Immigration-related inequalities across the perinatal mental health care pathway among new parents in Sweden: a population-based cohort study.

Abstract

To examine immigration-related inequities across the perinatal mental healthcare pathway, including differences in case detection, treatment uptake and timeliness of care, among first-time parents in Sweden. Population-based cohort study using linked administrative register data. The three largest Swedish regions (Stockholm, Västra Götaland and Skåne) covering approximately 55% of the national population. All first-time parents with a live first birth between 1 January 2008 and 31 December 2018 residing in the study regions (404 043 mothers and 391 068 fathers). Individuals' country of birth (born outside vs inside the Nordic countries). We examine immigration-related inequalities across the perinatal mental healthcare pathway, including case detection (issues recorded a year postpartum, with no diagnoses/treatments in the previous year), treatment uptake (antidepressants and/or psychotherapy) and timeliness of care (weeks from diagnosis to treatment). In the 12 months postpartum, 7.2% of mothers and 4.5% of fathers had common perinatal mental health conditions requiring clinical management. Parents born outside the Nordic countries had substantially lower detection rates: -5.3 percentage points for mothers (95% CI -5.8 to -4.9; 59% below the Nordic-born baseline of 9.0%) and -2.5 percentage points for fathers (95% CI -2.8 to -2.3; 48% below the Nordic-born baseline of 5.2%). Conditional on diagnosis, immigrant mothers and fathers were 12.1 and 7.6 percentage points less likely to receive treatment, respectively. Differences in time from diagnosis to treatment were small. Immigration-related inequalities were observed across multiple stages of the perinatal mental healthcare pathway. As previous evidence suggests similar or higher levels of perinatal mental health problems among immigrant parents, the observed differences are unlikely to reflect lower need for care. Findings instead point to inequalities in access and use of perinatal mental healthcare and highlight the need for more equitable screening, assessment and follow-up.