Maternity Leave, Role Quality, Work Involvement, and Mental Health One Year After Delivery

A realist synthesis to develop an explanatory model of how policy instruments impact child and maternal health outcomes

BACKGROUND

Child and maternal health, a key marker of overall health system performance, is a policy priority area by the World Health Organization and the United Nations, including the Sustainable Development Goals. Previous realist work has linked child and maternal health outcomes to globalization, political tradition, and the welfare state. It is important to explore the role of other key policy-related factors. This paper presents a realist synthesis, categorising policy instruments according to the established NATO model, to develop an explanatory model of how policy instruments impact child and maternal health outcomes.

METHODS

A systematic literature search was conducted to identify studies assessing the relationships between policy instruments and child and maternal health outcomes. Data were analysed using a realist framework. The first stage of the realist analysis process was to generate micro-theoretical initial programme theories for use in the theory adjudication process. Proposed theories were then adjudicated iteratively to produce a set of final programme theories.

FINDINGS

From a total of 43,415 unique records, 632 records proceeded to full-text screening and 138 papers were included in the review. Evidence from 132 studies was available to address this research question. Studies were published from 1995 to 2021; 76% assessed a single country, and 81% analysed data at the ecological level. Eighty-eight initial candidate programme theories were generated. Following theory adjudication, five final programme theories were supported. According to the NATO model, these were related to treasure, organisation, authority-treasure, and treasure-organisation instrument types.

CONCLUSIONS

This paper presents a realist synthesis to develop an explanatory model of how policy instruments impact child and maternal health outcomes from a large, systematically identified international body of evidence. Five final programme theories were supported, showing how policy instruments play an important yet context-dependent role in influencing child and maternal health outcomes.

Association between maternity leave policies and postpartum depression: a systematic review

PURPOSE

Working mothers are at greater risk for postpartum depression. Maternity leave characteristics, including length, wage replacement and employment protection, could have relevant implications for mothers' mental health. We propose to explore whether there is an association between maternity leave characteristics and postpartum depression.

METHODS

We conducted a systematic review searching for randomized controlled trials, quasi-experimental, cohort or cross-sectional studies on five databases using search terms including maternity and parental leave and depression, as well as references in relevant articles. We identified 500 articles and included 23 of those. We used the EPHPP Quality Assessment Tool for Quantitative Studies to assess the quality of the studies.

RESULTS

Paid and longer maternity leaves tend to be associated with a reduction of postpartum depression symptoms in high-income countries. No studies explored the association between employment protection and postpartum depression. The quality of studies ranged from strong to weak, mostly influenced by study design.

CONCLUSION

More restrictive maternity leave policies tend to be associated with higher rates of postpartum depression, although more research needs to be conducted in the Global South.

One size doesn't fit all: Attitudes towards work modify the relation between parental leave length and postpartum depression

The present study aimed to investigate the relationship between parental leave length and maternal depressive symptoms at six- and twelve-months postpartum and whether this relation was influenced by women's attitudes towards leave, whether leave was paid or unpaid, and the reason they returned to work. The sample included 115 working women recruited during pregnancy as part of a larger longitudinal study. Analyses revealed that maternal attitudes toward leave influenced the association between leave length and depressive symptoms. Specifically, longer leaves were associated with increased depressive symptoms for women who missed their previous activities at work. Furthermore, women who missed work and had leave for 16 weeks or more, exhibited higher depressive symptoms at six- and twelve-months. Last, results also indicated that women who returned to work solely for monetary reasons exhibited more depressive symptoms at six-months postpartum than those who returned to work for other reasons. This study is among the first to show that women's attitudes towards parental leave and their individual reasons for returning to work are important factors to consider that may have potential implications for parental leave policies.

