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Associations between Paid Paternity Leave and Parental Mental Health Across the Transition to Parenthood: Evidence from a Repeated-Measure Study of First-Time Parents in California

Abstract

Paid family leave may mitigate stress and health challenges across the transition to parenthood. The current study examined whether paid paternity leave is associated with first-time parents’ trajectories of depression, stress, and sleep from the prenatal to postpartum periods. Expectant parents (72 couples) reported on their depressive symptoms, perceived stress, and daytime fatigue during mid-to-late pregnancy and then again at six months postpartum. At one year postpartum, fathers reported on any paid or unpaid leave taken following their child’s birth. We used a repeated-measures design to compare couples in which the father either did or did not access paid paternity leave. When fathers took paid paternity leave, their partners’ stress and depressive symptoms showed smaller prenatal to postpartum increases than mothers whose partners did not take paid leave. Similarly, fathers who took paid paternity leave, compared to those who did not, reported smaller prenatal to postpartum increases in stress and daytime fatigue. These results remained largely unchanged when controlling for the length of fathers’ leave. The study’s longitudinal, within-subject design allows us to examine parents’ mental health relative to their own prenatal baseline, helping to account for some of the pre-existing differences between fathers who did and did not take paid paternity leave. The results suggest that paid paternity leave may be associated with greater well-being across the transition to parenthood for both fathers and mothers.

Highlights

  • When fathers accessed paid paternity leave, both mothers and fathers showed greater well-being across the transition to parenthood.

  • Fathers who used paid paternity leave showed less of an increase in stress and daytime fatigue from across the prenatal to postpartum periods.

  • Mothers whose partners used paid paternity leave reported less of an increase in depression and stress over the transition to parenthood.

The transition to parenthood is a period of profound biological, psychological, economic, and social change (Saxbe et al., 2018a, 2018b). Although the birth of a new child is often a joyful experience, it is also a challenging one, as parents must devote time, energy, and financial resources to support a growing family. Over the last half-century, the increased participation of mothers in the labor force has been accompanied by notable shifts towards paternal involvement in childrearing (Cabrera et al., 2000; Hoherz & Bryan, 2020; Sarkadi et al., 2008). The ability to take family leave after the birth of a child may afford fathers time to bond with their child (Plotka & Busch-Rossnagel, 2018; Rehel, 2014) and build competence in infant care (Bünning, 2015). However, more research is needed to explore how fathers’ leave policies support new parents’ stress and mental health. Specifically, few studies have focused on the health benefits of paid paternity leave for first-time fathers and their partners. The present study seeks to address this gap in the parenting literature by assessing the benefits of paid paternity leave on the mental health of first-time mothers and fathers during the transition to parenthood. We focus specifically on paid leave, rather than unpaid leave or informal time off, because paid family leave represents protected time off from work that is specifically dedicated to parental bonding following a birth. Further, as discussed below, prior research on paid versus unpaid leave in mothers suggests that paid leave is associated with enhanced mental and physical health outcomes. The present study extends this research to fathers.

Stress and Health Risks Associated with Parenthood

Both mothers and fathers are vulnerable to adverse mental health outcomes during the postpartum period. These include increased psychosocial stress (Reid & Taylor, 2015), heightened prevalence of mood disorders (Paulson & Bazemore, 2010), and sleep disturbances that may lead to fatigue and impair daytime functioning (Gay et al., 2004; Hagen et al., 2013). Parents often experience stress as they transition into parenthood, and many encounter further challenges, such as postpartum depression (Dennis et al., 2012; Gao et al., 2009; Yim et al., 2015). Many individuals report their first depressive episode following a child’s birth (Stowe & Nemeroff, 1995). Reported prevalence rates of maternal postpartum depression (PPD) range from 10–20% in mothers (O’Hara & McCabe, 2013). Postpartum depression symptoms have been negatively associated with mother-infant bonding (Dubber et al., 2015), breastfeeding (Henderson et al., 2003; Kawano & Emori, 2015), infant cognitive development (Kaplan et al., 2015; Sutter-Dallay et al., 2011), and the physical health of infants (Gress-Smith et al., 2012). Furthermore, fathers can also develop PPD, with prevalence rates estimated at 10% (Paulson & Bazemore, 2010). PPD, for both mothers and fathers, has widespread and lasting impacts on child development and therefore represents a significant health risk for families (Aktar et al., 2019; O’Hara & Wisner, 2014).

