Direct and indirect determinants of prenatal depression among Arab-Bedouin women in Israel: The role of stressful life events and social support.

OBJECTIVE: Prenatal depression (PND) negatively affects the health and well-being of both mother and child. The aim of this study was to identify the direct and indirect determinants of prenatal depression symptoms (PNDS) among Arab-Bedouin women in southern Israel. DESIGN: Data collection was conducted in two women's health centers from October 2017 to February 2018. SETTING: Participants were recruited during visits to women's health centers in southern Israel. PARTICIPANTS: We recruited 376 Arab-Bedouin women as part of a larger study of perinatal health and well-being. We recruited 376 Arab-Bedouin women as part of a larger study of perinatal health and well-being. All women were 18+ years of age and 26-38 weeks of gestational age. MEASUREMENTS: PNDS were measured by an Arabic version of the Edinburgh Postnatal Depression Scale. We computed path analyses to identify direct and indirect determinants of PND and estimated the contribution of stressful life events and social support. RESULTS: Positive direct associations emerged between stressful life events, history of depression and gestational age, and PNDS; direct inverse associations were found between social support, PND awareness, and education, and PNDS. History of depression was the single strongest direct predictor of PNDS yet when considering combined direct and indirect effects, the contribution of stressful life events is greater. Stressful life events (via history of depression and PND awareness) and education (via PND awareness) had both direct and indirect effects on PNDS. Age of the mother indirectly affects PNDS via education and PND awareness. Polygamy emerged as neither a direct nor indirect predictor of PNDS. CONCLUSIONS: PNDS in the underserved and understudied Bedouin women has serval direct and indirect predictors. Interventions aiming at reducing stress and increasing social support, via PND awareness might be successful in reducing PND and possibly future postpartum depression.

Barriers to postpartum depression treatment among Indigenous Bedouin women in Israel: A focus group study.

Postpartum depression (PPD), a common mental health problem among mothers worldwide, is higher among minority women. However, little is known about barriers faced by minority women when accessing mental health care services (MHCS) for PPD treatment. Drawing on McLeroy et al (Health Education Quartely 15: 351, 1988) ecological model, the current study explores barriers to mental health services among pregnant and postpartum minority Bedouin women in southern Israel. We conducted eight focus groups (FGs) in Arabic with 75 Bedouin women recruited using snowball sampling. Participants completed a socio-demographic questionnaire at each FG. Discussions were recorded and transcribed verbatim. Next, we conducted simultaneous thematic analysis and coded transcripts into conceptual categories based on the ecological model. We found multiple barriers that manifest at different levels (individual, family, organisational, economic, and public policy) and interact to limit Bedouin women's access to PPD treatment. At the individual level, factors included: women's negative attitudes toward PPD, women's societal status, grand multipara, gender, and limited knowledge about PPD; at the family level: low awareness among husbands and other family members regarding PPD symptoms and treatment, and lack of social support; at the organisational level: lack of culturally appropriate (health care services) HCSs, lack of PPD screening, and lack of PPD detection by family physicians; at the community level: economic barriers and poverty, stigmatisation of mental health problems, polygamy, and multiple births; finally, at the public policy level: residence in unrecognised villages lacking basic infrastructure. Our study thus sheds light on multilevel barriers impacting PPD prevention and treatment among Bedouin women. Policies and intervention programmes should seek to remove these barriers and protect Bedouin women and their children from the consequences of PPD.