Parental leave benefit levels and postpartum maternal mental health: a Swedish cohort study

Abstract Background While generous parental leave benefits are protective for postpartum maternal mental health, not all mothers qualify for these benefits due to strong work requirements. Sweden offers paid parental leave to all residents, but the benefit level depends on their salary and labour market attachment. Objectives To evaluate the association between parental leave benefit levels and maternal mental health in the postpartum period. Methods Using total population register data, we studied 210 800 first-time mothers, aged 18-52 years, who gave birth to a live singleton offspring in Sweden between January 1, 2007 and December 31, 2011. We performed multivariable logistic regression to compare odds of mental health outcomes from different levels of severity (prescribed anti-depressants or anxiolytics, specialist outpatient care and hospitalisation) between mothers receiving higher-level benefits (i.e., qualified for earnings-related benefits) and those with basic benefits (i.e., a low flat-rate level). We also performed decomposition analyses using the Karlson-Holm-Breen method, and subgroup analyses by region of birth. Results Mothers receiving basic benefits had increased odds of prescribed antidepressants or anxiolytics (OR 1.44 95% CI 1.37-1.51), specialist outpatient care (OR 2.27 95% CI 2.13-2.44), and hospitalisations (OR 2.47 95% CI 2.97) compared with mothers receiving higher-level benefits. Increased odds remained after adjustment for pre-existing mental health. After further adjustment for income and employment status, the odds remained elevated for specialist outpatient care (OR 1.13, 95%CI 1.02-1.24) and hospitalisation (OR 1.34, 95%CI 1.03-1.76). Conclusions Mothers with basic benefits are more likely to experience moderate-to-severe mental disorders compared to mothers with higher-level benefits, independent of pre-existing mental health, income and employment status. Key messages • Labour market attachment prior to childbirth affects parental leave benefit levels and plays an important role in determining mental health outcomes in the postpartum period. • The work requirements for more generous parental leave benefits may prevent mothers from benefiting from the protective mental health advantages of parental leave.