| Ahmed, A. Stewart, D. E., Teng, L., Wahoush, O., Gagnon, A. J., (2008)[42] Canada. |
To understand experiences and attributions of symptoms; experiences with services; factors that facilitated or hindered help seeking and recovery. |
10 participants with an EPDS score of ≥10. Women were born in China (n = 2), India (n = 2), Pakistan (n = 1), South America (n = 3), Egypt (n = 1) and Haiti (n = 1) and had lived in Canada < five years. |
A ‘qualitative study’ using semi-structured telephone interviews. Seven women were interviewed in English and interviews were conducted in languages other than English (French, Mandarin, Spanish) and later translated into and transcribed in English (do not report by whom). Data analysed using the constant comparative method. |
Five Themes: 1) Experience and attributions of causes of depression, 2) Experience with services, 3) Barriers to asking for help, 4) Attributions of causes of recovery, 5) Difference between women still sad and depressed and women who had recovered. Contributed to Themes 1,2,3 and 4 |
8/10 |
| Callister, L., Beckstrand, R, Litt, E., Souza, G., Corbett, C. (2010)[11] USA |
To describe perceptions of immigrant Hispanic women experiencing symptoms of PND; to identify barriers to help-seeking. |
20 immigrant Hispanic women aged 17 to 39 years (mean = 24) (19 from Mexico & one from Argentina) scoring positive for symptoms of PND determined by using the Postpartum Depression Screening Scale Spanish Version. Details on immigrant status collected but not reported. |
A qualitative descriptive study. Semi-structured interviews conducted in Spanish by a multilingual and bicultural member of research team. This researcher transcribed and translated the interviews. |
Three Themes: 1) Personal Barriers 2) Social Barriers 3) Health Care Delivery Barriers |
8/9 |
| Gardner, P. L., Bunton, P., Edge, D., Wittkowski, A. (2014)[40], UK |
To improve understanding of West African women's experiences of PND. |
Six immigrant women (three were born in Nigeria and three were born in Ghana, length of time in UK not described. Each woman had scored >nine on EPDS. |
Interpretive Phenomenological Approach. Semi-structured interviews, all conducted in English (inclusion criteria—fluent in English). Data analysed using |
Five themes: 1) conceptualising PND; 2) isolation; 3) loss of identity 4) issues of trust; 5) relationships as a protective factor |
7/10 |
| Mamisachvili, L., Ardiles, P., Mancewicz, G. Thompson, S. Rabin, K., Ross, LE. (2013)[41] Canada |
To compare the experiences between first- and second generation. Canadian women in order to understand the impact of cultural values, beliefs, and immigration experiences on Post-Partum Mood Problems. |
N = 9 First generation mothers average age 33.4 years (n = 5 from Chile, Uruguay, Guatemala, Ethiopia, Rwanda). Length of time in Canada ranged from two to 15 years (mean = 8.3 Years). N = 8 second generation mothers’, average 33.9 years first order data excluded from current metasynthesis |
Methodology not specified; however used thematic analysis and semi-structured interviews all conducted in English (inclusion criteria—fluent in English) |
Four themes: 1) PPMP stigma- both within context of culture of origin and Canadian culture; 2) relationship with parents/in-laws 3) expectations of managing motherhood 4) identity issues/relationship with self |
7/10 |
| Morrow, M., Smith, J. E., Lai, Y. Jaswal, S. (2008)[32] Canada |
To examine: 1) women's experiences of PND 2) variables associated with the experience of depression after childbirth, 3) the role of women's family and community 4) support needs. |
18 Punjabi-speaking, Cantonese-speaking and Mandarin-speaking immigrant women and one second-generation immigrant woman. Length of time in Canada ranged from approx four to 40 years. Women had either received a diagnosis of PND or self-identified as having experienced depression following child birth. |
Ethnographic narrative approach. Semi-structured open-ended interviews. Conducted in the first language of participants by bilingual members of the research team |
