Investigating Sociocultural Risk Factors for Maternal Depression Among South Asian Mothers with Toddlers in the United Kingdom

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This study explores the cultural, social, and environmental risk factors contributing to depression among British South Asian mothers with toddlers age 1–3 years. Toddler years are considered crucial and sensitive to maternal depression in developing optimal cognitive, motor, language and behavioural skills. While postnatal depression (PND) has been widely documented among South Asian women, this research specifically investigates the depressive symptoms beyond the first postnatal year; a period often overlooked in maternal mental health literature. Methods Using a qualitative design, in-depth interviews were conducted with a diverse sample of 19 South Asian mothers across the UK to understand their lived experiences. Reflexive thematic analysis was completed with hybrid deductive-inductive approach using pre-defined main topics and sub-themes were formed inductively using data. Results . The analysis identified three overarching themes. The first theme, risk factors for depression , reflected culturally embedded stressors, including hierarchical family structures emphasising obedience, high expectations and pressures, loss of traditional support networks, and challenge of keeping up with traditional roles of domestic responsibilities with balancing employment. The second theme, impact of depression , highlighted emotional exhaustion, reduced sense of willpower, and strained familial relationships, which collectively affected mothers’ wellbeing and parenting experiences. The final theme, overcoming depression , emphasised the importance of emotional support and encouragement, alongside the involvement of key stakeholders such as family members and community networks, in supporting mothers’ recovery. Conclusion These findings highlight the need for culturally responsive mental health services that address the multiple, layered risk factors faced by South Asian mothers, including cultural pressures and limited access to support systems. Policies should prioritise the strengthening of protective factors , such as family and partner involvement, community-based education, and improved engagement with health and social care services. Investment in culturally adapted psychosocial parenting programmes that integrate mental health support has the potential to improve maternal wellbeing and support healthier child development during the critical toddler years. Maternal depression South Asian toddlers culture Figures Figure 1 Background In the United Kingdom, the South Asian population form the largest ethnic group with 9.3% of the total population. The culture and familial practices are shared by most of the countries in the region including India, Pakistan, Bangladesh, Nepal, Sri Lanka and Bhutan [ 1 ]. Postnatal depression (PND) has consistently been found to be more prevalent among South Asian mothers compared to their native counterparts [ 2 ] [ 3 ] [ 4 ]. Women who develop PND are at a heightened risk of experiencing recurrent episodes of depression within the following five years[ 5 ]. Similar findings are echoed within the South Asian population, where 56% of pregnant South Asian mothers identified with PND remained depressed 12 months postpartum [ 6 ]. A multicentre Randomised controlled Trial of a culturally adapted group Cognitive Behaviour Therapy intervention for South Asian mothers reported short-term improvements in postnatal depression; however, these differences were no longer significant at 12-month follow-up, suggesting highlighting the potential need for identifying maintenance risk factors of depression in toddler years [ 7 ]. The nature of symptoms of depression can affect the mother with impaired self-esteem, low energy, higher irritability, dysmorphic effect, cognitive confusion, helplessness and hopelessness [ 8 ]). A meta-analytic review concluded significant association between depression and negative maternal behaviour such as hostility and irritability as well as obstructed warm and sensitive parenting [ 9 ] [ 8 ] and impact on over all secure mother toddler attachment [ 10 ]. A study in Bangladesh reported depressed mothers were less likely to provide responsive care-giving environment for young children [ 11 ]. There is dearth of literature showing toddler years as a critical and vulnerable point for neurodevelopment. Domains such as motor, perceptual, cognitive, language, and self-regulation develop significantly during this phase [ 12 ]. Research has shown that children of mothers with persistent depression are at higher risk for cognitive, emotional, and behavioural difficulties in early years [ 13 , 14 ] [ 15 ].Low caregiving quality can have an impact on the cognitive development including lower expressive language [ 16 ], intellectual functioning [ 17 ] emotional problems, disruptive behaviours, attention [ 18 ] and motor delays [ 12 ]. Longer term affects are also reported for academic performances, job success as well as physical and mental health. [ 19 ] [ 20 ] [ 21 ]. High rates of maternal depression amongst South Asian mothers have raised growing concerns about their potential impact in declining cognitive development [ 22 ] [ 23 ] and increase in internalising and externalising behaviour in early childhood [ 24 ]. These findings highlight the urgent need to address maternal wellbeing as part of a broader strategy to support child development in British South Asian mothers. Higher rates of depression among British South Asian mothers have been linked to a range of culturally specific risk factors, including postnatal isolation, limited social support, marital difficulties, financial stress, and dissatisfaction with the lack of culturally appropriate postnatal healthcare[ 25 ] [ 23 ]. Culturally adapted psychosocial interventions have been shown to be effective among mothers of South Asian origin, yet most existing programs focus on early infancy [ 23 , 26 ]. The risk factors for depression among South Asian mothers of toddlers is an underexplored area. The gaps in understanding risk factors and parenting challenges limit the development and delivery of culturally sensitive support services. There is a need to investigate how depressive symptoms impact the lives of mothers during the toddler years, and how interventions can be tailored to address both parenting challenges and culturally specific stressors. Aim: This study aimed to understand risk factors of depression, amongst British South Asian mothers with toddlers, including the cultural and social factors shaping it, its impact on daily life, and their approaches to seeking help. The study also aimed to explore the impact of depressive symptoms and both formal and informal support strategies. Methods To capture diverse viewpoints and the nuanced lived experiences of British South Asian mothers, individual qualitative semi-structured interviews were utilised to explore factors associated with maternal depression [ 27 ]. Qualitative approaches are particularly valuable because they also generate detailed narratives and participant quotes that provide insight into real-world experiences, behaviours, and the context in which challenges occur [ 28 ]. Therefore this study set out to investigate the distinctive personal experiences, beliefs, and interpretations of British South Asian mothers, with qualitative approaches recommended to identify culturally specific health determinants [ 29 ]. Recruitment A total of 19 mothers with toddlers were recruited to the study. Inclusion criteria for participation in the interviews required that participants self-identified as being of South Asian ethnicity, with heritage from at least one of the following countries: India, Pakistan, Sri Lanka, Bangladesh, Nepal, Bhutan, or the Maldives. Participants were aged 18 years or older and had at least one child between the ages of one and three years. The mothers must be experiencing low mood or depression. Participants were required to be able to communicate in Urdu or English. Other South Asian languages were not included due to limited linguistic capacity within the research team. Although Urdu is the national language of Pakistan, it is also widely understood and used across several South Asian communities, enabling inclusion of mothers from diverse South Asian backgrounds. [ 30 ]. Lastly, participants were required to score 7 or above on the PHQ-9, indicating the presence of low mood or symptoms consistent with depression [ 31 ]. The PHQ-9 is a brief self-report instrument that assesses the severity of depressive symptoms rather than providing a diagnostic classification. In this qualitative study, the PHQ-9 was used to identify the presence of low mood in order to inform sampling and contextualise participants’ narratives, rather than to establish a clinical diagnosis. Its use in this study was informed by its well-established psychometric strength and cross-cultural validity, including within South Asian populations [ 32 ] [ 33 ]. A poster with the study’s information and researcher’s contact details were posted on appropriate social media platforms and third sector organisations such as Bolton Hindu forum, Bangladeshi community in UK, Sri Lankans in UK and Respectful Parenting by Maryam Munir with the admin’s support. Interested participants contacted the researcher and were sent initial screening package (information sheet, screening consent form, PhQ-9 screening tool) The eligible participants were sent study information sheet and informed consent form and demographic information form electronically. Participants were purposely sampled to ensure diversity in ethnicity with South Asian region, native languages, and socio-economic status across the country. The research team arranged a convenient time with eligible participants to further discuss the aims and rationale of the study. The participants were given an opportunity to further ask questions. They were given 24 hours to decide their participation in the study. Consenting participants were asked to complete and sign the written informed consent form. Once written consent was received, the participants were contacted to arrange an interview at a time and location suitable for them. Procedure: All the interviews were conducted by AS. The interview was conducted using the topic guide. Development of the topic guide was informed by existing literature and social media insights and supported by consultation with a small Patient and Public Informant (PI) group comprising of two South Asian mothers of toddlers. The group provided input on the interview layout, mode of delivery, confidentiality considerations, and the final selection of topics. A consensus method was employed to reach agreement on all aspects discussed. The participants were offered flexible dates and timing to complete the interviews online (via zoom). Online interviews were decided at the recommendation by Patient informant group as well as its recent popularity amongst researchers due to its ability to overcome some of the barriers faced by in-person interview such as geographical distance and the time and cost involved in travelling to meet [ 34 ]. Comparative evidence concluded data collected through virtual means can be as rich and valuable to the researcher as that generated via traditional face-to-face meeting [ 35 ]. To minimise risk for data protection and participants privacy during the online interviews; the participants were given flexibility on timings and dates for the interviews. They were encouraged to pick a location, date and time. There were in space that provided confidentiality. The participants were given the option of pausing or stopping the interview should they feel their privacy was at risk. The researcher was also in a private room with no one else present to ensure participants privacy. The participants were further sent a distress policy post each interview. (The distress policy is available upon request from the author). Each interview lasted approximately an hour, and the participants were given the option to take as many breaks as they needed. All the interviews were completed mainly in English with some references of words in Urdu, translated by AS. Analysis The data collection took place from March 2024 till July 2024. The interviews were anonymised, transcribed verbatim and analysed using Thematic Analysis[ 36 ]. Reflexive thematic analysis allows flexibility to conduct using a hybrid deductive–inductive approach, whereby the analysis was guided by three pre-defined topic areas, while allowing sub-themes to be generated inductively from the data. This enabled the identification of novel and context-specific insights without forcing the data into a pre-existing theoretical framework. This approach is particularly well suited for exploring the culturally embedded experiences of South Asian parents, as it supports an in-depth examination of the complex social, emotional, and cultural interactions that shape their lives. Reflexivity was maintained throughout the analytic process, with the lead researcher’s background in cultural mental health research informing sensitivity to context, while ongoing reflection and peer discussion were used to minimise the influence of prior assumptions on theme development. In accordance with guidelines of thematic analysis, transcripts were read and re-read multiple times to establish thorough familiarisation with the data. This was then followed by creating initial codes based on significant statements in NVIVO software [ 37 ] creating consistent library of codes and sub-codes. The codes were recorded according to the data relevant to the research questions. Themes were developed to be conceptually homogenous where all codes grouped within a theme reflected a coherent underlying pattern. The themes were reviewed with the remaining research team and re-organized for overlaps and contradictions. The themes were finally defined and reported in the findings. Results Table 1 : Participants demographics The participants identified their ethnicity to six different countries (Pakistan, India, Sri-Lanka, Bangladesh, Maldives) with age range from 27–39 years, representing 4 religions (Muslim, Hindu, Sikh and Christianity). There were a total 19 mothers recruited and successfully interviewed