June 26, 2014 — Summary of "Maternal Depression, Pregnancy Intention, and Return to Paid Work After Childbirth," Dagher et al., Women's Health Issues, May/June 2014.
Maternal depression affects about 13% of mothers in the first year after childbirth, making it the most common serious mental health condition during that time period, according to Rada Dagher, Sandra Hofferth and Yoonjoo Lee of the University of Maryland-College Park's School of Public Health.
The majority (61%) of U.S. mothers with infants under age three participate in the workforce, they added, noting that U.S. mothers' higher rate of workforce participation compared with their European counterparts could be tied to the fact that the U.S. lacks a "national policy of paid maternity leave." In addition to financial concerns, factors such as personal values, maternal depression and pregnancy intention can affect a woman's decisions on whether and when to return to paid work after giving birth, past studies suggest.
The researchers devised a study to examine the relationships between return to paid work, maternal depression and pregnancy intention. They hypothesized that lack of depressive symptoms and unintended pregnancy would be associated with a quicker return to paid work. The researchers also predicted that "[t]he association between maternal depression and return to paid work [would] depend on pregnancy intention."
The researchers examined data from the Listening to Mothers II Survey, which was conducted from Jan. 20, 2006, to Feb. 21, 2006, via telephone and online interviews. Participants in the survey were women ages 18 through 45 who spoke English and delivered a live, singleton infant at a U.S. hospital in 2005. For the study, the researchers focused on data from women who worked for an employer during their pregnancies, resulting in a sample size of 882 women.
Women were asked whether they had returned to work at the time of the interview and, if so, how many weeks had passed since they gave birth when they went back to work. The researchers also measured maternal depression symptoms, using a screening tool.
Participants' average age was 29, 63% were white, 66% were college educated and 70% were married.
Women were interviewed, on average, at 33.26 weeks after giving birth, and 68% of them had returned to paid work at the time of the interview. On average, participants had stopped working 3.8 weeks before delivery. Forty-one percent of participants had paid maternity leave after birth, 59% experienced an intended pregnancy and 62% reported experiencing depressive symptoms.
At one month after delivery, 91.6% of women in the sample had not returned to work, which decreased to 40.9% at three months after delivery, 31% at six months and 18% at 12 months.
"[T]here was no difference" in the likelihood of returning to paid work among depressed and non-depressed mothers when depression was the only variable considered, the researchers found.
However, there was "a significant difference in the probability of returning to paid work among mothers with an intended pregnancy and those with unintended pregnancy." Specifically, mothers who experienced an intended pregnancy returned to work later than those who had an unintended pregnancy.
The researchers found "no difference in return to paid work patterns" among depressed and non-depressed mothers with intended pregnancies.
Overall, "[m]others who were not depressed and did not intend the pregnancy (the reference group) returned to paid work the soonest," the researchers wrote, adding that time of return to paid work was similar to the reference group for mothers who were depressed and did not intend the pregnancy.
Mothers who were depressed and intended the pregnancy were significantly less likely than the reference group to return to work, while those who were not depressed and intended the pregnancy had the lowest likelihood of returning to work.
There was no association between depression and return to work among mothers with unintended pregnancies. Among mothers with intended pregnancies, depression was associated with returning to work sooner.
Assessment of Hypotheses
Sixty-two percent of participants had some depressive symptoms, suggesting that "such symptoms may be common among new mothers," the researchers wrote, adding that this finding possibly explains why their first hypothesis -- that mothers with fewer depressive symptoms would return to work more quickly than depressed mothers -- was not supported.
The researchers were correct in hypothesizing that women who experienced unintended pregnancies would return to work more quickly than those with intended pregnancies. "The lack of preparation for a period of time at home for mothers with unintended pregnancies possibly increased the cost of remaining out of the workforce," they wrote, adding that additional analyses showed that paid maternity leave was less common among women with unintended pregnancies than those with intended pregnancies.
The data also supported the researchers' "third hypothesis of an interaction between depression and pregnancy intention." They "found that pregnancy intention is more important than depressive symptoms but also that, among those with an intended pregnancy, depressed mothers return to paid work more quickly than nondepressed mothers."
While it is generally accepted "that leave after childbirth provides mothers time for emotional recovery and for bonding with the baby, and returning to paid work sooner than desired may worsen depressive symptoms," it is alarming "that women with an intended pregnancy who are depressed return to the workplace sooner than those who are not depressed," the researchers wrote.
If future studies produce similar findings, "primary care and occupational health providers may want to advise women on the optimal amount of leave after childbirth given their mental health states," the researchers suggested. In addition, providers should "ensure that women have access to the most appropriate methods for delaying pregnancy until a woman is ready to have a baby and to delay additional childbearing as desired," they wrote.
Their "findings underscore the need for considering paid leave legislation at the national level, such as the recently introduced Family and Medical Insurance [Leave] Act [S 1810, HR 3712], to ensure more equitable access to these benefits," they added.