WITHDRAWN: Paid Sick Leave and Maternal Psychological Distress

Background and Purpose

Paid Sick Leave (PSL) is an important workplace benefit that allows an employee time off from work to attend to health-related matters without losing pay. Studies find consistent evidence of its association with better health outcomes in the general population; compared to workers without PSL, those with PSL are more likely to have access to preventive care practices or to take time off due to illness and less likely to report psychological distress. However, research examining occupational determinants of maternal mental health, has paid inadequate attention to the potential role of PSL. This is an important gap for two reasons. First, prior studies have found lack of PSL to be associated with delays in prenatal care, which in turn could exacerbate stress related to pregnancy and childbirth. Such delays could moreover prevent women from seeking much-needed help and from receiving timely referrals to specialist care. Second, maternity leaves in the United States are typically much shorter than the recommended minimum of 14 weeks and rarely cover the entire postpartum period. In such a situation, PSL may be particularly consequential for continued healthcare access in the months following the end of maternity leave. I address this gap in evidence by examining the association between access to paid sick leave and psychological distress among pregnant and post-partum women in the U.S.

Methods

Data and Sample: I pooled cross-sectional data from multiple waves of the National Health Interview Survey and identified a sample of employed women, 18-49 years old, who were pregnant or had a child less than a year old (n= 3405). I excluded women who reported being on maternity leave.

Key Variables

The key independent variable, having paid sick leave, is measured in the NHIS through a direct question (yes=1, no=0). I developed a measure of psychological distress (moderate to severe =1, none to mild=0) from the Kessler K6 psychological distress scale and dichotomized it following prior research.

Analytic strategy

To analyze the relationship between having PSL and reporting moderate to severe psychological distress, I estimated multiple logistic regression equations, controlling for key demographic, socio-economic, health and occupational characteristics. I used sampling weights in all analyses, adjusted for pooling.

Results

Overall, 6.5% of women reported moderate to severe psychological distress during pregnancy or in the postpartum period, with the proportion significantly lower among those with PSL compared to those without PSL (4.5% versus 9.1%, p<0.001). Results from regression analyses showed having PSL to be associated with a 33% lower odds of reporting moderate to severe psychological distress (p<0.05). Disaggregated analyses found the benefits to be concentrated mainly among post-partum women.

Conclusions and Implications

This study provides new evidence on occupational determinants of maternal mental health by demonstrating that with paid sick leave, women are less likely to report moderate to severe psychological distress, particularly in the postpartum period. The findings are encouraging for advocates of maternal health, particularly at a time of growing momentum for expanding and improving paid sick leave policies in the United States.