across UK (South, West, Midlands and Northern parts of UK). There were ten mothers from first generation residing in the UK and 9 mothers who identify themselves as second generation. Majority of the mothers completed tertiary education or above and are classified as highly educated. Table 1 Sample characteristics of Participants: Total PHQ-9 Score Ethnicity Generation Toddler's age Number of children Education Religion AGE 1 7 Pakistani 1st Generation 2 2 Doctorate Muslim 37 2 11 Pakistani 2nd Generation 1 1 Degree Muslim 28 3 7 Pakistani 2nd Generation 2 4 College Muslim 37 4 15 Pakistani 2nd Generation 1 and 3 2 Higher degree Muslim 38 5 7 Pakistani 2nd Generation 2 3 College Muslim 35 6 8 Pakistani 1st Generation 2 and 1 2 Doctorate Muslim 32 7 7 Pakistani 1st Generation 1.5 2 Doctorate Muslim 33 8 8 Pakistani 2nd Generation 1 and 3 2 Higher degree Muslim 39 9 7 Indian 1st Generation 1 2 Masters Muslim 36 10 12 Bangladeshi 2nd Generation 3 3 Degree Muslim 38 11 9 Indian 2nd Generation 2 2 Degree Sikh 39 12 10 Pakistani 2nd Generation 1 1 Degree Muslim 27 13 7 Bangladeshi 2nd Generation 1 3 College Muslim 35 14 13 Sri Lankan 1st Generation 3 2 Masters Muslim 35 15 12 West Bengal, Indian 1st Generation 1 2 MBA Hindu 37 16 10 Indian 1st Generation 3 1 Masters Hindu 35 17 9 Maldivian 1st Generation 3 2 Masters Muslim 39 18 11 Sri Lankan 1st Generation 1 1 Diploma Christian 35 19 7 Sri Lankan 1st Generation 3 2 Degree Christian 33 The analysis generated three main themes with subsequent sub-themes. The first main theme was Risk factors of depression with three associated sub-themes. The second themes were Impact of depression and included three sub-themes. Lastly, the final theme was mothers’ suggestions on strategies to minimise risks and to overcome depression with two associated sub-themes. Figure 1 presents all the main themes and subsequent sub-themes. Theme 1: Risk Factors of Depression Sub-theme: Cultural obedience and hierarchical power In traditional South Asian culture, showing respect and deference to elders is a deeply valued practice, one that is often seen as a marker of good upbringing and cultural pride. For many South Asian women, particularly daughters-in-laws, meeting the expectations of in-laws by demonstrating compliance and humility is viewed as essential to maintaining their identity as a respectful and “cultured” bride. While this custom is often regarded as endearing and rooted in familial harmony, several mothers described how it can also conflict with their personal autonomy. The pressure to meet these expectations left some feeling powerless, unheard, and unable to assert their own needs or parenting choices, particularly during emotionally demanding periods such as early motherhood. “I think elders do… elders do. It’s a hierarchal cultural system; you must respect the elders …they have ticket to say whatever they want because you know your elder you you know better p = 02 In South Asian culture, particularly within joint family systems the norm of showing respect and deference to elders for mothers can mean even compromising on routine, day-to-day decisions based on the preferences of senior family members. These expectations may conflict with a mother’s own needs, parenting style, or sense of autonomy, particularly during the already demanding phase of early motherhood. The constant negotiation of these dynamics can leave women feeling powerless, unheard, and unable to assert their own preferences. Over time, this lack of autonomy and emotional support may contribute to poor maternal mental health, including heightened stress and depressive symptoms. “I think it's a lot of pressure when you're living with in laws as well because everything just magnified like 100 times more. Like what time you go to bed, you're not involved, or you don't want to be there. She wants to isolate herself she doesn't want family time and dress code as well. if you want to just get into pyjamas sometimes you just don't or if you want to just put your hair in a bun…they frown upon that. If you've got brother in laws and father-in-law then you can’t be in English clothes. Everything is just magnified a lot more.” P = 07 The hierarchical nature of South Asian family system is so deeply embedded that, for generations, women have been socialised to accept their subordinate roles without question. As a result, many are less likely to seek avenues for support or challenge the difficulties they face within these structures. Over time, this has led to the internalised acceptance of powerlessness in various aspects of their lives; particularly in areas related to decision-making, autonomy, and self-expression. Rather than contest these constraints, many women choose to endure them silently, viewing resistance as either futile or culturally inappropriate. “In Asian culture… its that women don’t complain. women know it’s their life, they accept it. Whatever hardship are thrown … you still have to carry on with it. The biggest thing is cultural side… where you are not supposed to complain and I think religion can play a part.” P = 14 “Especially Christians value the respect of others we respect others speech we never argue or speak against the elder so I would always say OK…. so that OK itself you know finally (pauses for a laugh) made me cry.” p = 15 Sub-theme: High expectations and pressure Within the community and extended family, South Asian mothers are often expected to be all-rounders, fulfilling multiple roles with near perfection to be recognised as active and respectable members of the family or community. Despite the intense demands of motherhood, persistent pressure for mothers to remain available and responsive to the needs of others, including in-laws, spouses, and community obligations. Their performance as wives and mothers is often quietly scrutinized, adding another layer of invisible labour. These expectations frequently exceed a mother’s emotional and physical capacity, leaving her feeling overwhelmed, frustrated, and emotionally depleted. “Woman must strive hard to make each and everyone happy otherwise she is labelled as irresponsible and may be bad mum, bad wife or a bad daughter in-law. I think to full fill that criteria… she needs to do a lot … beyond her capacity sometimes” P = 13 Mothers also reported strong culture comparison within the community which added significant pressure to conform and trigger their low mood. A common theme was intergenerational comparison, particularly between the perceived struggles of mothers-in-law and those of daughters-in-law in raising children. These comparisons were often used to minimise the current challenges faced by younger mothers. In addition, mothers frequently felt compared to other women in the community in terms of how well they were fulfilling their roles as wives, mothers, or daughters-in-law. Collectively, these comparisons led to feelings of inadequacy, self-doubt, and increased emotional distress. “With us Pakistanis you know ‘hamari time asa nai tha’ (we were not like that in our time). They done a lot (women form older generation making the comparisons) more so while they're feeding their child they went on the housework their houses were spotless and this and that and we can just about manage to feed our children….you feel like low you're not as strong ….you know that just makes you feel really down” p = 05 Some mothers reported that even in the absence of direct external pressures, the lasting influence of cultural norms led them to self-inflict the same expectations. Many felt compelled to uphold the ideology of the 'perfect mother' one who manages all aspects of parenting and household responsibilities seamlessly to be perceived as a successful woman within their community. This internalised pressure often intensified their depressive symptoms, as they struggled to meet these unrealistic standards. “with my in laws I didn't get any pressure like they always offered help, and I felt like no I… I want to be the perfect mum and I want to and I want to set the standards high standards from the beginning and I want to do everything and I want to show people that yeah like but I was a good mum” P = 17 While maintaining high standards for themselves, mothers who have chosen to sacrifice their careers to focus on child-rearing reported experiencing a sense of lost identity and shame due to their perceived inability to effectively balance both career and parenting roles. “really bad… some days I feel very very depressed… that after working so hard I gave up. I used to be so career oriented, It’s like there is no win win situation… I would be in 2 boats at the same time… I wont be able to give 100% to my career nor to my children…. I think it does happen a lot with other mothers where they are not able to pursue their career” p = 11 Sub-Theme = It takes a village: the lost network of support for mothers Mothers reflected on the culturally embedded expectations of South Asian women, noting that in the past, these roles were more attainable when supported by a wider “village” network including extended family, neighbours, and community members who shared in the responsibilities of caregiving and domestic life. In contrast, today's mothers often face higher demands from both family and society, but without the same level of communal support. Family members, including husbands, are frequently unable to provide adequate help due to their own time constraints, work commitments, and personal obligations. As a result, the traditional expectations placed on women remain, but the support systems that once made them manageable have diminished, leaving mothers feeling isolated and overwhelmed. I feel like back in the days….there was more of support network…now a days… no one has time… people are working till their 45–50… I remember my grandma would come and stay with my mum after she would have a baby… and I didn’t get that Cultural and familial pressures were also reported to discourage husbands from offering support to their wives, due to the perception that doing so would suggest they were being controlled by their spouses. Within this context, receiving support was often viewed as a threat to traditional gender roles of man to be seen as working and provider. because he is a ‘banda’ (man), he works, that is his role… for example if my husband would wake up get kids ready for school… give them breakfast…. it would be an issue… why is she not doing it. He works so he should not be helping me. But If it’s a woman… she needs to work, do the chores, watch the kids and do everything P = 01 “He can't support his wife…they gonna start calling him comments like ‘ran mureed’ (under his wife’s control) so he he'll feel embarrassed to help because he doesn't want to look as if he's controlled by his wife.”P = 07 Even in the absence of explicit external discouragement, many couples remained deeply embedded in traditional gender role expectations. Women often expressed feelings of guilt when receiving support from their working husbands, internalising the belief that caregiving and household responsibilities were solely their domain. “If my husband even do a little bit… like he fed kids breakfast… I feel like it’s a lot and he shouldn’t be doing it. If he ever helps with the dishes or beginning of marriage… he used to help I would stop him and ensure I do it and tell him I am home he works so I should not be doing it” P = 11 Conversely, men who were willing to offer support frequently felt uncertain about how to do so, having grown up in environments where male participation in domestic and caregiving roles was rarely modelled. This mutual entrenchment in conventional gender norms contributed to a lack of support for mothers leaving them isolated in navigating high demands of balancing motherhood and cultural pressures. “they don't have this male dominance but they were brought up in a way that they don't know they're not capable of doing these things it's like my husband wants to support he would say that or really I feel like supporting I really want to support you but I don't know how so that's the issue” p = 18 On the contrary mothers living in a nuclear family system complained of having no family support, while they are trying to establish their feet in a new country. They talked about the protective factors of depression of having extensive support from in-laws or extended family. “the lack of support in general you know the village these days …I I I have a friend who lives with her in laws …it could pose other challenges but there is support also… rather than having nobody. if we are delayed from work by half an hour we will be really stressed out but if you have you know some elderly people or big cousins or sister-in-law with your kids… you have that extra layer of support …and you don't go mad. P = 08 In addition, mothers felt that their depression often worsened when it went unrecognised or unsupported by health services, leading to feelings of disappointment and neglect. Many felt that only those with supportive family members were able to effectively navigate and cope with this challenging period, highlighting a significant gap in formal mental health support. “we don't get told about it …. no… my my mother-in-law ….supported me.. she knows about the difficulties you know that come with pregnancy and after birth but same time ..we don't get told enough from the doctors ….” P = 05 S ub-theme = The Double Burden: Juggling Work and Domestic Duties Mothers felt in comparison to previous generations where they worked to simply earn money, South Asian women are more encouraged to build careers over the years. To achieve balance between running a house and continuously work on a career is an added challenge for current generation. “Because I think the older generation think that they've done it they've done their jobs they've had I wouldn't say careers because a lot of them weren't educated back then… so going forward they have educated their children their daughters for example sent them to universities and they have now degrees. So now women have a career rather than a job so it's not like you're just going for five hours to do a job somewhere coming home looking after the kids cleaning like now women have a career …..” p = 16 Over time, with each generation, the pressures and responsibilities placed on mothers have increased rather than shared. While men largely