Forced migrant women’s Mental Health in the perinatal period in Germany- A mixed-method study

Abstract Background After forced migration, pregnant women and new mothers face specific challenges in the host country. Little research focuses on the impact these challenges have on forced migrant (FM) women’s mental health (MH). The study’s aim shed light on FM women’s mental wellbeing in the perinatal period. Methods For this mixed-method study 15 individual problem-centered interviews were carried out in Arabic with FM mothers living in Germany within the postnatal period to one year postpartum. The transcripts were analysed using the Framework Analysis. In addition, structured quantitative interviews with 3070 new mothers were conducted on 3 obstetric wards in Berlin over a period of 23 months using an adapted version of the MFMCQ and the PHQ4. FM women (n = 187) were compared with immigrant (n = 1192) and non-immigrant women (n = 1673). A Kruskal-Wallis-Test was performed to compare the three groups. Results In the qualitative interviews mothers stated having depression and varied emotions (e.g. unavoidable sadness, relief). Most FM mothers indicated contextual factors (e.g. bad housing conditions) and structural barriers in perinatal healthcare as negatively impacting their MH. The preliminary quantitative analysis of the interviews conducted in birth clinics directly after birth showed no significant differences in the mean scores of the PHQ-4 within the compared groups (mFMW= 2.83; mimmi=2.61; mnonimmi= 2.5; p=.72). Conclusions While the quantitative study part indicates that PHQ-4 scores are independent of FM experience, the qualitative part shows that FM new mothers face particular burdens in their living conditions that make them vulnerable to MH issues. Inconsistent results could be attributed to the different timing in which the structured questionnaires and qualitative interviews were conducted. Key messages • To promote Mental health of new mothers, we advocate for a diversity oriented, responsive healthcare system. • Effective approaches must be provided to include FM mothers in existing Early Childhood Intervention programs.


Background:
The incidence of inflammatory bowel disease (IBD) among children and adolescence is increasing worldwide.Having a chronic condition at a young age may affect educational achievement and later employment and self-support.The study aims to examine the impact of being diagnosed with IBD before 18 years of age on achieving an upper secondary education before 25 years of age.

Methods:
Using the Danish National Patient Register  all patients (born 1970-1994) diagnosed with IBD at a young age (<18 years) were identified.The IBD-patients were matched on age and sex with 10 references without IBD at the index date (date of diagnosis of IBD).The outcome was achieving an upper secondary education using data from Danish Education Registers.The association between IBD diagnosis and achieving an upper secondary education was analyzed using Cox regression with robust variance estimation adjusting for parents' highest educational level.Furthermore, stratified analyses were performed on parental socioeconomic status (education and income).

Conclusions:
Being diagnosed with IBD before 18 years of age did not reduce the chance of achieving an upper secondary education.Patients with low socioeconomic status performed better than their peers, however the study gives no explanation of this.

Key messages:
Children diagnosed with IBD before 18 years of age had at least the same chance of achieving an upper secondary education compared to references.IBD patients with low social economic status performed better than their peers.

Background:
After forced migration, pregnant women and new mothers face specific challenges in the host country.Little research focuses on the impact these challenges have on forced migrant (FM) women's mental health (MH).The study's aim shed light on FM women's mental wellbeing in the perinatal period.

Methods:
For this mixed-method study 15 individual problem-centered interviews were carried out in Arabic with FM mothers living in Germany within the postnatal period to one year postpartum.The transcripts were analysed using the Framework Analysis.In addition, structured quantitative interviews with 3070 new mothers were conducted on 3 obstetric wards in Berlin over a period of 23 months using an adapted version of the MFMCQ and the PHQ4.FM women (n = 187) were compared with immigrant (n = 1192) and non-immigrant women (n = 1673).A Kruskal-Wallis-Test was performed to compare the three groups. Results: In the qualitative interviews mothers stated having depression and varied emotions (e.g.unavoidable sadness, relief).Most FM mothers indicated contextual factors (e.g.bad housing conditions) and structural barriers in perinatal healthcare as negatively impacting their MH.The preliminary quantitative analysis of the interviews conducted in birth clinics directly after birth showed no significant differences in the mean scores of the PHQ-4 within the compared groups (mFMW = 2.83; mimmi = 2.61; mnonimmi = 2.5; p = .72).

Conclusions:
While the quantitative study part indicates that PHQ-4 scores are independent of FM experience, the qualitative part shows that FM new mothers face particular burdens in their living conditions that make them vulnerable to MH issues.Inconsistent results could be attributed to the different timing in which the structured questionnaires and qualitative interviews were conducted.

Key messages:
To promote Mental health of new mothers, we advocate for a diversity oriented, responsive healthcare system.Effective approaches must be provided to include FM mothers in existing Early Childhood Intervention programs.

Background:
Mother ´s own milk (MOM) is the best nutrition for preterm infants because of its preventive effects.Nevertheless, current research shows that mothers have problems getting into continuous lactation, especially after preterm birth.Breastfeeding-related pressure after prematurity has not been measured yet.It's relevance for the lactation is thus unclear, as well as the role of the NICU staff's attitudes.The aim of this study is to gain more knowledge about breastfeeding-related pressure in order to enable mothers to have a positive breastfeeding experience and to sensitise NICU staff about this topic.

Methods:
The written survey included mothers of preterm infants with a birth weight under 1500g and an age from 6 to 24 months at the time of the survey.Descriptive and bivariate testing was used for analyses.
Results: Data of 506 mothers was included (32% response rate).One third totally agreed to perceive pressure regarding breastfeeding their child with MOM (36%).A milk volume over 500ml/day 14 days post-partum was reported in 60%.That the nutrition with MOM was promoted by the physicians in the NICU was totally agreed by 44% of the mothers.To the promotion by nurses, 50% totally agreed.Pearson Chi 2 -Test showed a significant correlation between milk volume and breastfeeding-related pressure (p = 0.005).Spearman's correlation test showed a significant correlation between a high promotion of MOM by physicians (Spearman's rho: -0.1150, p = 0.0109) and nurses (Spearman's rho: -0.0949, p = 0.0362) and lower breastfeeding-related pressure.

Conclusions:
Our findings indicate that breastfeeding-related pressure seems to affect most of the mothers of preterm infants and correlates with lactation, even if no direction of effect can be stated.A more breastfeeding promoting NICU staff is related to lower breastfeeding-related pressure.Therefore, NICU staff should be sensitised to breastfeeding-related pressure with regard to communication with mothers.

Key messages:
Noticing breastfeeding-related pressure as an important factor for mothers within their lactation process may have the potential to enhance mothers to achieve their breastfeeding goals.NICU staff should be aware of breastfeeding-related pressure to enable more mothers to have a positive breastfeeding experience.

Conclusions:
Stress levels and depression symptoms seem to be high and prevalent due to the pandemic and it is highly indicated to take 15th European Public Health Conference 2022