1. My primary health outcome of interest is maternal depression among pregnant women and those with young children, 0-3. As I stated in my introduction in class last week, this variable is both a health outcome in and of itself AND an intermediary determinant for other maternal and child health outcomes. Given this, the maternal mental health of the generation before the patient I see in clinic is one I think we should start to measure and examine. The 2 structural factors I would choose as important determinants of maternal depression are race/ethnicity and gender. Race/ethnicity is a confusing and still poorly understood topic in mental health. Because of the stigma associated with mental illness and the socially constructed need for people of color in the U.S. to portray images of strength and resilience, culturally competent and congruent mental health services for minority women are seriously lacking. Since the pregnant and postpartum states are inherently female, these important phases of the life course are often fraught with additional issues related to gender as a social determinant—whether it be employment, violence, power dynamics in a relationship, access to reproductive health care, etc.
2. As I answered in question 1, there is definitely an intergenerational component to maternal depression. Women with social disadvantage early in their life course will have a higher risk of maternal depression. This may be influenced by their own exposure to a caregiver with mental illness, by exposure to violence and other trauma early in life, or a host of other possibilities such as less reproductive power and choice resulting in an unplanned or undesired pregnancy and the lack of social resources to assist with the demands of pregnancy and motherhood. Neighborhood characteristics may certainly also play a role. The social support of moms groups or a supportive family/neighborhood structure may be less available in some neighborhoods. Less support equals greater risk for maternal depression.