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Mathew A, Akpotu IC, Lockwood MB, Tirkey AJ, Patil CL, Doorenbos AZ. Critical Realism in Symptom Science - A Scoping Review. ANS Adv Nurs Sci 2024:00012272-990000000-00091. [PMID: 38864677 DOI: 10.1097/ans.0000000000000534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
There has been an increasing interest in research positioned within critical realism (CR). This analysis aimed to determine how CR has been applied in symptom science through a scoping review of the literature. Fifty-two articles were identified through searches in seven databases and search engines, and grey literature. Quantitative and qualitative analyses were performed using Excel and ATLAS.ti 8.0. Review findings indicate that CR has been used to examine two key aspects of symptoms - symptom experiences and symptom interventions. The details of how CR was operationalized are presented. This first scoping review highlights how a critical realist lens would help examine individual and contextual factors that influence symptom experiences, response to interventions, and outcomes.
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Affiliation(s)
- Asha Mathew
- Author Affiliations: Department of Surgical Nursing, College of Nursing, Christian Medical College Vellore, The Tamil Nadu Dr M.G.R. Medical University, Chennai, India (Dr. Mathew); Head and Neck Surgery Unit II, Christian Medical College Vellore, India (Dr. Tirkey); Department of Biobehavioral Sciences, College of Nursing, University of Illinois, Chicago, USA (Ms Akpotu and Drs. Lockwood and Doorenbos); Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan (Dr. Patil); and University of Illinois Cancer Center, Chicago, USA (Dr. Doorenbos)
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Todd K, Eastwood JG, Fotheringham P, Salinas-Perez JA, Salvador-Carulla L. Using Geospatial Analysis to Inform Development of a Place-Based Integrated Care Initiative: The Healthy Homes and Neighbourhoods Experience. Int J Integr Care 2021; 21:23. [PMID: 34220387 PMCID: PMC8231470 DOI: 10.5334/ijic.5430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 06/02/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Disadvantaged families experience many barriers to accessing health and social care. The Healthy Homes and Neighbourhoods (HHAN) Integrated Care Initiative was developed to address these barriers, and ensure families have their complex needs met and are kept safe and connected to society. DESCRIPTION A spatial epidemiology approach was taken, as part of the HHAN feasibility phase, to identify the geographical distribution of the "most vulnerable" families in Sydney Local Health District (SLHD). A literature review was conducted to identify indicators of family stress and disadvantage, and cluster and hotspot analyses were undertaken. Hotspots of family stress and disadvantage were mapped for SLHD and used to identify areas for HHAN place-based delivery, and for collaborative co-design. DISCUSSION The HHAN initiative called for consideration of context and the undertaking of collaborative design with communities. The spatial analysis provided a more accurate picture of family stress and disadvantage than previously available and provided a tool that could be used during consultation and planning activities. CONCLUSION When planning place-based integrated care initiatives, spatial analysis of small geographic scales can allow identification of areas of concentrated or complex disadvantage that may be masked when analysis is performed on larger areas, allowing for targeted, place-based delivery of programs to those most in need.
