The complexity of postpartum mental health and illness: a critical realist study

Abstract

The complexity of postpartum mental health and illness: a critical realist study Postpartum depression (PPD) is a major public health issue that profoundly impacts the woman, her infant and family. Although it may be linked to hormone changes, no direct hormonal aetiology has been established. A large body of evidence implicates numerous psychosocial predictors of PPD. While a history of depression predicts about 50% of cases of PPD, it remains unclear why some women with a history do not develop depression following childbirth, even taking psychosocial factors into account. The aim of this study was to identify the main mechanisms and factors associated with the presence or absence of PPD in women with a history of depression, and the presence of PPD in women without a history, using a critical realist approach. The findings indicate a number of personal and contextual factors that influence postpartum mental health and illness. In addition, and perhaps most importantly, women who did not develop depression identified goal-oriented actions that were protective. These factors and processes did not exist in isolation and the interplay among them in influencing health was apparent. More research is needed to explore the effects of these mechanisms in different contexts.

A systematic review, evidence synthesis and meta-analysis of quantitative and qualitative studies evaluating the clinical effectiveness, the cost-effectiveness, safety and acceptability of interventions to prevent postnatal depression

“…Ten studies were conducted in the UK, 304,[306][307][308][309][310][311][312][313][314][315]319,321,322,324 seven studies were conducted in the USA, 286,292,[296][297][298]302,303,318,320 one in Switzerland, 316 one in Canada, 317 one in Norway, 323 one in India, 325 one in China 305 and one in multiple centres. 7 …”

“…Fifteen studies provided data from participants from a general population in the country of study, 7,286,302,303,305,312,313,[316][317][318][319][320][321][322][323][324][325] while the remaining studies examined evidence from minority groups within the country of study. The minority groups were either a culturally different group based within the country of study (n = 6) 292,306-311,314,315,318 or a selective group (n = 2).…”

“…Instrumental support took the form of making food, to allow women to sleep and to care for other children. 305,317 This was particularly provided by mothers and mother-in-laws. 319,320 Supporting references 286,292,303,[305][306][307][308][309][310]317,318,320,325 High/moderate Continuity of care, in the form of one-to-one care from a community midwife, was also particularly helpful in one study 315 …”

Critical realism in nursing: an emerging approach

“…Following on this observation is the very wide breadth of nursing issues to which critical realist research has been applied to date; as relatively few nursing scholars have used critical realism to frame their work, it follows that those articles published will have canvassed wideranging interests without the depth that results from other researchers pursuing similar study and publishing in the same area of interest. Therefore, published research that uses critical realism to philosophically frame nursing inquiry ranges across topics such as smoking and tobacco control (Oladele et al, 2013), postpartum mental health and illness (Sword et al, 2012), kidney dialysis decision-making (Harwood & Clark, 2014), racism and professionalism in the medical setting (Porter, 1993), nursing prioritization in the provision of care (Lake et al, 2009), understanding the role of stress in myocardial infarction (Clark, 2003), dementia care (Kontos et al, 2011) and the use of public settings for injection drug use (Rhodes et al, 2007). Different contexts, a key consideration in critical realist ontology, were also very evident in the various studies contained in this literature review; as one example, a number of different geographical contexts were evident in the studies (such as the African context in Oladele et al (2013), Canadian in Kontos et al (2011), Harwood & Clark (2014) and Baumbusch et al (2012), United Kingdom in Rhodes et al (2007) and Clark (2003), and the multi-country context in Lake et al (2009)).…”

Embracing the population health framework in nursing research

“…Another excellent recent nursing research study that exemplifies the population health framework is Sword and colleagues’ (2012) study exploring the mechanisms involved in the development of post‐partum depression. The authors display an excellent grasp of the complexity of nursing research that explores causal mechanisms.…”