SOCIAL SUPPORT AND PSYCHOLOGICAL DISTRESS BEFORE AND AFTER CHILDBIRTH

Although there is a substantial literature on the prevalence and deter minants of postnatal depression (PND), less attention has been given t o the more general distress that women may experience both before and after childbirth. The emphasis in the literature on PND can at least p artly be attributed to the dominance of a biomedical model (that stres ses conditions internal to the patient) over a psychosocial model (tha t stresses the social context of experience) in research on maternal m ental health. In this paper we combine elements of these two models to explore the social context of well-being for women before and after c hildbirth. In particular, we grant attention to the influence of suppo rt from partners, relatives and friends in predicting levels of antena tal and postnatal distress. Our data derive from a longitudinal survey of 80 women in Auckland, New Zealand, in which we included the Edinbu rgh Postnatal Depression Scale (EPDS) and measures of perceived social support. In order to focus on distress, we treated the EPDS as a cont inuous scale rather than using it to focus on 'cases' of depression. I nterviews were carried out at approximately 36 weeks gestation and 10 weeks post-partum. The ratings for distress were lower postnatally tha n antenatally and whereas mean ratings for partner support improved be tween interviews, levels of perceived support from friends and relativ es declined. One interpretation of the latter finding is that, at leas t within the social context of this study, there are higher expectatio ns of informal support in the postnatal period from beyond the househo ld than occurs in actuality. In further analysis we found a strong ten dency toward distress among younger and less affluent women who percei ve themselves as having weaker social support. This finding supports r ecent attempts to establish places such as women's centres which gener ate informal support in the community.