Increased mental health service use reported from simultaneous postpartum leave

Increased mental health service use reported from simultaneous postpartum leave | Image Credit: © grooveriderz - © grooveriderz - stock.adobe.com.

Health care uptake for postpartum mental health is increased by simultaneous parental leave use, according to a recent study published in JAMA Network Open.¹

Both mothers and fathers often experience increased stress during the transition to parenthood, with postpartum depression (PPD) reported in 17% of mothers and 9% of fathers globally. New parents are also at risk of other comorbid mental health symptoms such as substance use-related behaviors.

Data has indicated a need for improved maternal health planning, with patients reporting declines in discussions about maternal mental health with health care providers after birth.² This information came from a survey of over 1000 adults, which also found that 25% of new moms do not have the tools to prepare for mental health challenges.

A link has been reported between generous parental leave and protected postpartum mental health among both parents.¹ However, there is little information about the association between flexible parental leave that lets parents choose their level of involvement and postpartum mental health.

Paid simultaneous leave is a flexible program that allows parents to be reimbursed for leave at the same time. Alongside improving work-life balance, this method of parental leave may allow parents to seek care for mental health concerns.

Investigators conducted a cohort study to evaluate the association between simultaneous parental leave and postpartum mental health care. Total population registers were assessed for relevant data on live births between January 1, 2014, and December 31, 2015.

Exclusion criteria included missing paternal information, either parent not residing in Sweden during the follow-up period, and paternal death before birth or either parental death within 1 year postpartum. The Swedish Social Insurance Agency Microdata Register was assessed to determine simultaneous parental leave use, reported as any vs none.

PPD and related symptoms may be screened in new parents through routine checkups with Child Health Services (CHS). Following detection of mental health conditions, patents may receive counseling within the CHS or be referred to another service.

International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes were used to identify substance use disorder (SUD), mood or affective disorders, and neurotic disorders. Parental antidepressant prescriptions were identified using the Prescribed Drug Register.

A dichotomous covariate of parents’ prebirth mental health care use was also included. Additional covariates included parental age, education level, annual labor income, civil status, and nativity.

The sample included 207,283 parental dyads, 74% of whom did not use simultaneous parental leave in the first year postpartum. The mean age at childbirth among parents utilizing simultaneous parental leave was 29.63 years for mothers and 32.80 years for fathers. A high education level was reported among 44.2% and 31.4%, respectively.

Outpatient mental health service use was reported among 13% of mothers and 8% of fathers with simultaneous parental leave. Psychotropic prescriptions were reported among 14.2% and 9.2%, respectively. Of parents, 62.2% used up to 15 of the available 30 simultaneous parental leave days.

Among mothers, an association was reported between simultaneous parental leave and the use of outpatient mental health care visits and psychotropic prescriptions within 1 year postpartum. The odds ratio (OR) for outpatient visits among mothers with simultaneous parental leave was 1.15, vs 1.20 for antidepressant prescriptions.

For fathers, postpartum mental health care was not impacted by simultaneous parental leave use, but a higher risk of SUD-related disorder visits and antidepressant prescriptions was found after adjusting for parental characteristics. Prebirth mental health care lessened all results except for SUD-related visits, with an OR of 1.10.

The odds of antidepression prescription were increased among parents using up to 15 years of simultaneous parental leave, with an OR of 1.07. Among those using more than 15 days of simultaneous parental leave, the ORs of maternal outpatient visits for SUD and stress-related disorders were 1.16 and 1.09, respectively, indicating increased risks.

These results indicated an association between simultaneous parental leave and mental health care uptake. Investigators concluded, “flexible parental leave schemes are crucial for promoting postpartum mental health care among both mothers and fathers.”

References

1. Honkaniemi H, Juárez SP. Postpartum mental health care use among parents during simultaneous parental leave. JAMA Netw Open. 2024;7(10):e2438755. doi:10.1001/jamanetworkopen.2024.38755
2. Kronemyer B. The need for better maternal mental health planning. Contemporary OB/GYN. December 15, 2021. Accessed October 14, 2024. https://www.contemporaryobgyn.net/view/the-need-for-better-maternal-mental-health-planning