Abstract
BackgroundThere is increasing interest in the role played by maternal depression in mediating the effects of adversity during pregnancy and poor infant outcomes. There is also increasing evidence from multilevel regression studies for an association of area-level economic deprivation and poor individual mental health. The purpose of the study reported here is to explore the spatial distribution of postnatal depressive symptoms in South Western Sydney, Australia, and to identify covariate associations that could inform subsequent multilevel studies.MethodsMothers (n = 15,389) delivering in 2002 and 2003 were assessed at 2–3 weeks after delivery for risk factors for depressive symptoms. The individual-level binary outcome variables were Edinburgh Depression Scale (EDS) >9 and >12. The association between social, demographic and ecological factors and aggregated outcome variables were investigated using exploratory factor analysis and multivariate hierarchical Bayesian spatial regression. Relative risks from the final EDS >12 regression model were mapped to visualise the contribution from explanatory covariates and residual components.ResultsThe exploratory factor analysis identified six factors: neighbourhood adversity, social cohesion, health behaviours, housing quality, social services, and support networks. Variables associated with neighbourhood adversity, social cohesion, social networks, and ethnic diversity were consistently associated with aggregated depressive symptoms. Measures of social disadvantage, lack of social cohesion and lack of social capital were associated with increased depressive symptoms. The association with social disadvantage was not significant when controlling for ethnic diversity and social capital.ConclusionsThe findings support the theoretical proposition that neighbourhood adversity causes maternal psychological distress and depression within the context of social buffers including social networks, social cohesion, and social services. The finding have implications for the distribution of health services including early nurse home visiting which has recently been confirmed to be effective in preventing postnatal depression.Electronic supplementary materialThe online version of this article (doi:10.1186/2193-1801-3-55) contains supplementary material, which is available to authorized users.
Highlights
There is increasing interest in the role played by maternal depression in mediating the effects of adversity during pregnancy and poor infant outcomes
We have previously reported on individual level psychosocial predictors of perinatal depression in South Western Sydney (SWS) and proposed that the findings were consistent with group-level socioeconomic deprivation, neighbourhood environment, social capital and ethnic diversity having causal effects on postnatal depressive symptomatology and other perinatal outcomes (Eastwood et al 2011)
Exploratory factor analysis (EFA) We have previously reported the results of the factor analysis (Eastwood et al 2013b, Eastwood et al 2014a)
Summary
There is increasing interest in the role played by maternal depression in mediating the effects of adversity during pregnancy and poor infant outcomes. There is increasing evidence from multilevel regression studies for an association of area-level economic deprivation and poor individual mental health. There is increasing evidence from multilevel regression studies for an association of area-level economic deprivation and poor individual mental health (Fone et al 2007; Skapinakis et al 2005; Weich et al 2003). Perinatal depression has consistently been found, at the individual level, to be higher among women with low socio-economic status (Beck 2001; O’Hara and Swain 1996). This raises the possibility that the impact of economic and social deprivation on mothers and their infants may be mediated through perinatal depression. That proposition is consistent with a recent qualitative study of pathways from neighbourhoods to mental well-being which found that neighbourhood affordability, negative community factors including crime and vandalism, and social makeup including unemployment and poverty, were associated with poor mental wellbeing (O’Campo et al 2009)
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