The effect of parental leave on parents' mental health: a systematic review

Mental health disorders during the post-partum period are a common morbidity, but parental leave might help alleviate symptoms by preventing or reducing stress. We aim to summarise available evidence on the effect of different types of parental leave on mental health outcomes among parents. For this systematic review, we searched Ovid MEDLINE, Web of Science, PsycINFO, CINAHL, and Scopus from database inception to Aug 29, 2022, for peer-reviewed, quantitative studies written in English. We included studies if the exposure was postnatal parental leave; a relevant comparison group was present (eg, paid vs unpaid leave); and if indicators related to general mental health, including depression, anxiety, stress, and suicide, for either parent were evaluated or recorded at any time after childbirth. The Review is registered with PROSPERO (registration number CRD42021227499). Of the 3441 records screened, 45 studies were narratively synthesised. Studies were done in high-income countries, and they examined generosity by any parental leave (n=5), benefit amount (n=13), and leave duration (n=31). 38 studies were of medium or high quality. Improved mental health was generally observed among women (referred to as mothers in this Review) with more generous parental leave policies (ie, leave duration and paid vs unpaid leave). For example, increased duration of leave was generally associated with reduced risk of poor maternal mental health, including depressive symptoms, psychological distress and burnout, and lower mental health-care uptake. However, the association between fathers' leave and paternal mental health outcomes was less conclusive as was the indirect effect of parental leave use on partners' mental health.

Seeing Red: A Grounded Theory Study of Women's Anger after Childbirth

Persistent intense anger is indicative of postpartum distress, yet maternal anger has been little explored after childbirth. Using grounded theory, we explained how and why mothers develop intense anger after childbirth and the actions they take to manage their anger. Twenty mothers of healthy singleton infants described their experiences of anger during the first two postpartum years. Mothers indicated they became angry when they had violated expectations, compromised needs, and felt on edge (e.g., exhausted, stressed, and resentful), particularly around infants' sleep. Mothers described suppressing and/or expressing anger with outcomes such as conflict and recruiting support. Receiving support from partners, family, and others helped mothers manage their anger, with more positive outcomes. Women should be screened for intense anger, maternal-infant sleep problems, and adequacy of social supports after childbirth. Maternal anger can be reduced by changing expectations and helping mothers meet their needs through social and structural supports.

The Impact of Publicly Funded Childcare on Parental Well-Being: Evidence from Cut-Off Rules

As more and more countries consider expanding public childcare provision, it is important to have a comprehensive understanding of its implications for families. This article adds to the existing literature by investigating the effect of publicly funded childcare on parental subjective well-being. To establish causality, I exploit cut-off rules introduced following the implementation of a legal claim to childcare in Germany. The results suggest that childcare provision strongly increases the life satisfaction of mothers who were previously constrained by the lack of childcare supply. The effect is more pronounced for mothers with higher labour market attachment. The coefficients for fathers are smaller and not statistically significant. As potential mechanisms, a wide range of time-use and labour market outcomes are explored. This shows that mothers indeed shift time from non-market activities to formal work in response to childcare eligibility, resulting in direct and indirect pecuniary and non-pecuniary returns to maternal life satisfaction. The findings shed light on key issues of work-family reconciliation and stress the importance of considering subjective well-being measures in family policy evaluations.

Anger in the context of postnatal depression: An integrative review

BACKGROUND

Contrary to social constructions of new motherhood as a joyous time, mothers may experience postnatal depression and anger. Although postnatal depression has been thoroughly studied, the expression of maternal anger in the context of postnatal depression is conceptually unclear. This integrative review investigated the framing of anger in the context of postnatal depression.

METHODS

After undertaking a search of CINAHL, Ovid-Medline, PsycInfo, and Web of Science, we identified qualitative (n = 7) and quantitative (n = 17) papers that addressed maternal anger and postnatal depression. We analyzed the data by developing themes.

RESULTS

Our review indicated that anger was a salient mood disturbance for some postnatally depressed women with themes integrated as: (i) anger accompanying depression, (ii) powerlessness as a component of depression and anger, and (iii) anger occurring as a result of expectations being violated.

CONCLUSIONS

Our findings indicate that anger can coexist with women's postnatal depression. Anger can be expressed toward the self and toward children and family members with negative relationship effects. We recommend that health care providers and researchers consider anger in the context of postnatal mood disturbances.

