Understanding Depression Among Pregnant Aboriginal Women
Creators: name: Roy, Amrita
Publisher: name: Graduate Studies
Year: 2017
Subjects: subject: Education
subject: Health Sciences
subject: Epidemiology
subject: Health Care Management
subject: Mental Health
subject: Obstetrics and Gynecology
subject: Public Health
subject: Aboriginal
subject: Indigenous
subject: Women's Health
subject: Depression
subject: Pregnancy
subject: Public health
subject: Health services
subject: Mental Health
subject: Structural violence
subject: oppression
subject: race
subject: Stress
subject: Social Support
subject: Cultural safety
subject: Epidemiology
subject: grounded theory
subject: Multi-methods research
subject: Community-based research
subject: OCAP
subject: Colonization
subject: Indian Residential Schools
subject: Intergenerational trauma
subject: Gender
subject: Racism
subject: Prenatal health
subject: Maternal-child health
subject: Social Exclusion

description: Background: Prenatal depression is a significant maternal-child health concern. Research on depression among pregnant Aboriginal women is limited. Given the unique historical and present-day societal context involved, targeted research is warranted. Objectives: 1) To understand the risk factors, protective factors and societal context of prenatal depression in Aboriginal populations. 2) To examine accessibility and safety of clinical and social service systems used by pregnant Aboriginal women, and how they can be improved. Methods: A multi-methods, community-based approach was taken. A qualitative constructivist grounded theory study (Voices and PHACES) was conceived and conducted in Calgary, in partnership with local health and social services and with involvement of Aboriginal community members and Elders. The study involved personal interviews with pregnant Aboriginal women (n=13) and service-providing professionals (n=12), and focus-groups with stakeholders (n=11). Additionally, secondary analysis was conducted of data from the All Our Babies study, a large epidemiological cohort study of n=3354 pregnant women in Calgary. Key results: In this population, the individual-level risk factors commonly associated with depression (e.g., socioeconomic status, chronic life stress) appear to be mediators of the effects of more upstream, systemic factors related to historical and present-day societal context (e.g., racism, sexism, social exclusion, and intergenerational trauma from colonization). Substance abuse was found to be a common coping mechanism for stress, trauma and depression, indicating that mental health issues need to be addressed in order to effectively manage addictions. Social support and traditional Aboriginal healing practices appear protective, and thus may be key intervention strategies. While services in Calgary appear to be working well in certain ways, a need was identified for more culturally-appropriate services, better networking among agencies, as well as strategies to increase accessibility, reduce stigma, and enhance a safe and empowering healing environment for patients and clients. Significance: This dissertation contributes to a better understanding of the determinants of prenatal depression in Aboriginal women, and how the determinants may be addressed in health and social services. Moreover, it opens the door for further research on this important yet understudied topic, and also for the design of effective, evidence-based interventions targeted to this population’s needs.