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Affiliation(s)
- Katherine Todd
- Community Health Services, Sydney Local Health District, Level 9, King George V Building, Missenden Road, Camperdown NSW 2050 Australia
| | - John G. Eastwood
- Community Health Services, Sydney Local Health District, Level 9, King George V Building, Missenden Road, Camperdown NSW 2050 Australia
- School of Women’s and Children’s Health, The University of New South Wales, Sydney, NSW 2052 Australia
- Ingham Institute of Applied Medical Research, Liverpool, NSW Australia
- Charles Perkins Centre, Menzies Centre for Health Policy, Discipline of Child and Adolescent Health, and School of Public Health, University of Sydney, Sydney, New South Wales 2006 Australia
- Sydney Institute for Women, Children and their Families, Camperdown NSW 2050 Australia
| | - Penelope Fotheringham
- Community Health Services, Sydney Local Health District, Level 9, King George V Building, Missenden Road, Camperdown NSW 2050 Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308 Australia
| | - Jose A. Salinas-Perez
- Centre for Mental Health Research, Research School of Population Health, Australian National University. 63 Eggleston Rd. Acton, ACT 2601 Australia
- Department of Quantitative Methods, Universidad Loyola Andalucía. Avenida de las Universidades s/n. 41704 Dos Hermanas, Sevilla, Spain
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, Australian National University. 63 Eggleston Rd. Acton, ACT 2601 Australia
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Nascimento M, Lourenço B, Coelho I, Aguiar J, Lázaro M, Silva M, Pereira C, Neves-Caldas I, Gomes F, Garcia S, Nascimento S, Pereira G, Nogueira V, Costa P, Nobre A. No man is an island: spatial clustering and access to primary care as possible targets for the development of new community mental health approaches. BMC Health Serv Res 2020; 20:344. [PMID: 32321489 PMCID: PMC7178966 DOI: 10.1186/s12913-020-05190-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 04/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND to understand if patients seen at Centro Hospitalar Psiquiátrico de Lisboa (CHPL) live in geographical clusters or randomly throughout the city, as well as determine their access to the psychiatric hospital and primary care facilities (PCF). METHODS spatial autocorrelation statistics were performed (queen criterion of contiguity), regarding all patients observed at CHPL in 2017 (at the census subsection level), and considering not only their overall number but also main diagnosis, and admission to the psychiatric ward - voluntary or compulsory. Distance to the hospital and to the closest PCF was measured (for each patient and the variables cited above), and the mean values were compared. Finally, the total number of patients around each PCF was counted, considering specified radius sizes of 656 and 1000 m. RESULTS All 5161 patients (509 psychiatric admissions) were geolocated, and statistical significance regarding patient clustering was found for the total number (p-0.0001) and specific group of disorders, namely Schizophrenia and related disorders (p-0.007) and depressive disorders (p-0.0002). Patients who were admitted in a psychiatric ward live farther away from the hospital (p-0.002), with the compulsory admissions (versus voluntary ones) living even farther (p-0.004). Furthermore, defining a radius of 1000 m for each PCF allowed the identification of two PCF with more than 1000 patients, and two others with more than 800. CONCLUSIONS as patients seem to live in geographical clusters (and considering PCFs with the highest number of them), possible locations for the development of programs regarding mental health treatment and prevention can now be identified.
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Affiliation(s)
- M Nascimento
- Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, Lisbon, Portugal.
| | - B Lourenço
- Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, Lisbon, Portugal
| | - I Coelho
- Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, Lisbon, Portugal
| | - J Aguiar
- Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, Lisbon, Portugal
| | - M Lázaro
- Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, Lisbon, Portugal
| | - M Silva
- Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, Lisbon, Portugal
| | - C Pereira
- Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, Lisbon, Portugal
| | - I Neves-Caldas
- Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, Lisbon, Portugal
| | - F Gomes
- Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, Lisbon, Portugal