continued in the role of breadwinners, career-oriented mothers were expected to contribute financially while still maintaining their traditional roles at home. “they still want the professional wife like my background is law, so I would still work but then come home and then just switch hats and fully be doing everything and I think it's a lot of pressure when you're living with in laws. I have to dress accordingly, then make the food umm for everyone my mother in law would help here and there. My husband would also work but he'd come home and he just get into pyjamas and relax in front of the TV, where with me you know if…. if my mother-in-law was standing up it was like why she's standing and you're not standing like go and help (the mother-in-law).” P = 07 Mothers expressed a collective awareness of the challenges and cultural pressures faced by South Asian women, which they believed contributed to disproportionately high rates of postnatal depression within their community. They highlighted how culturally specific expectations, particularly surrounding familial roles and relationships, placed South Asian mothers at greater risk. “I don't think people realise because of our culture as well how likely we are to get depression like literally like I think 80% of us Asian women would have depression after first born there's only like the few rare cases where you have a great postpartum experience but the chances of that happening are so so low” p = 17 THEME 2: Impact of depression Sub-theme= Emotional Exhaustion and Lack of Willpower Mothers expressed that the aftermath of depression often leads to a lack of motivation in caring for themselves and managing essential daily tasks, which over time can contribute to a loss of self-identity. “so… with low mood now you have less energy you have less motivation to do things eventually you might be motivated with the reason so I’m not doing well I am going to try to better. You get to the stage where you burn out… you have stuff in your mind…stuff coming from other people…” p = 02 Sub-theme: Impact on familial relationship The mothers highlighted how the after-effects of depression can have a detrimental impact on their relationships, as mental health struggles affect one’s entire personality and interferes with the ability to fulfil the role already a high demanding role as a wife, mother as well as towards extended family or community. “you are very very low. just you know…. not happy with your life and very irritated with your partner like feeling resentful and then that does obviously affect our general mood day-to-day p = 05 “You cant pour from an empty cup… when you already feel so low what can you give to anyone else. I feel like a failure… I am not able to be the mother I can be for my kids… the patience I should have for kids that age… I don’t have that…p = 11 THEME 3: Overcoming depression Sub-theme- Support and Encouragement Mothers emphasised the importance of cultivating a supportive, non-judgmental environment amongst family and friends. A strong social network and gestures of encouragement from them can play a crucial role in helping them navigate the challenges and societal pressures faced by South Asian mothers. I think presence of non judgmental friends who support you instead of making you worse., especially in UK. It’s important to have that network nearby also… and able to take time out. I think generally if I am relaxed I would found those challenges challenges and wont be getting triggered easily. Also I struggle asking for help…. If you feel you cant cope then learn to get help from your partner, friends or hire help. p = 11 Sub-Theme= Support from stakeholders Mothers felt when support was provided, such as midwives taking simple yet meaningful actions like informing family members about the mother's struggles or postnatal depression, it was perceived as highly effective and validating. “this person used to come… I really liked that she gave me good tips… when you feel overwhelmed or low with the child just take a break from them. Go in a different room, for a small walk. I would leave the child with the dad and just step out for 15–20 minutes and it helped me a lot. If I continuously stayed in that routine… I felt irritable and resentful. P = 10 Healthcare professionals were also perceived as holding an influential position, where their advice was more likely to be taken seriously by extended family /in-laws, lending weight to the mother's needs. “ time of difficulty a recognized person like a midwife who used to visit yeah at the house often you know can console the mother-in-law’s because…. they are the mediators like the they are the ones who play an important role in between the other people and the mom and the child so people believe what the midwives tell because the the family members and the neighbours will not come to the hospitals to listen to what the doctor say they will listen those things from us through us but midwives comes to the home… come home… they come home and you know they speak in front of the others so uh so they can play a big role like midwives. P = 15 Discussion This study provides new insights into maternal depression among South Asian mothers during the toddler years, a period that has received limited attention in the literature. Four primary themes emerged as key risk factors: cultural obedience and the hierarchical influence of elders; particularly in-laws in South Asian households; cultural pressures placed on mothers; limited social and familial support; and the challenges of balancing domestic and work responsibilities without compromise. Additional themes highlighted the impact of depression on mothers’ well-being and familial relationships, as well as mothers’ perspectives on the support they need to cope and recover. This study specifically identified a lack of autonomy in relation to elders within the family as a key factor. In addition, there were strong cultural pressures to excel in all traditionally assigned roles, such as being a good wife, mother, and daughter-in-law. These expectations were further intensified by a pervasive culture of comparison either with mothers from previous generations or with other women in the community. Collectively these culturally specific factors emerged as common triggers for low mood and persistent depression amongst South Asian mothers. The findings of this study align with previous research, which has consistently shown that culturally specific pressures such as the authoritative role of in-laws and the high expectations placed on women contribute to an increased risk of depression amongst South Asian mothers [ 3 ] [ 38 ] [ 23 ] where even level of support from husbands can be influenced by other family members [ 39 ]. On the contrary, immigrant mothers away from the family or those in nuclear family setup reported unique challenges of raising children, while there is an emerging shift from collectivist, family-oriented culture. The communal support system often described as "a village to raise a child" is no longer accessible to many in the current generation due to the increasingly demanding lives of extended family members or living away from them. Lloyd and Duffy (1995) [ 40 ] believe that, beyond this natural ebb and flow of family members, families are becoming more dispersed. Young and elderly adults, spouses, and other relatives who might otherwise have shared a home are now more likely to live apart from one another. This study supports earlier findings that mothers now living in isolation are at greater risk of depression, largely due to the absence of practical and emotional support that traditionally emerged from wider familial networks [ 41 ] [ 42 ] [ 2 ]. With the diminishing support from community and with changing times, the traditional roles of gender still play a part with mothers struggling to access support from husbands due to cultural pressures and lack of time. Cultural pressures encourage the husbands to conform to rigid patriarchal roles, which typically exclude active involvement in domestic and caregiving responsibilities [ 25 , 43 ].While such norms are still present, this study found that even amongst couples who are willing to support each other, both partners often remain constrained by culturally defined gender expectations. Men may lack models or frameworks for engaging in childcare and emotional support, and when they do offer support, women may feel guilty or inadequate for accepting it, due to deeply internalised cultural ideology of the self-sacrificing mother and wife. Consequently, the mothers in current generation with their child in toddler years are more likely to have added layer of responsibilities as well as pressure of wanting to go back to work or even bear the loss of their career due to child rearing responsibilities. Research has shown barriers in South Asian women seeking employment are deeply rooted in cultural, familial, and societal norms. [ 44 ]. At the risk of minimum familial and partner’s support mothers further expressed disappointment in getting the appropriate care from health care services. Recent studies has strongly supported the notion on South Asian women continuing to demand culturally appropriate services where complex inter-generational and cultural risks factors affecting mothers mental health should be incorporated in treatment and support [ 1 , 45 , 46 ]. The mothers also described impact of living with enhanced challenges of depression leads to feelings of resentment toward partners, negatively impacting marital relationships. The quality of the marital relationship has consistently been shown to act as both a protective and a determining factor in the development and maintenance of depression among South Asian women. [ 3 , 26 ] [ 47 ]. It can further contribute to their low mood and feeling isolated, undermining their ability to fully engage in parenting during their child’s critical toddler years. Strengths and Weaknesses Despite growing evidence on maternal depression in the perinatal period, few studies have examined the experiences of South Asian mothers during the toddler years. This study addresses this gap by exploring parenting challenges and culturally adapted intervention needs for this population, providing insights that can inform more effective and culturally sensitive psychosocial programs. Due to the online nature of this study, a geographically diverse and representative sample of South Asian mothers from across the UK was attained. The sample included mothers from a range of South Asian countries and encompassed participants from the major religions practiced in the region. However, the study is limited. It did not include a significant number of participants from lower educational backgrounds. Previous research indicates that women from Pakistani and Bangladeshi backgrounds are more likely to have lower educational qualifications, and lower education levels are also associated with higher fertility rates within South Asian populations [ 48 ]. It appears that women with limited education may not have been adequately reached, as those with limited education may have faced challenges accessing or navigating the online recruitment materials and platform. As a result, the findings may underrepresent the experiences of more vulnerable or socioeconomically disadvantaged South Asian mothers. In a recent systematic review, deeper culturally adapted parenting programmes showed benefits for parenting knowledge, but effects on post-natal depression were inconsistent or non-significant in some analyses[ 49 ]. Moreover, interventions targeting parental mental health alone often do not lead to improvements in parenting behaviours, highlighting the need for integrated psychosocial parenting approaches [ 50 ]. To achieve this, future research and service provision should consider the cultural, social, and emotional challenges faced by South Asian mothers during periods of maternal depression. Conclusion This study supports previous research on the role of socio-cultural, immigration-related, and lack of support risk factors contributing to maternal depression amongst South Asian women. However, it also highlights additional layers of challenges that emerge beyond the first year postpartum. During this period, mothers face multiple pressures. Some struggled to balance domestic duties with career demands while others had a difficult realisation of having lost their careers due to motherhood. Alongside these challenges, they continue to navigate cultural expectations, such as managing hierarchical relationships with in-laws and meeting community standards. Despite these layered responsibilities, support from their husband, community and health care services for the mother often remains minimal. The present study highlights the importance of incorporating potential protective factors, such as family involvement, partner support, and engagement with healthcare providers, while simultaneously addressing and reducing the cultural pressures and judgement often placed on women during this vulnerable period. Such an approach may promote improved maternal mental health and support optimal toddler development. Declarations Funding: No funding was provided for this project. Competing Interests The authors declare they have no competing interests in relation to this study. Author contributions. AS conducted the interviews, carried out the analysis and drafted the manuscipt. KL and NH supervised the qualitative analysis and worked on editing the manuscript. MP assisted in editing and revising the manuscript. All authors read and approved the final manuscript. Human Ethics and Consent to Participate declarations Ethical approval for this study was obtained from the University of Manchester Ethical Committee (Ref: 2023-16909-32220)All participants were provided with detailed information about the study and gave written or electronic informed consent prior to participation. The study was conducted in accordance with the ethical standards of the Declaration of Helsinki. Data The qualitative data generated and analyzed during this study are de-identified; however, due to the qualitative nature of the data and the potential risk of participant re-identification, the full interview transcripts are not publicly available. De-identified excerpts relevant to the study are included within the manuscript. Additional data may be made available from the corresponding author upon reasonable request and subject to ethical considerations. References Prajapati R, Liebling H. Accessing Mental Health Services: a Systematic Review and Meta-ethnography of the Experiences of South Asian Service Users in the UK. J Racial Ethn Health Disparities. 