Infants born to first-time mothers with a refugee background faced an increased risk of regulatory problems.

AIM: This study investigated the association between mothers' migration background and infant regulatory problems and analysed the mediating role of maternal mental health. We also explored whether the child's sex, parity and length of residence moderated the effect of a maternal migrant background. METHODS: Child health surveillance data from the Danish home visiting programme were used. Community health nurses followed infants from birth to 12 months of age. The source population comprised 103 813 infants born between 1 January 2008 and 31 December 2018. The final sample comprised 62 964 infants, including 3.4% with a refugee background. A maternal migrant background was the primary exposure. The results are presented as risk ratios (RR) and 95% confidence intervals (CI). RESULTS: A maternal refugee background increased the risk of regulatory problems in offspring (RR 1.34, 95% CI: 1.18-1.51). The effect was partially mediated by maternal postpartum mental health concerns. The association between maternal refugee background and infant regulatory problems was more pronounced in first-time mothers (RR 1.80, 95% CI: 1.51-2.15). CONCLUSION: The risk of infant regulatory problems was higher in the first-born children of refugee mothers. First-time refugee parents may need tailored support to identify mental health needs and infants with regulatory problems.

Disparities in postpartum depression screening participation between immigrant and Danish-born women.

BACKGROUND: Qualitative studies suggest that immigrant women experience barriers for postpartum depression (PPD) screening. This study examines the prevalence of participation in PPD screening in the universal home-visiting programme in Denmark, in relation to migrant status and its association with acculturation factors, such as length of residence and age at migration. METHODS: The sample consists of 77 694 births from 72 292 mothers (2015-18) that participated in the programme and were registered in the National Child Health Database. Lack of PPD screening using the Edinburgh Postpartum Depression Scale (EPDS) was examined in relation to migrant group and acculturation factors. We used Poisson regression with cluster robust standard errors to estimate crude and adjusted relative risk. RESULTS: In total, 27.8% of Danish-born women and 54.7% of immigrant women lacked screening. Compared with Danish-born women, immigrant women in all groups were more likely to lack PPD screening (aRR ranging from 1.81 to 1.90). Women with low acculturation were more likely to lack screening. Women who migrated as adults [aRR = 1.27 (95% CI 1.16, 1.38)] and women who had resided in Demark for <5 years [aRR = 1.37 (95% CI 1.28, 1.46)] were more likely to lack screening. CONCLUSIONS: Immigrant women in Denmark, particularly recent immigrants, are at increased risk of not being screened for PPD using the EPDS. This can lead to under-recognition of PPD among immigrant women. More work is needed to understand how health visitors recognize the mental health needs of immigrant women who are not screened, and whether this gap results in reduced use of mental health services.