{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T04:55:51Z","timestamp":1789620951250,"version":"build-2803163510"},"reference-count":43,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"<jats:sec id=\"ab-zoi250295-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Generous parental leave benefits have been associated with better mental health outcomes for parents after childbirth. However, few studies account for preconception mental health and working conditions, the latter being a requirement for generous parental leave benefits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi250295-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the association between levels of parental leave benefits and maternal postpartum mental health when preconception mental health, income, and employment status were considered.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi250295-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This population-based nationwide cohort study included first-time mothers aged 18 to 52 years who gave birth to a live singleton offspring between January 1, 2007, and December 31, 2011. Data were analyzed from March 8 to February 18, 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi250295-7\">\n                    <jats:title>Exposure<\/jats:title>\n                    <jats:p>Paid parental leave benefits, including higher level (qualified for earnings-related benefits equal to approximately 80% of their salary) vs basic level (a flat-rate benefit for those not meeting the work requirements for earnings-related benefits).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi250295-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Nationwide registers were used to perform multivariable logistic regression to calculate the odds of mental health outcomes from different levels of severity (prescription of antidepressants or anxiolytics, specialist outpatient care, and hospitalization) between mothers receiving higher-level and basic benefits. Decomposition analyses using the Karlson-Holm-Breen method were conducted to examine the contribution of preconception mental health, income, and employment status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi250295-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The sample included 210 800 first-time mothers (mean [SD] age, 28.6 [5.0] years), of whom 35 255 (16.72%) received basic benefits and 175 545 (83.28%) qualified for higher-level benefits. Mothers receiving basic benefits had higher odds of being prescribed antidepressants or anxiolytics (odds ratio [OR], 1.44; 95% CI, 1.37-1.51), receiving specialist outpatient care (OR, 2.27; 95% CI, 2.13-2.44), and being hospitalized (OR, 2.47; 95% CI, 2.06-2.97) compared with mothers receiving higher-level benefits. Higher odds remained after adjusting for preconception mental health, accounting for a 46.1% decrease for prescribed antidepressants or anxiolytics, 15.1% for outpatient care, and 10.7% for hospitalization. After adjustment for income and employment status, the odds remained elevated for specialist outpatient care (OR, 1.13; 95% CI, 1.02-1.24) and hospitalization (OR, 1.34; 95% CI, 1.03-1.76).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-zoi250295-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this cohort study of first-time mothers in Sweden, higher-level benefits were associated with better mental health, particularly moderate-to-severe mental disorders. However, since eligibility for higher-level parental leave benefits is contingent on labor market attachment, both improving women\u2019s labor market attachment and relaxing the work requirements for higher-level parental leave could promote women\u2019s postpartum mental health.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.8062","type":"journal-article","created":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T19:30:22Z","timestamp":1746041422000},"page":"e258062","source":"Crossref","is-referenced-by-count":10,"title":["Parental Leave Benefits and Maternal Postpartum Mental Health in Sweden"],"prefix":"10.1001","volume":"8","author":[{"given":"Amy","family":"Heshmati","sequence":"first","affiliation":[{"name":"Centre for Health Equity Studies, Stockholm University\u2013Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Public Health Sciences, Stockholm University, Stockholm, Sweden"},{"name":"Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Honkaniemi","sequence":"additional","affiliation":[{"name":"Centre for Health Equity Studies, Stockholm