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Cited by 48Maternal Mental Health During Pregnancy and PostpartumMigration, Health and TraumaMental Health Treatment and Access

Pregnant migrant and refugee women’s perceptions of mental illness on the Thai-Myanmar border: a qualitative study

Open access
Fellmeth, Gracia, Plugge, Emma, Paw, Moo Kho, Charunwatthana, Prakaykaew, Nosten, François, McGready, Rose·2015·BMC Pregnancy and Childbirth
DOI 10.1186/s12884-015-0517-0PMC PMC4464696
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Abstract

BACKGROUND: Mental illness is a significant contributor to the global burden of disease, with prevalence highest in low- and middle-income countries. Rates are high in women of childbearing age, especially during pregnancy and the first year post-partum. Migrant and refugee populations are at risk of developing mental illness due to the multiple stressors associated with migration. The Thai-Myanmar border area is home to large populations of migrants and refugees as a result of long-standing conflict, poverty and unemployment in Myanmar. This study aims to explore perceptions of mental illness among pregnant migrants and refugees and antenatal clinic staff living and working along the Thai-Myanmar border. METHODS: Thirteen focus group discussions were conducted with pregnant migrants, pregnant refugees and antenatal clinic staff. Focus groups were held in one large refugee camp and two migrant health clinics along the Thai-Myanmar border. Thematic analysis was used to identify and code themes emerging from the data. RESULTS: A total of 92 pregnant women and 24 antenatal clinic staff participated. Discussions centered around five main themes: symptoms of mental illness; causes of mental illness; suicide; mental illness during pregnancy and the post-partum period; and managing mental illness. Symptoms of mental illness included emotional disturbances, somatic symptoms and socially inappropriate behavior. The main causes were described as current economic and family-related difficulties. Suicide was frequently attributed to shame. Mental illness was thought to be more common during and following pregnancy due to a lack of family support and worries about the future. Talking to family and friends, medication and hospitalization were suggested as means of helping those suffering from mental illness. CONCLUSIONS: Mental illness was recognized as a concept by the majority of participants and there was a general willingness to discuss various aspects of it. More formal and systematic training including the development of assessment tools in the local languages would enable better ascertainment and treatment of mental illness in this population.

AI snapshot

Written from the paper’s full text.

TL;DR

This qualitative study explored how pregnant migrant and refugee women and antenatal clinic staff on the Thai-Myanmar border perceive mental illness. Participants generally recognized mental illness, linked it mainly to current economic and family difficulties, and were willing to discuss it, supporting the feasibility of future mental health assessment in this population.

Key findings

  • A total of 92 pregnant women (29 refugees and 63 migrants) and 24 antenatal clinic staff participated in 13 focus group discussions; five main themes emerged: symptoms, causes, suicide, mental illness during pregnancy/post-partum, and management.
  • Symptoms included emotional disturbances, somatic symptoms, and socially inappropriate behavior; causes were mainly current economic and family-related difficulties; suicide was frequently attributed to shame; mental illness was thought more common during and after pregnancy due to lack of family support and worries about the future.
  • Approximately two-thirds of pregnant women had heard of “illnesses of the mind,” compared with all ANC staff; overall themes did not differ between refugee and migrant women or between Karen- and Burmese-language groups.
  • Suggested management included talking to family and friends, medication, and hospitalization; only ANC staff mentioned talking to healthcare workers or counseling.

Methods

  • Qualitative study using 13 focus group discussions: 10 with pregnant women and 3 with ANC staff, held in January 2014 at one refugee camp (Maela) and two migrant clinics (Mawker Tai and Wang Pha) on the Thai-Myanmar border.
  • Convenience samples of pregnant women attending ANC and rostered ANC staff; discussions lasted 20–40 minutes, were conducted in Karen or Burmese with translation into English, and used open-ended questions about perceptions of mental illness, sadness, suicide, causes, and perinatal occurrence.
  • Thematic analysis was conducted in NVivo 9, with two authors independently coding and comparing themes.

Limitations

  • The paper states that the foreign English-speaking researcher may have influenced responses, interpreter use risked misrepresentation or bias, discussions were not audio-recorded or transcribed, groups were not stratified by age, gravidity, ethnicity, or religion, and no demographic information was collected.
  • The paper also states that the number of focus groups was determined by pragmatic considerations rather than data saturation, and that ANC attenders may have greater health literacy than non-attenders, limiting generalizability.
  • Evident from the text: because participants were recruited only from ANC settings and staff, and because questions avoided direct personal disclosure, the findings may not capture the views or experiences of migrant women who do not access antenatal care or who would speak more freely in individual interviews.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s12884-015-0517-0

Cites

40 of 40 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 27 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Suicide was not seen so much as an endpoint or extreme manifestation of mental illness but more as a separate condition.

