“Being Alone and Expectations Lost”: A Realist Theory of Neighbourhood Context, Stress, Depression and the Developmental Origins of Health and Disease

Abstract

Introduction: We have previously reported on the findings of a critical realist concurrent triangulated mixed method multilevel study that sought to identify and explain complex perinatal contextual social and psychosocial mechanisms that may influence the developmental origins of health and disease. That study used both Emergent and Construction Phases of a realist Explanatory Theory Building Method (1). The purpose here is to present The Thesis, Theoretical Framework, Propositions and Models explaining neighbourhood context, stress, depression and the developmental origins of health and disease. Theory/Methods: The analysis draws on an extensive extant literature; intensive (qualitative), extensive (quantitative) and multilevel studies used for phenomena detection, description, and emergent phase theory development; and the abductive and retroductive analysis undertaken for the theory construction phase. The theory construction methods used included: “1) defining stratified levels; 2) analytic resolution; 3) abductive reasoning; 4) comparative analysis (triangulation); 5) retroduction; 6) postulate and proposition development; 7) comparison and assessment of theories; and 8) conceptual frameworks and model development”. Results: Global, economic, social and cultural mechanisms were identified that explain maternal stress and depression within family and neighbourhood contexts. There is a complex intertwining of historical, spatial, cultural, material and relational elements that contribute to the experiences of loss and nurturing. Emerging are the centrality of social isolation and “expectation lost” as possible triggers of stress and depression not only for mothers but possibly also others who have their dreams shattered during life’s transitions. Discussion: The theoretical framework takes a critical realist perspective of perinatal social context, stress, depression and the developmental origins of health and disease and builds on the emerging literature on stress process, social isolation, social exclusion, social capital, segregation, acculturation, Globalisation, neighbourhood effects on health, perinatal adversity, and the developmental origins of health and disease. We draw on the philosopher Bhaskar’s (2) articulation of critical realism with its ontological stratification of reality. Such a stratified ontological perspective adds theoretical depth to the layered ecological models advanced by earlier social epidemiologists. Conclusions: The Thesis: In the neighbourhood spatial context, in keeping with critical realist ontology, global-economic, social and cultural level generative powers trigger and condition maternal psychological and biological level stress mechanisms resulting in the phenomenon of maternal depression and alteration of the infants’ developmental trajectory. Lessons learned: The meta-theory of critical realism is used here to generate and construct social epidemiological theory using stratified ontology and both abductive and retroductive analysis. The findings will be applied to the development of a middle range theory and subsequent programme theory for local perinatal child and family interventions. Limitations: The stratified levels of analysis in this study were predominantly social and psychological. The macro and meso levels were not fully analysed. Suggestions for future research: We will use the theories developed here for future confirmatory studies and realist programme theory development.