University\u2013Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Public Health Sciences, Stockholm University, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Fritzell","sequence":"additional","affiliation":[{"name":"Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sol P.","family":"Ju\u00e1rez","sequence":"additional","affiliation":[{"name":"Centre for Health Equity Studies, Stockholm University\u2013Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Public Health Sciences, Stockholm University, Stockholm, Sweden"},{"name":"Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,4,30]]},"reference":[{"issue":"5","key":"zoi250295r1","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1007\/s00737-018-0935-x","article-title":"Transition to parenthood and mental health at 30 years: a prospective comparison of mothers and fathers in a large Brazilian birth cohort.","volume":"22","author":"Pearson","year":"2019","journal-title":"Arch Womens Ment Health"},{"issue":"1","key":"zoi250295r2","doi-asserted-by":"publisher","first-page":"e57","DOI":"10.1016\/S2468-2667(22)00311-5","article-title":"The effect of parental leave on parents\u2019 mental health: a systematic review.","volume":"8","author":"Heshmati","year":"2023","journal-title":"Lancet Public Health"},{"key":"zoi250295r3","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1016\/j.jpsychires.2018.08.001","article-title":"Prevalence and incidence of postpartum depression among healthy mothers: a systematic review and meta-analysis.","volume":"104","author":"Shorey","year":"2018","journal-title":"J Psychiatr Res"},{"issue":"12","key":"zoi250295r4","doi-asserted-by":"publisher","first-page":"2126","DOI":"10.1017\/S0033291720000902","article-title":"Adolescent antecedents of maternal and paternal perinatal depression: a 36-year prospective cohort.","volume":"51","author":"Thomson","year":"2021","journal-title":"Psychol Med"},{"issue":"2","key":"zoi250295r5","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1177\/1044389420913124","article-title":"Paid leave and maternal depressive symptoms after childbirth: the moderating role of perceived fairness of the division of household labor.","volume":"102","author":"Hwang","year":"2021","journal-title":"Fam Soc"},{"issue":"7","key":"zoi250295r6","doi-asserted-by":"publisher","first-page":"1827","DOI":"10.1177\/0192513X17728984","article-title":"Time off after childbirth and mothers\u2019 risk of depression, parenting stress, and parenting practices.","volume":"39","author":"Petts","year":"2018","journal-title":"J Fam Issues"},{"key":"zoi250295r7","doi-asserted-by":"publisher","first-page":"83","DOI":"10.2147\/JHL.S359389","article-title":"Giving 200%: workplace flexibility and provider distress among female physicians.","volume":"14","author":"Caperelli Gergel","year":"2022","journal-title":"J Healthc Leadersh"},{"issue":"2","key":"zoi250295r8","doi-asserted-by":"publisher","first-page":"364","DOI":"10.2307\/1131855","article-title":"Length of maternity leave and quality of mother-infant interactions.","volume":"68","author":"Clark","year":"1997","journal-title":"Child Dev"},{"issue":"2","key":"zoi250295r9","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1300\/J013v34n02_05","article-title":"Unravelling the complexities of the relationship between employment status and postpartum depressive symptomatology.","volume":"34","author":"des Rivieres-Pigeon","year":"2001","journal-title":"Women Health"},{"issue":"4","key":"zoi250295r10","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2021-050107","article-title":"Parenthood and parental leave decisions in pediatric residency.","volume":"148","author":"Dundon","year":"2021","journal-title":"Pediatrics"},{"issue":"4","key":"zoi250295r11","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1016\/j.appdev.2004.06.004","article-title":"Parental leave and work adaptation at the transition to parenthood: individual, marital, and social correlates.","volume":"25","author":"Feldman","year":"2004","journal-title":"J Appl Dev Psychol"},{"issue":"5","key":"zoi250295r12","first-page":"465","article-title":"The relationship of women\u2019s postpartum mental health to employment, childbirth, and social support.","volume":"38","author":"Gjerdingen","year":"1994","journal-title":"J Fam Pract"},{"issue":"2","key":"zoi250295r13","first-page":"161","article-title":"Changes in women\u2019s mental and physical health from pregnancy through six months postpartum.","volume":"32","author":"Gjerdingen","year":"1991","journal-title":"J Fam