| | - S Garcia
- Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, Lisbon, Portugal
| | - S Nascimento
- Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, Lisbon, Portugal
| | - G Pereira
- Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, Lisbon, Portugal
| | - V Nogueira
- Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, Lisbon, Portugal
| | - P Costa
- Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, Lisbon, Portugal
| | - A Nobre
- Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil 53, Lisbon, Portugal
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Vugts MA, Zedlitz AM, Joosen MC, Vrijhoef HJ. Serious Gaming During Multidisciplinary Rehabilitation for Patients With Chronic Pain or Fatigue Symptoms: Mixed Methods Design of a Realist Process Evaluation. J Med Internet Res 2020; 22:e14766. [PMID: 32149720 PMCID: PMC7091046 DOI: 10.2196/14766] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 10/31/2019] [Accepted: 12/15/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Serious gaming could support patients in learning to cope with chronic pain or functional somatic syndromes and reduce symptom burdens. OBJECTIVE To realize this potential, insight is needed into how, why, for whom, and when it works in actual treatment circumstances. METHODS Following a realist approach, process evaluations were performed before, during, and after a two-armed, natural quasi-experiment (n=275). A group of patients with interfering chronic pain or fatigue symptoms received a short additional blended mindfulness-based serious gaming intervention during a multidisciplinary rehabilitation program. A control group only received the regular rehabilitation program. During two sessions before and one session after the experiment, expectations about serious gaming processes were discussed in focus groups with local care providers, implementers, and experts. Patients participated in a survey (n=114) and in semistructured interviews (n=10). The qualitative data were used to develop tentative expectations about aspects of serious gaming that, in certain patients and circumstances, trigger mechanisms of learning and health outcome change. Hypotheses about indicative quantitative data patterns for tentative expectations were formulated before inspecting, describing, and analyzing-with regression models-routinely collected clinical outcome data. An updated program theory was formulated after mixing the qualitative and quantitative results. RESULTS Qualitative data showed that a subset of patients perceived improvement of their self-awareness in moments of daily social interactions. These results were explained by patients, who played the serious game LAKA, as a "confrontation with yourself," which reflected self-discrepancies. Important characteristics of serious gaming in the study's context included innovation factors of relative advantage with experiential learning opportunity, compatibility with the treatment approach, and the limited flexibility in regard to patient preferences. Perceived patient factors included age and style of coping with stress or pain. Learning perceptions could also depend on care provider role-taking and the planning and facilitating (ie, local organization) of serious gaming introduction and feedback sessions in small groups of patients. Quantitative data showed very small average differences between the study groups in self-reported depression, pain, and fatigue changes (-.07<beta<-.17, all 95% CI upper bounds <0), which were mediated by small group differences in mindfulness (beta=.26, 95% CI .02-.51). Mindfulness changes were positively associated with patient involvement in serious gaming (n=114, beta=.36, P=.001). Acceptance of serious gaming was lower in older patients. Average health outcome changes went up to a medium size in patients that reported lower active coping with stress and lower pain coping before serious gaming. Mindfulness changes and gaming acceptance perceptions covaried with group structure and immediate feedback sessions after serious gaming. CONCLUSIONS This study developed transferable insight into how and why serious gaming can facilitate additional learning about coping in order to reduce burdens of chronic pain or fatigue symptoms in certain patients and in actual treatment circumstances. Future studies are needed to continue the development of this fallible theory. Such research will further support decisions about using, designing, allocating, and tailoring serious gaming to optimize important patient health benefits. TRIAL REGISTRATION Netherlands Trial Register NTR6020; https://www.trialregister.nl/trial/5754.