Sleep deprivation is another critical challenge faced by new parents. During the postpartum period, new parents often experience changes in sleep patterns (Paavonen et al., 2017). However, sleep problems may influence parents’ ability to perform day-to-day tasks due to exhaustion and reduced alertness (Filtness et al., 2014; Hagen et al., 2013). Though many mothers may assume the primary responsibility for nighttime parenting (Teti et al., 2016), fathers’ sleep is also impacted, especially because their return to work often occurs sooner than mothers. A study that used an actigraphy wristwatch to objectively measure parental sleep at one month postpartum found that, whereas both parents had disturbed sleep at night, mothers were able to “catch up” on sleep during the day. In contrast, fathers had more stable 24-hour sleep patterns but obtained less daily sleep than mothers (Gay et al., 2004). Additionally, Elek et al. (2002) found that a sample of first-time United States (US) fathers, compared to their female partners, reported larger increases in fatigue from late pregnancy to four weeks postpartum (Elek et al., 2002). While sleep quality typically improves during infancy, many infants continue to wake frequently during the first year (Henderson et al., 2010; Montgomery-Downs et al., 2010), and many parents report daytime fatigue due to sleep dysfunction even several months after the birth of the child (Filtness et al., 2014; Loutzenhiser et al., 2015). Daytime dysfunction due to sleep problems may compromise parents’ ability to function at work and contribute to work-family conflict at home. Moreover, postpartum sleep disturbance may exacerbate depressive symptoms in new parents (Saxbe et al., 2016), along with other mental and physical health problems among both parents and children.

Potential Benefits of Paid Paternity Leave

The predominant household configuration in the US consists of dual-income couples with children, in which both partners are employed outside the home (Pew Research Center, 2013). Therefore, family leave may be of particular importance for contemporary parents managing their careers and caregiving responsibilities while maintaining their health. Paid leave may confer benefits over unpaid or informal leave because it offers protected, recognized time for family bonding that does not require significant financial sacrifice. Several studies have examined the specific benefits of paid versus unpaid leave. For instance, an international meta-analysis of studies comparing paid and unpaid maternity leave, including samples from Australia, Sweden, Norway, USA, Canada, and Lebanon, found a positive association between paid maternity leave and women’s mental health (Gay et al., 2004). Another study by Jou et al. (2018) examined the benefits of paid leave in a large representative sample of US mothers, finding that women who took paid or partially paid leave were 53% less likely to seek mental health care than women who did not take paid maternity leave (Jou et al., 2018). Women who took paid or partially paid leave were 1.78 times more likely to report that they were doing well with stress management than women who took unpaid leave. This work emphasizes the unique benefits of paid leave, which provides parents with more protected time and income to recover and adjust to parenthood.

Similar to maternity leave, paid paternity leave may potentially offset the long-term stress and mental health challenges faced by new caregivers (Saxbe et al., 2018a, 2018b). Månsdotter et al. (2007) found that Swedish fathers whose children were born shortly after implementation of a 1974 paid paternity leave policy had longer life expectancies than fathers whose children were born shortly before the policy was implemented, suggesting that paid leave may offer long-term health protection (Månsdotter et al., 2007). Another study found that a Swedish policy granting greater workplace flexibility to fathers, specifically 30 days of paid family leave that could be taken in tandem with their partners, predicted both physical and mental health improvements for mothers, including reduced use of psychiatric medication (Persson & Rossin-Slater, 2019). These findings suggest that paid family leave for fathers may benefit both fathers’ and mothers’ mental and physical health. In other words, rather than being a policy intervention that only benefits fathers, paternity leave may affect the well-being of the entire family.

The US is one of the only industrialized countries with no national policy on paid leave for parents. The Family Medical Leave Act (Family and Medical Leave Act of 1993, 1993) provides 12 weeks of job-protected, unpaid leave after a child’s birth but does not mandate that employers financially compensate parents. However, unpaid leave can introduce financial and logistical challenges, and may not have the same mental health protective benefits as paid leave. Since the inception of The Pregnancy Discrimination Act (1978), birth mothers, excluding fathers and adoptive parents, are eligible for several weeks of paid leave as part of the state temporary disability program (TDI) in more states, including California, Hawaii, New Jersey, New York, and Rhode Island (The Pregnancy Discrimination Act of 1978, 1978). In 2004, California created and passed a paid family leave (PFL) policy (CA-PFL) that provides paid family leave to a more inclusive group of caregivers, including birth mothers, birth fathers, adopted parents, and individuals caring for sick family members. Preliminary evidence suggests CA-PFL increases the likelihood of fathers taking leave. One study found that fathers are 46% more likely to be on leave when CA-PFL is available, and effects are more substantial for first-born children (Bartel et al., 2018). The current study uses a sample that resides in California, allowing for greater variability in leave outcomes compared to potential samples of fathers in other states.