Pract"},{"issue":"2","key":"zoi250295r14","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1111\/j.1471-6402.1995.tb00291.x","article-title":"Maternity leave and womens mental-health.","volume":"19","author":"Hyde","year":"1995","journal-title":"Psychol Women Q"},{"issue":"2","key":"zoi250295r15","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1007\/s10995-017-2393-x","article-title":"Paid maternity leave in the United States: associations with maternal and infant health.","volume":"22","author":"Jou","year":"2018","journal-title":"Matern Child Health J"},{"issue":"2","key":"zoi250295r16","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1111\/j.1471-6402.1998.tb00153.x","article-title":"Maternity leave, role quality, work involvement, and mental health one year after delivery.","volume":"22","author":"Klein","year":"1998","journal-title":"Psychol Women Q"},{"issue":"4","key":"zoi250295r17","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1016\/j.whi.2018.03.008","article-title":"Exploring the link between maternity leave and postpartum depression.","volume":"28","author":"Kornfeind","year":"2018","journal-title":"Womens Health Issues"},{"issue":"10","key":"zoi250295r18","doi-asserted-by":"publisher","first-page":"1470","DOI":"10.1007\/s10995-018-2542-x","article-title":"The effect of paid leave on maternal mental health.","volume":"22","author":"Mandal","year":"2018","journal-title":"Matern Child Health J"},{"issue":"2","key":"zoi250295r19","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1080\/13668803.2016.1252721","article-title":"Workplace policies and mental health among working-class, new parents.","volume":"20","author":"Perry-Jenkins","year":"2017","journal-title":"Community Work Fam"},{"issue":"1","key":"zoi250295r20","doi-asserted-by":"publisher","first-page":"1676","DOI":"10.1186\/s12889-021-11667-y","article-title":"Determinants of maternal health four weeks after delivery: cross-sectional findings from the KUNO-kids health study.","volume":"21","author":"Pinker","year":"2021","journal-title":"BMC Public Health"},{"issue":"3","key":"zoi250295r21","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1097\/00005053-199103000-00005","article-title":"Gender roles, social support, and postpartum depressive symptomatology: the benefits of caring.","volume":"179","author":"Richman","year":"1991","journal-title":"J Nerv Ment Dis"},{"issue":"11-12","key":"zoi250295r22","doi-asserted-by":"publisher","first-page":"1937","DOI":"10.1093\/milmed\/usaa137","article-title":"Maternity leave length impact on breastfeeding and postpartum depression.","volume":"185","author":"Shumbusho","year":"2020","journal-title":"Mil Med"},{"issue":"11","key":"zoi250295r23","doi-asserted-by":"publisher","first-page":"1738","DOI":"10.1097\/ACM.0000000000002780","article-title":"Maternity leave in residency: a multicenter study of determinants and wellness outcomes.","volume":"94","author":"Stack","year":"2019","journal-title":"Acad Med"},{"issue":"1118","key":"zoi250295r24","doi-asserted-by":"publisher","first-page":"694","DOI":"10.1136\/postgradmedj-2018-135960","article-title":"Childbearing and maternity leave in residency: determinants and well-being outcomes.","volume":"94","author":"Stack","year":"2018","journal-title":"Postgrad Med J"},{"issue":"10","key":"zoi250295r25","doi-asserted-by":"publisher","first-page":"1356","DOI":"10.1177\/0192513X12459014","article-title":"Leave duration after childbirth: impacts on maternal mental health, parenting, and couple relationships in Australian two-parent families.","volume":"34","author":"Whitehouse","year":"2013","journal-title":"J Fam Issues"},{"issue":"2","key":"zoi250295r28","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1007\/s10680-015-9365-x","article-title":"Use it or save it? migration background and parental leave uptake in Sweden.","volume":"32","author":"Mussino","year":"2016","journal-title":"Eur J Popul"},{"issue":"6","key":"zoi250295r29","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-049682","article-title":"Unintended health consequences of Swedish parental leave policy (ParLeHealth): protocol for a quasi-experimental study.","volume":"11","author":"Ju\u00e1rez","year":"2021","journal-title":"BMJ Open"},{"issue":"2","key":"zoi250295r30","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1007\/s10654-016-0117-y","article-title":"Registers of the Swedish total population and their use in medical research.","volume":"31","author":"Ludvigsson","year":"2016","journal-title":"Eur J