.  Validity of depression rating scales during pregnancy and the postpartum period: impact of trimester and parity. , 2011, Journal of psychiatric research.

[10]  B. Erens,et al.  Common mental disorders and ethnicity in England: the EMPIRIC Study , 2004, Psychological Medicine.

[11]  J. Nazroo,et al.  Relation between racial discrimination, social class, and health among ethnic minority groups. , 2002, American journal of public health.

[12]  A. Fabio,et al.  A systematic review of the effects of postnatal maternal anxiety on children , 2010, Archives of Women's Mental Health.

[13]  M. Quigley,et al.  Health status, health behaviour and healthcare use among migrants in the UK: evidence from mothers in the Millennium Cohort Study. , 2010, Social science & medicine.

[14]  Paul D. Williams,et al.  A user's guide to the General Health Questionnaire , 1988 .

[15]  John Wright,et al.  The psychometric properties of the subscales of the GHQ-28 in a multi-ethnic maternal sample: results from the Born in Bradford cohort , 2013, BMC Psychiatry.

[16]  O. Gureje,et al.  The validity of the 28-item general health questionnaire in a Nigerian antenatal clinic , 1992, Social Psychiatry and Psychiatric Epidemiology.

[17]  C T Beck,et al.  Predictors of Postpartum Depression: An Update , 2001, Nursing research.

[18]  G. Dunn,et al.  Persistent depressive disorders and social stress in people of Pakistani origin and white Europeans in UK , 2009, Social Psychiatry and Psychiatric Epidemiology.

[19]  J. Nazroo Ethnicity, Class and Health , 2001 .

[20]  T. Field,et al.  Comorbid depression and anxiety effects on pregnancy and neonatal outcome. , 2010, Infant behavior & development.

[21]  R. Uher,et al.  The contribution of prenatal and postnatal maternal anxiety and depression to child maladjustment , 2011, Depression and anxiety.

[22]  Carla M Bann,et al.  Prevalence of Anxiety, Depression and Associated Factors Among Pregnant Women of Hyderabad, Pakistan , 2009, The International journal of social psychiatry.

[23]  H. McAdoo,et al.  An integrative model for the study of developmental competencies in minority children. , 1996, Child development.

[24]  K. Bhui,et al.  Ethnicity and Mental Health , 1997, The Practitioner.

[25]  Feryad A. Hussain,et al.  Depression in South Asian Women Living in the UK: A Review of the Literature with Implications for Service Provision , 2004, Transcultural psychiatry.

[26]  S. Matthey,et al.  The validity of DSM symptoms for depression and anxiety disorders during pregnancy. , 2011, Journal of affective disorders.

[27]  D. Bhugra Cultural identities and cultural congruency: a new model for evaluating mental distress in immigrants , 2005, Acta psychiatrica Scandinavica.

[28]  David R. Williams Race, Socioeconomic Status, and Health The Added Effects of Racism and Discrimination , 1999, Annals of the New York Academy of Sciences.

[29]  O. Gureje,et al.  The validity of two versions of the GHQ in the WHO study of mental illness in general health care , 1997, Psychological Medicine.

[30]  Debbie A Lawlor,et al.  Cohort Profile: the Born in Bradford multi-ethnic family cohort study. , 2013, International journal of epidemiology.

[31]  R. Wilkinson,et al.  People like us: ethnic group density effects on health , 2008, Ethnicity & health.

[32]  S. Matthey Are we overpathologising motherhood? , 2010, Journal of affective disorders.

[33]  K. Cruickshank,et al.  Social stress and depression during pregnancy and in the postnatal period in British Pakistani mothers: A cohort study , 2012, Journal of affective disorders.

[34]  Sherry Grace,et al.  Antenatal risk factors for postpartum depression: a synthesis of recent literature. , 2004, General hospital psychiatry.

[35]  Diana Adams,et al.  High EPDS scores in women from ethnic minorities living in London , 2003, Archives of Women’s Mental Health.

[36]  S. Matthey,et al.  Repeat testing on the Edinburgh Depression Scale and the HADS-A in pregnancy: differentiating between transient and enduring distress. , 2012, Journal of affective disorders.

[37]  I. Goodyer,et al.  Maternal postnatal depression and the development of depression in offspring up to 16 years of age. , 2011, Journal of the American Academy of Child and Adolescent Psychiatry.

[38]  D. Goldberg,et al.  A scaled version of the General Health Questionnaire , 1979, Psychological Medicine.

[39]  C. Henshaw,et al.  Understanding General Health Questionnaire (GHQ–28) score and its threshold , 2004, Social Psychiatry and Psychiatric Epidemiology.

[40]  G. Dunn,et al.  Cultural influences on the prevalence of common mental disorder, general practitioners' assessments and help-seeking among Punjabi and English people visiting their general practitioner , 2001, Psychological Medicine.

[41]  David R Williams,et al.  Race, socioeconomic status, and health: Complexities, ongoing challenges, and research opportunities , 2010, Annals of the New York Academy of Sciences.

[42]  T. Mcguire,et al.  Rethinking a universal framework in the psychiatric symptom-disorder relationship. , 2003, Journal of health and social behavior.

[43]  Maarten Mennes,et al.  Antenatal maternal anxiety and stress and the neurobehavioural development of the fetus and child: links and possible mechanisms. A review , 2005, Neuroscience & Biobehavioral Reviews.

[44]  Michael R. Hulsizer,et al.  Stress, psychosocial resources, and depressive symptomatology during pregnancy in low-income, inner-city women. , 2000, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[45]  L. McIntyre,et al.  Feeling Poor: The Felt Experience Low-Income Lone Mothers , 2003 .

[46]  T. O'Connor,et al.  Antenatal anxiety predicts child behavioral/emotional problems independently of postnatal depression. , 2002, Journal of the American Academy of Child and Adolescent Psychiatry.

[47]  J. Oosthuizen,et al.  Magnitude and contributory factors of postnatal depression: a community-based cohort study from a rural subdistrict of Bangladesh , 2008, Psychological Medicine.

[48]  J. Nazroo,et al.  The Ethnic Density Effect: Results From a National Community Survey of England and Wales , 2000, The International journal of social psychiatry.

[49]  M. Knapp,et al.  Income-related inequalities in common mental disorders among ethnic minorities in England , 2012, Social Psychiatry and Psychiatric Epidemiology.

[50]  Allyson M. Abrams,et al.  Sociodemographic predictors of antenatal and postpartum depressive symptoms among women in a medical group practice , 2006, Journal of Epidemiology and Community Health.

[51]  Rachel Jenkins,et al.  Risk factors, prevalence, and treatment of anxiety and depressive disorders in Pakistan: systematic review , 2004, BMJ : British Medical Journal.

[52]  R. Bhopal,et al.  Self report in clinical and epidemiological studies with non-English speakers: the challenge of language and culture , 2004, Journal of Epidemiology and Community Health.

[53]  D. Bhugra,et al.  Assessing the Prevalence of Depression in Punjabi and English Primary Care Attenders: The Role of Culture, Physical Illness and Somatic Symptoms , 2004, Transcultural psychiatry.

[54]  L. Cavalli-Sforza,et al.  Consanguineous marriages, pearls and perils: Geneva International Consanguinity Workshop Report , 2011, Genetics in Medicine.