Explaining ecological clusters of maternal depression in South Western Sydney.
BACKGROUND
The 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.


METHODS
Critical 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.


RESULTS
Using 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.


CONCLUSIONS
We 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.
School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia. John.eastwood@sswahs.nsw.gov.au.
John
J
Eastwood ED
Lynn
L
Kemp
Bin
B
Jalaludin
D016000:Cluster Analysis; D003132:Commerce; D018864:Cultural Diversity; D019052:Depression, Postpartum / Q000453:epidemiology*; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D009035:Mothers; D009517:New South Wales / Q000453:epidemiology; D010821:Physicians, Family; D011632:Public Assistance; D036301:Qualitative Research; D063505:Racism; D012924:Social Conditions; D012944:Social Support; D012959:Socioeconomic Factors