Three Themes: 1) Women's experiences and expressions of PPD. 2) Psychosocial Stresses—The migration experience, Adherence to gendered roles, the roles of mothers in society and conflicts with family members, The desire for boy babies. 3) The role of family, community and social support and help seeking, 4.The role of health care professionals. |
9/10 |
| Nahas, V. L. Amasheh, N. (1999)[33] Australia. |
To examine the care meanings and expressions of PND among Jordanian immigrant women in Sydney. |
22 Jordanian Australian women. Nine key informants and 13 general informants. No further demographic details provided. Women were diagnosed as suffering from PND (screening method not reported) |
Ethnonursing research method (Leininger, 1991). Interviews conducted in either Arabic or English. One of the authors speaks Arabic |
Three Themes: 1) Care means carrying and fulfilling traditional gender roles as mother and wife. 2)Care means strong family support and kinship ties during the postpartum period. 3) Care is preservation of the Jordanian childbearing customs as expressed in the celebration of the birth of the baby. |
8/10 |
| Nahas, V. L., Hillege, S and Amasheh, N. (1999)[34] Australia |
To explore the lived experiences of PND among Middle Eastern women living in Sydney, Australia. |
45 Middle eastern women (18 Lebanese, 14 Egyptian, and 13 Palestinian) ranged 19 to 38 years (mean 28.3 years) self-reported experience of PND. Length of time in Australia not clear but had lived in Sydney for the past five years. |
Phenomenological research design & analysis used to conduct and analyse in-depth, unstructured interviews. Interviews conducted in either Arabic or English. One of the authors speaks Arabic |
Five Themes: 1) Loneliness due to feelings of isolation and lack of social support. 2) Helplessness due to inability to cope with the overwhelming task of fulfilling her traditional role as mother and wife. 3) Fear of failure and being labelled a "bad mother" by in-laws. 4) Insufficient knowledge about postpartum depression and available support services. 5) Coming to terms with PPD by undertaking diversional activities and learning new skills. |
8/10 |
| O’Mahony, J. Truong Donnelly, T., Raffin Bouchal, S. & Este, D. 2012a [44] Canada |
To understand the factors influencing help-seeking behaviour in immigrant and refugee women, surrounding PPD. To increase understanding of the mental health needs of immigrant and refugee women after childbirth. |
30 women described by authors as having immigrant or refugee status and living in Canada for < 10 years (8 were refugees and 22 were immigrants) who had either been formally diagnosed with PND or had an EPDS score of ≥10. Women were from Mexico (n = 8) South America (n = 4), Central America (n = 1), South East Asia (n = 1) South Asia (n = 3), China (n = 5), the Middle East (n = 6) and Africa (n = 2). Years living in Canada– 14<2years; nine women two- to- five years; seven women six to 10 years. |
Critical ethnography, Semi-structured, open ended interviews conducted in the language the participant preferred. Professionally trained female interpreters were used in interviews with 12 women. Data were analysed based on Carspecken (1996), Sandelowski (1995) and Denzin and Lincoln (1994). 10 Participants re-interviewed to confirm and further explore interpretations. Varying frameworks applied in the individual papers (see below) |
Four themes emerged from data analysis: 1) the conceptualization of PND, 2) complex challenges in seeking help, 3) facilitators in seeking help, 4) intervention strategies for care and treatment. |
9/10 |
| O’Mahony, J. Donnelly, TT., Raffin Bouchal, S. & Este, D. 2013[46] Canada |
(1) Understand factors that influence immigrant and refugee women’s mental health care experiences (2) Explore service needs and appropriate strategies to address PPD in these populations |
Analysed using Kleinman’s explanatory model. |
Three Themes: 1) Cultural influence in seeking support 2) Socioeconomic influence in seeking support and 3) Spiritual and religious beliefs. |
9/10 |
| O’Mahony, J. Donnelly, TT., Raffin Bouchal, S. & Este, D. 2012b [45] Canada |
To understand health service utilisation & social support networks and needs among immigrant and refugee women in relation to PND. |
