The prevalence of depression during the perinatal period was examined in ten studies [12, 14–19, 21, 23, 24]. Across these studies, the reported prevalence of perinatal depression among forced migrant women ranged from approximately 17% to over 80%. In all studies that included comparison groups, the prevalence of depression was higher among forced migrant women than among non-migrant women.

Several studies used the Edinburgh Postnatal Depression Scale (EPDS), with a high proportion of participants scoring above the depression cut-off, although the thresholds applied differed across studies. Nakash et al. found that 81.6% of Eritrean asylum seekers in Israel scored above an EPDS cut-off of 13, with a mean score of 14.9 (SD = 5.5) [17]. Ahmed et al. reported that 58% of Syrian refugee women in Canada exceeded an EPDS cut-off of 10, while Mohammad et al. found that 49.6% of Syrian refugee women in Jordan scored above 12 on the EPDS, with a mean score of 12.6 (SD = 3.3) [16]. Differences in EPDS thresholds limited direct comparability across studies but consistently indicated a substantial burden of depression among forced migrant women.

Studies including non-migrant comparison groups similarly demonstrated higher rates of perinatal depression among forced migrant women. Stewart et al. reported postpartum depression in 25.7% of refugees and 31.1% of asylum seekers, compared with 8.1% of Canadian-born women [18]. Blackmore et al. identified current depression in 25% of Afghan refugee women attending an Australian antenatal clinic, based on a validated Dari version of the EPDS with a cut-off score greater than nine [12].

Longitudinal evidence suggested persistence of depression beyond the immediate postpartum period. Dennis et al. reported that elevated EPDS scores were present among refugees and asylum seekers at both 1 and 16 weeks postpartum [23]. They found that the prevalence of EPDS >9 at 1 and 16 weeks postpartum was 26.6% and 18.2% for refugees, and 25.2% and 24.1% for asylum seekers, respectively. In contrast, only 14.8% and 7.4% of Canadian-born women had postpartum depression at 1 and 16 weeks postpartum, respectively. Similarly, the prevalence of EPDS >12 at 1 and 16 weeks postpartum was 10.5% and 11.2% for refugees, and 10.8% and 14.4% for asylum seekers, respectively. Whereas for Canadian-born women, it was 4.8% and 2.9%, respectively [23].

Other measurement instruments yielded similar findings. Using Beck’s Depression Inventory (BDI), Akgor et al. reported that 28% of pregnant refugee adolescents in Turkey scored above the clinical cut-off of 17, compared with 12% of Turkish-born adolescents [19]. Rees et al. found that 32.5% of refugee women met criteria for major depressive disorder using a structured diagnostic interview, compared with 14.5% of Australian-born women [15]. Along the Thai-Myanmar border, Fellmeth et al. reported that 47.3% of refugee women and 38.6% of migrant women met criteria for perinatal depression using the Structured Clinical Interview for the Diagnosis (SCID) [21]. Although Kaufmann et al. reported a comparatively lower prevalence of 17.5% among refugee women in a German reception centre, depression remained more common in this population than in general perinatal populations [14].

The prevalence of anxiety during the perinatal period was examined in three studies [12, 14, 24]. Across these studies, the reported prevalence of anxiety among forced migrant women ranged from 15% to 50%, depending on the measurement tool and cut-off thresholds used.

Two studies assessed anxiety using anxiety subscales of the Edinburgh Postnatal Depression Scale (EPDS), applying different cut-off thresholds. Blackmore et al. reported that 21% of Afghan refugee women exceeded an anxiety subscale threshold of 4 (mean = 5.82, SD = 0.75), whereas Ahmed et al., using a lower threshold of 3 on the same subscale, found that 50% of Syrian refugee women screened positive for anxiety (mean = 3.6, SD = 2.5) [12, 24]. Differences in thresholds likely contributed to variation in reported prevalence across studies.

Kaufmann et al. assessed anxiety using the GAD-7 and reported that 15% of refugee women met the cut-off score of 10 or higher, indicating clinically significant anxiety. Although prevalence estimates varied across studies, all findings indicated elevated levels of anxiety among forced migrant women when compared with reported estimates for general perinatal populations (8.5%–10.5%) [28–30].

Post-traumatic stress disorder during the perinatal period was examined in three studies [13, 14, 24]. Reported prevalence of PTSD among forced migrant women ranged from approximately 6%–36%.

Kaufmann et al. reported the highest prevalence, with 36.1% of refugee women diagnosed with PTSD [14]. Ahmed et al. found that 17% of Syrian refugee women exceeded the relevant cut-off score for PTSD [24]. Blackmore et al. using the Harvard Trauma Questionnaire, reported a lower prevalence of 5.8% among refugee women [13]. However, the study noted a substantial proportion of women experienced subthreshold PTSD symptoms, demonstrating that many women still faced considerable psychological trauma despite not meeting the full diagnostic criteria for PTSD [13].

Social support was consistently identified as a major protective factor for perinatal mental health across quantitative and qualitative studies [15, 16, 18–22]. Lower levels of perceived or actual support were associated with higher risks of depression and anxiety among forced migrant women. Some works [21, 22] highlighted that perceived support was a stronger predictor of mental health outcomes than actual amount of support received.

Quantitative findings showed that insufficient perceived social support was consistently associated with poorer perinatal mental health outcomes among forced migrant women. In studies conducted along the Thai-Myanmar border, Fellmeth et al. reported that women with low perceived social support had statistically significantly higher odds of perinatal depression (OR = 1.89, 95% CI 1.10–3.24) [21]. Similar findings were reported in an earlier study by Fellmeth et al. where insufficient perceived social support more than doubled the odds of perinatal depression (OR = 2.10, 95% CI = 1.10–3.70) [22]. Mohammad et al. also demonstrated a statistically significant association between low levels of social support and depression among Syrian refugee women in Jordan, reporting a moderate positive correlation between lower social support scores and higher EPDS scores (r = 0.44, p-value <0.01) [16].

