Explaining ecological clusters of maternal depression in South Western Sydney

Abstract

BackgroundThe aim of the qualitative study reported here was to: 1) explain the observed clustering of postnatal depressive symptoms in South Western Sydney; and 2) identify group-level mechanisms that would add to our understanding of the social determinants of maternal depression.MethodsCritical realism provided the methodological underpinning for the study. The setting was four local government areas in South Western Sydney, Australia. Child and Family practitioners and mothers in naturally occurring mothers groups were interviewed.ResultsUsing an open coding approach to maximise emergence of patterns and relationships we have identified seven theoretical concepts that might explain the observed spatial clustering of maternal depression. The theoretical concepts identified were: Community-level social networks; Social Capital and Social Cohesion; "Depressed community"; Access to services at the group level; Ethnic segregation and diversity; Supportive social policy; and Big business.ConclusionsWe postulate that these regional structural, economic, social and cultural mechanisms partially explain the pattern of maternal depression observed in families and communities within South Western Sydney. We further observe that powerful global economic and political forces are having an impact on the local situation. The challenge for policy and practice is to support mothers and their families within this adverse regional and global-economic context.

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

“…As described above the Emergent Phase used a constant comparative approach between qualitative (intensive) and quantitative (extensive) study arms. The findings of those studies have been previously reported (Eastwood et al 2012a , b , 2013a , b , c , 2014b ). Theory generation was undertaken in both the qualitative and quantitative arms of the Emergent Phase, to develop a tentative conceptual framework.…”

“…Chronic stressors may also contribute and include: status strains (i.e., race, sole parent, poverty, and religion), role strains (i.e., wife, motherhood, and daughter), ambient strains (i.e., neighbourhood crime, services, physical decay), and quotidian strains (i.e., loneliness, daily hassle of sole parenthood). The Stress Process Model is able to explain our observed association of financial stress and infant temperament with depressive symptoms (Eastwood et al 2012b , 2014b ).…”

“…During the Emergent Phase a constant comparative approach between qualitative (intensive) and quantitative (extensive) study arms was used. The methods used to detect and describe the phenomena under study included: interviews, focus groups, exploratory data analysis, exploratory factor analysis, regression, and exploratory ecological and multilevel spatial data analysis (Eastwood et al 2012a , b , 2013a , b , c , 2014b ). Theory generation was undertaken in both the qualitative and quantitative arms of the Emergent Phase, to develop tentative conceptual frameworks.…”

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

“…Possible hierarchical structures, mechanisms, contexts and outcomes are shown below (Table 4 ) based on the findings of this study, and our previously reported ecological analysis (Eastwood et al 2014 ).…”

“…We have previously reported the strengths and limitations of the quantitative (extensive) (Eastwood et al 2012a , b , 2013 ) and qualitative (intensive) methods (Eastwood et al 2014 ) used in this study.…”