Research projects

Pilot study on postnatal depression in refugee communities

Principal researchers

Associate Professor Renata Kokanovic1
Dr Sara Niner1
Ms Violet Cho1, 2
Professor Denise Cuthbert3


1 Monash University
3 RMIT University



Award type

Beyond Blue grant

Project completion year


Project brief

It is widely acknowledged that people from refugee backgrounds experience significant distress related to pre-migration life events and experiences of resettlement. Depression and anxiety are often cited as being experienced in higher rates by these people compared with the majority population (DHS, 2008).

Aims and objectives

The aim of this project is to address the gap in knowledge about the transition to new parenthood in refugee background families, their emotional responses to this and the relevance and effectiveness of current approaches to perinatal depression as a framework to address emotional distress in refugee-background mothers, taking into account socio-economic, cultural and political contexts that shape emotional responses to parenthood.

The objective of this project is to document maternal experiences and understandings of perinatal mental health amongst refugee-background mothers, specifically of the Karen-Burmese community in Australia, and to contribute to the development of culturally-informed health and community services and policies relating to the perinatal mental health of refugee-background women and their families, specifically of the Karen-Burmese community in Australia.

Recruitment of participants

This research was an exploratory study aimed at understanding how new mothers in the Karen community conceive of maternal mental health and wellness and their emotions and reactions to pregnancy and birth. The study focused on women who had recently given birth in Australia and purposefully sampled women with a range of experiences and ages including older mothers who had previously had children in their villages in Burma while displaced inside Burma and while living in refugee camps in Thailand. The majority of women were interviewed 12-24 months postpartum to ensure recovery from the birth and to enable some reflection on their experiences.

Building engagement with the community was an integral element of the research project and was made possible by the skills and community connections of bi-lingual Research Assistant (RA) Violet Cho. Ms Cho is a Karen woman of refugee-background with experience of interviewing and currently studying sociology and anthropology at Australia National University (ANU). The addition of a researcher with ‘insider’ status who shared language and cultural experience with interviewees was deemed crucial to this project.


In total 17 interviews with 15 Karen women were held from July to November 2011. Pseudonyms are used in the project report and were either chosen by participants or assigned by the RA. The oldest participant in the study, Lah K’por, was 47 and the youngest, Eli Moe, was 20. Say Say had the largest number of children, eight, and three mothers had one child only. Children ranged in age from 21years to one month old.

Data collection

Although participants were provided with options concerning the venue for interviews, all participants opted for being interviewed at their homes due to comfort and convenience, especially as all our participants were mothers with young children. This presented an opportunity to observe the participant’s environment which also provided valuable insights into relevant contextual factors. Only one mother asked to provide information remotely by audio-recording her account verbally and sending it to us.

Interviews were conducted in Karen, the participants’ first language. This was essential, not just because English proficiency is low in the Karen community but to encourage a ‘natural narrative flow’. Also language is recognised as a powerful organiser of cognitive and affective experience through which people are able to ‘negotiate meanings and come to shared understandings’ (Anderson 2003).

NOTE ABOUT LANGUAGE: Karen refers to a group of ethnic peoples and languages spoken by around 4 million people. The two most common Karen languages are the Sgaw (mostly Christian and animists from the hill regions) and the Pwo (mostly lowland Buddhist). The RA is fluent in both Sgaw and Pwo. Both these language began to be written down in the mid-1800s in a newly invented script based on the Burmese alphabet. This process has resulted in the introduction of Burmese words to these Karen languages, especially to express modern concepts and other terms that had no equivalent in Karen. Many Karen people are bi- or multi-lingual, with some knowledge of other Karen languages and Burmese.

Data analysis

Upon a completion of several interviews, the RA transcribed verbatim the audio files of interviews into Karen script and then translated these transcripts into English. Interviews were read through by the RF and queries related to translating complex concepts concerned with emotional and mental health were clarified by the RA.

Karen people in Australia

To contextualise participant experiences, some basic data about Karen peoples in Australia follows.

Karen peoples were counted as ‘Burmese’ in the 2006 Australian Census and according to this, over 12,000 Burmese resided here (DIMA 2006) and of these, 3.7% reported some Karen ancestry (DIC 2006). This figure is known to have increased significantly since this time due to changes in immigration policy. The difficult refugee history of most is detailed:

‘The Burmese people have experienced decades of oppression under a succession of military regimes. By the end of 2002 an estimated 600 000 Burmese were internally displaced, including people who were forcibly relocated by the military, and others who refused to relocate or who fled the relocation areas because they could not survive there. At the same time, more than a half million Burmese had sought refuge in neighbouring countries. To this day, arrests and harassment of pro-democracy activists continue.’ (DIMA 2006)

Most Burmese-born humanitarian entrants to Australia had been living in displaced persons or refugee camp environments for more than a decade prior to their arrival (Queensland Health 2011). There is no published data on health service utilisation of Burma-born people in Australia.

Key findings

The following data was documented for the first time in regard to refugee-background Karen women in Australia:

  • different understanding and conception of maternal and perinatal mental health including the language women used to express these ideas and their different cultural understandings and approaches to emotional health and illness and related gender concerns
  • the significant impact of refugee-life experiences on emotional health concerns including the possible effects of past physical and mental stress and hardship on perinatal mental health;
  • the situation of the stigmatisation of mental illness within the Karen community and the impact of this on mental health concerns
  • accounts of their settlement experiences and reactions to life in Australia and the relationship with emotional health and illness particularly relating to accounts of difficulties in use of health services in regard to birthing and maternal experience
  • accounts of self-reliance, self-help and resilience in the face of significant difficulties in their lives
  • sense of being able to contribute through the sharing of their experiences and suggestions for solutions to problems identified.

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