The central purpose in this section is to ascribe meaning to the phenomenon of postnatal depression within a social capital conceptual framework. Kawachi et al. The idea that social capital has both individual and group attributes is consistent with the findings in this study which has found network-based resources to be important at both the individual and group levels.
The authors also observe that there is currently contention as to whether social capital should be conceptualised as social cohesion or as resources imbedded in social networks. Moore et al. The authors argue that social capital was originally viewed within public health as a psychosocial mechanism operating at an ecological level that might mediate the income inequality-health pathway.
They argued that network approaches to social capital should be recovered in order to enable the full translation and conceptualisation of social capital in public health [and epidemiology] Moore et al. Hulse and Stone , writing from an Australian policy perspective, reviewed the use of the terms social cohesion, social capital and social exclusion across North American, European and Australasian jurisdictions.
Social relations of everyday life, family and social relationships, networks, and voluntary social processes social capital. Reduction of differences, cleavages and inequalities between groups of people and people living in different geographical areas social exclusion. This debate is well articulated by Carpiano , who compares two theories of social capital as advanced by Putman , , and Bourdieu Bourdieu ; Bourdieu and Wacquant Of relevance to the analysis here are the bonding and bridging forms of social capital.
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Bonding social capital refers to resources that can be accessed within social groups whose members are alike in terms of their social identify. Bonding capital may have detrimental effects and a key to improving health may be increasing access to resources outside of immediate social milieu Kawachi et al. The individual level literature review and quantitative study Eastwood et al. The group level findings were paradoxical and suggest that ethnic diversity is playing a significant role Eastwood et al.
The individual level logistic regression Eastwood et al. The group level quantitative studies included a number of indicators of social capital. Both these latent variables included measures of ethnic diversity. Ecological visualisation and bivariate analysis found associations between most measures of social networks, social cohesion and social capital and the aggregated and spatial distribution of postnatal depression.
Bayesian bivariate analysis was consistent except for measures of change of address. Factor 6 significantly improved the Bayesian multi-level model reducing the DIC from to Eastwood , p.
The Process of Theory Building
These findings are paradoxical and suggesting that low group level social capital may be protective when controlling for individual level measures of support. The ecological studies linear regression and spatial found a strong association of aggregated postnatal depression with aggregated measures of social support. In the stratified studies this finding was not found for mothers born in Australia. For mothers not born in Australia this finding was associated with a group level protective effect from increased neighbourhood ethnic diversity Maly Index Maly The multi-level quantitative findings suggest that social capital is operating predominantly at the individual family level with the exception of mothers not born in Australia.
For mothers not born in Australia living in communities with high levels of social capital social networks is detrimental to mental health. Recontextualisation of these multilevel findings within the social capital conceptual framework suggests that for migrant mothers, social relations and possible bridging networks are stronger in ethnically diverse communities and protect against maternal depression. The converse logic is that, for migrant mothers, there is more social support than might be expected, in suburbs with low aggregated social support.
There limited literature in relation to perinatal depression and social capital. There is, however, extensive empirical evidence for the role of the social support component of social capital as described by Carpiano Social support has also been found to be protective of a wide range of other adverse perinatal outcomes Orr Social support is a concept with multiple dimensions. Support can be from a spouse, relatives, friends, or associates. Social support can be defined as being of three types: 1 informational support where advice and guidance is given ; 2 instrumental support practical help in terms of material aid or assistance with tasks ; and 3 emotional support expressions of caring and esteem.
Instrumental support has been described as tangible assistance and includes support available to the individual from members of his or her family or others to help with specific, concrete needs, such as lending money, giving a ride, helping with childcare etc.
Introduction to theory
Beck identified 27 studies that examined social support and postpartum depression. The relationship between social support and postpartum depression had a moderate effect size. Social support might be particularly relevant in relation to stressors experienced by immigrants. Surkan et al. Ritter et al. They also note that social support has been found to limit the negative psychological effects of chronic life stress. In the relation to pregnancy, social support has been found to have a positive effect on psychological well-being even among low income women.
The impact of social capital on mental health has been recently reviewed by Almedom and Glandon , The review included both individual level and ecological level studies and none of the studies reviewed were in relation to perinatal mental health. De Silva et al. They concluded that current evidence is inadequate to inform the development of specific social capital intervention to combat mental illness.
Their review included 7 ecological 6 multilevel studies none of which related specifically to perinatal maternal mental health. With respect to the ecological studies there was no clear pattern of association between ecological social capital and mental illness.
