Social+Determinants+of+Postpartum+Depression

= 1. Introduction  =

toc A common mental health disorder (CMD) that affects women disproportionately is sub-type of major depression called postpartum depression (PPD). The [|Center of Disease Control] (CDC) has estimated 1 in 9 women will experience the mental illness. [|Symptoms] of postpartum depression include; extreme fatigue, irritability, losing interest in things that you enjoy, feeling sad and/or empty, fear of not being a good mother, and even thoughts of harming yourself and/or the baby. Although women are more at risk, men can be diagnosed with PPD as well [1]. Research has shown that postpartum depression can be attributed by social and economic factors.



= 2. Social Influences =

The [|socialization] of gender roles in society plays an important factor in the [|prevalence] of CMD in women [2]. For example, gender roles are [|socially constructed] —a new mother has different roles and duties while taking care of a new infant compared to a new father. Thus, creating different social pressures on women compared to their male counterparts based on the social construction of gender roles. Postpartum depression is more prevalent in women who are low-socioeconomic status (SES), have experienced economic hardships, violence, used substances as coping mechanisms, and have experienced unstable relationships pre-and postpartum—all social or economic factors.

= 2.1. Social Support =

When women have these societal roles to fulfill in order to be a “good mother”, they often seek external social support in order to succeed in these roles. Evaluating the social support that a woman receives from their [|paternal] partner before and after giving birth to a child is correlated with PPD. Women who are receiving less support from their partners are more likely to be diagnosed with PPD than women who are receiving more support [3]. A lot of research has focused on the determinant of ‘social support’ in an array of aspects and how it influences the risk of PPD. Research has been done to study how the new mothers perceive the ‘fairness’ of the roles in caring for the newborn [1]. When there is less paternal involvement in rearing a child that creates a risk factor for PPD in women [2]. Even if there is support from the paternal partner, maternal disappointment in the relationship or the marriage with the partner increases the risk for PPD[3]. = = = 2.1.1.The Equity Theory =

The perception of ‘fairness’ among heterosexual couples is theorized by the ‘equity theory’; this theory looks at the equitableness of exchanges in human relationships. The mother’s perception of infant-care fairness was more likely to have a negative effect on a mother when they perceived infant-care was being performed less by their paternal partners than when equitable infant-care was perceived [1]. Socially, a woman is expected to contribute more to the rearing of a child compared to a man. Therefore, if a man has the mindset that the woman has the sole responsibility of raising a child, that already creates an imbalance of the equableness between women and men’s duties. When paternal infant-care is lower in relationships, lower paternal support is given, and interactions spent with the child by the father is lower that increases the risk of PPD in women, especially those who are unemployed. Mothers who were unemployed in this study were found to be 4.3 times more at-risk for PPD than women who were employed with low-paternal support or involvement [2].

= 2.2. Socioeconomic Status =

[|Socioeconomic status] also was a common factor in the literature for PPD. One of the measures evaluated in examining SES is unemployment; mother’s that are unemployed are at greater risk for PPD, especially if they lack the support from their partner [5,6]. Women who typically experience more financial hardships and/or are unemployed before, during or after their pregnancy are at a higher risk of PPD [7]. Mothers are expected to provide for their children so if they do not have other support and are unemployed it puts them and their children at risk for inadequate food and or housing. The job status of a mother is crucial in determining what women are more at-risk for PPD. There is not a significant risk among employed mothers and the amount of social support received. Mothers who are unemployed have higher levels of depressive symptoms due to their socioeconomic position [9]. A relevant theory to take into consideration while examining socioeconomic status at a determinant for postpartum depression is the Fundamental Cause Theory.

= 2.2.1. The Fundamental Cause Theory =

The fundamental cause theory is a theoretical approach to determine the strong association between health and socioeconomic status. The theory suggests that when people are of higher socioeconomic status that they have more access to resources such as money, power, education, and overall social connections. These resources are used to lower their risk of illnesses and ill health. This theory helps give insight in the division of social structures and [|individual agency]. It gives structure to show how social influences such as resources are determinant on one’s social position in society [8]. A woman of higher-socioeconomic status is more likely to have more resources available and capable for them compared to women of lower socioeconomic status. The fundamental cause theory shows the association between mothers who are (un) employed and their risk of being diagnosed with postpartum depression due to the various resources available to them correlated with PPD.