Current Study

One major challenge for research on paid paternity leave in US samples is that fathers with access to paid paternity leave typically differ significantly from fathers without paid paternity leave. Low-income families are less likely to take unpaid leave or may not be eligible for FMLA (Waldfogel, 2001). Additionally, fathers often report reluctance to take leave out of fear that their careers will be negatively impacted (Waldfogel, 2001), and some evidence suggests that men who quit or are unemployed may earn less money in the future. Thus, higher-income fathers in occupations with greater autonomy may be more likely to access paid paternity leave, meaning that between-group comparisons between fathers who take versus do not take paid leave may be biased. Moreover, the baseline characteristics of fathers who choose to take paid leave may differ from fathers who have access to paid leave but do not use it. Thus, the current study takes a longitudinal, within-person approach, using repeated measures analysis to examine prenatal-to-postpartum trajectories of stress, depression, and sleep within individuals to help adjust for these potential pre-existing baseline differences.

Although paid paternity leave has been associated with mental health benefits to new mothers and fathers in international samples, limited research exists on the mental health benefits of paid paternity leave in the United States. This study focused on three mental health-relevant outcomes, assessed both before and after the birth of the first child: (a) perceived stress, (b) depressive symptoms, and (c) daytime fatigue due to sleep problems. We tested two broad hypotheses. First, we predicted that paid paternity leave would be associated with better trajectories of these mental health-relevant outcomes in new fathers over the transition to parenthood. Second, given the evidence that paternity leave may also benefit mothers’ mental and physical health (Persson & Rossin-Slater, 2019), we expected to find benefits to mothers as well as to fathers. Therefore, we hypothesized that when fathers took paid parental leave, their partners would also report better trajectories of stress, depressive symptoms, and daytime fatigue due to sleep problems over the transition to parenthood. We conducted two follow up analyses to examine whether leave characteristics, such as length of leave and a more fine-grained comparison of leave type (i.e., paid, unpaid, no leave), were associated with mothers’ and fathers’ mental health trajectories over the transition to parenthood.

Method

Participants

Data for this study were drawn from a larger longitudinal study on the transition to parenthood that took place in a large city in California (Cardenas et al., 2021; Khaled et al., 2020, 2021; Khoddam et al., 2020; Saxbe et al., 2019; Saxbe et al., 2018a, 2018b). Couples were recruited during pregnancy through fliers posted in obstetricians’ offices, community health clinics, and social media. Eligibility criteria included those participants be in an opposite-sex relationship, both be expecting their first child, having a singleton birth, and able to respond to study measures in English. Exclusion criteria included that either partner is unable to abstain from smoking or illegal drug use during the study visit, is taking medications known to interfere with the hormones being measured in the study (i.e., steroid medications, androgen replacement therapy), has a condition that interferes with stress hormones (e.g., Cushing’s disease), or is diagnosed with a severe psychiatric illness. Also, to standardize family configurations and aid interpretation of hormones, which were not examined in the present study, we restricted the sample to couples who were cohabitating with their partner and planning to continue cohabitating after the child’s birth. All study procedures were approved by the Institutional Review Board of the university where the research took place, and informed consent was obtained at the prenatal visit before study procedures commenced.

The present study examined 72 opposite-sex couples within the larger study who also reported on paternity leave and provided prenatal and postpartum data. The overall study retention rate was roughly 90% at 12 months. Mothers and fathers in the sample were on average 31 and 33 years old, respectively. Table 1 contains descriptive statistics for other participant demographics. Slightly less than half of the mothers in the sample (44%) identified as White, and the rest of the mothers (56%) identified as Latina, Asian-American, African American, or multi-racial. Similarly, slightly less than half of the fathers in the sample (47.2%) identified as White, and the rest of the fathers (52.8%) identified as Latino, Asian-American, African American, or multi-racial. The sample was well-educated, with most (82.64%) participants having at least a bachelor’s degree. Participant occupations varied widely, with some occupations including nurse, graduate student, civil engineer, sales representative, product manager, and photographer. A Missing Values Analysis with all main study variables (i.e., paternity leave status, BDI, PSS, PSQI) for mothers and fathers and at both time points (i.e., prenatal, postpartum) and covariates (i.e., mothers’ education level, fathers’ education level, weeks pregnant, infant age) indicated that data were missing completely at random (Little & Rubin, 1987) MCAR test: χ 2 = 93.197, DF = 82, p = 0.187.

Table 1 Descriptive statistics of sample demographics and responses

Procedures and Design

Couples participated in both a prenatal and a six-month postpartum laboratory visit and an online follow-up survey at 12 months postpartum. The prenatal visit, which lasted between three and four hours, occurred when mothers were between 20–39 weeks pregnant (M = 29.03, SD = 3.94, range = 20.39–38.52). During the visit, expectant mothers and fathers completed prenatal measures, including the Beck Depression Inventory-II (BDI-II), Perceived Stress Scale-14 (PSS-14), and Pittsburgh Sleep Quality Index (PSQI). The postpartum laboratory visit, also lasting between three and four hours, occurred at around six months postpartum (M = 28.87 weeks, SD = 2.70, range = 23.80–39.20). Fathers and mothers were stationed in separate rooms within the lab where they independently responded again to the same questionnaire measures of stress, depressive symptoms, and sleep. At twelve months postpartum, the study team sent fathers and mothers password-protected links to independently complete surveys online via the Qualtrics platform. There, mothers and fathers responded to questions about whether they took any paid or unpaid time off from work following their infant’s birth and the length of their time off. They were also given an open-ended prompt to elaborate on any details on their leave status.