Epidemiol"},{"issue":"1","key":"zoi250295r31","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1007\/s10654-022-00947-5","article-title":"The Swedish medical birth register during five decades: documentation of the content and quality of the register.","volume":"38","author":"Cnattingius","year":"2023","journal-title":"Eur J Epidemiol"},{"issue":"4","key":"zoi250295r34","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1007\/s10654-019-00511-8","article-title":"The Longitudinal Integrated Database for Health Insurance and Labour Market Studies (LISA) and its use in medical research.","volume":"34","author":"Ludvigsson","year":"2019","journal-title":"Eur J Epidemiol"},{"key":"zoi250295r35","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2020.112869","article-title":"Psychological distress by age at migration and duration of residence in Sweden.","volume":"250","author":"Honkaniemi","year":"2020","journal-title":"Soc Sci Med"},{"issue":"2","key":"zoi250295r36","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1016\/j.rssm.2010.12.005","article-title":"Decomposing primary and secondary effects: a new decomposition method.","volume":"29","author":"Karlson","year":"2011","journal-title":"Res Soc Strat Mobil"},{"issue":"3","key":"zoi250295r37","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1177\/1536867X1101100306","article-title":"Comparing coefficients of nested nonlinear probability models.","volume":"11","author":"Kohler","year":"2011","journal-title":"Stata J"},{"issue":"2","key":"zoi250295r38","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1177\/0049124113494572","article-title":"Total, direct, and indirect effects in logit and probit models.","volume":"42","author":"Breen","year":"2013","journal-title":"Sociol Methods Res"},{"issue":"1","key":"zoi250295r39","first-page":"250","article-title":"Addressing extreme propensity scores via the overlap weights.","volume":"188","author":"Li","year":"2019","journal-title":"Am J Epidemiol"},{"key":"zoi250295r41","doi-asserted-by":"publisher","first-page":"i17","DOI":"10.1093\/heapro\/dau036","article-title":"The Helsinki statement on health in all policies.","volume":"29","year":"2014","journal-title":"Health Promot Int"},{"issue":"1","key":"zoi250295r42","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1177\/09589287231216688","article-title":"Parental leave use among newly arrived immigrant mothers in Sweden: causes and consequences.","volume":"34","author":"Mussino","year":"2024","journal-title":"J Eur Soc Policy"},{"issue":"6","key":"zoi250295r43","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1093\/eurpub\/ckac158","article-title":"Mental health by native-immigrant intermarriage in Sweden: a register-based retrospective cohort study.","volume":"32","author":"Honkaniemi","year":"2022","journal-title":"Eur J Public Health"},{"key":"zoi250295r40","volume-title":"Stata Statistical Software: Release 17","author":"StataCorp","year":"2021"},{"key":"zoi250295r26","unstructured":"Parental benefits. Swedish Social Insurance Agency. Updated February 20, 2025. Accessed March 7, 2024. https:\/\/www.forsakringskassan.se\/privatperson\/foralder\/foraldrapenning"},{"key":"zoi250295r27","unstructured":"Blum? S, Dobrotic? I, Kaufman? G, Koslowski? A, Moss? P. 19th International review of leave policies and related research 2023. Report 19. September 2023. Accessed April 25, 2024. https:\/\/www.leavenetwork.org\/fileadmin\/user_upload\/k_leavenetwork\/annual_reviews\/2023\/Blum_etal_LPRN_full_report_2023.pdf"},{"key":"zoi250295r32","unstructured":"National Patient Register Stockholm. Swedish National Board of Health and Welfare. 2024. Accessed March 7, 2024. https:\/\/www.socialstyrelsen.se\/en\/statistics-and-data\/registers\/national-patient-register\/"},{"key":"zoi250295r33","unstructured":"National Prescribed Drug Register. Swedish National Board of Health and Welfare. Updated February 8, 2024. Accessed March 7, 2024. https:\/\/www.socialstyrelsen.se\/en\/statistics-and-data\/registers\/national-prescribed-drug-register\/"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2833323\/heshmati_2025_oi_250295_1745261948.22542.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T19:30:26Z","timestamp":1746041426000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2833323"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,30]]},"references-count":43,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,4,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.8062","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,30]]}}}