“I keep it to myself”: A qualitative meta‐interpretive synthesis of experiences of postpartum depression among marginalised women

Abstract

Postpartum depression (PPD) is a significant public health concern due to the physical, emotional, economic, and life course outcomes. Rates of PPD are significantly higher for marginalised populations and can impact low-income, minority, and/or immigrant women differently when compared to white middle-class women. Commonly studied negative effects of PPD include poor health outcomes, mother-child bonding challenges, and negative child educational outcomes. However, research surveying the postpartum experience and negative outcomes among marginalised women is sparse. This study implemented a qualitative meta-interpretive synthesis (QIMS) methodology to synthesise themes across 12 qualitative research articles surveying postpartum experiences of marginalised women in North American countries. Articles included in the QIMS were extracted from online databases from a 10-year window spanning January 2008-2018. The guiding research question was "What are the PPD experiences of women belonging to marginalized populations?" Constant comparative analysis was used with coding in atlas.ti and themes were synthesised with input of all three authors. Five main themes emerged. The themes are (a) intersections of PPD and poverty, (b) culture and PPD, (c) pressures of mothering, (d) strengths and coping, and (e) abuse affects my PPD experience. Subthemes such as "I keep it to myself" relating to cultural response to PPD and idealised mothering were also discovered. Implications for social workers, nurses, and future research are discussed.

Stakeholder perspectives on antenatal depression and the potential for psychological intervention in rural Ethiopia: a qualitative study

“…Both women and HCWs commonly perceived depressive symptoms as a reaction ("thinking too much") to social adversities such as the additional burden of pregnancy in the context of pre-existing poverty, marital conflict and perinatal physical health complications and they emphasized the difficulty that women with depression have relating with others, manifested in poor engagement with the clinicians. These findings are in keeping with other qualitative studies in LMICs [41,42] and also among marginalised groups in HICs [43].…”

An Item Response Theory examination of the original and short forms of the Difficulties in Emotion Regulation Scale (DERS) in pregnant women

“…Critically, emotion dysregulation has been associated with smoking during pregnancy (Fillo et al, 2019) and increased offspring obesity (de Campora et al, 2016), problems that may disproportionally impact the pregnancies of racially marginalized women (Howell, 2018). In addition, emotion dysregulation may contribute to disparities in accessing health care for racially marginalized women (Chang et al, 2016;Maxwell et al, 2019). Thus, it is increasingly evident that emotion regulation is particularly important for pregnant women and their offspring, and especially for those facing added stressors related to socioeconomic disadvantage and racial/ethnic health disparities.…”

"I Gotta Carry The Burden By Myself"

“…Although the mothers discussed the difficulties, they described their tenacity to be independent. This finding is reinforced by Maxwell et al's (2018) meta-analysis, which indicated that low-income mothers do their best to cope with the pressures of mothering despite often feeling isolated and alone. Keefe et al (2018aKeefe et al ( , 2018b concluded that lowincome mothers of color strive to be excellent mothers while only rarely giving themselves credit for handling the ongoing difficulties of living in poverty.…”