Postpartum Mental Health Disorders in Indigenous Women: A Systematic Review and Meta-Analysis

Kristin A Black; Isaiah MacDonald; Thane Chambers; Maria B Ospina

doi:10.1016/j.jogc.2019.02.009

Postpartum Mental Health Disorders in Indigenous Women: A Systematic Review and Meta-Analysis

J Obstet Gynaecol Can. 2019 Oct;41(10):1470-1478. doi: 10.1016/j.jogc.2019.02.009. Epub 2019 Apr 10.

Authors

Kristin A Black¹, Isaiah MacDonald¹, Thane Chambers², Maria B Ospina³

Affiliations

¹ Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB; Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB.
² John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB.
³ Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB; Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB; School of Public Health, University of Alberta, Edmonton, AB. Electronic address: mospina@ualberta.ca.

PMID: 30981617
DOI: 10.1016/j.jogc.2019.02.009

Abstract

Objective: This systematic review synthesized and evaluated the evidence on the prevalence of postpartum mental health disorders in Indigenous women.

Methods: Comprehensive searches of biomedical electronic databases including Medline, EMBASE, PsychINFO, CINAHL, and Web of Science were performed for peer-reviewed literature published from 1990 to September 2018. The search strategy included terms related to the postpartum period, mental health disorders, and Indigenous ancestry. Epidemiological observational studies that evaluated the prevalence of mental health disorders in the postpartum and included Indigenous women from Australia, Canada, New Zealand, and the United States were included. Two independent reviewers screened and evaluated the risk of bias of included studies. A narrative synthesis of study results was conducted. Prevalence estimates from homogeneous studies were pooled in a random-effects meta-analysis (Canadian Task Force Classification II-2).

Results: A total of 2297 references were initially identified, of which six studies were included in the review. All included studies evaluated the prevalence of postpartum depression (PPD) and were of moderate or low risk of bias. Other postpartum mental health disorders were not evaluated. Overall, Indigenous women had 87% increased odds of PPD compared with Caucasian groups of women (odds ratio 1.87; 95% confidence interval 1.14-3.09). Substantial heterogeneity across prevalence estimates was observed.

Conclusion: Limited evidence suggests a greater burden of PPD affecting Indigenous women. There is insufficient evidence informing the prevalence of other postpartum mental health disorders in Indigenous women. More epidemiological research in this area is essential to provide accurate and reliable prevalence estimates of postpartum mental health disorders among Indigenous women.

Keywords: Indigenous health services; Indigenous population; Native American Indians; Postpartum; postpartum depression; postpartum mental health.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Anxiety Disorders / ethnology
Australia / epidemiology
Canada / epidemiology
Depression, Postpartum / ethnology*
Feeding and Eating Disorders / ethnology
Female
Humans
Indians, North American / psychology
Indians, North American / statistics & numerical data
Indigenous Peoples / psychology
Indigenous Peoples / statistics & numerical data*
Mental Disorders / ethnology
Native Hawaiian or Other Pacific Islander / psychology
Native Hawaiian or Other Pacific Islander / statistics & numerical data
New Zealand / epidemiology
Obsessive-Compulsive Disorder / ethnology
Pregnancy
Prevalence
Psychotic Disorders / ethnology*
Puerperal Disorders / ethnology
Stress Disorders, Post-Traumatic / ethnology*
United States / epidemiology