2022;9(2):598–619. Husain N, Creed F, Tomenson B. Adverse social circumstances and depression in people of Pakistani origin in the UK. Br J Psychiatry. 1997;171:434–8. Nilaweera I, Doran F, Fisher J. Prevalence, nature and determinants of postpartum mental health problems among women who have migrated from South Asian to high-income countries: a systematic review of the evidence. J Affect Disord. 2014;166:213–26. Traviss GD, West RM, House AO. Maternal mental health and its association with infant growth at 6 months in ethnic groups: results from the Born-in-Bradford birth cohort study. PLoS ONE. 2012;7(2):e30707. Horwitz SM, et al. Persistence of Maternal Depressive Symptoms throughout the Early Years of Childhood. J Women's Health. 2009;18(5):637–45. Rahman A, Creed F. Outcome of prenatal depression and risk factors associated with persistence in the first postnatal year: prospective study from Rawalpindi, Pakistan. J Affect Disord. 2007;100(1–3):115–21. Husain N, et al. Efficacy of a culturally adapted, cognitive behavioural therapy-based intervention for postnatal depression in British south Asian women (ROSHNI-2): a multicentre, randomised controlled trial. Lancet. 2024;404(10461):1430–43. Cicchetti D et al. An organizational perspective on attachment beyond infancy: Implications for theory, measurement, and research. 1990. Lovejoy MC, et al. Maternal depression and parenting behavior: A meta-analytic review. Clin Psychol Rev. 2000;20(5):561–92. Teti DM, Gelfand DM, Messinger DS, Isabella R. Maternal depression and the quality of early attachment: An examination of infants, preschoolers, and their mothers. 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Intellectual problems shown by 11-year-old children whose mothers had postnatal depression. J Child Psychol Psychiatry. 2001;42(7):871–89. Brennan P, et al. Chronicity, Severity, and Timing of Maternal Depressive Symptoms: Relationships With Child Outcomes at Age 5. Dev Psychol. 2000;36:759–66. Berens AE, Jensen SKG, Nelson CA 3. Biological embedding of childhood adversity: from physiological mechanisms to clinical implications. BMC Med. 2017;15(1):135. Brito NH, Noble KG. Socioeconomic status and structural brain development. Front Neurosci. 2014;8:276. Kim P et al. Effects of childhood poverty and chronic stress on emotion regulatory brain function in adulthood. Proceedings of the National Academy of Sciences, 2013. 110(46): pp. 18442–18447. Baird H, Harris RA, Santos HP Jr.. The Effects of Maternal Perinatal Depression on Child IQ: A Systematic Review. Matern Child Health J. 2023;27(9):1489–502. Husain N, et al. Social stress and depression during pregnancy and in the postnatal period in British Pakistani mothers: a cohort study. J Affect Disord. 2012;140(3):268–76. Prady SL, Kiernan KE. The effect of post-natal mental distress amongst Indian and Pakistani mothers living in England on children's behavioural outcomes. Child Care Health Dev. 2013;39(5):710–21. Parvin A, Jones CE, Hull SA. Experiences and understandings of social and emotional distress in the postnatal period among Bangladeshi women living in Tower Hamlets. Fam Pract. 2004;21(3):254–60. Insan N, et al. Social determinants of antenatal depression and anxiety among women in South Asia: A systematic review & meta-analysis. PLoS ONE. 2022;17(2):e0263760. Van Manen M. Researching lived experience: Human science for an action sensitive pedagogy. Routledge; 2016. Denzin NK, Lincoln YS. The Sage handbook of qualitative research. sage; 2011. Patton MQ. Qualitative research & evaluation methods: Integrating theory and practice. Sage; 2014. Language U. Encyclopædia Britannica. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13. Rahman MA, et al. Validity and reliability of the Patient Health Questionnaire scale (PHQ-9) among university students of Bangladesh. PLoS ONE. 2022;17(6):e0269634. Gallis JA, et al. Criterion-related validity and reliability of the Urdu version of the patient health questionnaire in a sample of community-based pregnant women in Pakistan. PeerJ. 2018;6:e5185. James N, Busher H. Online Interviewing . 2009: London. O'Connor H, Madge C. Cyber-Mothers: Online Synchronous Interviewing using Conferencing Software. Sociol Res Online. 2004;9(2):136–52. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3(2):77–101. Dhakal K. J Med Libr Assoc. 2022;110(2):270–2. NVivo. Kallivayalil D. Narratives of suffering of South Asian immigrant survivors of domestic violence. Violence Against Women. 2010;16(7):789–811. Lingam R, et al. Understanding care and feeding practices: building blocks for a sustainable intervention in India and Pakistan. Volume 1308. Annals of the New York Academy of Sciences; 2014. pp. 204–17. 1. Lloyd CBaND. Families in transition, in Families in Focus:. New Perspectives on Mothers, Fathers, and Children, 1995: pp. 5–23. Chadda R, Deb K. Indian family systems, collectivistic society and psychotherapy. Indian J psychiatry. 2013;55:S299–309. Saad M. Examining the Social Patterning of Postpartum Depression by Immigration Status in Canada: an Exploratory Review of the Literature. J Racial Ethn Health Disparities. 2019;6(2):312–8. Manderson L, Bennett LR. Violence against women in Asian societies. Psychology; 2003. Wigfield A, Turner R. South Asian women and the labour market in the UK: Attitudes, barriers, solutions. J Community Posit Practices. 2012;12(4):642–66. Lorna Phillips PA. An exploratory study of South Asian women’s experiences of mental health services in England: a thematic analysis of cultural sensitivity. Mental Health Rev. 2022;27(4):437–54. Bicknell S, et al. Family members' experiences of supporting black and South Asian women with perinatal mental illness: a qualitative study in the UK. BMC Psychol. 2025;13(1):363. Khan S, et al. Culturally-adapted cognitive behavioural therapy based intervention for maternal depression: a mixed-methods feasibility study. BMC Womens Health. 2019;19(1):21. Dubuc S. Fertility and education among British Asian women: a success story of social mobility? Vienna Yearbook Popul Res. 2017;15:269–91. Syed A, et al. Effectiveness and Cultural Adaptation of Parenting Interventions for South Asian Families: A Mixed-Methods Systematic Review Using Bernal’s Ecological Validity Model. Children. 2026;13:86. 10.3390/children13010086 . Everett Y, Martin CG, Zalewski M. A Systematic Review Focusing on Psychotherapeutic Interventions that Impact Parental Psychopathology, Child Psychopathology and Parenting Behavior. Clin Child Fam Psychol Rev. 2021;24(3):579–98. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 08 May, 2026 Reviews received at journal 06 May, 2026 Reviews received at journal 06 Apr, 2026 Reviewers agreed at journal 13 Mar, 2026 Reviewers agreed at journal 15 Feb, 2026 Reviewers agreed at journal 12 Feb, 2026 Reviewers invited by journal 12 Feb, 2026 Editor assigned by journal 12 Feb, 2026 Editor invited by journal 30 Jan, 2026 Submission checks completed at journal 29 Jan, 2026 First submitted to journal 29 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8710510","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":591774834,"identity":"93352d04-9d50-48c4-b0cd-e3f20737ac8a","order_by":0,"name":"Aleena Syed","email":"data:image/png;base64,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","orcid":"","institution":"University of Manchester","correspondingAuthor":true,"prefix":"","firstName":"Aleena","middleName":"","lastName":"Syed","suffix":""},{"id":591774835,"identity":"c7137997-5068-4368-9a00-3763ef19ebcb","order_by":1,"name":"Husain Nusrat","email":"","orcid":"","institution":"University of Manchester","correspondingAuthor":false,"prefix":"","firstName":"Husain","middleName":"","lastName":"Nusrat","suffix":""},{"id":591774836,"identity":"ac9e6d35-4722-4306-bd3c-4dccd3736283","order_by":2,"name":"Maria Panagioti","email":"","orcid":"","institution":"University of Manchester","correspondingAuthor":false,"prefix":"","firstName":"Maria","middleName":"","lastName":"Panagioti","suffix":""},{"id":591774837,"identity":"d7b08197-bd84-4ba1-81ed-49274c287a37","order_by":3,"name":"Karina Lovell","email":"","orcid":"","institution":"University of Manchester","correspondingAuthor":false,"prefix":"","firstName":"Karina","middleName":"","lastName":"Lovell","suffix":""}],"badges":[],"createdAt":"2026-01-27 12:38:40","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8710510/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8710510/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102855772,"identity":"ff0cdeec-6c56-4e06-8ac2-82906f21da31","added_by":"auto","created_at":"2026-02-17 14:57:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":51086,"visible":true,"origin":"","legend":"\u003cp\u003eThemes and their subsequent sub-themes from Thematic Analysis.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8710510/v1/bef53b59d7bcdc5a7436c6d0.png"},{"id":102855801,"identity":"23232f09-0a31-4e82-91ce-ce283e95695b","added_by":"auto","created_at":"2026-02-17 14:57:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1006090,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8710510/v1/fc38a475-c1cc-44e0-a79f-cece1a77cb14.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Investigating Sociocultural Risk Factors for Maternal Depression Among South Asian Mothers with Toddlers in the United Kingdom","fulltext":[{"header":"Background","content":"\u003cp\u003eIn the United Kingdom, the South Asian population form the largest ethnic group with 9.3% of the total population. The culture and familial practices are shared by most of the countries in the region including India, Pakistan, Bangladesh, Nepal, Sri Lanka and Bhutan [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePostnatal depression (PND) has consistently been found to be more prevalent among South Asian mothers compared to their native counterparts [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Women who develop PND are at a heightened risk of experiencing recurrent episodes of depression within the following five years[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Similar findings are echoed within the South Asian population, where 56% of pregnant South Asian mothers identified with PND remained depressed 12 months postpartum [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. A multicentre Randomised controlled Trial of a culturally adapted group Cognitive Behaviour Therapy intervention for South Asian mothers reported short-term improvements in postnatal depression; however, these differences were no longer significant at 12-month follow-up, suggesting highlighting the potential need for identifying maintenance risk factors of depression in toddler years [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe nature of symptoms of depression can affect the mother with impaired self-esteem, low energy, higher irritability, dysmorphic effect, cognitive confusion, helplessness and hopelessness [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]). A meta-analytic review concluded significant association between depression and negative maternal behaviour such as hostility and irritability as well as obstructed warm and sensitive parenting [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] and impact on over all secure mother toddler attachment [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. A study in Bangladesh reported depressed mothers were less likely to provide responsive care-giving environment for young children [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere is dearth of literature showing toddler years as a critical and vulnerable point for neurodevelopment. Domains such as motor, perceptual, cognitive, language, and self-regulation develop significantly during this phase [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Research has shown that children of mothers with persistent depression are at higher risk for cognitive, emotional, and behavioural difficulties in early years [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].Low caregiving quality can have an impact on the cognitive development including lower expressive language [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], intellectual functioning [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] emotional problems, disruptive behaviours, attention [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and motor delays [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Longer term affects are also reported for academic performances, job success as well as physical and mental health. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHigh rates of maternal depression amongst South Asian mothers have raised growing concerns about their potential impact in declining cognitive development [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and increase in internalising and externalising behaviour in early childhood [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. These findings highlight the urgent need to address maternal wellbeing as part of a broader strategy to support child development in British South Asian mothers.\u003c/p\u003e \u003cp\u003eHigher rates of depression among British South Asian mothers have been linked to a range of culturally specific risk factors, including postnatal isolation, limited social support, marital difficulties, financial stress, and dissatisfaction with the lack of culturally appropriate postnatal healthcare[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Culturally adapted psychosocial interventions have been shown to be effective among mothers of South Asian origin, yet most existing programs focus on early infancy [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe risk factors for depression among South Asian mothers of toddlers is an underexplored area. The gaps in understanding risk factors and parenting challenges limit the development and delivery of culturally sensitive support services. There is a need to investigate how depressive symptoms impact the lives of mothers during the toddler years, and how interventions can be tailored to address both parenting challenges and culturally specific stressors.