Depression, anxiety, and post-traumatic stress disorder in pregnancies among Métis people in Alberta: a...

Despite high stress from historical trauma, systemic discrimination, and limited access to culturally-safe healthcare, the perinatal mental health of the Métis, Canada's second-largest Indigenous group, remains poorly understood. We evaluated the prevalence and sociodemographic and clinical factors associated with depression, anxiety, and post-traumatic stress disorder (PTSD) in Métis pregnancies.

This cross-sectional study used population-based retrospective cohort data of all pregnancies resulting in live births (≥ 22 weeks' gestation) in Alberta, Canada, from 2006 to 2016. The Métis cohort was identified through linkage between the Identification Registry of the Otipemisiwak Métis Government of the Métis Nation within Alberta and administrative health databases. Diagnoses of depression, anxiety, and PTSD were identified in administrative health databases using validated case-finding algorithms. Age-standardized prevalence of depression, anxiety, and PTSD were compared between Métis and non-Métis pregnancies. Multilevel, multivariable Poisson regression models examined sociodemographic and clinical factors associated with these conditions in Métis pregnancies. Adjusted prevalence ratios (aPR) with 95% confidence intervals (CI) were reported, adjusting for relevant sociodemographic and clinical characteristics.

The study analyzed 8,163 Métis and 487,294 non-Métis pregnancies. The age-adjusted prevalence of depression in Métis pregnancies was 3.3% (95% CI 2.7, 3.9), while the prevalence of anxiety was 3.5% (95% CI 2.9, 4.2). Depression was 1.44 times (95% CI 1.25, 1.64) and anxiety 1.31 times (95%CI 1.15, 1.49) more prevalent in Métis than non-Métis pregnancies. PTSD prevalence was low in both groups. Among Métis pregnancies, urban residence, pre-existing medical conditions, and smoke or substance use in pregnancy were associated with higher depression and anxiety prevalence.

Depression and anxiety during pregnancy were more common in Métis than non-Métis pregnancies. Collaboration with Métis organizations is critical to developing culturally-relevant detection and treatment for mental health challenges.