A Situated Analysis of Postpartum Depression Among Mothers Living in Poverty

Background and Purpose: Postpartum depression (PPD) is a DSM-IV defined mental health disorder estimated to affect 13-16% of new mothers (Robertson, Grace, Wallington, & Stewart, 2004). Research finds that prevalence rates of PPD are higher among low-income women than among middle- or high- income women (Rich-Edwards et al., 2006), and that low-income mothers are less likely than their middle-class counterparts to seek or receive mental health treatment in the postpartum period (O'Hara & Swain, 1996; Song, Sands, & Wong, 2004). Existing qualitative research on PPD has not explicitly considered poverty as a key contextual factor in mothers' experiences and understandings of PPD (Beck, 1992, 1993; Ugarriza, 2002; Dennis & Chung-Lee, 2006), thus leaving a glaring gap for the formulation of effective prevention and intervention strategies (Abrams & Curran, 2007). To address this research gap, this study: 1) examines low-income mothers' subjective experiences of their PPD symptoms; 2) investigates low-income mothers' explanatory frameworks for their PPD symptoms; and 3) situates these experiences and understandings of their PPD symptoms in mothers' day to day experiences of mothering in poverty.

Method: In this grounded theory study, a purposeful sample of 19 low-income mothers was recruited from four Women, Infant, and Children (WIC) federal nutrition program sites located in two major urban areas. Mothers who indicated an interest in the study were screened according to several eligibility criteria, including self-report of past year PPD symptoms as measured by an adapted version of the Edinburgh Postnatal Depression Scale (Cox, Holden, & Sagovsky, 1987). Data collection consisted of one-time, open-ended qualitative interviews and a brief demographic questionnaire. We discontinued recruitment when we reached a point of theoretical saturation (Charmaz, 2006). Data analysis followed the constant comparative method associated with grounded theory (Strauss & Corbin, 1998).

Results: Qualitative analysis uncovered four primary theoretical constructs that connect the participants' lived experiences of mothering in poverty to their explanatory frameworks for their PPD symptoms. These include: 1) “mothering as overwhelming,” which captures how mothers related their symptoms to parenting demands; 2) “mothering alone,” which describes how mothers understood their depression in relation to their emotional and environmental isolation; 3) “juggling,” which underscores how women experienced their symptoms in the context of multiple and demanding responsibilities; and 4) “worry,” which captures how women grounded their anxiety features of PD in relation to their daily circumstances. These constructs overall indicate that the PPD symptoms that mothers' described do not “stand alone” as arbitrary or abstract feelings or experiences. Rather, our analysis strongly indicates that mothers' symptoms need to be understood as situated in the larger material and social context of poverty.

Conclusions and Implications: These emergent theoretical constructs challenge the prevailing biomedical discourse surrounding PPD and situate mothers' symptoms in their material and environmental hardships. This study adds to prior understandings by situating low-income mothers' experiences and understandings of their PPD symptoms in the context of living in poverty. The findings highlight the significance of contextual variations in researching PPD and suggest that practitioners must address women's material needs during treatment.