Workplace Policies and Mental Health among Working-Class, New Parents

Little research has explored linkages between workplace policies and mental health in working-class, employed parents, creating a gap in our knowledge of work-family issues across social class levels. The current U.S. study addresses this gap by employing hierarchical linear modeling techniques to examine how workplace policies and parental leave benefits predicted parents' depressive symptoms and anxiety in a sample of 125, low-income, dual-earner couples interviewed across the transition to parenthood. Descriptive analyses revealed that, on average, parents had few workplace policies, such as schedule flexibility or child care supports, available to them. Results revealed, however, that, when available, schedule flexibility was related to fewer depressive symptoms and less anxiety for new mothers. Greater child care supports predicted fewer depressive symptoms for fathers. In terms of crossover effects, longer maternal leave predicted declines in fathers' anxiety across the first year. Results are discussed with attention to how certain workplace policies may serve to alleviate new parents' lack of time and resources (minimize scarcity of resources) and, in turn, predict better mental health during the sensitive period of new parenthood.

Postnatal Depression

Although breastfeeding has multiple benefits for baby and mother, including maternal mental well-being, many mothers terminate breastfeeding earlier than they desire. We examined two key factors in breastfeeding duration and maternal mental health––breastfeeding efficacy and family–work conflict. Specifically, we examined the moderating role of family–work conflict in the process of breastfeeding efficacy as a predictor of maternal depression by way of duration. In a sample of 61 first-time mothers, we found that breastfeeding duration mediated the relation between prenatal breastfeeding efficacy and depression at 9 months postpartum for working mothers who experienced low levels of family-to-work conflict. That is, for mothers with low family-to-work conflict, higher expected breastfeeding efficacy during pregnancy predicted a longer duration of breastfeeding, which in turn was associated with lower depression at 9 months postpartum. However, for working mothers with high family-to-work conflict, breastfeeding duration did not emerge as an indirect effect on the relation between efficacy and depression. These findings have important implications for a healthy family–work balance to help new mothers adjust when they return to the workforce and as they transition to parenthood.

Personal Attitudes or Structural Factors? A Contextual Analysis of Breastfeeding Duration

A personal attitudes model (i.e., infant feeding choices are based on personal attitudes primarily) and a structural factors model (i.e., feeding choices are shaped by the structural contexts of women's lives, as much as personal attitudes) of women's breastfeeding behavior were tested by surveying a longitudinal sample of 548 mostly European American women recruited for the Wisconsin Maternity Leave and Health Project. Personal attitudes (enjoyment of breastfeeding, gender-role attitudes, and work and family salience) accounted for half as much variance in breastfeeding duration for women who were employed outside the home compared to those who were not. For women employed outside the home, both structural variables (length of maternity leave and workplace flexibility) and personal attitudes predicted duration. These results have implications for how we construct the issue of women's breastfeeding decisions.

Reduced-Hours Job-Role Quality and Life Satisfaction among Married Women Physicians with Children

Interest in reduced-hours career options has been sparked by recent studies indicating an increase in the work week, especially among professional and managerial employees, a preference among all employees to reduce work hours substantially, and the perception that the absence of reduced-hours career options is an obstacle to professional advancement. Interest has also been fueled by the growing numbers of dual-earner couples whose ability to manage work/family demands might be facilitated by reduced-hours options. Yet, the belief that part-time work is associated with beneficial health effects has received scant empirical support. Building on prior research with full-time employees, we hypothesized that the quality of the experience of working reduced hours would better predict life satisfaction than would work hours per se. This hypothesis, which we tested in a sample of female reduced-hours physicians with children in two-earner couples, was supported.

Interventions for Women With Postpartum Depression Symptoms

Using the stress-buffering hypothesis as a guide, this integrative review aims to identify how human resource development (HRD) professionals can address the issues faced by working women who are experiencing postpartum depression symptoms, in addition to identifying gaps in HRD research on this emerging topic. Most of the studies reviewed came from the nursing and psychology literature; none were found in the HRD literature. This review was undergirded by the stress-buffering hypothesis, which posits that social support can moderate the effect of a stressful event. Studies pointed to social support, especially from coworkers and supervisors, as having a positive effect on postpartum depression symptom scores. Overall, the findings of this study are entry points into HRD research and practice about how employers can support working women who are experiencing postpartum depression symptoms. Further research should examine the type of social support that is effective in helping working mothers.

