The complexity of postpartum mental health and illness: A critical realist study

Wendy Sword, Alexander M. Clark, Kathleen Hegadoren, Sandra Brooks, Dawn Kingston

Research output: Contribution to journalJournal Articlepeer-review

17 Citations (Scopus)


Postpartum depression (PPD) is a major public health issue that profoundly impacts the woman, her infant and family. Although it may be linked to hormone changes, no direct hormonal aetiology has been established. A large body of evidence implicates numerous psychosocial predictors of PPD. While a history of depression predicts about 50% of cases of PPD, it remains unclear why some women with a history do not develop depression following childbirth, even taking psychosocial factors into account. The aim of this study was to identify the main mechanisms and factors associated with the presence or absence of PPD in women with a history of depression, and the presence of PPD in women without a history, using a critical realist approach. The findings indicate a number of personal and contextual factors that influence postpartum mental health and illness. In addition, and perhaps most importantly, women who did not develop depression identified goal-oriented actions that were protective. These factors and processes did not exist in isolation and the interplay among them in influencing health was apparent. More research is needed to explore the effects of these mechanisms in different contexts.

Original languageEnglish
Pages (from-to)51-62
Number of pages12
JournalNursing Inquiry
Issue number1
Publication statusPublished - Mar. 2012


  • Critical realism
  • Depression
  • Maternal-child health
  • Mental health
  • Postpartum


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