Analysed using Kleinman’s explanatory model. |
Two Themes: 1) Formal support given. 2) Informal support. |
9/10 |
| O’Mahony, J. & Donnelly, TT. 2013 [43] Canada |
The aim of this study was to explore with participants how the roles of gender, race and class might affect the ways in which they access PPD services. |
Employed postcolonial feminist perspective to interpret data. |
Two Themes: 1) Immigration policy as a barrier 2) Gender role as a barrier to help seeking. |
9/10 |
| Ornelas, IJ, Perreira, KM., Beeber, L., Maxwell, L., (2009)[47] USA |
To understand factors leading to the development of depressive symptoms among Mexican immigrant mothers |
20 low-income, Mexican-born mothers, mean age 27 years. Half (n = 10) scored higher than 16 on the CES–D Scale. The average length of residence in the US was five years, and the average age at arrival in the US was 23 years. |
Informed by Family Stress Model Semi structured interviews, conducted in Spanish by a trained bilingual research assistant who had an ongoing relationship with the women as part of the larger study. Thematic analysis |
Factors impacting on maternal mental health: 1) Economic stressors 2) Social stressors. Coping strategies: 1) Support from husbands; 2) Support from female friends and relatives; 3) Accessing community resources. |
8/10 |
| Parvin, A. Jones, C. E. Hull, S. A. (2004)[38] UK |
To understand Bangladeshi women's understandings, experiences and coping strategies used to deal with postnatal distress. |
25 Bangladeshi women living in Tower Hamlets, east London. All born in Bangladesh, ranged in age from 21 to 54 years (mean 34.3) and spoke little English. Mean time living in UK 9.97 years |
Three focus groups with 10, eight and seven women, respectively. Thematic content analysis used to interpret data. Focus groups conducted in Sylheti, a dialect from northern Bangladesh by one of the researchers. |
Four Themes: 1) Experiences of giving birth in the UK 2) Family circumstances after birth 3) Responses to emotional distress and problems within the family. 4) Experiences of primary care services in the postnatal period |
7/10 |
| Shafiei, T., Small, R, McLachlan, H. (2015)[35] Australia |
To investigate immigrant Afghan women's emotional wellbeing and experiences of PND; to explore health service utilisation in relation to this. |
Total sample 39 Afghani women (11< 25years old; 20 between 25 and 34 years and seven >35 years old). 20 had been in Australia <5 years, nine between six to 10 years and 10>10 years, 10 Afghan women participated in in-depth interviews. |
Mixed Methods design using a semi-structured telephone interview with closed and some open questions and an in-depth face to face interview. Telephone interviews were conducted four months after the birth in women's preferred language (Dari/Persian or English) by one of the authors, a bilingual researcher Thematic content analysis used to interpret data |
Two themes:1) feeling alone and lack of support 2) being overwhelmed. Reasons for not seeking help with emotional wellbeing: 1) reluctance due to discomfort; 2) belief that health professionals wouldn’t be able help 3) belief that health professionals wouldn't want to deal with emotional issues |
9/10 |
| Templeton, L. Velleman, R. Persaud, A. Milner, P. (2003)[39], UK |
To describe the experiences of women suffering from postnatal depression in black and minority ethnic communities. |
Six women participated in interviews; Scored 12 or above on the EPDS. These women were classed as Bangladeshi, Indian, other Asian and ‘other’ (in this latter group there were two women from Portugal and one woman who identified herself as mixed race). 12 additional women participated in focus groups No information on how long women had been in UK |
Semi-structured interviews and focus groups. Data analysed using descriptive thematic analysis. Interviews with four women were conducted in English and in two an interpreter was used. All focus groups were conducted in English. |
Three Themes: 1) Issues specific to pregnancy and birth (Incl. Postnatal Depression). 2) Issues specific to health care. 3) Issues specific to culture. |
7/10 |