    “Interestingly, suicide was not seen so much as an endpoint or extreme manifestation of mental illness but more as a separate condition.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Many women described partners' lack of involvement in childcare meaning that the new mother was often left feeling alone and overwhelmed.

    “Many women described partners’ lack of involvement in childcare meaning that the new mother was often left feeling alone and overwhelmed.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Individuals with mental illness were described as wanting to spend time alone and without talking to other people.

    “For example, individuals with mental illness were described as wanting to spend time alone and without talking to other people”
    Quote in the paperNot a substantial claim
  • Findingown data

    The most commonly described symptoms associated with mental illness were emotional and mood disturbances including feelings of intense sadness, anger and fear.

    “The most commonly described symptoms associated with mental illness were emotional and mood disturbances including feelings of intense sadness, anger and fear.”
    Quote in the paperNot a substantial claim
  • Findingnone given

    Mental illness was recognized as a concept by the majority of participants.

    “Mental illness was recognized as a concept by the majority of participants”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 33
  • May combine two claims. 31

  • Classified as probably not a substantial claim.

    Findingown data

    Themes emerging from the focus group discussions fell into five key areas: symptoms and behaviours related to mental illness; causes of mental illness; explanations and reasons for suicide; mental illness during pregnancy and the post-partum period; and managing mental illness.

    “Themes emerging from the FGDs fell into five key areas: symptoms and behaviours related to mental illness; causes of mental illness; explanations and reasons for suicide; mental illness during pregnancy and the post-partum period; and managing mental illness.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Other common elements in discussions around suicide were economic hardships, domestic and family issues.

    “Other common elements were economic hardships, domestic and family issues.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Economic hardships, domestic and family issues were often described as factors which brought shame upon an individual and led to suicide.

    “These were often described as factors which brought shame upon an individual and led to suicide.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Unsupportive partners, parents and other family members were regarded as causing strained relationships which were exacerbated by low household incomes.

    “Unsupportive partners, parents and other family members were regarded as causing strained relationships which were exacerbated by low household incomes.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    A total of 92 pregnant women (29 refugees and 63 migrants) participated in ten focus groups, of which four were conducted in Karen and six in Burmese.

    “A total of 92 pregnant women (29 refugees and 63 migrants) participated in ten focus groups, of which four were conducted in Karen and six in Burmese.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Twenty-four ANC staff participated in three focus groups, all of which were conducted in Karen.

    “Twenty-four ANC staff participated in three focus groups, all of which were conducted in Karen.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Participants suggested practical support such as helping affected individuals re-engage in social life and find employment.

    “A number of participants also discussed the value of providing practical support such as helping affected individuals to re-engage in social life and find employment”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    One single participant raised the idea that a specific event or trauma could lead to mental illness.

    “One single participant raised the idea that a specific event or trauma could lead to mental illness”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Approximately two-thirds of participating pregnant women had heard of 'illnesses of the mind', compared with all of the ANC staff.

    “approximately two-thirds of participating pregnant women had heard of ‘illnesses of the mind’ compared with all of the ANC staff”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Participants described new mothers not knowing how to take care of the children, especially given the lack of support from family, but also worrying about the longer-term future and opportunities for their children.

    “Participants described new mothers not knowing how to take care of the children, especially given the lack of support from family, but also worrying about the longer-term future and opportunities for their children.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The overall themes that arose were common across all focus groups, and there were very few differences between pregnant women and ANC staff in terms of discussion content.

    “However, the overall themes that arose were common across all focus groups and there were very few differences between pregnant women and ANC staff in terms of discussion content.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Pregnant women and ANC staff were equally likely to suggest talking informally to friends and family, but only ANC staff mentioned talking to healthcare workers and counseling as means of helping those with mental illness.

    “While pregnant women and ANC staff were equally likely to suggest talking informally to friends and family, only ANC staff mentioned talking to healthcare workers and, more specifically, counseling (including referral to an existing counseling service) as a means of helping those with mental illness.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Only one mention of prayer and no mention of animistic mechanisms of healing were made.

