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Open Access Open Badges Research article

Explaining ecological clusters of maternal depression in South Western Sydney

John Eastwood1345*, Lynn Kemp2 and Bin Jalaludin1

Author Affiliations

1 School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia

2 Centre for Health Equity Training Research and Evaluation, University of New South Wales, Sydney, NSW 2052, Australia

3 Department of Community Paediatrics, South Western Sydney Local Health District, Locked Bag 7279, Liverpool BC, NSW 1871, Australia

4 School of Women's and Children's Health, University of New South Wales, Sydney, NSW 2052, Australia

5 School of Public Health, University of Sydney, Sydney, NSW 2006, Australia

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BMC Pregnancy and Childbirth 2014, 14:47  doi:10.1186/1471-2393-14-47

Published: 24 January 2014



The aim of the qualitative study reported here was to: 1) explain the observed clustering of postnatal depressive symptoms in South Western Sydney; and 2) identify group-level mechanisms that would add to our understanding of the social determinants of maternal depression.


Critical realism provided the methodological underpinning for the study. The setting was four local government areas in South Western Sydney, Australia. Child and Family practitioners and mothers in naturally occurring mothers groups were interviewed.


Using an open coding approach to maximise emergence of patterns and relationships we have identified seven theoretical concepts that might explain the observed spatial clustering of maternal depression. The theoretical concepts identified were: Community-level social networks; Social Capital and Social Cohesion; "Depressed community"; Access to services at the group level; Ethnic segregation and diversity; Supportive social policy; and Big business.


We postulate that these regional structural, economic, social and cultural mechanisms partially explain the pattern of maternal depression observed in families and communities within South Western Sydney. We further observe that powerful global economic and political forces are having an impact on the local situation. The challenge for policy and practice is to support mothers and their families within this adverse regional and global-economic context.

Postnatal depression; Social capital; Poverty; Access; Ethnic segregation; Qualitative; Realism; Business social responsibility