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Affiliation(s)
- Miel Ap Vugts
- Tranzo Scientific Centre for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Aglaia Mee Zedlitz
- Leiden Institute for Brain and Cognition, Department of Health, Medical and Neuropsychology, Leiden University, Leiden, Netherlands
| | - Margot Cw Joosen
- Tranzo Scientific Centre for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Department of Human Resource Studies, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Hubertus Jm Vrijhoef
- Department of Patient & Care, Maastricht University Medical Center, Maastricht, Netherlands.,Panaxea, Amsterdam, Netherlands
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Hetherington E, McDonald S, Williamson T, Patten SB, Tough SC. Social support and maternal mental health at 4 months and 1 year postpartum: analysis from the All Our Families cohort. J Epidemiol Community Health 2018; 72:933-939. [PMID: 29921649 DOI: 10.1136/jech-2017-210274] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 04/25/2018] [Accepted: 05/28/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Low social support is consistently associated with postpartum depression. Previous studies do not always control for previous mental health and do not consider what type of support (tangible, emotional, informational or positive social interaction) is most important. The objectives are: to examine if low social support contributes to subsequent risk of depressive or anxiety symptoms and to determine which type of support is most important. METHODS Data from the All Our Families longitudinal pregnancy cohort were used (n=3057). Outcomes were depressive or anxiety symptoms at 4 months and 1 year postpartum. Exposures were social support during pregnancy and at 4 months postpartum. Log binomial models were used to calculate risk ratios (RRs) and absolute risk differences, controlling for past mental health. RESULTS Low total social support during pregnancy was associated with an increased risk of depressive symptoms (RR 1.50, 95% CI 1.24 to 1.82) and anxiety symptoms (RR 1.63, 95% CI 1.38 to 1.93) at 4 months postpartum. Low total social support at 4 months was associated with an increased risk of anxiety symptoms (RR 1.65, 95% CI 1.31 to 2.09) at 1 year. Absolute risk differences were largest among women with previous mental health challenges resulting in a number needed to treat of 5 for some outcomes. Emotional/informational support was the most important type of support for postpartum anxiety. CONCLUSION Group prenatal care, prenatal education and peer support programmes have the potential to improve social support. Prenatal interventions studies are needed to confirm these findings in higher risk groups.
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Affiliation(s)
- Erin Hetherington
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sheila McDonald
- Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne C Tough
- Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Jones DE, Tang M, Folger A, Ammerman RT, Hossain MM, Short J, Van Ginkel JB. Neighborhood Effects on PND Symptom Severity for Women Enrolled in a Home Visiting Program. Community Ment Health J 2018; 54:420-428. [PMID: 29063413 DOI: 10.1007/s10597-017-0175-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 10/05/2017] [Indexed: 11/28/2022]
Abstract
The aim of this study was to investigate the association between postnatal depression (PND) symptoms severity and structural neighborhood characteristics among women enrolled in a home visiting program. The sample included 295 mothers who were at risk for developing PND, observed as 3-month Edinburgh Postnatal Depression Scale (EPDS) scores ≥ 10. Two neighborhood predictor components (residential stability and social disadvantage) were analyzed as predictors of PND symptom severity using a generalized estimating equation. Residential stability was negatively associated with PND symptom severity. Social disadvantage was not found to be statistically significantly. The findings suggest that residential stability is associated with a reduction in PND symptom severity for women enrolled in home visiting program.
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Affiliation(s)
- David E Jones
- Counseling Program, School of Psychology and Counseling, Regent University , Virginia Beach, VA, USA.
| | - Mei Tang
- Counseling Program, School of Human Services, College of Education, Criminal Justice, and Human Services, Cincinnati, OH, USA
| | - Alonzo Folger
- Department of Pediatrics, Cincinnati Children's Hospital and Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Robert T Ammerman
- Department of Pediatrics, Cincinnati Children's Hospital and Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Md Monir Hossain
- Department of Pediatrics, Cincinnati Children's Hospital and Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jodie Short
- Department of Pediatrics, Cincinnati Children's Hospital and Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Judith B Van Ginkel
- Department of Pediatrics, Cincinnati Children's Hospital and Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Johnson BT, Cromley EK, Marrouch N. Spatiotemporal meta-analysis: reviewing health psychology phenomena over space and time. Health Psychol Rev 2017. [PMID: 28625102 DOI: 10.1080/17437199.2017.1343679] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Individual studies of health psychology are samples taken in particular places at particular times. The results of such studies manifest multiple processes, including those associated with individual, sample, intervention, and study design characteristics. Although extant meta-analyses of health phenomena have routinely considered these factors to explain heterogeneity, they have tended to neglect the environments where studies are conducted, which is ironic, as health phenomena cluster in space and times (e.g., epidemics). The settings in which study participants live, work, and recreate can be characterised by such environmental factors such as disease, weather, local and broad economic trends, the level of stigmatisation of minority groups, and allostatic load due to all causes. We introduce spatiotemporal meta-analysis, designed to address heterogeneity in study environments. We list potential challenges in developing spatiotemporal meta-analyses, and discuss future directions for this form of systematic reviewing methodology. Logically, to the extent that relevant spatiotemporal information on environmental conditions is available and varies widely, it can help to explain variability in study results that is not explained by individual, sample, study, or intervention features.