Measures

Paternity leave

Overall, 20 (27.8%) fathers took paid leave subsidized by their employer, 13 (18.1%) took paid leave that was subsidized by sources other than an employer (e.g., state disability pay), 4 (5.6%) took unpaid leave only, 6 (8.3%) took a combination of paid and unpaid leave, 16 (22.2%) worked as freelancers or were self-employed and arranged own time off from work, and 13 (18.1%) did not take any paid or unpaid leave. Given our focus on paid leave, we divided the sample into two groups based on fathers’ leave type: those who took any paid paternity leave (including leave subsidized by employers, other sources than their employer, or a combination of paid and unpaid leave (PL; n = 39, 54.2% of the sample); and those who took unpaid leave, no leave, or were self-employed and arranged their own time off from work (UNL; n = 33, 45.8% of the sample). Although this paper did not focus on maternity leave, most (88.57%) of mothers reported taking some leave following their pregnancy, and about 2/3 of mothers (64.3%) reported use of paid leave.

Length of leave

Of the 39 fathers in the PL group, 3 (7.7%) took 2 weeks, 11 (28.2%) took less than one month, 24 (61.5%) took 1–3 months, and 1 (2.6%) took 4–6 months off. Of the 33 fathers in the UNL group, more than half (n = 21; 63.6%) reported taking some time off. Specifically, in the UNL group, 12 (36.4%) took no time off, 5 (15.2%) took two weeks, 7 (21.2%) took less than one month, 3 (9.1%) took 1–3 months off, 2 (6%) took 4–6 months off, and 4 (12.1%) took more than 9 months off. Figure 1 displays the frequency of leave time within each leave group. Of note, the UNL group displayed more variability in leave times, with almost one-third of fathers taking no leave time, several fathers taking more than four months off, and some even taking more than 9 months off. Of the six fathers who reported taking more than three months off, five reported that they were freelancers who arranged their own time off. Thus, it is possible that fathers were working intermittently while also taking time off. In contrast, fathers in the PL group mostly took between one and three months off, and only one father reported taking more than 4–6 months off.

Fig. 1
figure1

Fathers’ leave time across leave groups. Note. Bar graph displays the frequency various time off that fathers took for paternity times in the UNL group (i.e., fathers took unpaid leave, no leave, or were self-employed and arranged their own time off from work) and PL group (i.e., fathers who took paid paternity leave subsidized by employees, other sources than employer, or a combination of paid and unpaid leave

Depressive symptoms

At both the prenatal and postpartum lab visits, fathers and mothers completed the revised BDI-II (Beck et al., 1996), widely used to assess depression in both clinical and community samples. Participants are asked whether they have been experiencing depressive symptoms such as sadness, irritation, and appetite changes during the past two weeks. At the university IRB’s request, the suicidality item was dropped from this measure to include 20 rather than the typical 21 items. This method has been widely used and shows good reliability and validity. Further, research on parent depression has used this measure to assess changes in parent depression (Casper et al., 2003). Descriptive statistics for this and the other measures are shown in Table 1. The Cronbach’s alpha for this sample for the prenatal BDI was 0.83 for mothers and 0.87 for fathers.

Perceived stress

At both the prenatal and postpartum lab visits, fathers and mothers completed the PSS-14, a 14-item measure that assesses non-specific appraisal of situational stress over the last month (Cohen et al., 1983). Participants responded to questions about current feelings of stress, irritation, and difficulty on a 5-point Likert scale ranging from never to very often. The PSS-14 is a widely used measure that correlates with biological markers of stress, such as cortisol (Walvekar et al., 2015), and has been used to study parental stress and well-being (Tsiouli et al., 2014). The Cronbach’s alpha for this sample for the prenatal PSS was 0.82 for mothers and 0.85 for fathers.

Daytime fatigue

At both the prenatal and postpartum lab visits, fathers and mothers completed the PSQI (Buysse et al., 1989), a self-report measure of sleep quality over the past month. The present study focused on the daytime dysfunction scale, which asks about difficulty staying awake while engaging in routine activities and maintaining enthusiasm to get things done during the day. The PQSI measure is widely used and shows good reliability and validity. Researchers have used the PSQI to study sleep changes during the transition to parenthood (Gao et al., 2019). We did not calculate Cronbach’s alpha for daytime fatigue as it is a two-item subscale. The Pittsburgh Sleep Quality Index was added partway through data collection, so sample sizes were smaller (n = 59 for fathers, n = 58 for mothers) for analyses of daytime fatigue.