\u003c/p\u003e\n\u003ch3\u003eAim:\u003c/h3\u003e\n\u003cp\u003eThis study aimed to understand risk factors of depression, amongst British South Asian mothers with toddlers, including the cultural and social factors shaping it, its impact on daily life, and their approaches to seeking help.\u003c/p\u003e \u003cp\u003eThe study also aimed to explore the impact of depressive symptoms and both formal and informal support strategies.\u003c/p\u003e \n\n \n\n \n\n "},{"header":"Methods","content":"\u003cp\u003eTo capture diverse viewpoints and the nuanced lived experiences of British South Asian mothers, individual qualitative semi-structured interviews were utilised to explore factors associated with maternal depression [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Qualitative approaches are particularly valuable because they also generate detailed narratives and participant quotes that provide insight into real-world experiences, behaviours, and the context in which challenges occur [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Therefore this study set out to investigate the distinctive personal experiences, beliefs, and interpretations of British South Asian mothers, with qualitative approaches recommended to identify culturally specific health determinants [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\u003ch3\u003eRecruitment\u003c/h3\u003e\u003cp\u003eA total of 19 mothers with toddlers were recruited to the study. Inclusion criteria for participation in the interviews required that participants self-identified as being of South Asian ethnicity, with heritage from at least one of the following countries: India, Pakistan, Sri Lanka, Bangladesh, Nepal, Bhutan, or the Maldives. Participants were aged 18 years or older and had at least one child between the ages of one and three years. The mothers must be experiencing low mood or depression. Participants were required to be able to communicate in Urdu or English. Other South Asian languages were not included due to limited linguistic capacity within the research team. Although Urdu is the national language of Pakistan, it is also widely understood and used across several South Asian communities, enabling inclusion of mothers from diverse South Asian backgrounds. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Lastly, participants were required to score 7 or above on the PHQ-9, indicating the presence of low mood or symptoms consistent with depression [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The PHQ-9 is a brief self-report instrument that assesses the severity of depressive symptoms rather than providing a diagnostic classification. In this qualitative study, the PHQ-9 was used to identify the presence of low mood in order to inform sampling and contextualise participants’ narratives, rather than to establish a clinical diagnosis. Its use in this study was informed by its well-established psychometric strength and cross-cultural validity, including within South Asian populations [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA poster with the study’s information and researcher’s contact details were posted on appropriate social media platforms and third sector organisations such as Bolton Hindu forum, Bangladeshi community in UK, Sri Lankans in UK and Respectful Parenting by Maryam Munir with the admin’s support. Interested participants contacted the researcher and were sent initial screening package (information sheet, screening consent form, PhQ-9 screening tool)\u003c/p\u003e\u003cp\u003e The eligible participants were sent study information sheet and informed consent form and demographic information form electronically. Participants were purposely sampled to ensure diversity in ethnicity with South Asian region, native languages, and socio-economic status across the country.\u003c/p\u003e\u003cp\u003eThe research team arranged a convenient time with eligible participants to further discuss the aims and rationale of the study. The participants were given an opportunity to further ask questions. They were given 24 hours to decide their participation in the study. Consenting participants were asked to complete and sign the written informed consent form. Once written consent was received, the participants were contacted to arrange an interview at a time and location suitable for them.\u003c/p\u003e\u003ch3\u003eProcedure:\u003c/h3\u003e\u003cp\u003eAll the interviews were conducted by AS. The interview was conducted using the topic guide. Development of the topic guide was informed by existing literature and social media insights and supported by consultation with a small Patient and Public Informant (PI) group comprising of two South Asian mothers of toddlers. The group provided input on the interview layout, mode of delivery, confidentiality considerations, and the final selection of topics. A consensus method was employed to reach agreement on all aspects discussed.\u003c/p\u003e\u003cp\u003eThe participants were offered flexible dates and timing to complete the interviews online (via zoom). Online interviews were decided at the recommendation by Patient informant group as well as its recent popularity amongst researchers due to its ability to overcome some of the barriers faced by in-person interview such as geographical distance and the time and cost involved in travelling to meet [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Comparative evidence concluded data collected through virtual means can be as rich and valuable to the researcher as that generated via traditional face-to-face meeting [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTo minimise risk for data protection and participants privacy during the online interviews; the participants were given flexibility on timings and dates for the interviews. They were encouraged to pick a location, date and time. There were in space that provided confidentiality. The participants were given the option of pausing or stopping the interview should they feel their privacy was at risk. The researcher was also in a private room with no one else present to ensure participants privacy. The participants were further sent a distress policy post each interview. (The distress policy is available upon request from the author).\u003c/p\u003e\u003cp\u003e Each interview lasted approximately an hour, and the participants were given the option to take as many breaks as they needed. All the interviews were completed mainly in English with some references of words in Urdu, translated by AS.\u003c/p\u003e\u003ch3\u003eAnalysis\u003c/h3\u003e\u003cp\u003eThe data collection took place from March 2024 till July 2024. The interviews were anonymised, transcribed verbatim and analysed using Thematic Analysis[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Reflexive thematic analysis allows flexibility to conduct using a hybrid deductive–inductive approach, whereby the analysis was guided by three pre-defined topic areas, while allowing sub-themes to be generated inductively from the data. This enabled the identification of novel and context-specific insights without forcing the data into a pre-existing theoretical framework. This approach is particularly well suited for exploring the culturally embedded experiences of South Asian parents, as it supports an in-depth examination of the complex social, emotional, and cultural interactions that shape their lives. Reflexivity was maintained throughout the analytic process, with the lead researcher’s background in cultural mental health research informing sensitivity to context, while ongoing reflection and peer discussion were used to minimise the influence of prior assumptions on theme development.\u003c/p\u003e\u003cp\u003e In accordance with guidelines of thematic analysis, transcripts were read and re-read multiple times to establish thorough familiarisation with the data. This was then followed by creating initial codes based on significant statements in NVIVO software [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] creating consistent library of codes and sub-codes. The codes were recorded according to the data relevant to the research questions. Themes were developed to be conceptually homogenous where all codes grouped within a theme reflected a coherent underlying pattern. The themes were reviewed with the remaining research team and re-organized for overlaps and contradictions. The themes were finally defined and reported in the findings.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e: \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eParticipants demographics\u003c/span\u003e\u003c/p\u003e \u003cp\u003eThe participants identified their ethnicity to six different countries (Pakistan, India, Sri-Lanka, Bangladesh, Maldives) with age range from 27\u0026ndash;39 years, representing 4 religions (Muslim, Hindu, Sikh and Christianity). There were a total 19 mothers recruited and successfully interviewed across UK (South, West, Midlands and Northern parts of UK). There were ten mothers from first generation residing in the UK and 9 mothers who identify themselves as second generation. Majority of the mothers completed tertiary education or above and are classified as highly educated.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSample characteristics of Participants:\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePHQ-9 Score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEthnicity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGeneration\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eToddler's age\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNumber of children\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAGE\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePakistani\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1st Generation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDoctorate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePakistani\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2nd Generation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDegree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePakistani\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2nd Generation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCollege\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePakistani\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2nd Generation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 and 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHigher degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePakistani\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2nd Generation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCollege\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePakistani\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1st Generation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 and 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDoctorate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePakistani\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1st Generation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDoctorate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePakistani\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2nd Generation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 and 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHigher degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIndian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1st Generation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMasters\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBangladeshi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2nd Generation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDegree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIndian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2nd Generation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDegree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSikh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePakistani\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2nd Generation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDegree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBangladeshi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2nd Generation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCollege\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSri Lankan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1st Generation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMasters\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWest Bengal, Indian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1st Generation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMBA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHindu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIndian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1st Generation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMasters\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHindu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMaldivian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1st Generation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMasters\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSri Lankan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1st Generation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eChristian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSri Lankan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1st Generation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDegree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eChristian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe analysis generated three main themes with subsequent sub-themes. The first main theme was \u003cem\u003eRisk factors of depression\u003c/em\u003e with three associated sub-themes. The second themes were \u003cem\u003eImpact of depression\u003c/em\u003e and included three sub-themes. Lastly, the final theme was mothers\u0026rsquo; suggestions on strategies to minimise risks and to \u003cem\u003eovercome depression\u003c/em\u003e with two associated sub-themes. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents all the main themes and subsequent sub-themes.