The maternal health outcomes of paid maternity leave: a systematic review

Paid maternity leave has become a standard benefit in many countries throughout the world. Although maternal health has been central to the rationale for paid maternity leave, no review has specifically examined the effect of paid maternity leave on maternal health. The aim of this paper is to provide a systematic review of studies that examine the association between paid maternity leave and maternal health. We conducted a comprehensive search of electronic databases (Medline, Embase, CINAHL, PsycINFO, Web of Science, Sociological Abstracts) and Google Scholar. We searched websites of relevant organisations, reference lists of key papers and journals, and citation indices for additional studies including those not in refereed journals. There were no language restrictions. Studies were included if they compared paid maternity leave versus no paid maternity leave, or different lengths of paid leave. Data were extracted and an assessment of bias was performed independently by authors. Seven studies were identified, with participants from Australia, Sweden, Norway, USA, Canada, and Lebanon. All studies used quantitative methodologies, including cohort, cross-sectional, and repeated cross-sectional designs. Outcomes included mental health and wellbeing, general health, physical wellbeing, and intimate partner violence. The four studies that examined leave at an individual level showed evidence of maternal health benefits, whereas the three studies conducting policy-level comparisons reported either no association or evidence of a negative association. The synthesis of the results suggested that paid maternity leave provided maternal health benefits, although this varied depending on the length of leave. This has important implications for public health and social policy. However, all studies were subject to confounding bias and many to reverse causation. Given the small number of studies and the methodological limitations of the evidence, longitudinal studies are needed to further clarify the effects of paid maternity leave on the health of mothers in paid employment.

The symphonic structure of childhood stress reactivity: patterns of sympathetic, parasympathetic, and adrenocortical responses to psychological challenge

Despite widespread recognition that the physiological systems underlying stress reactivity are well coordinated at a neurobiological level, surprisingly little empirical attention has been given to delineating precisely how the systems actually interact with one another when confronted with stress. We examined cross-system response proclivities in anticipation of and following standardized laboratory challenges in 664 4- to 14-year-olds from four independent studies. In each study, measures of stress reactivity within both the locus coeruleus-norepinephrine system (i.e., the sympathetic and parasympathetic branches of the autonomic nervous system) and the corticotrophin releasing hormone system (i.e., the hypothalamic-pituitary-adrenal axis) were collected. Latent profile analyses revealed six distinctive patterns that recurred across the samples: moderate reactivity (average cross-system activation; 52%-80% of children across samples), parasympathetic-specific reactivity (2%-36%), anticipatory arousal (4%-9%), multisystem reactivity (7%-14%), hypothalamic-pituitary-adrenal axis specific reactivity (6%-7%), and underarousal (0%-2%). Groups meaningfully differed in socioeconomic status, family adversity, and age. Results highlight the sample-level reliability of children's neuroendocrine responses to stress and suggest important cross-system regularities that are linked to development and prior experiences and may have implications for subsequent physical and mental morbidity.

Maternal depression, pregnancy intention, and return to paid work after childbirth

BACKGROUND

Maternal depression is an important public health issue for women, their families, and their employers. Previous studies have examined the impact of leave duration on maternal depression, but none have studied the association between maternal depression and the pace of return to paid work. We examine herein the relationship between maternal depression and return to work, and the moderating effects of pregnancy intention.

METHODS

We utilized data from the Listening to Mothers II Survey collected from January 20 through February 21, 2006. The woman had to be 18 to 45 years old, speak English, and have given birth in 2005 to a live singleton baby in a U.S. hospital. Our analyses were limited to women who worked for an employer during pregnancy (n = 882). The primary outcome was return to paid work at the time of the interview and the analyses utilized Cox proportional hazard models.

FINDINGS

In combination, intending the baby and being depressed suppressed return to paid work. Nondepressed mothers with unintended pregnancies returned to work the soonest. Compared with mothers who were not depressed and with unintended pregnancy, the risk ratio of returning to paid work (0.70) was significantly lower for mothers who were depressed and had an intended pregnancy. Mothers who were not depressed and with intended pregnancy also had a significantly lower risk ratio (0.60) of returning to paid work than those who were not depressed and with unintended pregnancy.

CONCLUSION

Primary care providers and policy makers can use these findings to support employed women in their childbearing years.

Paid parental leave supports breastfeeding and mother-infant relationship: a prospective investigation of maternal postpartum employment

OBJECTIVE

To investigate the association between the mother-infant relationship, defined as maternal-infant emotional attachment, maternal separation anxiety and breastfeeding, and maternal employment status at 10 months following first childbirth.