Analysis Plan

Before testing our primary hypotheses, we investigated demographic factors that might contribute to differences between the PL and UNL groups. We conducted chi-square tests to check for differences in the paternity leave group versus the unpaid paternity leave group regarding education level, race/ethnicity, and relationship status. We also conducted independent samples t-tests to determine whether there were mean differences in parents’ age due to being in the paid paternity leave versus unpaid paternity leave group.

For our main study hypotheses, we conducted repeated measures ANCOVAs to examine the relationship between paternity leave (PL vs. UNL) and changes in depression, stress, and daytime dysfunction from prenatal to postpartum in both fathers and mothers. Given evidence that socioeconomic status (SES) is linked to mental health outcomes (Kivimäki et al., 2020; Link et al., 1993), we controlled for fathers’ and mothers’ education levels, a proxy for SES, in their respective analyses. Additionally, research suggests that parent mental health varies across the transition to parenthood (Condon et al., 2004). Thus, gestational age (weeks of pregnancy at the time of the prenatal visit) and infant age at the postpartum visit were included as covariates in all analyses to account for variation in the prenatal and postpartum visits. These two measures of child age were not correlated with each other because they were collected at two different visits and corresponded with the timing of families’ availability to complete study sessions. Of note, all results held when education and weeks pregnant were not included as covariates.

To better understand our analyses, we ran two follow-up analyses to examine the role of the length of fathers’ leave and fathers’ leave type (i.e., paid leave, unpaid leave, no leave) on the main results. To examine whether fathers’ length of leave impacted the results, we ran ANCOVAs (as completed for analyzing main study hypotheses) with length of leave as an additional covariate. To examine whether fathers’ leave type impacted results, we ran ANCOVAs (as completed for analyzing main study hypotheses) but divided the couples into three groups: no leave (n = 13), unpaid leave (n = 20), and paid leave (n = 39).

We conducted analyses using IBM SPSS (Version 26.0).

Results

Preliminary Analyses

Bivariate correlations between main study variables by gender are shown in Tables 2 and 3. Mental health measures (stress, depression, and daytime dysfunction due to sleep problems) were generally correlated with each other across the prenatal and postpartum periods, except for maternal prenatal daytime fatigue, which was not associated with postpartum mental health for mothers.

Table 2 Intercorrelation of study variables by gender and independent samples t-tests for mothers
Table 3 Intercorrelation of study variables by gender and independent samples t-tests for fathers

To assess for differences in main study variables as a function of being in the PL or UNL groups, we conducted a series of independent samples t-tests (results shown in Tables 2 and 3). Of the main study variables, we only found one significant difference between the PL and UNL groups. Specifically, an independent samples t-test comparing daytime sleep disruption showed that men who took paid paternity leave (PL group) showed greater prenatal daytime fatigue than fathers with no paid leave/unpaid leave (UNL) t (57) = −0.51, p = 0.000, 95% CI [−0.78, −0.24]. Otherwise, parents’ age, education level, income, race/ethnicity, and relationship status did not differ between the PL and UNL groups.

Hypothesis 1

We first tested the hypothesis that paid paternity leave would be associated with better trajectories of mental health outcomes in new fathers over the transition to parenthood. This hypothesis was supported for stress and daytime fatigue but not for depressive symptoms. Specifically, fathers who took paid paternity leave did not differ from fathers who did not take paid leave in their trajectories of self-reported depressive symptoms (F (1, 67) = 0.40, p = 0.527) over the transition to parenthood. However, fathers’ changes in self-reported perceived stress from prenatal to postpartum did differ based on leave group (F (1, 67) = 4.19, p = 0.045). Further, of the subsample of fathers that completed the PSQI, there was a significant difference in the effect on fathers’ self-reported daytime fatigue from prenatal to postpartum (F (1, 54) = 14.63, p < 0.001). All results held when we excluded covariates from analyses. Table 4 shows repeated measure ANCOVA results for fathers, Fig. 2a provides a graph of differences in fathers’ perceived stress, and Fig. 2b provides a graph of differences in fathers’ daytime dysfunction.