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eTheme 1: Risk Factors of Depression\u003c/h2\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eSub-theme: Cultural obedience and hierarchical power\u003c/h2\u003e \u003cp\u003eIn traditional South Asian culture, showing respect and deference to elders is a deeply valued practice, one that is often seen as a marker of good upbringing and cultural pride. For many South Asian women, particularly daughters-in-laws, meeting the expectations of in-laws by demonstrating compliance and humility is viewed as essential to maintaining their identity as a respectful and \u0026ldquo;cultured\u0026rdquo; bride. While this custom is often regarded as endearing and rooted in familial harmony, several mothers described how it can also conflict with their personal autonomy. The pressure to meet these expectations left some feeling powerless, unheard, and unable to assert their own needs or parenting choices, particularly during emotionally demanding periods such as early motherhood.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I think elders do\u0026hellip; elders do. It\u0026rsquo;s a hierarchal cultural system; you must respect the elders \u0026hellip;they have ticket to say whatever they want because you know your elder you you know better p\u0026thinsp;=\u0026thinsp;02\u003c/em\u003e \u003c/p\u003e \u003cp\u003eIn South Asian culture, particularly within joint family systems the norm of showing respect and deference to elders for mothers can mean even compromising on routine, day-to-day decisions based on the preferences of senior family members. These expectations may conflict with a mother\u0026rsquo;s own needs, parenting style, or sense of autonomy, particularly during the already demanding phase of early motherhood. The constant negotiation of these dynamics can leave women feeling powerless, unheard, and unable to assert their own preferences. Over time, this lack of autonomy and emotional support may contribute to poor maternal mental health, including heightened stress and depressive symptoms.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I think it's a lot of pressure when you're living with in laws as well because everything just magnified like 100 times more. Like what time you go to bed, you're not involved, or you don't want to be there. She wants to isolate herself she doesn't want family time and dress code as well. if you want to just get into pyjamas sometimes you just don't or if you want to just put your hair in a bun\u0026hellip;they frown upon that. If you've got brother in laws and father-in-law then you can\u0026rsquo;t be in English clothes. Everything is just magnified a lot more.\u0026rdquo; P\u0026thinsp;=\u0026thinsp;07\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe hierarchical nature of South Asian family system is so deeply embedded that, for generations, women have been socialised to accept their subordinate roles without question. As a result, many are less likely to seek avenues for support or challenge the difficulties they face within these structures. Over time, this has led to the internalised acceptance of powerlessness in various aspects of their lives; particularly in areas related to decision-making, autonomy, and self-expression. Rather than contest these constraints, many women choose to endure them silently, viewing resistance as either futile or culturally inappropriate.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;In Asian culture\u0026hellip; its that women don\u0026rsquo;t complain. women know it\u0026rsquo;s their life, they accept it. Whatever hardship are thrown \u0026hellip; you still have to carry on with it. The biggest thing is cultural side\u0026hellip; where you are not supposed to complain and I think religion can play a part.\u0026rdquo; P\u0026thinsp;=\u0026thinsp;14\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Especially Christians value the respect of others we respect others speech we never argue or speak against the elder so I would always say OK\u0026hellip;. so that OK itself you know finally (pauses for a laugh) made me cry.\u0026rdquo; p\u0026thinsp;=\u0026thinsp;15\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eSub-theme: High expectations and pressure\u003c/h3\u003e\n\u003cp\u003eWithin the community and extended family, South Asian mothers are often expected to be all-rounders, fulfilling multiple roles with near perfection to be recognised as active and respectable members of the family or community. Despite the intense demands of motherhood, persistent pressure for mothers to remain available and responsive to the needs of others, including in-laws, spouses, and community obligations. Their performance as wives and mothers is often quietly scrutinized, adding another layer of invisible labour. These expectations frequently exceed a mother\u0026rsquo;s emotional and physical capacity, leaving her feeling overwhelmed, frustrated, and emotionally depleted.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Woman must strive hard to make each and everyone happy otherwise she is labelled as irresponsible and may be bad mum, bad wife or a bad daughter in-law. I think to full fill that criteria\u0026hellip; she needs to do a lot \u0026hellip; beyond her capacity sometimes\u0026rdquo; P\u0026thinsp;=\u0026thinsp;13\u003c/em\u003e \u003c/p\u003e \u003cp\u003eMothers also reported strong culture comparison within the community which added significant pressure to conform and trigger their low mood. A common theme was intergenerational comparison, particularly between the perceived struggles of mothers-in-law and those of daughters-in-law in raising children. These comparisons were often used to minimise the current challenges faced by younger mothers. In addition, mothers frequently felt compared to other women in the community in terms of how well they were fulfilling their roles as wives, mothers, or daughters-in-law. Collectively, these comparisons led to feelings of inadequacy, self-doubt, and increased emotional distress.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;With us Pakistanis you know \u0026lsquo;hamari time asa nai tha\u0026rsquo; (we were not like that in our time). They done a lot (women form older generation making the comparisons) more so while they're feeding their child they went on the housework their houses were spotless and this and that and we can just about manage to feed our children\u0026hellip;.you feel like low you're not as strong \u0026hellip;.you know that just makes you feel really down\u0026rdquo; p\u0026thinsp;=\u0026thinsp;05\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSome mothers reported that even in the absence of direct external pressures, the lasting influence of cultural norms led them to self-inflict the same expectations. Many felt compelled to uphold the ideology of the 'perfect mother' one who manages all aspects of parenting and household responsibilities seamlessly to be perceived as a successful woman within their community. This internalised pressure often intensified their depressive symptoms, as they struggled to meet these unrealistic standards.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;with my in laws I didn't get any pressure like they always offered help, and I felt like no I\u0026hellip; I want to be the perfect mum and I want to and I want to set the standards high standards from the beginning and I want to do everything and I want to show people that yeah like but I was a good mum\u0026rdquo; P\u0026thinsp;=\u0026thinsp;17\u003c/em\u003e \u003c/p\u003e \u003cp\u003eWhile maintaining high standards for themselves, mothers who have chosen to sacrifice their careers to focus on child-rearing reported experiencing a sense of lost identity and shame due to their perceived inability to effectively balance both career and parenting roles.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;really bad\u0026hellip; some days I feel very very depressed\u0026hellip; that after working so hard I gave up. I used to be so career oriented, It\u0026rsquo;s like there is no win win situation\u0026hellip; I would be in 2 boats at the same time\u0026hellip; I wont be able to give 100% to my career nor to my children\u0026hellip;. I think it does happen a lot with other mothers where they are not able to pursue their career\u0026rdquo; p\u0026thinsp;=\u0026thinsp;11\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eSub-Theme\u003c/b\u003e\u0026thinsp;=\u0026thinsp;\u003cb\u003eIt takes a village: the lost network of support for mothers\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMothers reflected on the culturally embedded expectations of South Asian women, noting that in the past, these roles were more attainable when supported by a wider \u0026ldquo;village\u0026rdquo; network including extended family, neighbours, and community members who shared in the responsibilities of caregiving and domestic life. In contrast, today's mothers often face higher demands from both family and society, but without the same level of communal support. Family members, including husbands, are frequently unable to provide adequate help due to their own time constraints, work commitments, and personal obligations. As a result, the traditional expectations placed on women remain, but the support systems that once made them manageable have diminished, leaving mothers feeling isolated and overwhelmed.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI feel like back in the days\u0026hellip;.there was more of support network\u0026hellip;now a days\u0026hellip; no one has time\u0026hellip; people are working till their 45\u0026ndash;50\u0026hellip; I remember my grandma would come and stay with my mum after she would have a baby\u0026hellip; and I didn\u0026rsquo;t get that\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eCultural and familial pressures were also reported to discourage husbands from offering support to their wives, due to the perception that doing so would suggest they were being controlled by their spouses. Within this context, receiving support was often viewed as a threat to traditional gender roles of man to be seen as working and provider.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003ebecause he is a \u0026lsquo;banda\u0026rsquo; (man), he works, that is his role\u0026hellip; for example if my husband would wake up get kids ready for school\u0026hellip; give them breakfast\u0026hellip;. it would be an issue\u0026hellip; why is she not doing it. He works so he should not be helping me. But If it\u0026rsquo;s a woman\u0026hellip; she needs to work, do the chores, watch the kids and do everything\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eP\u0026thinsp;=\u0026thinsp;01\u003c/h2\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;He can't support his wife\u0026hellip;they gonna start calling him comments like \u0026lsquo;ran mureed\u0026rsquo; (under his wife\u0026rsquo;s control) so he he'll feel embarrassed to help because he doesn't want to look as if he's controlled by his wife.\u0026rdquo;P\u0026thinsp;=\u0026thinsp;07\u003c/em\u003e \u003c/p\u003e \u003cp\u003eEven in the absence of explicit external discouragement, many couples remained deeply embedded in traditional gender role expectations. Women often expressed feelings of guilt when receiving support from their working husbands, internalising the belief that caregiving and household responsibilities were solely their domain.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;If my husband even do a little bit\u0026hellip; like he fed kids breakfast\u0026hellip; I feel like it\u0026rsquo;s a lot and he shouldn\u0026rsquo;t be doing it. If he ever helps with the dishes or beginning of marriage\u0026hellip; he used to help I would stop him and ensure I do it and tell him I am home he works so I should not be doing it\u0026rdquo; P\u0026thinsp;=\u0026thinsp;11\u003c/em\u003e \u003c/p\u003e \u003cp\u003eConversely, men who were willing to offer support frequently felt uncertain about how to do so, having grown up in environments where male participation in domestic and caregiving roles was rarely modelled. This mutual entrenchment in conventional gender norms contributed to a lack of support for mothers leaving them isolated in navigating high demands of balancing motherhood and cultural pressures.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;they don't have this male dominance but they were brought up in a way that they don't know they're not capable of doing these things it's like my husband wants to support he would say that or really I feel like supporting I really want to support you but I don't know how so that's the issue\u0026rdquo; p\u0026thinsp;=\u0026thinsp;18\u003c/em\u003e \u003c/p\u003e \u003cp\u003eOn the contrary mothers living in a nuclear family system complained of having no family support, while they are trying to establish their feet in a new country. They talked about the protective factors of depression of having extensive support from in-laws or extended family.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;the lack of support in general you know the village these days \u0026hellip;I I I have a friend who lives with her in laws \u0026hellip;it could pose other challenges but there is support also\u0026hellip; rather than having nobody. if we are delayed from work by half an hour we will be really stressed out but if you have you know some elderly people or big cousins or sister-in-law with your kids\u0026hellip; you have that extra layer of support \u0026hellip;and you don't go mad. P\u0026thinsp;=\u0026thinsp;08\u003c/em\u003e \u003c/p\u003e \u003cp\u003eIn addition, mothers felt that their depression often worsened when it went unrecognised or unsupported by health services, leading to feelings of disappointment and neglect. Many felt that only those with supportive family members were able to effectively navigate and cope with this challenging period, highlighting a significant gap in formal mental health support.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;we don't get told about it \u0026hellip;. no\u0026hellip; my my mother-in-law \u0026hellip;.supported me.. she knows about the difficulties you know that come with pregnancy and after birth but same time ..we don't get told enough from the doctors \u0026hellip;.