In particular there was no clear evidence of an inverse relationship between the level of social capital and mental illness. Recent multi-level studies lend some support to the hypothesis that ecological level social capital may protect against mental health disorders. In another UK multilevel study Stafford et al. For people living in deprived circumstances, however, an association between social capital contact amongst local friends and lower reporting of common mental disorders was found. Of relevance to the findings of this study was the finding that elements of bonding social capital were associated with higher reporting of common mental disorders.
This finding was only in deprived households. Kawachi and colleagues cite other studies that also Caughy et al. The redescription of maternal depression within a social capital conceptual framework focuses analysis on social network structures that may generate causative mechanisms.
Those mechanisms may be protective or detrimental depending upon the context. In this study emotional and practical support and social networks all had protective effects at the individual level. Put simplistically these modes of support may reduce the effects of social exclusion, social isolation, stress and depression. The social capital mechanisms may arise at macro and meso levels but are impacting directly on the individual psychological level. The outcome of this social capital is usually a reduction in stress but in some circumstances there may be an increase in stress.
The forms of social capital are complex and cannot be reduced to a single construct. We have therefore considered that bonding, bridging and linking social ties should be considered as separate social capital mechanisms. The contextual conditions are poorly understood but based on the findings in this study and the above literature we have included the following conditional mechanisms in the model:.
A critical realist model of the social capital mechanism is below Fig. Social capital social networks is a social level mechanism that protects against maternal stress and isolation when certain other personal characteristics and contextual conditions exist. The intention was to limit this study to neighbourhood and community level economic, social and physical influences.
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The critical realist ontology provides another perspective by claiming that reality is stratified and that each level can influence each other level. The levels are defined by the structures and their generative mechanisms. We have limited the analysis in this manuscript to the social level with some exploration of psychological and cultural Levels. Here we will provide brief analysis of a number of global-economic level mechanisms identified from the qualitative studies and associated retroductive analysis Eastwood et al.
Migration has been a significant historical feature of the populating of South West Sydney.
Following the Second World War those migrants originated predominantly from Europe. Since the s there has been a significant migration of Indo-Chinese peoples and more recently migration of peoples from Eastern Europe and the Middle East. In this study approximately forty five percent of mothers were not born in Australia. The role of migration and acculturation will be included as a Global-Economic Level mechanism in the development of the theoretical conceptual framework.
Analysis is at Additional file 1 : Appendix 1. The role that media and advertising might play in relation to perinatal depression and maternal expectation emerged from focus groups and situational analysis in the individual level qualitative study Eastwood et al. These dreams and aspirations relate to aspirations that she may have regarding wealth, material goods, holidays and education for her children.
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Emerging from the interviews was concern regarding the impact that this had had on the local community when the local Rugby League team merged with a team from outside the region. Rugby League in South West Sydney was reported to have declined with no obvious replacement sporting outlet for young people. Media and Advertising will be included as Global-Economic Level mechanisms in the development of the theoretical conceptual framework.
The strong influence of big business, media and the global economy on the situation for mothers and infants emerged from both qualitative studies Eastwood et al. The later process inevitably leads to dehumanisation of jobs, settings and circumstances Ritzer , p. During the course of this study, South West Sydney experienced the impact of global economic mechanisms with closure of large business and loss of employment.
Corporate Business elected to move industry to other countries and jurisdictions. As a result the New South Wales Government budgets were affected leading to impacts on urban development, social services and maintenance of essential infrastructure. We have postulated that corporate business is a global-economic level structure with generative powers that can have significant impacts on the neighbourhood context. Corporate Business will be included as a Global-Economic Level mechanism in the conceptual framework that follows.
As suggested by Danermark and colleagues we initially undertook this process as part of the abductive and retroduction abstraction as in the previous sections. The theories used for that analysis are complementary and focus on different mechanisms and context. The retroductive analysis across sections remained consistent. Areas of complexity and uncertainty, such as the role of bonding and bridging social capital, were similar for each of the theoretical perspectives and were consistent with findings from empirical studies.
No one theoretical perspective was able to provide a complete explanation of neighbourhood context and the phenomenon of perinatal depression. Stress Process theory provided a strong foundation for building a conceptual framework of maternal depression, stress and neighbourhood context. Theories of social isolation, exclusion, and capital were able to strengthen the explanatory power of the emerging framework. Missing from analysis at the psychological and social levels was the explanatory power provided by a study of culture. The analysis of acculturation and ethnic segregation contributed significant to explaining the study findings.
The brief analysis of media and advertising argued that advertising was a mechanism that influenced maternal expectations of motherhood.