Table 4 Repeated measures ANOVA for study variables for fathers
Fig. 2
figure2

Fathers’ stress and daytime dysfunction scores as a function of leave status and time. Note. a Line graph displays mothers’ Perceived Stress Scale (PSS) score based on leave group and time point. b Line graph displays fathers’ Pittsburgh Sleep Quality Index (PSQI) Daytime Dysfunction score based on leave group and time point. Of note, the UNL group consists of fathers who took unpaid leave, no leave, or were self-employed and arranged their own time off from work and the PL group consists of fathers who took paid paternity leave subsidized by employees, other sources than employer, or a combination of paid and unpaid leave. For context, the range for the PSS measure is 0–40 and the range for PSQI daytime dysfunction measure is 0–3

Hypothesis 2

Next, we tested our second hypothesis, positing that when fathers took paid parental leave, mothers would also show better mental health trajectories over the transition to parenthood. This hypothesis was supported for depressive symptoms and stress but not daytime fatigue. As shown in Fig. 3, mothers whose partners took paid paternity leave exhibited less of an increase in self-reported depressive symptoms from prenatal to postpartum (F (1, 67) = 4.81, p = 0.032). Similarly, and shown in Fig. 3, when fathers took paid paternity leave, their partners also exhibited less of an increase in perceived stress across the transition to parenthood (F (1, 67) = 5.40, p = 0.023). However, fathers’ paid paternity leave did not appear to affect mothers’ changes in daytime fatigue (F (1, 53) = 0.04, p = 0.835). Table 5 shows repeated measure ANCOVA results for mothers. Of note, all results in mothers held when fathers’ education level was included as a covariate instead of mothers’ own education level and when we excluded covariates from analyses.

Fig. 3
figure3

Mothers’ stress and depression scores as a function of fathers’ leave status and time. Note. a Line graph displays mothers’ Perceived Stress Scale (PSS) score based on leave group and time point. b Line graph displays mothers’ Beck Depression Inventory (BDI) score based on leave group and time point. Of note, the UNL group consists of fathers who took unpaid leave, no leave, or were self-employed and arranged their own time off from work and the PL group consists of fathers who took paid paternity leave subsidized by employees, other sources than employer, or a combination of paid and unpaid leave. For context, the range for the PSS measure is 0–40 and the range for BDI measure is 0–63

Table 5 Repeated measures ANOVA for study variables for mothers

Follow-up Analyses to Examine Leave Length and Leave Type

We repeated the above analyses, controlling for the length of fathers’ leave. After controlling for length of paternity leave, and results were largely unchanged. However, our finding of smaller increases in self-reported depressive symptoms in mothers whose male partners took paid paternity became marginally significant after controlling for length of leave (F (1, 66) = 3.71, p = 0.058). Supplementary Tables S1 and S2 display repeated measure ANCOVA results for fathers and mothers, respectively.

We next tested whether fathers’ access to any leave, regardless of whether it was paid, was associated with mothers’ or fathers’ trajectories of mental health symptoms over the transition to parenthood. We ran all ANCOVAS with the sample divided into three groups of leave type: no leave (n = 13), unpaid leave (n = 20), and paid leave (n = 39). Most results became marginally significant except fathers’ daytime fatigue. As shown in Fig. 4, fathers’ leave type predicted fathers’ trajectories of daytime fatigue (F (2, 53) = 17.17, p = 0.000). To examine the direction of the interaction, we examined the estimated marginal means. Fathers who took unpaid leave showed greater increases in daytime fatigue than fathers who took no leave (CI = 0.01–0.64). However, fathers’ leave type only marginally predicted trajectories of fathers’ perceived stress symptoms (F (1, 66) = 7.01, p = 0.010), mothers’ depression symptoms (F (2, 66) = 57.08, p = 0.093), and mothers’ perceived stress symptoms (F (2, 66) = 2.82, p = 0.067). Given that these results were not significant, we did not conduct follow up analyses to probe for differences between trajectories for each leave type. Supplementary Tables S3 and S4 display repeated measure ANCOVA results for fathers and mothers, respectively.

Fig. 4
figure4

Fathers’ daytime dysfunction scores as a function of fathers’ leave status and time. Note. Line graph displays fathers’ Pittsburgh Sleep Quality Index (PSQI) Daytime Dysfunction score based on leave group and time point. Of note, the NL group consists of fathers who took no leave, the NPL group consists of fathers who took unpaid leave, and the PL group consists of fathers who took paid paternity leave subsidized by employees, other sources than employer, or a combination of paid and unpaid leave. For context, the range for PSQI daytime dysfunction measure is 0–3

Discussion

The present study found paid paternity leave to be associated with better adaptation to first-time parenthood for both fathers and mothers. As expected, when fathers took paid paternity leave, they showed smaller increases in perceived stress and daytime fatigue from prenatal to postpartum. Also as expected, mothers whose partners took paid paternity leave showed smaller prenatal-to-postpartum increases in both depressive symptoms and perceived stress across the transition to parenthood compared to mothers whose partners did not take paid leave. In other words, paid paternity leave buffered new fathers and mothers from increases in stress, daytime fatigue, and depressive symptoms across the transition to parenthood.

