Maternal Identity Negotiations among Low-Income Women with Postpartum Depression

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 literature has long related PPD symptoms to a compromised maternal identity and, more specifically, to women's inability to achieve a sense of maternal competency (Rubin, 1984). Beck's (2002) meta-synthesis of 18 qualitative studies finds that women with PPD often self-define as “bad mothers”. However, the bulk of this research has been conducted with white and middle-class women and the experiences of low-income women of color are not well documented. In response, this grounded theory study sought to understand the meaning and experience maternal identity for low-income ethnic minority mothers experiencing PPD.

Methods:

The authors used a constructivist grounded theory design (Charmaz, 2006). A purposive 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. Data analysis followed the constant comparative method associated with grounded theory (Strauss & Corbin, 1998). Strategies to ensure rigor included peer debriefing, audit trails, and the use of more than one coder.

Results:

Analysis revealed that mothers selectively adopted and reworked elements of dominant discourses on motherhood and poverty in constructing their maternal identities. Mothers experienced their depressive symptoms, poverty, and their ability to parent under these circumstances as evidence of a failed maternal self, but also drew on moral discourses of maternal self-sacrifice, engagement with their children, and pleasure in mothering to construct a positive sense of self. To negotiate these conflicting versions of the self, mothers appraised their own maternal identities in relation to stigmatized “others” and framed their depression as a foreign entity, one that stood outside of a core, authentic sense of self.

Implications:

This study adds to prior investigations of PPD by focusing the investigation on marginalized mothers and situating their experiences of PPD in the context of maternal identity. For clinicians, the findings highlight the significance of identity struggles in relation to the experience of maternal depression. Future research should continue to investigate the experiences of this population in order to craft more culturally responsive prevention and intervention strategies for PPD.