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Affiliation(s)
- Blair T Johnson
- a Department of Psychological Sciences and Institute for Collaboration on Health, Intervention, and Policy , University of Connecticut , Storrs , CT , USA.,c Department of Psychological Sciences , University of Connecticut , Storrs , CT , USA
| | - Ellen K Cromley
- b School of Medicine, University of Connecticut , Storrs , CT , USA
| | - Natasza Marrouch
- a Department of Psychological Sciences and Institute for Collaboration on Health, Intervention, and Policy , University of Connecticut , Storrs , CT , USA.,c Department of Psychological Sciences , University of Connecticut , Storrs , CT , USA
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Eastwood JG, Kemp LA, Jalaludin BB. Realist theory construction for a mixed method multilevel study of neighbourhood context and postnatal depression. SPRINGERPLUS 2016; 5:1081. [PMID: 27468381 PMCID: PMC4945545 DOI: 10.1186/s40064-016-2729-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 06/30/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND We have recently described a protocol for a study that aims to build a theory of neighbourhood context and postnatal depression. That protocol proposed a critical realist Explanatory Theory Building Method comprising of an: (1) emergent phase, (2) construction phase, and (3) confirmatory phase. A concurrent triangulated mixed method multilevel cross-sectional study design was described. The protocol also described in detail the Theory Construction Phase which will be presented here. METHODS The Theory Construction Phase will include: (1) defining stratified levels; (2) analytic resolution; (3) abductive reasoning; (4) comparative analysis (triangulation); (5) retroduction; (6) postulate and proposition development; (7) comparison and assessment of theories; and (8) conceptual frameworks and model development. THEORY CONSTRUCTION The stratified levels of analysis in this study were predominantly social and psychological. The abductive analysis used the theoretical frames of: Stress Process; Social Isolation; Social Exclusion; Social Services; Social Capital, Acculturation Theory and Global-economic level mechanisms. Realist propositions are presented for each analysis of triangulated data. Inference to best explanation is used to assess and compare theories. A conceptual framework of maternal depression, stress and context is presented that includes examples of mechanisms at psychological, social, cultural and global-economic levels. Stress was identified as a necessary mechanism that has the tendency to cause several outcomes including depression, anxiety, and health harming behaviours. The conceptual framework subsequently included conditional mechanisms identified through the retroduction including the stressors of isolation and expectations and buffers of social support and trust. CONCLUSION The meta-theory of critical realism is used here to generate and construct social epidemiological theory using stratified ontology and both abductive and retroductive analysis. The findings will be applied to the development of a middle range theory and subsequent programme theory for local perinatal child and family interventions.
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Affiliation(s)
- John G. Eastwood
- />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
| | - Lynn A. Kemp
- />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
| | - Bin B. Jalaludin
- />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
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Eastwood JG, Kemp LA, Jalaludin BB. Being alone and expectations lost: a critical realist study of maternal depression in South Western Sydney. SPRINGERPLUS 2015; 4:700. [PMID: 26609502 PMCID: PMC4646882 DOI: 10.1186/s40064-015-1492-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 10/30/2015] [Indexed: 11/29/2022]
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.
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Affiliation(s)
- John G. Eastwood
- />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
| | - Lynn A. Kemp
- />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
| | - Bin B. Jalaludin
- />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
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Erdem Ö, Prins RG, Voorham TA, van Lenthe FJ, Burdorf A. Structural neighbourhood conditions, social cohesion and psychological distress in the Netherlands. Eur J Public Health 2015; 25:995-1001. [DOI: 10.1093/eurpub/ckv120] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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