\u0026rdquo;\u003c/em\u003e P\u0026thinsp;=\u0026thinsp;05\u003c/p\u003e \u003cp\u003e \u003cb\u003eS\u003c/b\u003e \u003cb\u003eub-theme\u0026thinsp;=\u0026thinsp;The Double Burden: Juggling Work and Domestic Duties\u003c/b\u003e \u003c/p\u003e \u003cp\u003eMothers felt in comparison to previous generations where they worked to simply earn money, South Asian women are more encouraged to build careers over the years. To achieve balance between running a house and continuously work on a career is an added challenge for current generation.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Because I think the older generation think that they've done it they've done their jobs they've had I wouldn't say careers because a lot of them weren't educated back then\u0026hellip; so going forward they have educated their children their daughters for example sent them to universities and they have now degrees. So now women have a career rather than a job so it's not like you're just going for five hours to do a job somewhere coming home looking after the kids cleaning like now women have a career \u0026hellip;..\u0026rdquo; p\u0026thinsp;=\u0026thinsp;16\u003c/em\u003e \u003c/p\u003e \u003cp\u003eOver time, with each generation, the pressures and responsibilities placed on mothers have increased rather than shared. While men largely continued in the role of breadwinners, career-oriented mothers were expected to contribute financially while still maintaining their traditional roles at home.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;they still want the professional wife like my background is law, so I would still work but then come home and then just switch hats and fully be doing everything and I think it's a lot of pressure when you're living with in laws. I have to dress accordingly, then make the food umm for everyone my mother in law would help here and there. My husband would also work but he'd come home and he just get into pyjamas and relax in front of the TV, where with me you know if\u0026hellip;. if my mother-in-law was standing up it was like why she's standing and you're not standing like go and help (the mother-in-law).\u0026rdquo;\u003c/em\u003e P\u0026thinsp;=\u0026thinsp;07\u003c/p\u003e \u003cp\u003eMothers expressed a collective awareness of the challenges and cultural pressures faced by South Asian women, which they believed contributed to disproportionately high rates of postnatal depression within their community. They highlighted how culturally specific expectations, particularly surrounding familial roles and relationships, placed South Asian mothers at greater risk.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I don't think people realise because of our culture as well how likely we are to get depression like literally like I think 80% of us Asian women would have depression after first born there's only like the few rare cases where you have a great postpartum experience but the chances of that happening are so so low\u0026rdquo; p\u0026thinsp;=\u0026thinsp;17\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eTHEME 2: Impact of depression\u003c/h2\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003eSub-theme= Emotional Exhaustion and Lack of Willpower\u003c/h2\u003e \u003cp\u003eMothers expressed that the aftermath of depression often leads to a lack of motivation in caring for themselves and managing essential daily tasks, which over time can contribute to a loss of self-identity.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;so\u0026hellip; with low mood now you have less energy you have less motivation to do things eventually you might be motivated with the reason so I\u0026rsquo;m not doing well I am going to try to better. You get to the stage where you burn out\u0026hellip; you have stuff in your mind\u0026hellip;stuff coming from other people\u0026hellip;\u0026rdquo; p\u0026thinsp;=\u0026thinsp;02\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eSub-theme: Impact on familial relationship\u003c/h2\u003e \u003cp\u003eThe mothers highlighted how the after-effects of depression can have a detrimental impact on their relationships, as mental health struggles affect one\u0026rsquo;s entire personality and interferes with the ability to fulfil the role already a high demanding role as a wife, mother as well as towards extended family or community.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;you are very very low. just you know\u0026hellip;. not happy with your life and very irritated with your partner like feeling resentful and then that does obviously affect our general mood day-to-day p\u0026thinsp;=\u0026thinsp;05\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;You cant pour from an empty cup\u0026hellip; when you already feel so low what can you give to anyone else. I feel like a failure\u0026hellip; I am not able to be the mother I can be for my kids\u0026hellip; the patience I should have for kids that age\u0026hellip; I don\u0026rsquo;t have that\u0026hellip;p\u0026thinsp;=\u0026thinsp;11\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eTHEME 3: Overcoming depression\u003c/h2\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003eSub-theme- Support and Encouragement\u003c/h2\u003e \u003cp\u003eMothers emphasised the importance of cultivating a supportive, non-judgmental environment amongst family and friends. A strong social network and gestures of encouragement from them can play a crucial role in helping them navigate the challenges and societal pressures faced by South Asian mothers.\u003c/p\u003e \u003cp\u003e \u003cem\u003eI think presence of non judgmental friends who support you instead of making you worse., especially in UK. It\u0026rsquo;s important to have that network nearby also\u0026hellip; and able to take time out. I think generally if I am relaxed I would found those challenges challenges and wont be getting triggered easily. Also I struggle asking for help\u0026hellip;. If you feel you cant cope then learn to get help from your partner, friends or hire help. p\u0026thinsp;=\u0026thinsp;11\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eSub-Theme= Support from stakeholders\u003c/h2\u003e \u003cp\u003eMothers felt when support was provided, such as midwives taking simple yet meaningful actions like informing family members about the mother's struggles or postnatal depression, it was perceived as highly effective and validating.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;this person used to come\u0026hellip; I really liked that she gave me good tips\u0026hellip; when you feel overwhelmed or low with the child just take a break from them. Go in a different room, for a small walk. I would leave the child with the dad and just step out for 15\u0026ndash;20 minutes and it helped me a lot. If I continuously stayed in that routine\u0026hellip; I felt irritable and resentful.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eP\u0026thinsp;=\u0026thinsp;10\u003c/h2\u003e \u003cp\u003eHealthcare professionals were also perceived as holding an influential position, where their advice was more likely to be taken seriously by extended family /in-laws, lending weight to the mother's needs.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo; time of difficulty a recognized person like a midwife who used to visit yeah at the house often you know can console the mother-in-law\u0026rsquo;s because\u0026hellip;. they are the mediators like the they are the ones who play an important role in between the other people and the mom and the child so people believe what the midwives tell because the the family members and the neighbours will not come to the hospitals to listen to what the doctor say they will listen those things from us through us but midwives comes to the home\u0026hellip; come home\u0026hellip; they come home and you know they speak in front of the others so uh so they can play a big role like midwives.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eP\u0026thinsp;=\u0026thinsp;15\u003c/h2\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides new insights into maternal depression among South Asian mothers during the toddler years, a period that has received limited attention in the literature. Four primary themes emerged as key risk factors: cultural obedience and the hierarchical influence of elders; particularly in-laws in South Asian households; cultural pressures placed on mothers; limited social and familial support; and the challenges of balancing domestic and work responsibilities without compromise. Additional themes highlighted the impact of depression on mothers\u0026rsquo; well-being and familial relationships, as well as mothers\u0026rsquo; perspectives on the support they need to cope and recover.\u003c/p\u003e \u003cp\u003eThis study specifically identified a lack of autonomy in relation to elders within the family as a key factor. In addition, there were strong cultural pressures to excel in all traditionally assigned roles, such as being a good wife, mother, and daughter-in-law. These expectations were further intensified by a pervasive culture of comparison either with mothers from previous generations or with other women in the community. Collectively these culturally specific factors emerged as common triggers for low mood and persistent depression amongst South Asian mothers. The findings of this study align with previous research, which has consistently shown that culturally specific pressures such as the authoritative role of in-laws and the high expectations placed on women contribute to an increased risk of depression amongst South Asian mothers [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] where even level of support from husbands can be influenced by other family members [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOn the contrary, immigrant mothers away from the family or those in nuclear family setup reported unique challenges of raising children, while there is an emerging shift from collectivist, family-oriented culture. The communal support system often described as \"a village to raise a child\" is no longer accessible to many in the current generation due to the increasingly demanding lives of extended family members or living away from them. Lloyd and Duffy (1995) [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e] believe that, beyond this natural ebb and flow of family members, families are becoming more dispersed. Young and elderly adults, spouses, and other relatives who might otherwise have shared a home are now more likely to live apart from one another. This study supports earlier findings that mothers now living in isolation are at greater risk of depression, largely due to the absence of practical and emotional support that traditionally emerged from wider familial networks [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e] [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWith the diminishing support from community and with changing times, the traditional roles of gender still play a part with mothers struggling to access support from husbands due to cultural pressures and lack of time. Cultural pressures encourage the husbands to conform to rigid patriarchal roles, which typically exclude active involvement in domestic and caregiving responsibilities [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].While such norms are still present, this study found that even amongst couples who are willing to support each other, both partners often remain constrained by culturally defined gender expectations. Men may lack models or frameworks for engaging in childcare and emotional support, and when they do offer support, women may feel guilty or inadequate for accepting it, due to deeply internalised cultural ideology of the self-sacrificing mother and wife.\u003c/p\u003e \u003cp\u003eConsequently, the mothers in current generation with their child in toddler years are more likely to have added layer of responsibilities as well as pressure of wanting to go back to work or even bear the loss of their career due to child rearing responsibilities. Research has shown barriers in South Asian women seeking employment are deeply rooted in cultural, familial, and societal norms. [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAt the risk of minimum familial and partner\u0026rsquo;s support mothers further expressed disappointment in getting the appropriate care from health care services. Recent studies has strongly supported the notion on South Asian women continuing to demand culturally appropriate services where complex inter-generational and cultural risks factors affecting mothers mental health should be incorporated in treatment and support [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe mothers also described impact of living with enhanced challenges of depression leads to feelings of resentment toward partners, negatively impacting marital relationships. The quality of the marital relationship has consistently been shown to act as both a protective and a determining factor in the development and maintenance of depression among South Asian women. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. It can further contribute to their low mood and feeling isolated, undermining their ability to fully engage in parenting during their child\u0026rsquo;s critical toddler years.\u003c/p\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Weaknesses\u003c/h2\u003e \u003cp\u003eDespite growing evidence on maternal depression in the perinatal period, few studies have examined the experiences of South Asian mothers during the toddler years. This study addresses this gap by exploring parenting challenges and culturally adapted intervention needs for this population, providing insights that can inform more effective and culturally sensitive psychosocial programs.\u003c/p\u003e \u003cp\u003eDue to the online nature of this study, a geographically diverse and representative sample of South Asian mothers from across the UK was attained. The sample included mothers from a range of South Asian countries and encompassed participants from the major religions practiced in the region.