We discovered a series of themes regarding how informants appeared to interpret sadness, stress or demoralization in the context of their life experiences. Informants spoke of wanting reprieves from chaos – a desire often expressed in terms of wanting to be alone. By contrast, informants expressed loneliness not only in interpersonal terms, but also related to having problems that precluded future relationships, or feeling unique in experiencing an adversity. Informants contrasted the sense of empowerment associated with owning problems to the demoralization associated with feeling that one’s problems were externally imposed and therefore beyond their control. Informants also discussed sadness in relation to their own abilities to readjust their mood. On the mild end of the spectrum, informants related their ability to engage in activities to alleviate sadness. In the middle, informants related an ability to attempt such activities, but saw the attempts as unsuccessful. On the severe end, informants lost the ability to even attempt to make themselves feel better, and as a result expressed feeling stuck or hopeless.
These findings have potential implications for the design of culturally relevant, community-based interventions for maternal depression. First, attention to expressions of loneliness or aloneness may be important to understanding how young mothers interpret sadness. Specifically, programs that acknowledge the importance of “protected time” – in which individuals experience brief reprieves from chaos – appear likely to resonate with potential intervention recipients. Additionally, many of our informants’ expressions of loneliness appear modifiable, though not necessarily through conventional support group mechanisms. Rather, other forms of loneliness (like feeling one’s problems preclude interpersonal relationships) may be more amenable to other remedies, such as cognitive restructuring, motivational techniques, or more “internal” mechanisms of processing life events such as journaling or bibliotherapy.
Second, it may be important for interventions geared to populations like ours to foster the perception of greater control over one’s life. Distinguishing between what an individual can’t control and what she can – and focusing intervention efforts on the latter – may be important. In light of our finding that perceiving ownership of problems can be an empowering notion, it may be important to work to dispel the potential misconception that dealing with problems represents a focus on deficits; rather, that actively dealing with problems may be empowering.
Lastly, community-based maternal depression interventions may consider how to bolster women’s coping strategies so that they can better self-manage their feelings – irrespective of whether such feelings meet conventional criteria for depressive illness. Within community organizations, whose social service personnel are more accustomed to dealing with stress or social problems than with depression per se, such a strategy may represent an alternative to more conventional screening and referral intervention models.
Much of the literature on community-based mental health interventions has emphasized group models that promote social support. Such interventions have demonstrated mixed success (50
), and are logistically unfeasible in certain settings. Additionally, interventions based on screening and referral are limited by the lack of available mechanisms to assure that referrals are brought to fruition (15
). By contrast, many of our specific findings raise the possibility that interventions based on brief cognitive restructuring models may hold promise in settings outside the traditional medical system. Many such interventions have been developed and have demonstrated success in both community and medical settings (18
). There is also evidence that they can be taught to providers relatively inexperienced in mental health (54
Our study has a number of limitations. First, an in-depth discussion of our informants’ strengths and resiliencies was beyond the scope of our study. Although each informant expressed a unique set of strengths, this paper intentionally focused on perceptions of sadness, stress and demoralization; and that should not be interpreted as a comment that our informants’ weaknesses overwhelmed their strengths. Second, like many qualitative research endeavors, ours is not necessarily generalizable. All our informants were recruited from a single metropolitan area; all spoke English; and all had the social wherewithal to access the services from which they were recruited into the study. We cannot, therefore, comment about other, possibly more marginalized populations. We contend, however, that the venues from which our subjects were recruited reflect important national-level programs within which future depression programs are likely to be implemented, and that such a recruitment paradigm represents one of our study’s principal strengths. Lastly, our sampling frame was meant to maximize variability in responses. Its primary benefit was that it allowed us to hear from a wide range of informants; but this came at the expense of being able to make inferences on the basis of a proportionally representative sample.
Understanding women’s perceptions of their own feelings of sadness, stress or demoralization is important to maximizing the effectiveness of interventions designed to help them address these feelings. That said, our results do not indicate that one specific intervention model would be superior to any other. However, when viewed in the context of the Life Course Model – in which factors that impact wellbeing affect families across generations, and in which building capacity in the community represents a key strategy to reduce risk and foster resilience (55
) – our findings do shed light on potentially promising avenues for intervention planning. Given the morbidities associated with maternal depression – and the poor access to quality mental health services that low-income women have – the public health implications of such interventions, if successful, could be substantial.