Air Force Institute of Technology PhD Student, Nutrition and Health Sciences, University of Nebraska Lincoln, Lincoln NE 68503, USA.
Nutrition and Health Sciences, University of Nebraska Lincoln, Lincoln NE 68503, USA.
Mil Med. 2024 Feb 27;189(3-4):e773-e780. doi: 10.1093/milmed/usad354.
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.
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.
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.
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.
产后抑郁症在美国影响着 1/8 的女性。研究表明，产假时长和薪酬可能对产后抑郁症症状产生影响。美国军方在 2016 年将其产假时间从 6 周增加到 12 周。本研究旨在通过利用 2011 年至 2019 年期间的军事健康记录中的客观数据，在当前关于产假对产后抑郁症影响的文献基础上进行扩展。
从 2011 年至 2019 年期间，对所有在军事医疗系统中分娩的现役女性进行了分析。共有 60746 名女性符合纳入标准。现役女性按分娩年份进行分层，以确定她们是否有 6 周（2011-2015 年）或 12 周（2016-2019 年）的产假。国际疾病分类（ICD）第 9 版和第 10 版代码用于识别产后抑郁症的诊断。使用逻辑回归模型，在调整协变量的情况下，评估产假时间长短与产后抑郁症诊断之间的关联。
总体而言，4.8%的女性被诊断患有产后抑郁症。与被分配 6 周（2011-2015 年）产假的女性相比，被分配 12 周（2016-2019 年）产假的现役女性产后抑郁症诊断的可能性更高（12 周产假与 6 周产假相比：比值比[OR] = 1.29；95%置信区间[CI] = 1.20-1.39，P < 0.0001）。然而，与 2011-2015 年相比，2016-2017 年（12 周产假实施后的 2 年）产后抑郁症的可能性降低了 50%（OR = 0.50；95%CI = 0.43-0.57，P < 0.0001）。这种趋势在各军种中相似。此外，在 2011 年至 2019 年期间，产后抑郁症的最低发病率出现在 2016-2017 年，但从 2018 年开始，发病率显著上升。总体而言，军衔较低的女性比军衔较高的女性产后抑郁症发病率更高。
我们的研究结果表明，美国军方将产假时间从 6 周增加到 12 周，这一政策在实施后（2016 年）和退伍军人事务部和国防部妊娠管理临床实践指南发布前（2018 年），确实降低了现役女性产后抑郁症诊断的可能性。之后，2018-2019 年期间，产后抑郁症发病率增加（2018-2019 年）可能是由于军事治疗设施在围产期增加了抑郁筛查方案。