It is notable that when fathers took paid paternity leave, their partners’ stress and mental health trajectories seemed healthier, but the fathers themselves did not show the same benefit for depressive symptoms. Fathers who take paternity leave may engage more in housework and childcare and show a more equitable division of household labor (Castro-García & Pazos-Moran, 2016; Petts & Knoester, 2018; Rehel, 2014). This may, in turn, reduce the burden of new parenthood that mothers experience. In other words, although not directly investigated in the current study, the relationship between paid paternity leave and maternal well-being may be explained by fathers’ contributions to domestic responsibilities. Previous research supports this explanation, suggesting that well-designed paid paternity leave policies encourage a more equitable division of childcare (Kotsadam & Finseraas, 2011), which in turn supports maternal mental health (Séjourné et al., 2012). More flexible work arrangements have been associated with enhanced mental health outcomes in mothers, including lower rates of prescriptions for anti-anxiety medication (Persson & Rossin-Slater, 2019). Men who take paid paternity leave may also confront stigma in terms of their social role and workplace identity (Anxo et al., 2011; Rehel, 2014), which may explain why paid paternity leave did not appear to be as protective for depressive symptoms.

Paid paternity leave was associated with healthier trajectories in other domains, such as perceived stress and daytime fatigue. Though fathers are likely losing sleep due to infant feedings and crying at night, paid leave may allow fathers to gain additional sleep during the day while the infant naps (Gay et al., 2004). Given the importance of sleep to both mental and physical health (Irwin, 2015), fathers’ enhanced sleep may promote health over time. These findings warrant further exploration of the long-term benefits of postpartum sleep on fathers’ mental and physical health, including cardiometabolic and obesity risk (Saxbe et al., 2018a 2018b). Interestingly, fathers in the paid leave group showed higher rates of daytime fatigue prenatally, which may help to explain the differences in trajectories across the two groups. Fathers in the PL group may be in more structured or demanding occupations, making the contrast between prenatal and postpartum sleep quality greater. Of note, we found no differences in trajectories of daytime fatigue between mothers with partners in the paid leave or unpaid leave group, perhaps because mothers remained engaged in nighttime parenting regardless of fathers’ leave status.

Interestingly, among fathers who took unpaid leave, we found more variability in the amount of time they took off, with some fathers taking no time and others taking more than three months off. However, as noted, most fathers who took more than three months off reported that they were freelancers, and it is possible that this time “off” was not fully protected time for parenting. For example, one freelancer father in our sample in the unpaid leave group reported that he took 6–9 unpaid months off but also wrote, “I have been able to …balance my work schedule to have quality time with the baby and we have been taking him to work which is great because we’re close, but often hard to get quality work done. So, we continue to compromise on how to manage.” In other words, this father’s “unpaid” time included some paid work. Another father in the unpaid leave group who reported 6–9 months off wrote, “I decided to take a job opportunity out of state three weeks after my son was born. The opportunity lasted about two months before I decided to come back home. I regret leaving my son in those early days.” Another father in this group reported that he is an actor who tried to do fewer auditions during the first year following his baby’s birth. Although we do not have open-ended responses from every father in our sample, these responses point to the potential for more discontinuities and complexities in the unpaid leave group that help to explain this greater variability. Thus, even if some fathers in the UNL group may have taken more time off than men in the PL group, it is possible that men in the UNL group who took unpaid time off experienced their time off as less continuous, less protected, and less restorative than fathers who took structured paternity leave. For this reason, our study focused on paid leave only (rather than duration of time off) to better capture the experiences of couples in which fathers had protected time off from work that was specifically dedicated to family bonding. As the number of freelance and gig workers increases in the US, more research is needed to understand the specific financial and family circumstances by which fathers decide to take paid or unpaid leave as well as the actual behavior (e.g., childrearing, housework, work ventures) these fathers take part in while at home.

In follow-up analyses, we included fathers’ length of leave as a covariate in key study analyses. Our key results largely held when we controlled for duration of fathers’ leave. However, we do not have comprehensive data on when the leave occurred or whether it was taken continuously or divided into multiple time portions. Future research should document exact timing of leave during the postpartum period to track continuity of leave use. Additionally, any form of leave, regardless of whether it is paid, may offer some form of support for couples’ mental health trajectories during the transition to parenthood. When repeating the analyses but with the sample divided into three groups (i.e., paid leave, unpaid leave, no leave), our results held for father daytime fatigue, but our other findings became marginally significant, likely because these analyses were underpowered given our sample size. Future studies on fathers’ leave should examine unpaid leave in comparison with both paid leave and no leave.

