Health and well being are significantly affected by the social factors, which are also responsible for shaping the health and well being status of an entire population. Some of these factors and their impacts are responsible for creating gaps among different population; thus, these factors are known as social determinants of health. While considering a population, it is important to investigate and consider all the factors affecting and shaping the health and well being of the population (O'hara & McCabe, 2013). For instance, there are several social determinants of health, which commonly creates gap in the social groups. Some health and social issues like racial discrimination, depression, suicide, domestic violence, poverty, social inclusion or social support, drug addiction or substance abuse, cardiovascular disease, social isolation, sexually transmitted diseases etc are determining the health status of a population, like SDH. The impact of this social determinant of health is different for different population. In this context, this essay would focus on demonstrating the impact of a specific social determinant of health upon a particular population.
The health problem and the affected population which I am going to discuss in this essay is post natal depression in women. During the post natal period, women are most susceptible to psychiatric illness and the rate of psychiatric admission is increased mostly because after the first month of childbirth. It is characterized by a type of mood disorder associated with childbirth. Although women are mostly affected by the disorder, in rare percentage, males are also affected by the disorder. However, in this essay, the target population is women affected by post-natal depression. About 10% women are affected by post natal depression in the early weeks after child birth and having episodes which lasts from two to six months (Wisner et al., 2013). The symptoms related to post natal depression include extreme sadness, hopelessness, anxiety, changes in sleeping patterns, eating patterns, loss of appetite, crying episodes, irritability, severe mood swings, low self esteem, exhaustion, less energetic and agitation. The onset of the health issue has been observed within one week to one month of child delivery. Little evidence is available to support a biological basis to postpartum depression.
According to a study conducted among a small subgroup of women experiencing postpartum depression, thyroid dysfunction was considered to be a possible cause. Although no hormonal basis has been found to the association, but the presence of maternity blues immediately after the postpartum period has been found to be related to the development of postpartum depression. According to a number of prospective studies, a definite association exists between maternal mood disorder and impaired infant cognitive development. The risk factors include previous episodes of postpartum depression, bipolar disorder, psychological stress, complication in childbirth, lack of support or drug abuse (O’Hara, 2013). Ultimately, the health issue significantly reduces the quality of life of the new mother, which may also negatively affect upon the newborn’s maternal care after birth. Thus, it is crucial to address the issue as soon as possible.
Depression is a key chronic psychological illness, which is a related to several social determinant of health. Post partum depression is significantly affecting the quality of life of the patients. In addition, it is significantly affecting the care provision to the new born, which in turn may affect the newborn’s health status. Thus, it is important to identify the factors causing or promoting the health issue in the target population. Among all the social determinant of health, there are several determinants, influencing post partum depression. For instance, Beydoun et al., (2012) identified that ‘stress’ is the key SDH that is influencing depression and related symptoms among postpartum woman. It is more common among women, who have undergone complicated pregnancy. Recent studied have identified that the initiation of depressive symptoms are actually take place prior delivery, especially women, who are undergoing a complicated pregnancy. It is mainly due to the change of the thinking patterns (Dennis & Dowswell, 2013). In complicated pregnancy, women are more worried about the fate of their pregnancy, the health of their and their babies, which leads to development of stress and anxiety, which are the preliminary elements in developing depression. The depressive events remain consistent even after birth, because, till at least 1 month the mother is remains weak, especially in case of cesarean birth.
Another determinant of health of post partum depression that has been highlighted in previous evidences is ‘income of the woman’. The birth of a child introduce additional financial constrain on the family. In case of non-working mother, usually the financial burden remains up to the father of the new born. If the family have a single working man, it becomes difficult for the father to meet all the physiological needs of both the mother and son, inducing stress related symptoms in both the mother and father (Gress-Smith et al., 2012). In case of working women, the health status and the care responsibilities towards the newborn hinders the woman to continue her professional practice, which also brings social isolation, inducing stressful situation among new mothers. In case of single mother, the discontinuation of work also enhances the financial burden for the woman, due to the incorporation of the cost related to newborn’s care.
‘Lack of support’ is another determinant, influencing the onset of post partum depressive symptoms. In post partum period, mothers remain physically weak to provide appropriate support to her as well as the newborn. In addition, during that period, the newborn’s care is new and difficult for the new mother and she needs guidance from either family members or other social members (Allen et al., 2014). Thus, lack of both family and social support make the women isolated, excluded and stress out, which ultimately leads to the development of depressive symptoms. Social isolation is a key consequence of ‘lack of support’, which influence development depressive symptoms. Due to compromised health status and care responsibilities towards the new born, the mother becomes unable to meet people or communicate with others and seeks emotional and spiritual support from close family members, like husband, parents and friends. Lack of support from family and social groups, lowers the self-esteem of the mother and increase the sense of hopelessness and social exclusion, thereby enhancing the risk of developing depression.