METHOD

Samples of employed, pregnant women, over 18 years of age and with sufficient English literacy were recruited systematically from one public and one private maternity hospital in Victoria. Data were collected by structured interview and self-report questionnaire in the third trimester, and at 3 and 10 months postpartum. Socio-demographic, employment, and breastfeeding information was collected. Participants completed standardised assessments of maternal separation anxiety and mother-to-infant emotional attachment.

RESULTS

Of 205 eligible women, 165 (81%) agreed to participate and 129 (78%) provided complete data. A reduced odds of employment participation was independently associated with continuing to breastfeed at 10 months (OR=0.22, p=0.004) and reporting higher maternal separation anxiety (OR=0.23, p=0.01) when maternal age, education, occupational status and use of paid maternity leave and occupational status were adjusted for in analyses.

CONCLUSION

Employment participation in the first 10 months postpartum is associated with lower maternal separation anxiety, and shorter breastfeeding duration.

IMPLICATIONS

Paid parental leave has public health implications for mothers and infants. These include permitting sufficient time to protect sustained breastfeeding, and the development of optimal maternal infant attachment, reflected in confidence about separation from her infant.

Prenatal health behaviors and postpartum depression: is there an association?

Postpartum depression is a prevalent mental disorder; however, scarce research has examined its association with prenatal health behaviors. This study investigated the associations of cigarette smoking, caffeine intake, and vitamin intake during pregnancy with postpartum depressive symptoms at 8 weeks after childbirth. Using a prospective cohort study design, participants were recruited from the postpartum floor at a hospital for women and newborns located in a northeastern city, from 2005 through 2008. Eligible women who were at least 18 years old and spoke English were interviewed in person while hospitalized for childbirth (N = 662). A follow-up home interview was conducted at 8 weeks postpartum with a 79% response rate (N = 526). Hierarchical regression analyses showed that smoking cigarettes anytime during pregnancy and not taking prenatal vitamins in the first trimester were significantly associated with worse depressive symptoms (Edinburgh Postnatal Depression Scale). Moreover, having a colicky infant, an infant that refuses feedings, being stressed out by parental responsibility, and having difficulty balancing responsibilities were stressors associated with worse depressive symptoms. Primary health care providers should consider evaluating women for risk of postpartum depression during their first prenatal visit, identifying prenatal health behaviors such as smoking and taking prenatal vitamins.

Employment conditions and maternal postpartum mental health: results from the Longitudinal Study of Australian Children

Maternal postpartum mental health is influenced by a broad range of risk and protective factors including social circumstances. Forty percent of Australian women resume employment in the first year postpartum, yet poor quality employment (without security, control, flexibility or leave) has not been investigated as a potential social determinant of maternal psychological distress. This paper examines whether poor quality jobs are associated with an increased risk of maternal postpartum psychological distress. Data were collected from employed mothers of infants ≤12 months (n = 1,300) participating in the Longitudinal Study of Australian Children. Logistic regression analyses estimated the association between job quality and maternal psychological distress, adjusting for prior depression, social support, quality of partner relationship, adverse life events and sociodemographic characteristics. Only 21% of women reported access to all four optimal job conditions. After adjustment for known risk factors for poor maternal mood, mothers were significantly more likely to report psychological distress (adjusted OR = 1.39, 95% CI 1.09, 1.77) with each reduction in the number of optimal employment conditions. Interventions for maternal postpartum affective disorders are unlikely to be successful if major risk factors are not addressed. These results provide strong evidence that employment conditions are associated with maternal postpartum mood, and warrant consideration in psychosocial risk assessments and interventions.

Shift Work, Role Overload, and the Transition to Parenthood

This article examines how the work hours, work schedules, and role overload of working-class couples are related to depressive symptoms and relationship conflict across the transition to parenthood. Data are from 132 dual-earner couples interviewed 5 times across the transition. Multilevel modeling analyses revealed that working evening or night shifts, as opposed to day shifts, was related to higher levels of depressive symptoms. For mothers only, working rotating shifts predicted relationship conflict. Increases in role overload were positively related to both depression and conflict; working a nonday shift explained variance in depression and conflict above and beyond role overload. Results suggest that for new parents, working nonday shifts may be a risk factor for depressive symptoms and relationship conflict.

Marital-role quality and stress-related psychobiological indicators

BACKGROUND

The quality of one's marital relationship is gaining recognition as a potential stressor associated with negative health outcomes.

