title: 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.
authors.affiliation: Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, 24 Liverpool Road, Croydon, NSW 2132 Australia ; School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia ; School of Women's and Children's Health, The University of New South Wales, Sydney, NSW 2052 Australia ; Ingham Institute of Applied Medicine, The University of New South Wales, Liverpool, NSW 2170 Australia ; School of Public Health, The University of Sydney, Sydney, NSW 2006 Australia ; School of Medicine, Griffith University, Gold Coast, QLD 4222 Australia.
authors.forename: John G
authors.initials: JG
authors.lastname: Eastwood
authors.affiliation: Ingham Institute of Applied Medicine, The University of New South Wales, Liverpool, NSW 2170 Australia ; School of Nursing and Midwifery, Western Sydney University, Campbelltown, NSW 2560 Australia.
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Kemp
authors.affiliation: School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia ; Ingham Institute of Applied Medicine, The University of New South Wales, Liverpool, NSW 2170 Australia.
authors.forename: Bin B
authors.initials: BB
authors.lastname: Jalaludin
keywords: Critical realism; Expectations; Isolation; Mixed methods; Postnatal depression