Improving health outcomes for refugee women

Date: 09/10/2018


Cabrini is supporting PhD scholar Sue Willey to evaluate the implementation of a perinatal mental health screening program to improve health outcomes for refugee women and their families.

When she saw the Cabrini advertisement for a PhD scholarship in refugee perinatal mental health, it was like a dream come true. Ms Willey has a strong career in nursing and midwifery, with substantial experience in maternal and child health and refugee health nursing and teaching. The PhD scholarship was an opportunity to undertake research fulltime in the areas she was most passionate about: refugee health, mental health, primary healthcare, health promotion and maternity care. She is guided in her studies by her three supervisors, Associate Professor Jacqueline Boyle and Dr Melanie Gibson-Helm at Monash University, and Professor Lee Boyd at Cabrini. Now in her third year of her PhD, Ms Willey is excited about how her work can improve care provided to women and clinical practice:


I really love how it can improve care provided to the women and clinical practice. The midwives are valuing the program and it allows them to provide more holistic care for the women visiting the clinic. The program has also been well embraced by the other health professionals involved. I’m excited knowing my research will contribute to an improvement in healthcare.


The perinatal mental health national guidelines recommend women are screened for mental health in pregnancy, at the beginning, during and postnatally. While postnatal depression is commonly screened, it is less well appreciated that depression and anxiety can develop in earlier stages of pregnancy. By picking up the signs early, it is hoped women can be referred to services and get the support they need.

Ms Willey’s research is based at a dedicated refugee health antenatal clinic at Dandenong Hospital. While most who attend the clinic are women from a refugee background, she has also been working with a group of non-refugee migrant women who have culturally and linguistically diverse backgrounds. Early screening in women of refugee or migrant backgrounds is particularly important because previous research has shown less than five per cent of refugee women in the Monash Health database were being identified as having a mental health condition in pregnancy.

This is low given that in the general refugee population, 31 per cent experience mental health issues. Following the implementation of the perinatal mental health screening program at the antenatal clinic at Dandenong Hospital, 36 per cent of refugee women are self-reporting mental health issues during pregnancy, including depression and anxiety symptoms.

The screening program utilises the digital platform ICOPE, which has been developed by the Centre of Perinatal Excellence. All women attending their first antenatal appointment with a midwife are given an iPad on arrival and asked to complete the self-report questionnaires: the Edinburgh Postnatal Depression Scale (which includes a sub-anxiety assessment and self-harm question) and the Monash Health psychosocial assessment.

Midwives are able to access an online clinical report and make an assessment from the score as to whether further clinical discussion and referral is required to assist a woman. The assessments have been translated into a number of common refugee and migrant languages including Arabic, Dari, Farsi, Pashto, Tamil and Vietnamese. The program also frequently uses interpreters because a lot of women attending the clinic have limited education and cannot read. The research team is in the process of developing the iPad assessments to be delivered in an audio format so women can listen to it and respond accordingly.

Ms Willey’s PhD project forms part of a large-scale program. Her aims are to evaluate the effectiveness of the program, including whether:

  • the women are being supported effectively
  • the program is effective in identifying mental health concerns
  • women are being referred for help

Her studies will investigate what still needs improvement and what would be required to scale up the program across all maternity services. Ms Willey has completed interviews and focus groups with health professionals and is in the process of completing interviews with refugee and non-refugee migrant women.

Read more about research at Cabrini in our Cabrini Institute Annual Report 2017-18