'If they Don’t ask; I Won’t tell': Perinatal mental health screening for women of refugee background

Introduction: Women of refugee background have a higher risk of perinatal mental health illness due to the refugee experience and resettlement stressors. In 2016, we established a perinatal mental health screening programme at a dedicated refugee antenatal clinic in Melbourne, Australia. The Edinburgh Postnatal Depression Scale and a psychosocial assessment were administered in common refugee languages using a digital platform. Score-based, language appropriate information for women and management guides for midwives were generated immediately. Codesigned, refugee-appropriate referral pathways were provided. We aimed to assess the feasibility and acceptability of the perinatal mental health screening programme from the perspective of women of refugee background. Method: One focus group (five participants) and semistructured interviews (n = 9) were held in April/May 2018 with Afghan and Burmese women. Audio-recorded narratives were transcribed verbatim, prior to thematic analysis. Results: Findings indicate women value the screening programme, it makes them feel cared for by the maternity healthcare professionals which in turn allow women to feel confident in disclosing sensitive information. Women support the programme and would recommend it to others in their community. Improvements such as the availability of an audio version of screening measures are considered to be a vital component especially for women with low literacy. Programme refinement and scale-up will be made based on these results. Discussion: Perinatal mental health screening in pregnancy is feasible and acceptable to women of refugee background. Screening enables discussion of sensitive issues, early intervention and referral. This evaluation has identified key components required for a sustainable and effective programme applicable across maternity services.