= 2.3. Violence =

Past or current interpersonal [|violence] has a strong association with women’s risk of postpartum depression. Women who have experienced or are experiencing physical, psychological or sexual violence are 3.6 to 8.4 more likely to be diagnosed with PPD. Studies have shown that violent exposures in adulthood are linked to postpartum depression. Although all types of violence whether it be physical, psychological, or sexual increases the risk of PPD, it is undetermined if any violence outweighs another in terms of increasing the risk of PPD [10].



= 2.4. Substance Abuse =

Substance abuse is highly correlated with intimate partner violence, or any of the other forms of violence (physical, psychological or sexual). When a woman reports any form of violence they are most likely to self-report using a substance as well. The substance that is most used among women who are diagnosed with PPD, are cigarettes. Studies have shown that reported drug and alcohol use wasn’t as much as recreational drugs, such as marijuana. Risk of PPD is greater when both partner report substance abuse. Depressive symptoms are more common in women who report that they have an alcohol or drug problem or if their partner abuses substances compared to women who do not report these risks [10].

= 4. Conclusion =

Overall, social determinants are imperative factors to examine while determining who is more at risk for postpartum depression (PPD). Social support is measured in several different ways throughout the research but each way indicates that the social determinant—social support, is imperative to analyze. The social support given to a mother, especially from the paternal partner, is a strong indicator for high-risk women more susceptible to postpartum depression.

**4.1.Trajectory of Children**

Children as early as one month old are at a greater [|risk] of lower social skills when there are maternal depressive symptoms. Studies have shown that this is a great indicator of social outcomes for children who have mothers that experience PPD. Other demographics such as maternal age, marital status, child sex, and family income are also factors that increase the risk of lower-social outcomes of children [11].

= **References** =

1. Reichenheim, M. E., Morales, C. L., Lopes, C. S., & Lobato, G. (2014). The role of intimate partner violence and other health-related social factors on postpartum common mental disorders: a survey-based structural equation modeling analysis. // BMC Public Health //, // 14 // (1), 1-27. doi : 10.1186/1471-2458-14-427

2. Mickelson, K. K., Biehle, S., Chong, A., & Gordon, A. (2017). Perceived Stigma of Postpartum Depression Symptoms in Low-Risk First-Time Parents: Gender Differences in a Dual-Pathway Model. //Sex Roles//, //76//(5/6), 306-318.

3. Maliszewska, K., Świątkowska-Freund, M., Bidzan, M., & Preis, K. (2016). Relationship, social support, and personality as psychosocial determinants of the risk for postpartum blues. //Ginekologia Polska,////87//(6), 442-447. doi:10.5603/gp.2016.002

4. DeMaris, A. a., & Mahoney, A. (2017). The perception of fairness in infant care and mothers' postpartum depression. //Social Science & Medicine//, //190//199-206.

5. Lin, W., Chang, S., Chen, Y., Lee, H., & Chen, Y. (2017). Postnatal paternal involvement and maternal emotional disturbances: The effect of maternal employment status. //Journal of Affective Disorders,////219//, 9-16. doi:10.1016/j.jad.2017.05.010

6. Xie, R., Yang, J., Liao, S., Xie, H., Walker, M., & Wen, S. W. X. (2010). Prenatal family support, postnatal family support and postpartum depression. //Australian & New Zealand Journal Of Obstetrics & Gynaecology//, //50//(4), 340-345. doi:10.1111/j.1479-828X.2010.01185.x

7. Corman, H., Curtis, M. A., Noonan, K. k., & Reichman, N. E. (2016). Maternal depression as a risk factor for children's inadequate housing conditions. //Social Science & Medicine//,//149//76-83.

8.Veenstra, G. (2018). Infusing fundamental cause theory with features of pierre bourdieu's theory of symbolic power. Scandinavian Journal of Public Health, 46(1), 49-52. doi:10.1177/1403494817748253 9. Abrams, L. S., & Curran, L. (2007). Not Just a Middle-Class Affliction: Crafting a Social Work Research Agenda on Postpartum Depression. Health & Social Work, 32(4), 289-296.

10. Quelopana, A. M., D.N.S.R.N. (2012). Violence against women and postpartum depression: The experience of chilean women. Women & Health, 52(5), 437. Retrieved from https://colorado.idm.oclc.org/login?url=https://search.proquest.com/docview/1023777536?accountid=14503//

11. Wu, Y. y., Selig, J., Roberts, M., & Steele, R. (2011). Trajectories of Postpartum Maternal Depressive Symptoms and Children's Social Skills. Journal Of Child & Family Studies, 20//(4), 414-423.