    “The fact that only one mention of prayer and no mention of animistic mechanisms of healing were made is also interesting.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Participants identified emotional, behavioural and physical manifestations of mental illness and agreed that economic, family and domestic issues often contributed to these illnesses.

    “Participants identified a number of emotional, behavioural and physical manifestations of mental illness, and agreed that economic, family and domestic issues often contributed to these illnesses.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Prayer to help alleviate mental illness of others was mentioned only once by one ANC staff member.

    “The use of prayer to help alleviate the mental illness of others was mentioned only once by one ANC staff member.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    ANC staff had more in-depth awareness and experiences of dealing with mental illness than patients, but discussions of both revealed similar content and themes.

    “Although ANC staff had more in-depth awareness and experiences of dealing with mental illness, discussions of both ANC staff and patients revealed similar content and themes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Many participants believed that mental illness is best managed by emotional and social support from friends and family, although some identified input from health care staff and medication as helpful.

    “Many participants believed that mental illness is best managed by emotional and social support from friends and family although some identified input from health care staff and medication as helpful.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Participants were willing to talk about mental illness and generally engaged positively in discussion.

    “Participants were willing to talk about mental illness and generally engaged positively in discussion.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Social support from friends and family was commonly cited as management, as were more formal means such as medication and hospitalisation.

    “With regards to the management of mental illness, social support from friends and family was commonly cited as were more formal means such as medication and hospitalisation.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Participants believed that mental illness occurred more commonly during pregnancy and the post-partum period, attributing this to lack of emotional, practical and financial support from family and partners.

    “They believed that mental illness occurred more commonly during pregnancy and the post-partum period, attributing this to the lack of emotional, practical and financial support offered by family and partners.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    No differences were elicited between refugee and migrant women, nor between groups conducted in Karen or Burmese.

    “There were also no differences elicited between refugee and migrant women, nor between groups conducted in Karen or Burmese.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Participants regarded social isolation and wanting to be alone as important sequelae of abnormal emotional states, as was social disinhibition in the form of going out late at night and without reason.

    “Social isolation and wanting to be alone were regarded as important sequelae of these abnormal emotional states, as was social disinhibition in the form of going out late at night and without reason.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Another author (GF), who was not known to participants and not involved in their clinical care, was also present during the FGDs.

    “Another author (GF), who was not known to participants and not involved in their clinical care, was also present.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Discussions were led by one author (MKP) who has lived in a refugee camp for more than 25 years, completed her training in the camp and worked with pregnant women from the local population but was not personally known to the FGD participants.

    “Discussions were led by one author (MKP) who has lived in a refugee camp for more than 25 years, completed her training in the camp [35] and worked with pregnant women from the local population but was not personally known to the FGD participants.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Two authors (GF and EP) independently analysed and coded data before comparing and discussing themes identified.

    “Two authors (GF and EP) independently analysed and coded data before comparing and discussing themes identified.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Data saturation was not formally assessed during the data collection period.

    “Data saturation was not formally assessed during the data collection period.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Evidence suggests that migrants and refugees experience higher rates of mental illness than host populations.

    “Evidence suggests that migrants and refugees experience higher rates of mental illness than host populations [14,16,17].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [14] Zimmerman C, Kiss L, Hossain M. Migration and health: a framework for 21st century policy-making. PLoS Medicine. 2011;8(5):e1001034. doi:10.1371/journal.pmed.1001034. Epub 2011 May 24. source

      Not checked in the free run.

    • cites [16] Collins C, Zimmerman C, Howard LM. Refugee, asylum seeker, immigrant women and postnatal depression: rates and risk factors. Archives of Women’s Mental Health. 2011;14:3–11. source

      Not checked in the free run.

    • cites [17] Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet. 2005;365:1309–14. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Translated versions of the questions were back-translated by another staff member at SMRU to ensure that the meanings of individual questions had been maintained.

    “Translated versions were back-translated by another staff member at SMRU to ensure that the meanings of individual questions had been maintained.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The midwife leading the FGDs is fluent in Karen, Burmese and English and has extensive experience in conducting FGDs.

    “This midwife is fluent in Karen, Burmese and English and has extensive experience in conducting FGDs.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    In order to maintain confidentiality, no names were recorded on paper.

    “In order to maintain confidentiality, no names were recorded on paper.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Discussions were conducted in Karen in order to ensure all could understand and participate in discussions equally well.

