Being alone and expectations lost: a critical realist study of maternal depression in South Western Sydney

Abstract

The study reported here is part of a critical realist multilevel study. It seeks to identify and explain complex perinatal contextual social and psychosocial mechanisms that may influence the developmental origins of health and disease, with a focus on the role of postnatal depression. The aims of the greater study are to: (1) describe the phenomenon of postnatal depression in South Western Sydney; and (2) identify mechanisms that would add to our understanding of the psycho-social causes of maternal depression. This paper will move beyond our previous quantitative descriptions of individual-level predictors of depressive symptoms by seeking the views of local mothers and practitioners, to explain the mechanisms that might be involved. The study was set in South Western Sydney, New South Wales, Australia. An Explanatory Theory Building Method was used. The previously reported quantitative study was a non-linear principal component analysis and logistic regression study of 15,389 months delivering in 2002 and 2003. This intensive qualitative study used open coding of interviews, of seven practitioners and three naturally occurring mothers groups, to enable maximum emergence. The theoretical concepts identified were: attachment and nurturing, infant temperament, unplanned pregnancy and sole parenthood, support for mothers, access to services, stress, financial hardship, isolation and marginalisation, mothers’ “loss of control” and “power”, and expectations and dreams. Being alone and expectations lost emerged as possible triggers of stress and depression for mothers. These findings might also apply to others who have their dreams shattered during life’s transitions. In these situations social and cultural context can either nurture and support or marginalise and isolate. The challenge for policy and practice is to support mothers and their partners during the transition to parenthood within a challenging social and material context.

Realist theory construction for a mixed method multilevel study of neighbourhood context and postnatal depression

“…Stress was identified as a phenomenon causing depression in both the qualitative studies and literature review (Eastwood 2011 ; Eastwood et al 2015 ). The stress process model was first described by Pearlin et al ( 1981 ).…”

“…Redescription and recontextualisation of perinatal stress, and depression, will be undertaken here within the conceptual framework provided by the “Stress Process Model”. The analysis is intentionally limited to the social levels and will not consider our findings regarding the role of infant temperament (Eastwood et al 2012a , b , 2015 ).…”

“…The qualitative arm of the study identified stress as a cause of both antenatal and postnatal depression (Eastwood 2011 , 2015 ). While the term “stress” was only mentioned by one mother, we interpreted the coded category “loss of control” as expressing a similar concept.…”

“…Isolation and loneliness were identified as phenomenon associated with postnatal depression (Eastwood 2011 ; Eastwood et al 2015 ). We have used abductive logic to redescribe and recontexualise the phenomena of isolation and loneliness associated with postnatal depression within the theoretical concept of social isolation.…”

War or Peace? How the Subjective Perception of Great Power Interdependence Shapes Preemptive Defensive Aggression

“…The “Thucydides Trap” refers to the idea that the growth of Athenian power itself made war with Sparta inevitable—and is likely to be repeated by great powers like the United States and China today (Allison, 2015). However, peaceful power transitions such as that from Great Britain to the United States in the 20th century strongly suggest that shifts in the objective balance of power itself do not make great power conflict inevitable (Lebow and Valentino, 2009). Instead, this paper argues that the subjective perception of negative outcome interdependence is a critical psychological trigger of great power conflict.…”