Finally, Dolatian et al., (2013) claimed that education is a significant SDH, which can influence the development of post partum depression among women. In most of the cases, lack of knowledge regarding post partum consequences, how to care for an infant and the coping strategies related to post partum stress and anxiety, lead to the development of negative thoughts, lowered self esteem, stress, leading ton depressive symptoms development. During pregnancy, several physiological as well as psychological changes take place in the body, affecting the post partum health consequences. Thus, physicians or midwife should undergo a thorough discussion session with the patient and patient family to make the patient understand the coping strategies for dealing with complications prior, during and after pregnancy. Health care and social support staffs also encourage the pregnant women regarding delivery and post natal consequences. For instance, caring for the infant, feeding, bathing, diaper changing and keep the child happy. Lack of these skills and knowledge, the self esteem of the new mother is lowered, leading to the development stress and anxiety of the patient.
To address the health issue, by considering the social determinant of health, it has been revealed that it is important to control these SDHs to reduce the negative effect of the health issue upon the target population. The evidence base is indicating that a strong social support is needed to reduce the risk of developing these depressive symptoms among the target group. For this, both the care givers, social workers and family members of the woman are needed to be consulted (Dolatian et al., 2013).
Initially, while working with the issue, a collaborative framework needed to be developed, within which all the stakeholders can work successfully to mitigate the health issue, as soon as possible. Initially, the care workers and the social workers would be consulted to collaborate with the patient, in order to improve patient’s emotional and spiritual health. For this a person-centered approach can be undertaken. The person-centred approach would help to address all the factors affecting the post partum woman’s health. The care workers need to build up a good rapport with the woman to motivate her to adopt the coping skills. The care workers should also include the social workers, who would provide continuous support to the woman to deal with the difficulties during the post-partum period. In the next phase, the family members and friends of the woman would be included in the care plan, whose’ support is key factor that would help the woman to resolve the stressful and depressive symptoms (O'Mahony et al., 2012). In this context, the family members would be discussed regarding the causes of depressive symptoms and the importance of their moral and spiritual support for mitigating the health issues and encouraging the woman to comply with her new role as a mother.
All the stakeholders need to make a collaborative decision related to psychological therapy for the woman. In this context, several previous literatures have suggested that cognitive behavioral therapy is suitable for improving the depression related symptoms among women in post partum period. One of the key concerns of the health issue is lowered self esteem, social isolation, irritation and feeling least valued, which are controlled by the negative cognition. Thus, in this context, the cognitive behavioral therapy would assist the patient to modify the negative cognition, through a through communication. Based on the woman’s status, the number and duration of therapeutic sessions are determined, where all the stakeholders participate and anticipate the decision, in order to maximize the health outcomes (O'Mahen et al., 2012). In the counseling session of CBT, the family members would also be involved, who would be able to provide the client continuous support, thereby encouraging the patient to adopt the coping skills faster and replace her negative thoughts towards the positive one. Therefore, the fate of these strategies would be to improve client’s self esteem and reduce depressive symptoms.
Here, the health issue that has been selected for the population is depression, more specifically post natal depression, which is affecting significantly the health status of the women, undergoing childbirth. The impact of the issue has been discussed upon the population, which is followed by the identification of the SDHs, which include ‘lack of support, education, financial constrain and stress. In the next step, the key stakeholders needed to be consulted for mitigating the health issue has been identified, followed by the identification of the therapeutic and collaborative strategies for mitigating the issue faced by the population.
Allen, J., Balfour, R., Bell, R., & Marmot, M. (2014). Social determinants of mental health. International Review of Psychiatry, 26(4), 392-407.
Beydoun, H. A., Beydoun, M. A., Kaufman, J. S., Lo, B., & Zonderman, A. B. (2012). Intimate partner violence against adult women and its association with major depressive disorder, depressive symptoms and postpartum depression: a systematic review and meta-analysis. Social science & medicine, 75(6), 959-975.
Dennis, C. L., & Dowswell, T. (2013). Psychosocial and psychological interventions for preventing postpartum depression. The Cochrane Library.
Dolatian, M., Mirabzadeh, A., Forouzan, A. S., Sajjadi, H., Majd, H. A., & Moafi, F. (2013). Preterm Delivery and Psycho–Social Determinants of Health Based on World Health Organization Model in Iran: A Narrative Review. Global journal of health science, 5(1), 52.
Gress-Smith, J. L., Luecken, L. J., Lemery-Chalfant, K., & Howe, R. (2012). Postpartum depression prevalence and impact on infant health, weight, and sleep in low-income and ethnic minority women and infants. Maternal and child health journal, 16(4), 887-893.
O’Hara, M. W. (2013). Postpartum depression: Causes and consequences. Springer-Verlag.
O'hara, M. W., & McCabe, J. E. (2013). Postpartum depression: current status and future directions. Annual review of clinical psychology, 9, 379-407.
O'Mahen, H., Fedock, G., Henshaw, E., Himle, J. A., Forman, J., & Flynn, H. A. (2012). Modifying CBT for perinatal depression: what do women want?: a qualitative study. Cognitive and Behavioral Practice, 19(2), 359-371.
O'Mahony, J. M., Donnelly, T. T., Bouchal, S. R., & Este, D. (2012). Barriers and facilitators of social supports for immigrant and refugee women coping with postpartum depression. Advances in nursing science, 35(3), E42-E56.
Wisner, K. L., Sit, D. K., McShea, M. C., Rizzo, D. M., Zoretich, R. A., Hughes, C. L., ... & Confer, A. L. (2013). Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA psychiatry, 70(5), 490-498.