    “Although some staff spoke English, discussions were conducted in Karen in order to ensure all could understand and participate in discussions equally well.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    No participants left during any of the focus group discussions.

    “No participants left during any of the FGDs.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Ethical approval for the study was obtained from the University of Oxford's Tropical Research Ethics Committee (OXTREC 1056-13) in December 2013 and from the Tak Border Community Advisory Board (T-CAB) in January 2014.

    “Ethical approval for the study was obtained from the University of Oxford’s Tropical Research Ethics Committee (OXTREC 1056-13) in December 2013 and from the Tak Border Community Advisory Board (T-CAB) in January 2014.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    It is possible that differences were not elicited due to indirect phrasing of questions.

    “It is possible that differences were not elicited due to the indirect phrasing of questions (“have you heard of…”).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    No demographic information on participants was collected, so we cannot say how representative our sample was in terms of age, parity, educational level and migration history.

    “Third, no demographic information on participants was collected and therefore we cannot say how representative our sample was in terms of age, parity, educational level and migration history, all of which may impact perceptions of mental illness.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In Power's study of Burmese refugees in the USA, depression was attributed to the lingering impact of having lived in refugee camps, past traumas and physical and psychological hardships endured, as well as ongoing social and cultural isolation following resettlement.

    “In Power’s study of Burmese refugees in the USA, for example, depression was attributed to the lingering impact of having lived in refugee camps, past traumas and physical and psychological hardships endured, as well as ongoing social and cultural isolation following resettlement [38].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] Power DV, Pratt RJ. Karen refugees from Burma: focus group analysis. International Journal of Migration, Health and Social Care. 2012;82(4):156–66. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A study of general health of Karen refugees resettled in the USA found that contrary to expectations, the topic of mental illness generated more discussion than any other aspect of health.

    “A similar observation was made in a study of the general health of Karen refugees resettled in the USA, which found that contrary to expectations, the topic of mental illness generated more discussion than any other aspect of health [38].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] Power DV, Pratt RJ. Karen refugees from Burma: focus group analysis. International Journal of Migration, Health and Social Care. 2012;82(4):156–66. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    A perception amongst participants that researchers might be dismissive of local spiritual beliefs may have negatively influenced their willingness to discuss this as an explanatory mechanism for mental illness.

    “For example, a perception amongst participants that researchers might be dismissive of local spiritual beliefs may have negatively influenced their willingness to discuss this as an explanatory mechanism for mental illness.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    FGDs provide effective means of eliciting and sharing information especially on sensitive topics, and evidence suggests they work particularly well with women.

    “They provide effective means of eliciting and sharing information especially on sensitive topics, and evidence suggests they work particularly well with women [42].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [42] Kitzinger J. The methodology of focus groups: the importance of interaction between research participants. Sociology of Health and Illness. 1994;16:103–21.6. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The presence of a foreign and English-speaking researcher may have influenced participants' responses.

    “First, the presence of a foreign and English-speaking researcher may have influenced participants’ responses [36,38].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [36] Fitzpatrick R, Boulton M. Qualitative methods for assessing health care. Quality in Health Care. 1994;3:107–13. source

      Not checked in the free run.

    • cites [38] Power DV, Pratt RJ. Karen refugees from Burma: focus group analysis. International Journal of Migration, Health and Social Care. 2012;82(4):156–66. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    Women attending ANC may have greater health literacy than women who do not access antenatal services, so findings may not be generalizable to all migrant women in this area.

    “Women attending ANC and therefore able to participate in our discussions may also have greater levels of health literacy than women who do not access antenatal services, and therefore findings may not be generalizable to all migrant women in this area.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    The running of these FGDs will have created a certain level of awareness amongst participants and others of mental illness in the population.

    “The running of these FGDs in themselves will have created a certain level of awareness amongst participants and others of mental illness in the population.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Cultural factors related to data collection may have influenced results.

    “Finally, cultural factors related to the data collection may have influenced results.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Culturally-bound interpretations or manifestations of mental illness may have been missed if we did not use the right language or terminology.

    “For instance, culturally-bound interpretations or manifestations of mental illness may have been missed if we did not use the right language or terminology to describe conditions we wanted to discuss [40].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40] Lim AG, Stock L, Oo EKS, Jutte DP. Trauma and mental health of medics in eastern Myanmar’s conflict zones: a cross-sectional and mixed methods investigation. Confl Heal. 2013;7:15. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    Health literacy in women attending is generally low at around 50%, so we suspect the results to remain robust.

