Postpartum Depression In Immigrant and US-Born Mothers: Impact On Family Functioning and Child Outcomes

Background and Purpose: Despite the increasing visibility of immigrant communities across the country, little is understood about their mental health and services utilization. In addition to the stressors associated with being an immigrant, new motherhood represents a period of vulnerability for immigrant women due to the increased need to mobilize resources, language and cultural barriers, and the need to interface with the health-care system. Depression during the postpartum period has been documented to have devastating consequences not only for the women experiencing it but also for the children and family, and has become a major public health concern in the recent years. The few studies that have examined depressive symptoms in immigrant women, for example Martinez-Schallmoser et al.'s study (2003) on Mexican American women, have relied on self-reports exclusively. The present study addresses this gap by investigating the impact and course of postpartum maternal depression on the family functioning in ethnically and economically diverse immigrant and non-immigrant families, at 5 and 15 months postpartum. Methods: The present study is based on a multi-ethnic sample of immigrant (n=68) and nonimmigrant families (n=125). Mothers were classified into clinically Depressed (n=77) and Control groups (n=116) based on a psychiatric interview (SCID-I) at 5 months postpartum, and were followed-up at 15 months. Self-reports were obtained from mothers on sociodemographics, social support (ISSB), negative life events (LES), and from both mothers and resident fathers on marital adjustment (RDAS) and reports of children's problem behaviors (ITSEA) at 15 months. Results: More immigrant mothers were clinically depressed compared to nonimmigrant mothers (50% vs. 35%) at 5 months, and the trend continued at 15 months. This is striking given that the two groups did not differ significantly on socioeconomic risk factors. Depressed immigrant mothers had lower global functioning scores and were less likely to be in treatment (therapy or medication) compared with depressed nonimmigrant mothers. Immigrant mothers had lower psychosocial functioning (marital adjustment, social support) and lower social support at 5 months, and more negative events at 15 months. We examined the interaction between immigrant status and negative life events in predicting child problem behaviors at 15 months by conducted GLM Multivariate Analyses. The impact of negative life events on child internalizing at 15 months problems was significant only in the immigrant group, even after controlling for socioeconomic status and parental depressive symptoms (F(1,214) = 4.09, p<.05, B=.21). Conclusions: Results showed that although immigrant mothers were comparable to US-born mothers on socioeconomic risk factors, they were more clinically depressed at 5 months, and more likely to remain depressed. Not only do immigrant mothers have lower psychosocial functioning in the postpartum period, but also lower social support from friends and family and more negative life events, which impacted child internalizing problems. These findings highlight the gap in mental health services utilization between immigrant and US-born families, and the need to tailor interventions to the postpartum period. Targeting parenting competence and improving social support networks can be crucial for immigrant mothers that can eventually improve child outcomes.