‘There's something in their eyes’ – Child Health Services nurses’ experiences of identifying signs of postpartum depression in non‐Swedish‐speaking immigrant mothers

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Sweden is a country in Northern Europe which due to the current world situation has one of the highest rates of asylum applicants registered among the member states in the European Union 1. Postpartum depression (PPD) has during the last decade been globally recognised as a major public health problem which immigrant mothers are found to be at particular risk of being affected by. The prevalence of PPD among immigrant mothers is estimated to be as high as 20% 2 compared to 13% among resident mothers living in Western societies 3. The recently migrated mothers are found to be a specifically vulnerable group with five times higher risk of developing PPD than native‐born women 4. Another vulnerable group is immigrant mothers less proficient in the language of their new country 5.
In 2010, the Swedish National Board of Health and Welfare recommended that all mothers should be invited to participate in a routine screening for PPD 6–8 weeks after giving birth since left untreated 6, a PPD could have long‐term traumatic effects not only on the mother's own health but also the relationship with her partner 7 and foremost on the baby's health and development 8. In Sweden, the nurses in the Child Health Services (CHS) bear responsibility for identifying mothers with signs of PPD. The CHS are a voluntary primary health services which are provided for free and play an important part in Swedish public health work since it reaches almost all families with children between zero and six years of age including groups that could be difficult to reach, for example immigrant families 9. When the CHS nurse meets and starts interacting with an immigrant family, a transcultural caring relationship develops, which is described by Leininger as a professional nursing relationship across cultures 10.
The CHS nurses are educated in recognising risk factors and symptoms and in screening for PPD using the Edinburgh Postnatal Depression Scale (EPDS) by maternal and child health psychologists who also provide training in implementing counselling and who give regular tuition 11. The ten‐item self‐report screening scale, EPDS, is used as guidance in connection with a clinical interview to assess the mothers’ mental health 6–8 weeks postpartum 12.
Providing effective screening for PPD to immigrant mothers seems to be a challenging task for healthcare professionals 13. Earlier findings show that immigrant mothers are not offered screening to the same extent as resident mothers 15. Likewise, statistics show that immigrant mothers do not agree to participate in the screening to the same extent as resident mothers 16. Despite the increased risk of PPD in this vulnerable population, to our knowledge few studies have explored healthcare professionals’ experiences of identifying mental ill health in immigrant mothers who do not speak the language of their country of residence. The aim of the study was to elucidate CHS nurses’ experiences of identifying signs of PPD in non‐Swedish‐speaking immigrant mothers.

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