    “However, given that health literacy in women attending is generally low at around 50% [29], we suspect the results to remain robust.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Carrara VI, Hogan C, De Pree C, Nosten F, McGready R. Improved pregnancy outcome in refugees and migrants despite low literacy on the Thai-Burmese border: results of three cross-sectional surveys. BMC Pregnancy Childbirth. 2011;11:45. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The presence of a non-local researcher may have affected discussions.

    “Furthermore, the presence of a non-local researcher (GF) may have affected discussions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The number of FGDs and participants was determined by pragmatic considerations rather than achieving data saturation.

    “Fourth, the number of FGDs conducted and the number of participants was determined by pragmatic considerations (including the amount of staff time available in a busy clinic setting and the number of pregnant women attending ANC on the dates of data collection) rather than achieving data saturation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    Discussions ideally should have been audio-recorded and transcribed, but due to limited resources and time constraints results were recorded in note form only.

    “Ideally discussions should have been audio-recorded and transcribed [36] but due to limited resources and time constraints results were recorded in note form only.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] Fitzpatrick R, Boulton M. Qualitative methods for assessing health care. Quality in Health Care. 1994;3:107–13. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    More formal and systematic training including development of diagnostic tools in Karen and Burmese would enable more cases of mental illness to be picked up and treated earlier.

    “more formal and systematic training including the development of diagnostic tools in Karen and Burmese language, would enable more cases of mental illness to be picked up and treated earlier.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Premisecitation

    Mental illness poses an important challenge for health systems globally, and improvement in population health is only possible if prevention and treatment of mental illness is included as priority public health issue.

    “Mental illness poses an important challenge for health systems globally, and an improvement in population health is only possible if prevention and treatment of mental illness is included as a priority public health issue [1].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, et al. Global burden of disease attributable to mental and substance use disorders: findings from the global burden of disease study 2010. Lancet. 2013;382:1575–86. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Malaria was solely responsible for a maternal mortality of 1,000 per 100,000 in 1986.

    “malaria was solely responsible for a maternal mortality of 1,000 per 100,000 in 1986 [28]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] McGready R, Boel M, Rijken MJ, Ashley EA, Cho T, et al. Effect of early detection and treatment on malaria related maternal mortality on the north-western border of Thailand 1986–2010. PLoS One. 2012;7(7), e40244. 10.1371/journal.pone.0040244 . source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    FGDs have been used in the Thai-Myanmar border population for many years and are a culturally-accepted method particularly suited to low-literacy populations.

    “FGDs have been used in the Thai-Myanmar border population for many years [44] and are a culturally-accepted method particularly suited to low-literacy populations [31,32].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [44] Lindsay SW, Ewald JA, Samung Y, Apiwathnasorn C, Nosten F. Thanaka (limonia acidissima) and deet (di-methyl benzamid) mixture as a mosquito repellent for use by Karen women. Med Vet Entomol. 1998;12:295–301. source

      Not checked in the free run.

    • cites [31] White AL, Carrara VI, Paw MK, Malika H, Dahbu C, Gross MM, et al. High initiation and long duration of breastfeeding despite absence of early skin-to-skin contact in Karen refugees on the Thai-Myanmar border: a mixed methods study. Int Breastfeed J. 2012;7(1):19. source

      Not checked in the free run.

    • cites [32] Rijken MJ GME, Thwin MM, Kajeechewa HML, Wiladpahingern J, Lwin KM, Jones C, et al. Refugee and migrant women’s views of antenatal ultrasound on the Thai Burmese border: a mixed methods study. PLoS One. 2012;7:4–e34018.

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Qualitative methods including FGDs are especially useful in the exploration of new and relatively under-researched fields of study.

    “Qualitative methods including FGDs are especially useful in the exploration of new and relatively under-researched fields of study [36].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [36] Fitzpatrick R, Boulton M. Qualitative methods for assessing health care. Quality in Health Care. 1994;3:107–13. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    The interpreter in this study was a midwife with extensive clinical and research experience who was also involved in the development of the guiding questions, minimizing potential negative effects.

    “However, given that the interpreter in this study was a midwife with extensive clinical and research experience who was also involved in the development of the guiding questions, potential negative effects were minimized.”
    Quote in the paperNot a substantial claim
54 of 54

  • The paper relies on this without support.