Comparative studies further indicated that forced migrant women experienced lower levels of social support than non-migrant women, alongside higher rates of perinatal depression. Stewart et al. reported markedly lower social support scores among refugees and asylum seekers compared with Canadian-born women [18], while Rees et al. observed that women who had fewer than two confidants were more susceptible to major depressive disorder (aOR = 1.62, 95% CI 1.18, 2.23) [15]. Partner support emerged as a particularly important aspect of social support [19, 20]. Castaner et al. found that refugee women living without a partner were 1.5 times more likely to experience a perinatal psychiatric episode (PPE) compared with those living with a partner (95% CI 1.36–1.65). Similarly, Akgor et al. reported that living without a partner was a statistically significant predictor of higher depression scores among both refugee women (p = 0.023) and Turkish-born women (p = 0.001) during the perinatal period [19].

Qualitative evidence [24, 27] supported the quantitative findings by describing how separation from family and limited social networks contributed to emotional distress during pregnancy and postpartum. Participants linked depressive symptoms to “being away from her family, alienation” [24] and emphasised the importance of close female relatives as a source of reassurance and practical support around childbirth: “when you are going to give birth, you really need your mother, your aunt or somebody” [24]. Reuniting with family members was described as a key way to reduce distress and restore a sense of support; one woman explained that being able to visit relatives, or for relatives to visit them, would prevent feeling “like a bird in a cage or imprisoned” [24]. Similarly, Nithianandan et al. reported that community representatives emphasised family support as a protective factor and identified lack of social support as a major risk factor for mental health deterioration among refugee women [27].

Four quantitative studies [13, 15, 21, 22] reported that exposure to traumatic events (TEs), including violence and abuse was associated with poorer perinatal mental health outcomes among forced migrant women. Across these studies, cumulative trauma exposure was linked to higher odds of perinatal depression and PTSD. For example, Blackmore et al. reported that women with PTSD had higher trauma scores than women without PTSD [13], indicating a relationship between trauma burden and PTSD symptoms during the perinatal period.

Along the Thai-Myanmar border, Fellmeth et al. found that women who reported traumatic events had increased odds of perinatal depression; among refugees, the adjusted odds of perinatal depression were 1.63 times higher compared with those who did not report traumatic events (aOR = 1.63, 95% CI 1.23–2.17) [21]. Similar findings were reported in an earlier study by Fellmeth et al. where women with a history of trauma had increased odds of perinatal depression (OR = 2.17, 95% CI 1.38–3.41) [22].

Rees et al. reported higher exposure to TEs and interpersonal violence (IPV) among refugee women compared with Australian-born women. In this study, 29.8% of refugee women reported two or more traumatic events compared with 19.0% of Australian-born women (p < 0.001), and 42.9% of refugee women reported IPV compared with 20.5% of Australian-born women (p < 0.001) [15]. Furthermore, trauma and violence exposure were associated with increased likelihood of major depressive disorder (MDD), including among women reporting two or more TEs (aOR = 2.13, 95% CI 1.47–3.08), severe psychological IPV (aOR = 1.62, 95% CI 1.18–2.23), and physical IPV (aOR = 4.64, 95% CI 2.78–7.74) [15].

Qualitative findings further described the persistence of interpersonal violence and abuse within intimate relationships during pregnancy and postpartum, ranging from emotional abuse to physical violence and sexual coercion [26]. Participants described experiences of criticism and intimidation, for example: “[My husband] says that I am not a good mother… it hurts me so much that I would cry” [26], as well as severe physical violence: “He beat me up and squeezed my neck…” [26]. Accounts also included sexual coercion within relationships: “I was 18 or 19 years old, He was kissing and hugging me in front of people… so I had to marry him” [26].

Three qualitative studies reported that stigma and fear of judgment acted as major barriers to help-seeking for mental health concerns among forced migrant women during the perinatal period [24, 25, 27]. Across these studies, women expressed concerns about being labelled as “crazy,” experiencing shame, or being perceived negatively by family members and the wider community if they disclosed mental health difficulties or sought professional support.

In Ahmed et al. stigma was one of the most frequently cited barriers to accessing mental health services. One participant explained, “I might have depression… If I went to a psychiatrist, they would say that she went crazy” [24]. Although some women indicated a willingness to seek care despite anticipated stigma: “I’m sure that they will speak about me and say that I’m crazy but this doesn’t matter to me” [24], these accounts highlighted the emotional and social costs associated with disclosure.

Similarly, Willey et al. found that stigma could prevent follow-up even when women initially agreed to a mental health referral. As one participant described, “Most of them feel embarrassed… They avoid going because they think it affects their dignity” [25]. In addition to community-level stigma, concerns about confidentiality emerged as a barrier in relation to the use of interpreters. Nithianandan et al. reported that some women felt uncomfortable discussing mental health concerns in the presence of interpreters, although female interpreters and healthcare professionals were often perceived as more trustworthy: “With a female interpreter, we feel safe and we feel comfortable so everything that we wanted to express…we can say it easily” [27]. In contrast, participants in Ahmed et al (2017) described interpreter involvement as unacceptable due to fears of breaches of confidentiality: “If you speak with a psychiatrist… but if there is an interpreter … this person might speak about what you said….” [24].

Overall, these qualitative findings indicated that stigma surrounding mental health, combined with concerns about confidentiality and dignity, substantially limited forced migrant women’s engagement with perinatal mental health services.