PURPOSE

In this study, we estimated the relationship between marital-role quality and three psychobiological stress indicators (self-reported stress, cortisol levels, and ambulatory blood pressure).

METHOD

Participants were 105 middle-age adults (67 men, 38 women) who had previously taken part in the Whitehall psychobiology study. Ambulatory monitoring and saliva sampling were carried out over a working day, and marital relationships were assessed with the Marital/Partner Role Quality scales.

RESULTS

We found that marital-role concerns (but not marital-role rewards) were related to all three psychobiological stress indicators; results did not vary by gender. Specifically, participants with more marital concerns reported greater stress throughout the day (p=.014), showed an attenuated cortisol increase following waking (p=.042) and a flatter cortisol slope over the day (p=.010), and had elevated ambulatory diastolic blood pressure over the middle of the workday (p=.004), with a similar trend in systolic pressure (p=.069).

CONCLUSIONS

The results suggest that in addition to the carryover of work stress into domestic life that has been evident for many years, there are also influences of domestic strain on biological function over the working day and evening. Previous research suggests that a possible mechanism linking troubled marriages to health outcomes is depressed immune functioning. This study suggests a second mechanism-poorer stress-related biological response.

Division of labor and working-class women's well-being across the transition to parenthood

This study examines the degree to which the division of household and child-care tasks predicts working-class women's well-being across the transition to parenthood. Women completed questionnaires about the division of labor and their well-being before the birth of their first child and upon returning to work. Results showed that violated expectations regarding the division of child care were associated with increased distress postnatally, and there was some evidence that this relationship was moderated by gender ideology. Traditional women whose husbands did more child care than they expected them to do were more distressed. Work status also moderated the relationship between violated expectations and distress. The results suggest that the division of child care is more salient in predicting distress than the division of housework, for working-class women, at this time point.

Some controls control too much

Investigators of complex phenomena often seek to isolate variables of interest by statistical control. However, they run the risk of studying situations that do not exist in the real world, missing mediational links, and drawing incorrect policy conclusions. In the National Institute of Child Health and Human Development (NICHD) Early Child Care Research Network article in this issue, amount of time in child care was studied controlling for family income and maternal depression. However, use of child care is closely linked with maternal employment, which increases family income and decreases maternal depression, which in turn are linked to children's socioemotional adjustment. Hence, the negative effects of amount of time in child care reported in the article are likely overestimated relative to causal pathways in the lives of real families.

Developmental and contextual influences on autonomic reactivity in young children

Studies of cardiovascular reactivity in young children have generally employed integrated, physiologically complex measures, such as heart rate and blood pressure, which are subject to the multiple influences of factors such as blood volume, hematologic status, thermoregulation, and autonomic nervous system (ANS) tone. Reactivity studies in children have rarely employed more differentiated, proximal measures of autonomic function capable of discerning the independent effects of sympathetic and parasympathetic responses. We describe 1) the development, validity, and reliability of a psychobiology protocol assessing autonomic reactivity to challenge in 3- to 8-year-old children; 2) the influences of age, gender, and study context on autonomic measures; and 3) the distributions of reactivity measures in a normative sample of children and the prevalences of discrete autonomic profiles. Preejection period (PEP) and respiratory sinus arrythmia (RSA) were measured as indices of sympathetic and parasympathetic nervous system reactivity, respectively, and autonomic profiles were created to offer summative indices of PEP and RSA response. Results confirmed the protocol's validity and reliability, and showed differences in autonomic reactivity by age and study context, but not by gender. The studies' findings offer guidelines for future research on autonomic reactivity in middle childhood and support the feasibility of examining sympathetic and parasympathetic responses to challenge in 3- to 8-year-old children.

Women, men, work, and family. An expansionist theory

The lives of women and men, the relationships that they establish, and their work have changed dramatically in the past 50 years, but the dominant theories driving research in these areas have not. In this article, the authors argue that the facts underlying the assumptions of the classical theories of gender and multiple roles have changed so radically as to make the theories obsolete. Moreover, a large body of empirical data fails to support the predictions flowing from these theories. Yet the development of new theory for guiding research and clinical practice has not kept pace. The authors attempt to fill this theoretical gap by reviewing the research literature and articulating an expansionist theory of gender, work, and family that includes four empirically derived and empirically testable principles better matched to today's realities.

