Facilitators and barriers to accessing mental health care services and social supports among perinatal refugee women: a qualitative systematic review.

The objective of this review was to identify and synthesize qualitative evidence on the lived experiences of facilitators and barriers to accessing mental health care services and social supports among perinatal refugee women. Perinatal refugee women experience multiple intersecting personal, social, and environmental factors that can influence their mental health and emotional well-being. Understanding the facilitators and barriers to accessing mental health care services will provide a clearer understanding of their experiences to inform health care practices, programs, and policies. This review appraised published qualitative research that explored perinatal refugee women's experiences of accessing mental health care services and social supports. Non-English articles and studies that did not explicitly state participants' migration status as refugees were excluded. Searches for published studies located in CINAHL Plus (EBSCOhost), PsycINFO (EBSCOhost), PubMed, and Web of Science Core Collection, which includes the Social Sciences Citation Index, were conducted in May 2022 and updated in June 2024. ProQuest Dissertations and Theses Database was searched for unpublished literature such as theses, dissertations, and publicly available information consisting of peer-reviewed qualitative studies. Sources of evidence published in English between January 2011 and June 2024 were assessed for inclusion. Study selection involved 2 reviewers independently screening titles and abstracts against the eligibility criteria. The reviewers critically appraised the methodological quality and rigor and extracted study findings. Data synthesis involved assigning categories to findings, which were aggregated into synthesized findings and graded using the ConQual approach. Forty-one articles were included in the review yielding 159 findings that were grouped into 6 categories. The categories were aggregated to form 2 synthesized findings: i) Women are impacted by unique and interconnected social determinants of migrant health in accessing mental health services and social supports, and ii) Women experienced characteristics of mental health services as both facilitators and barriers to access. Confidence levels for each synthesized finding were rated as low according to ConQual. Experiences of diverse forms of stigma, as well as literacy, migration status, and racial discrimination, were expressed as significant barriers to accessing mental health services among perinatal refugee women. Additional barriers described by women included not being given opportunities to express their mental and emotional well-being, fear of sociocultural consequences from pursuing mental health services, and fear of deportation. Cultural navigators, faith-based organizations, and neighbors with similar cultural backgrounds were raised as facilitators to linking with social supports and connecting safely with mental health services. Digital tools were also described as improving inequities in access to mental health service information and social supports. Care provision that included guidance on services needed to address trauma and violence experienced during migration journeys were recommended. Further recommendations from this review include culturally and gender-responsive care. Recommendations for practice and policy include adopting cultural navigator services to disrupt stigma, and providing culturally appropriate supports to perinatal refugee women. Low ConQual scores for both systematic findings indicates the need for more rigorous qualitative research within perinatal mental health and forced migration. PROSPERO CRD42021245240.