    ANC staff familiarity with the concept of mental illness and comfort discussing it are important for staff who would potentially administer questionnaires in a prevalence study.

    “We also included antenatal clinic (ANC) staff as we felt it was important to ascertain whether staff who would potentially be involved in administering questionnaires as part of a prevalence study were familiar with the concept of mental illness and felt comfortable discussing it.”

  • The paper relies on this without support.

    Pregnant migrant and refugee women's perceptions and understanding of mental illness are relevant to the design and methods of a planned prevalence study.

    “Results will be used to inform the design and methods of the planned prevalence study.”

  • The paper relies on this without support.

    Mental illness remains ‘taboo’ in this society.

    “This in itself is an important observation in a society where mental illness remains ‘taboo’.”

  • The paper relies on this without support.

    Rates of mental illness are at their highest among pregnant and post-partum women.

    “As rates of mental illness are at their highest among pregnant and post-partum women, the views of this group are particularly important.”

  • The paper relies on this without support.

    This is the first investigation of the perceptions of mental illness from the perspective of pregnant and refugee migrant women in the local area.

    “First, to our knowledge it is the first investigation of the perceptions of mental illness from the perspective of pregnant and refugee migrant women in the local area.”

  • The paper relies on this without support.

    This is one of the few mental health studies conducted in Myanmar refugees and migrants living in Thailand and the first to focus on pregnant and post-partum women.

    “This is one of the few mental health studies conducted in Myanmar refugees and migrants living in Thailand and, to our knowledge, the first to focus on pregnant and post-partum women.”

  • The paper relies on this without support.

    Mental health services on the Thai-Myanmar border are lacking.

    “Mental health services on the Thai-Myanmar border are lacking, due in part to the health agenda being dominated by what are considered more acute or ‘urgent’ conditions including infectious diseases such as malaria and HIV.”

  • The paper relies on this without support.

    As these diseases have been brought under control, non-infectious chronic conditions such as cancer, cardiovascular disease and diabetes have moved higher up the agenda.

    “As these diseases have been brought under control, non-infectious chronic conditions such as cancer, cardiovascular disease and diabetes have moved higher up the agenda.”

  • The paper relies on this without support.

    Trained counselling staff are in extreme shortage.

    “though such trained counselling staff are in extreme shortage.”

  • The paper relies on this without support.

    The local population has experienced a high level of risk factors.

    “given the epidemiological shift and the high level of risk factors the local population has experienced”
10 of 10

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Dunlop N. Invisible people: stories of migrant labourers in Thailand. Bangkok: Raks Thai Foundation; 2011.
  2. Der Wang, P. Southeast Asian mental health from the perspective of the bicultural provider (PhD thesis). University of Minnesota, 2007. UMI 3292991.

Cited by

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Related

Authors
Fellmeth, G., Plugge, E., Paw, M. K., Charunwatthana, P., Nosten, F., & McGready, R.
Affiliations
  • University of Oxford (GB)
  • Mahidol University (TH)
Corresponding author
Fellmeth, Gracia
ORCID
Venue
BMC Pregnancy and Childbirth
Publisher
Springer Science and Business Media LLC
Published
2015-04-15
Volume
15
Issue
1
Pages
93-93
ISSN
1471-2393 (ISSN-L)
DOI
10.1186/s12884-015-0517-0
PMC
PMC4464696
OpenAlex
W2031447826
Cited by
48
References
40
Citations by year
2026: 4 · 2025: 7 · 2024: 6 · 2023: 6 · 2022: 4 · 2021: 7 · 2020: 2 · 2019: 5 · 2018: 3 · 2017: 2 · 2016: 2
FWCI
2.50
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Pregnancy and Childbirth (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • ePrints Soton (University of Southampton) (acceptedVersion)
Funders
University of Oxford
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
mental illness, pregnant women, refugees, migrants, Thai-Myanmar border, prenatal care, postpartum mental health, suicide, stigma, family support, access to mental health care, refugee camps, Myanmar
MeSH terms
Adult, Mental Disorders, Myanmar, Family Relations, Female, Health Personnel, Humans, Maternal Health Services, Pregnancy, Pregnancy Complications, Refugees, Shame, Social Support, Socioeconomic Factors, Thailand, Transients and Migrants, Prevalence, Focus Groups, Qualitative Research, Pregnant People, Postpartum Period, Young Adult

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

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