Maternity leave, women's employment, and marital incompatibility

This research investigated the relationship between the length of women's maternity leave and marital incompatibility, in the context of other variables including the woman's employment, her dissatisfaction with the division of household labor, and her sense of role overload. Length of leave, work hours, and family salience were associated with several forms of dissatisfaction, which in turn predicted role overload. Role overload predicted increased marital incompatibility for experienced mothers but did not for first-time mothers, for whom discrepancies between preferred and actual child care were more important. Length of maternity leave showed significant interactions with other variables, supporting the hypothesis that a short leave is a risk factor that, when combined with another risk factor, contributes to personal and marital distress.

Women's work roles and their impact on health, well-being, and career: comparisons between the United States, Sweden, and The Netherlands

As women have become more assimilated into the work-force over recent decades, they have realized considerable changes in their work roles which may contribute to health problems and other negative outcomes such as marital strain and diminished job status. The purpose of this review was threefold: (1) to synthesize data on the distribution of women's work efforts in the areas of paid employment, household chores, and childcare; (2) to outline research which addresses the impact of women's workload on their well-being and careers; and (3) to make international and gender comparisons regarding women's work responsibilities. Our findings showed that women from each of the three countries examined--the United States, Sweden, and The Netherlands--contribute more effort to household chores and childcare and less to the workplace than men do. As a result, their total workloads appear to be somewhat greater and more diffusely distributed than those of men. Heavy workloads may adversely affect women's health, especially in the presence of certain role characteristics (e.g., having a clerical, managerial, professional, or executive position, or caring for young children). Heavy work responsibilities may also undermine marital happiness, particularly if there is perceived inequity in the way partners share household work. Finally, women's total work responsibilities often impact their careers due to compensatory reductions in work commitment and job status. These observations point to the need for further research on women's workload and work roles, on the relationship of work to well-being, and on methods of preventing or alleviating adverse effects on overburdened workers.

Predictors, prodromes and incidence of postpartum depression

The purpose of this study was to determine the incidence of clinically significant depression occurring between 1 and 4 months postpartum and to investigate whether somatic complaints, subsyndromal depressive symptoms, or birth-related concerns among non-depressed women at 1 month were predictive of postpartum depression. This is a prospective cohort study of 465 women from the Wisconsin Maternity Leave and Health Project (WMLHP). Women who were not depressed at 1 month postpartum were reassessed 3 months later for depression occurring at any time in the interval between 1 and 4 months postpartum. Depression was defined as either meeting the criteria for major depression on the National Institute of Mental Health (NIMH) Diagnostic interview Schedule (DIS) or scoring above 15 on the Center for Epidemiologic Studies Depression Scale (CES-D). Physical symptoms were assessed by an adapted Health Responses Scale. Other measures were developed specifically for the WMLHP. Of 465 women, 27 (5.8%) became clinically depressed between 1 and 4 months postpartum. In a logistic regression analysis, four variables (maternal age, depression during pregnancy, thoughts of death and dying at 1 month postpartum, and difficulty falling asleep at 1 month postpartum) were predictive of depression at 4 months postpartum. Breast-feeding, mode of delivery, family income, parity and mother's education did not predict depression. The existence of subsyndromal depressive symptoms, particularly thoughts of death and dying, may represent a prodromal phase of depression and should alert clinicians to the possibility of future postpartum depression. Women with a history of depression during pregnancy should be monitored for signs of postpartum depression for a minimum of 4 months. Obstetricians are in a unique position during the postpartum check-up to screen women for these predictors of future postpartum depression and possibly to avert the development of a clinically significant depressive episode.

Motherhood, health status, and health care

This study examines the impact of multiple roles and stressors on women of childbearing age, and compares the health status of women with and without children and their ability to access health care. Motherhood has many complex interactions with income level, availability of health insurance, and available social and income support. A cumulative burden of multiple stressors (eg, being poor, uninsured, less educated, employed full-time, or being a single mother) relates to worse health status, levels of depression, and opportunities for obtaining health care. Multiple stressors seem to have a stronger effect on mothers than on nonmothers. Research should focus on identifying vulnerable groups and combinations of stressors for women both with and without children, and how to mitigate adverse impacts on physical and mental health.