Incidence of Postpartum Depression Decreases After Initial Expansion of Military Maternity Leave

Abstract

ABSTRACT Introduction Postpartum depression impacts 1 in 8 women in the United States. Research has indicated maternity leave duration, and compensation can have an impact on postpartum depression symptoms. The U.S. military increased their maternity leave provision from 6  to 12 weeks in 2016. The aim of this study was to expand upon current literature on the role of maternity leave on postpartum depression by analyzing objective data from 2011 to 2019 utilizing military health records. Methods All deliveries to active duty women in the Military Health System from 2011 to 2019 were considered for analysis. A total of 60,746 women met inclusion criteria. Active duty women were stratified by year of delivery to identify if they had 6 weeks (2011–2015) or 12 weeks (2016–2019) of maternity leave. International Classification of Disease (ICD)-9 and ICD-10 codes were used for the identification of postpartum depression diagnosis. Logistic regression models were used to assess the association between maternity leave provision and postpartum depression diagnosis adjusting for covariates. Results Overall, 4.8% of the women were diagnosed with postpartum depression. Active duty women who were allotted 12 weeks (2016–2019) of maternity leave had higher odds of postpartum depression diagnosis than those allotted 6 weeks (2011–2015) (12 weeks vs. 6 weeks of leave: odds ratio [OR] = 1.29; 95% confidence interval [CI] = 1.20–1.39, P < 0.0001). However, there was a 50% reduction in odds of postpartum depression during 2016–2017 (the 2 years following the 12-week leave implementation) in comparison to 2011–2015 (OR = 0.50; 95% CI = 0.43–0.57, P < 0.0001). The trends were similar across military branches. Additionally, between 2011 and 2019, the lowest rates of postpartum depression were observed during 2016–2017, but the rates significantly increased starting 2018. Overall, women with lower military ranks had higher postpartum depression rates than those with higher ranks. Conclusions Our results indicate increasing paid maternity leave in the military from 6  to 12 weeks did initially lower the odds of postpartum depression diagnosis among active duty women from immediately after policy implementation (2016) and prior to the release of the Veterans Affairs and Department of Defense Clinical Practice Guidelines on Pregnancy Management (2018). Later, increased odds of depression (2018–2019) are likely due to increased depression screening protocols at the Military Treatment Facilities in the perinatal period.