\u003c/p\u003e \u003cp\u003eHowever, the study is limited. It did not include a significant number of participants from lower educational backgrounds. Previous research indicates that women from Pakistani and Bangladeshi backgrounds are more likely to have lower educational qualifications, and lower education levels are also associated with higher fertility rates within South Asian populations [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. It appears that women with limited education may not have been adequately reached, as those with limited education may have faced challenges accessing or navigating the online recruitment materials and platform. As a result, the findings may underrepresent the experiences of more vulnerable or socioeconomically disadvantaged South Asian mothers.\u003c/p\u003e \u003cp\u003eIn a recent systematic review, deeper culturally adapted parenting programmes showed benefits for parenting knowledge, but effects on post-natal depression were inconsistent or non-significant in some analyses[\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Moreover, interventions targeting parental mental health alone often do not lead to improvements in parenting behaviours, highlighting the need for integrated psychosocial parenting approaches [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. To achieve this, future research and service provision should consider the cultural, social, and emotional challenges faced by South Asian mothers during periods of maternal depression.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study supports previous research on the role of socio-cultural, immigration-related, and lack of support risk factors contributing to maternal depression amongst South Asian women. However, it also highlights additional layers of challenges that emerge beyond the first year postpartum.\u003c/p\u003e \u003cp\u003eDuring this period, mothers face multiple pressures. Some struggled to balance domestic duties with career demands while others had a difficult realisation of having lost their careers due to motherhood. Alongside these challenges, they continue to navigate cultural expectations, such as managing hierarchical relationships with in-laws and meeting community standards. Despite these layered responsibilities, support from their husband, community and health care services for the mother often remains minimal.\u003c/p\u003e \u003cp\u003eThe present study highlights the importance of incorporating potential protective factors, such as family involvement, partner support, and engagement with healthcare providers, while simultaneously addressing and reducing the cultural pressures and judgement often placed on women during this vulnerable period. Such an approach may promote improved maternal mental health and support optimal toddler development.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding: No funding was provided for this project.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare they have no competing interests in relation to this study.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAS conducted the interviews, carried out the analysis and drafted the manuscipt. KL and NH supervised the qualitative analysis and worked on editing the manuscript. MP assisted in editing and revising the manuscript. All authors read and approved the final manuscript.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate declarations\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from the University of Manchester Ethical Committee (Ref: 2023-16909-32220)All participants were provided with detailed information about the study and gave written or electronic informed consent prior to participation. The study was conducted in accordance with the ethical standards of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\u003cp\u003e\u0026nbsp;The qualitative data generated and analyzed during this study are de-identified; however, due to the qualitative nature of the data and the potential risk of participant re-identification, the full interview transcripts are not publicly available. De-identified excerpts relevant to the study are included within the manuscript. Additional data may be made available from the corresponding author upon reasonable request and subject to ethical considerations.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePrajapati R, Liebling H. Accessing Mental Health Services: a Systematic Review and Meta-ethnography of the Experiences of South Asian Service Users in the UK. J Racial Ethn Health Disparities. 2022;9(2):598\u0026ndash;619.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHusain N, Creed F, Tomenson B. Adverse social circumstances and depression in people of Pakistani origin in the UK. Br J Psychiatry. 1997;171:434\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNilaweera I, Doran F, Fisher J. 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Dev Psychol. 2000;36:759\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerens AE, Jensen SKG, Nelson CA 3. Biological embedding of childhood adversity: from physiological mechanisms to clinical implications. BMC Med. 2017;15(1):135.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrito NH, Noble KG. Socioeconomic status and structural brain development. Front Neurosci. 2014;8:276.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim P et al. \u003cem\u003eEffects of childhood poverty and chronic stress on emotion regulatory brain function in adulthood.\u003c/em\u003e Proceedings of the National Academy of Sciences, 2013. 110(46): pp. 18442\u0026ndash;18447.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaird H, Harris RA, Santos HP Jr.. The Effects of Maternal Perinatal Depression on Child IQ: A Systematic Review. Matern Child Health J. 2023;27(9):1489\u0026ndash;502.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHusain N, et al. Social stress and depression during pregnancy and in the postnatal period in British Pakistani mothers: a cohort study. J Affect Disord. 2012;140(3):268\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrady SL, Kiernan KE. The effect of post-natal mental distress amongst Indian and Pakistani mothers living in England on children's behavioural outcomes. Child Care Health Dev. 2013;39(5):710\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParvin A, Jones CE, Hull SA. Experiences and understandings of social and emotional distress in the postnatal period among Bangladeshi women living in Tower Hamlets. Fam Pract. 2004;21(3):254\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInsan N, et al. 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Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3(2):77\u0026ndash;101.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDhakal K. J Med Libr Assoc. 2022;110(2):270\u0026ndash;2. NVivo.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKallivayalil D. Narratives of suffering of South Asian immigrant survivors of domestic violence. Violence Against Women. 2010;16(7):789\u0026ndash;811.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLingam R, et al. Understanding care and feeding practices: building blocks for a sustainable intervention in India and Pakistan. Volume 1308. Annals of the New York Academy of Sciences; 2014. pp. 204\u0026ndash;17. 1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLloyd CBaND. \u003cem\u003eFamilies in transition, in Families in Focus:.\u003c/em\u003e New Perspectives on Mothers, Fathers, and Children, 1995: pp. 5\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChadda R, Deb K. Indian family systems, collectivistic society and psychotherapy. Indian J psychiatry. 2013;55:S299\u0026ndash;309.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaad M. Examining the Social Patterning of Postpartum Depression by Immigration Status in Canada: an Exploratory Review of the Literature. J Racial Ethn Health Disparities. 2019;6(2):312\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eManderson L, Bennett LR. Violence against women in Asian societies. Psychology; 2003.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWigfield A, Turner R. South Asian women and the labour market in the UK: Attitudes, barriers, solutions. J Community Posit Practices. 2012;12(4):642\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLorna Phillips PA. An exploratory study of South Asian women\u0026rsquo;s experiences of mental health services in England: a thematic analysis of cultural sensitivity. Mental Health Rev. 2022;27(4):437\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBicknell S, et al. Family members' experiences of supporting black and South Asian women with perinatal mental illness: a qualitative study in the UK. BMC Psychol. 2025;13(1):363.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhan S, et al. Culturally-adapted cognitive behavioural therapy based intervention for maternal depression: a mixed-methods feasibility study. BMC Womens Health. 2019;19(1):21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDubuc S. Fertility and education among British Asian women: a success story of social mobility? Vienna Yearbook Popul Res. 2017;15:269\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSyed A, et al. Effectiveness and Cultural Adaptation of Parenting Interventions for South Asian Families: A Mixed-Methods Systematic Review Using Bernal\u0026rsquo;s Ecological Validity Model. Children. 2026;13:86. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/children13010086\u003c/span\u003e\u003cspan address=\"10.3390/children13010086\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEverett Y, Martin CG, Zalewski M. A Systematic Review Focusing on Psychotherapeutic Interventions that Impact Parental Psychopathology, Child Psychopathology and Parenting Behavior. Clin Child Fam Psychol Rev. 2021;24(3):579\u0026ndash;98.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Maternal depression, South Asian, toddlers, culture","lastPublishedDoi":"10.21203/rs.3.rs-8710510/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8710510/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSouth Asian women are at higher risk of experiencing maternal depression.\u003cu\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/u\u003eThis study explores the cultural, social, and environmental risk factors contributing to depression among British South Asian mothers with toddlers age 1–3 years. \u0026nbsp;Toddler years are considered crucial and sensitive to maternal depression in developing optimal cognitive, motor, language and behavioural skills. While postnatal depression (PND) has been widely documented among South Asian women, this research specifically investigates the depressive symptoms beyond the first postnatal year; a period often overlooked in maternal mental health literature.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUsing a qualitative design, in-depth interviews were conducted with a diverse sample of 19 South Asian mothers across the UK to understand their lived experiences. Reflexive thematic analysis was completed with hybrid deductive-inductive approach using pre-defined main topics and sub-themes were formed inductively using data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e. The analysis identified three overarching themes. The first theme, \u003cem\u003erisk factors for depression\u003c/em\u003e, reflected culturally embedded stressors, including hierarchical family structures emphasising obedience, high expectations and pressures, loss of traditional support networks, and challenge of keeping up with traditional roles of domestic responsibilities with balancing employment. The second theme, \u003cem\u003eimpact of depression\u003c/em\u003e, highlighted emotional exhaustion, reduced sense of willpower, and strained familial relationships, which collectively affected mothers’ wellbeing and parenting experiences. The final theme, \u003cem\u003eovercoming depression\u003c/em\u003e, emphasised the importance of emotional support and encouragement, alongside the involvement of key stakeholders such as family members and community networks, in supporting mothers’ recovery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThese findings highlight the need for \u003cstrong\u003eculturally responsive mental health services \u003c/strong\u003ethat address the multiple, layered risk factors faced by South Asian mothers, including cultural pressures and limited access to support systems. Policies should prioritise the \u003cstrong\u003estrengthening of protective factors\u003c/strong\u003e, such as family and partner involvement, community-based education, and improved engagement with health and social care services. Investment in \u003cstrong\u003eculturally adapted psychosocial parenting programmes\u003c/strong\u003e that integrate mental health support has the potential to improve maternal wellbeing and support healthier child development during the critical toddler years.\u003c/p\u003e","manuscriptTitle":"Investigating Sociocultural Risk Factors for Maternal Depression Among South Asian Mothers with Toddlers in the United Kingdom","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-17 14:55:39","doi":"10.21203/rs.3.rs-8710510/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-08T08:14:57+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-07T00:38:43+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-06T18:24:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"26310429855900600828261611057970853864","date":"2026-03-13T16:13:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"324651188196978336146851611976166455643","date":"2026-02-15T23:32:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"73338212192016077687291359262310191121","date":"2026-02-12T21:10:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-12T09:25:38+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-12T09:17:27+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-30T12:50:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-29T20:32:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2026-01-29T20:26:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ebd5ac43-515c-46ff-a061-9220093c5677","owner":[],"postedDate":"February 17th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-08T08:14:57+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-07T00:38:43+00:00","index":64,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-08T08:26:18+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-17 14:55:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8710510","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8710510","identity":"rs-8710510","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}