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“Each is in different circumstances anyway”: A realist multilevel situational analysis of maternal depression

Authors:

John Graeme Eastwood ,

Department of Community Paediatrics, Croydon Community Health Centre; School of Women’s and Children’s Health, The University of New South Wales; Charles Perkins Centre, Menzies Centre for Health Policy, and School of Public Health, University of Sydney, AU
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Lynn Ann Kemp,

Translational Research and Social Innovation (TReSI), School of Nursing and Midwifery, Western Sydney University; Ingham Institute of Applied Medical Research, Liverpool, AU
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Bin Badrudin Jalaludin

School of Public Health and Community Medicine, University of New South Wales, Sydney; Ingham Institute of Applied Medical Research, Liverpool, AU
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Abstract

Introduction: We present here the findings of a realist multilevel situational analysis of maternal depression.  We use situational analysis to identify the interaction of mothers with social structures and the possible causal influence of those social structures on her wellbeing.  The analysis moves from an emergent empirical approach toward the more reflexive and abductive approach of situational analysis thus better informing our abductive reasoning and the generation of theory.  The purpose is to understand the social determinants of health affecting families in stressful situations.

Theory/Methods: Critical realism and symbolic interactionism provide the methodological underpinning for the study.  Interviews of mothers and practitioners were analysed using open coding to enable maximum emergence.  Situational analysis was then undertaken using situational and social worlds/arena maps.

Results: Home and neighbourhood situational analysis mapping and analysis of relations identified the following concepts: a) expectations and dreams; b) marginalisation and being alone; c) loss or absence of power and control; and d) support and nurturing.  The neighbourhood and macro-arena situational analysis mapping and analysis of relations identified the following concepts: a) social support networks, social cohesion and social capital; b) services planning and delivery and social policy; and c) global economy, business and media.

Discussion: The use of qualitative methods for emergent theory building was suited to the aim and objectives of this study which was to explain the mechanisms by which circumstances influence developmental and life course outcomes with a focus on perinatal depression.  Emergent theory building methods such as those used here are also consistent with accepted critical realist methodologies (i.e. grounded theory).  We were not able to identify where situation analysis had been previously used for critical realist theory building but, as a symbolic interactionist methodology, its use within a critical realist epistemology is appropriate.

Conclusions: Emerging was the centrality of being alone and expectations lost as possible triggers of stress and depression within circumstances where media portrays expectations of motherhood that are shattered by reality and social marginalisation.  We further observe that powerful global economic and political forces are having an impact on the local situations.  The challenge for policy and practice is to support mothers and their families within this adverse regional and global-economic context.

Lessons learned: Situational analysis is a grounded theory method that can be usefully used to visually map the local neighbourhood setting.  The findings proved useful for the designing of local integrated care initiatives.

Limitations: The study undertaken utilised data from three focus groups and 8 key informant interviews.  Further interviews and focus groups would have enabled exploration of emerging themes related to cultural diversity and the impact acculturation.

Suggestions for future research: We propose that future research using situational analysis take a mixed method approach with, for example, concept mapping and social network analysis.   

How to Cite: Eastwood JG, Kemp LA, Jalaludin BB. “Each is in different circumstances anyway”: A realist multilevel situational analysis of maternal depression. International Journal of Integrated Care. 2017;17(5):A167. DOI: http://doi.org/10.5334/ijic.3475
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Published on 17 Oct 2017.

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