Several study limitations warrant comment. First, our sample size was relatively small and may limit statistical power. Second, although the sample showed ethnic and racial diversity, participating couples tended to be well-educated, all were in a heterosexual relationship, and most were married. As such, our results may not generalize to low-income couples, LGBTQA+ couples, or couples in less stable relationships. Third, our sample was drawn from the community and did not capture particularly high stress or clinically depressed populations. Fourth, rather than a diagnostic interview or behavioral observation, the present study relied on participant self-report, which may be vulnerable to social desirability, to measure depressive symptoms, stress, and sleep. Future studies can incorporate qualitative or observational approaches to deepen understanding couples’ perceptions and concerns regarding paid paternity leave, and their engagement in postpartum parenting, as well as objective reporting of sleep quality via approaches such as actigraphy. Fifth, consistent with other studies (Janković et al., 2014), we used education rather than income as a proxy for socio-economic status, but income may be linked with healthcare access and physical and mental health (Hodgkinson et al., 2017; Larson, 2007). Finally, to investigate the interdependent of couples’ outcomes, future studies with more robust samples should consider using dyadic analyses, such as Actor-Partner Interdependence Models (APIM), to facilitate analysis of couple level factors, such as relationship quality, that may vary as a function of leave type. Future studies with larger samples and with data on mother and fathers’ leave types can also consider how combinations of leave within couples shapes parents’ mental health trajectories across the transition to parenthood.

Despite these limitations, this study also has significant strengths. This is the first study, to our knowledge, to compare longitudinal trajectories of well-being across the transition to parenthood in couples that did and did not take paid paternity leave. By focusing on within-person changes and adjusting for prenatal levels of stress, depression, and daytime dysfunction, this approach helps to circumvent the problem that couples who do and do not take paid paternity leave may show significant pre-existing differences in stress levels and other measures of well-being. Additionally, the present study focused on men’s parental leave and collected longitudinal measures from both mothers and fathers, which is unusual given that much research on well-being during the transition to parenthood has focused primarily on mothers. Our sample was also limited to first-time parents, strengthening our ability to look prospectively across the transition to parenthood. Therefore, our study contributes to an understanding of how fathers contribute to and are affected by the transition to parenthood and the implications for both paternal and maternal health. These findings can inform emerging research on the neurobiology of new parenthood. For example, parenting experience can affect neural responses to infant stimuli, suggesting that time with infants can remodel the brain (Abraham et al., 2014). Moreover, the parenting brain and biology literatures points to interesting differences between fathers and mothers that warrant further investigation and support the importance for specifically studying fathers’ engagement in parenting in addition to mothers (Cardenas et al., 2021; Seifritz et al., 2003).

Findings for this study have both clinical and policy implications. For instance, clinical trials seeking to address postpartum depression and stress often focus on therapeutic and psychotropic treatment options (McDonagh et al., 2014). However, larger, systemic structural factors, like access to paid family leave, could also be considered interventions for parents’ postpartum mental health. Epidemiological studies evaluating paid paternity leave can ask caregivers about mental health symptoms to examine the large-scale mental health outcomes of paid leave policies. Currently, 10 US states have established paid family leave policies (CA, NJ, RI, NY, DC, WA, MA) and CT, OR, and CO passed legislation and are working to enact the policies (StGeorge & Freeman, 2017). However, most states do not offer paid family leave policy. Findings like ours can be shared with legislators to inform policies that may have significant mental health benefits for millions of new parents.

Future research is needed to elucidate further the effects of paid paternity leave in the US. The field can benefit both from large-scale, population studies of paid leave and mental health, and from person-centered, daily diary studies that measure paid leave in tandem with type of family support, daily activities, and multiple measures of well-being across time. Future studies can also explore the role of workplace stigma on fathers’ willingness to opt for paternity leave. Finally, future research could assess the role of paid paternity leave on child outcomes. For example, maternity leave is associated with enhanced child language outcomes (Kozak et al., 2021), suggesting that family leave for fathers may also support child cognitive development.

In conclusion, this study suggests that paid paternity leave may play a valuable role in supporting new parents’ well-being. We found that mothers reported less prenatal-to-postpartum increases in perceived stress and depressive symptoms when fathers took paid paternity leave. Additionally, fathers who took paid paternity leave appeared to be buffered from increases in stress and daytime fatigue across the transition to parenthood. Therefore, paid paternity leave may have positive implications for both new fathers’ and mothers’ mental health across the transition to parenthood and warrants further study.

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Acknowledgements

Many thanks to the couples and infants who participated in this study, and Angela Rodriguez, Bryan Tsai, Katelyn Horton, and Nia Barbee for their assistance in coordinating the laboratory visits. This work was supported by a National Science Foundation CAREER Award (#1552452) to D.E.S., a National Science Foundation Graduate Research Fellowship Grant (DGE-1418060) to A.R.M., and a National Science Foundation Grant/Award DGE-1842487 to S.I.C.

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Cardenas, S.I., Corbisiero, M.F., Morris, A.R. et al. Associations between Paid Paternity Leave and Parental Mental Health Across the Transition to Parenthood: Evidence from a Repeated-Measure Study of First-Time Parents in California. J Child Fam Stud 30, 3080–3094 (2021). https://doi.org/10.1007/s10826-021-02139-3

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Keywords

  • Paid paternity leave
  • Mental health
  • Stress
  • Depression
  • Sleep