Breaking the Silence

Website for the American Mental Health Counselors Association's Breaking the Silence initiative to address mental health stigma.

Mother and Child – and – Elderly Reunion: Childbirth, Maternity Leave and Depression in Older Women

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By contributing blogger Joel E. Miller

From the paid parental leave one-upmanship by Silicon Valley companies to Democratic presidential candidates calling for guaranteed paid leave to Republicans arguing mandated paid leave could drive small businesses out of business, the issue is getting more attention in the United States. Currently, the U.S. is the only industrialized country in the world that does not guarantee paid parental leave.

But what are the health benefits of paid parental leave on children, mothers and fathers? There is considerable evidence now that paid parental leave can have a significant positive effect on the health of children and mothers and can have major benefits down the road. There can be mental health effects of having job-protected, paid leave after the birth of a child. In one study, women who took longer than 12 weeks maternity leave reported fewer depressive symptoms, a reduction in severe depression and improvement in their overall mental health.

Maternity leave benefits are an example of a government intervention that affects women at a critical stage in their lives and has the potential to generate positive health externalities. The U.S. has mandated non-paid maternity leave policy aimed at employers for 12 weeks, but employers have wide discretion in implementing the policy and all employers with less than 50 employees are exempt from the measure. Twelve weeks is a drop in the bucket. Research has shown it takes women a full year to recover psychologically from the upheaval of bringing a child into the world. British women are offered up to 39 paid weeks off to adjust to this significant life transition.

We now know based on new research that beyond any potential benefits on employment, families and child outcomes, maternity leave entitlements also have important benefits in regard to women’s mental health in the long-run by reducing the long-term consequences of stress and mental health disorders associated with the experience of childbirth.

A strand of literature in epidemiology has shown that the birth of a child is a stressful life event that carries a new role for mothers, potentially generating an imbalance between the demands from multiple roles. This is often accompanied by a sudden change in hormone levels around childbirth. New mothers are at increased risk for a range of serious psychiatric disorders such as postpartum depression, post traumatic stress disorder, anxiety disorders, obsessions of child harm, and postpartum psychosis. The prevalence of postpartum depression is exceptionally high in the weeks after delivery: it is estimated that between 10-15 percent of mothers experience depression in the postpartum period.

As a result, women are more likely to be admitted to an inpatient psychiatric hospital shortly after giving birth than at any other time in their lives. Recent evidence suggests that an increase in the length of maternity leave entitlements is associated with a decrease in depressive symptoms in the first six months after childbirth.

These findings suggest that, in the short-run, maternity leave is an effective public policy to reduce the negative mental health effects of childbirth. Maternity leave policies may also have long-term effects by preventing the possibility that the stressful weeks around childbirth result in long-term psychological consequences.

A series of psychological studies suggest that stressful life events during mid-life have a strong relationship with the risk of subsequent episodes of major depression and other psychiatric disorders in older age.

This literature draws on the concept of chronic stress, whereby stressful life events have enduring sequelae that increase vulnerability to physical and mental health disorders in later life.

Reducing depression in the period around childbirth, maternity leave benefits can lead to enduring benefits in long-term mental health. Maternity leave entitlements have spillover effects on the mental health of women decades after delivery. As we have highlighted in AMHCA’s Campaign on Mental Health and Older Adults, late-life depression is a serious and growing public health problem. Late-life depression is a common condition substantially more prevalent among women than men in aging societies. Late-life depression leads to impairments in the ability to function socially, decreased quality of life, and increased risk of health problems.

We are witnessing a significant connection and convincing evidence that a longer period of fully-paid maternity leave around the birth of a first child leads to a reduction in late life depression scores. One study points out that that moving from a maternity leave with limited coverage to one with comprehensive coverage reduces late-life depression scores by 14 percent. This is really what economists call a human capital investment. You invest in this, you will end up picking up the benefits of this policy years later.

Depression is a leading cause of disability and it is a prevalent condition in old age affecting one to two fifths of older people, and it is disproportionately high among older women.

A key question relates to the mechanisms that account for the effects of maternity leave on the long-run mental health of mothers at old age. A possible explanation is that maternity leave benefits reduce the risk of postpartum depression or other mental health problems shortly after the birth of a child, which may in turn reduce the risk of future episodes of depression in old age. There is increasing support that maternity leave benefits improve mental health outcomes around the period of birth potentially influencing mental health in the long-run.

Maternity leave benefit policies yield significant mental health benefits for working mothers, which extend beyond the period of birth and persist into old age. Maternity leave benefits do not only protect mothers and their children around the period of childbirth, but may contributing to healthy aging among women during the last decades of life. This may have profound implications for the costs of medical care, the social participation and productivity of older women, and the societal impact of older mother’s mental health on family members and society.

 

References

The Connection between Maternity Leave and Mental Health, The Blog-Huffington Post, May 11. 2015.

Avendano, M., et al. The Long-run Effect of Maternity Leave Benefits on Mental Health: Evidence from European Countries. Netspar Discussion Papers. 2013.

Stewert, D., et al. Postpartum Depression: Literature Review of Risk Factors and Interventions, University Health Network Women’s Health Program Prepared for Toronto Public Health, October 2003.

Dagher, R., McGovern, P.. & Dowd, B. Maternity Leave Duration and Postpartum Mental and Physical Health: Implications for Leave Policies. J Health Polit Policy Law. 2013.

Dahl, G., Loken, K., Mogstad, M. & Salvanes, K. What Is the Case for Paid Maternity Leave? National Bureau of Economic Research, Inc., NBER Working Papers: 19595. 2013.

Doucet, S., Dennis, C., Letourneau, N. & Blackmore, E. Differentiation and Clinical Implications of Postpartum Depression and Postpartum Psychosis. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 38, 269-279. 2009.

Fiske, A., et al. Depression in Older Adults. Annu Rev Clin Psychol.; 5: 363–389.  2009.

Avendano, M., et al. The Long-run Effect of Maternity Leave Benefits on Mental Health: Evidence from European Countries. Netspar Discussion Papers. 2013.

One thought on “Mother and Child – and – Elderly Reunion: Childbirth, Maternity Leave and Depression in Older Women

  1. Pingback: A Perfect Storm: Biological, Behavioral, Social and Environmental Factors Affecting Women’s Mental Health | Breaking the Silence

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