A Narrative Review of Maternal Depression Research Focusing on Women of Caribbean Descent in the Diaspora and Caribbean Women in the Region

Introduction The postpartum period can bring significant emotional and mental health challenges to women who experience maternal depression. North American and European research on postpartum depression estimates a 10-15% rate for the condition (O'Hara, 1987; O'Hara, 1990; Pitt, 1968; Seyfried and Marcus 2003), while studies on the 'baby blues' indicate a rate of 30-85% (Pitt, 1968; O'Hara, 1987; Seyfried and Marcus 2003; Pearlstein, Howard, Salisbury, and Zlotnick, 2009). Postpartum depression is described as a major form of depression that can share the same characteristics of other depressions (O'Hara, 1987). Its onset usually occurs within four to six weeks after birth and can last for several weeks, months, or years (Cole, 2009). Symptoms of the condition include forgetfulness, low mood, low self-esteem, anxiety, inability to find pleasure in activities that were once enjoyable, weight loss or weight gain, irritability, sleep disturbance, poor functioning, and in some cases thoughts of self-harm or harming one's child (Almond, 2009; Halbreich and Karkun, 2006; Fritz and McGregor, 2013). The 'baby blues' is described as a mild affective syndrome common during the week after birth and can last up to 10 days (O'Hara, 1987; Cole, 2009). Symptoms of the condition include irritability, restlessness, despondency, mild confusion, hypochondrias, mood swings, crying, poor appetite, inability to concentrate, difficulty bonding with one's baby, sadness, feelings of isolation, and tension (Halbreich and Karkun, 2006; Rondon, 2003). Studies conducted in last five decades which have explored postpartum depression and the 'baby blues' are largely based on research done in developed nations like the United States and the United Kingdom. Within these contexts women from diverse backgrounds may report different experiences with maternal depression due to the interplay of factors like race, income, culture, and identity. For example, postpartum depression research conducted amongst Black Caribbean descent women in the United Kingdom shows that financial difficulties were believed to be a common pathway that triggered psychological distress (Edge and Rogers, 2005, p. 18). Experiences of maternal depression may also differ amongst women living in the Global South. Research from Barbados highlights socioeconomic issues and their relation to women's maternal moods, and found that this was a significant risk factor which negatively impacted their maternal mental health (Galler, Harrison, Biggs, Ramsey, and Forde, 1999). In spite of such reported differences in their experiences, maternal depression research that focuses on women from diverse backgrounds, such as Black Caribbean women, is lacking in comparison to available research on White women (Edge and Rogers, 2005). To further investigate the available research on maternal depression, a narrative review of studies from Europe, North America and the English-speaking Caribbean is presented and organized according to three thematic areas emerging from these bodies of work. The central questions that guide the narrative review are: 1. From the previous literature, what do different focuses on postpartum depression and the 'baby blues' tell us about women's experiences with these conditions? 2. What are the central explanations given for postpartum depression and the 'baby blues' in research from Europe, North America and the Caribbean? The review includes a section on the methods, inclusion and exclusion criteria that were used to assess the research studies. Following this is the presentation of the three thematic areas which are: prevalence and incidence of the 'baby blues' and postpartum depression; explaining and understanding maternal depression; and grappling with difference. The paper concludes with a discussion that further problematizes some of the gaps in the research and discusses what kinds of interventions and conceptual/theoretical tools may be useful to advancing the study of maternal depression amongst Caribbean descent women in the Diaspora and Caribbean women living in the region. …