Parents’ mental health therapy engagement drops after childbirth

Key takeaways:

• Therapy attendance declined 76.7% and 47.5% for mothers and fathers, respectively, at 1 month postpartum.
• Parents with preexisting mental health treatment had greater decreases in attendance after birth.

Transitioning to parenthood was associated with reduced mental health therapy attendance among a large cohort of U.S. service member families, according to cohort study results published in JAMA Network Open.

“Barriers to mental health treatment occur at individual and structural levels. One reason for low use could be a lack of time to attend appointments. Childbirth increases time pressure on new parents, especially mothers. Pregnancy involves an increase in prenatal health care visits, which could crowd out time for other medical appointments,” wrote Jennifer A. Heissel, PhD, senior economist at the RAND Corp., and Olivia J. Healy, PhD, of the department of economics at Elon University in North Carolina. “In theory, parental leave could alleviate time pressure, allowing parents to attend appointments. However, staying at home with an infant, especially in the early postpartum period, may mean alternative child care for the infant is not available.”

Heissel and Healy conducted a cohort study utilizing data from a monthly sample of 15,554,193 person-month observations from 321,200 U.S. Army and Navy service members with first births from 2014 to 2017 and 12 months of data before and 24 months of data after birth. These participants were matched with nonparents with 36 months of data. Researchers compared parents’ monthly therapy attendance with matched nonparents’ across childbirth. In addition, researchers compared mothers’ weekly therapy attendance before compared with after returning to work.

Primary outcome was monthly counts of mental health therapy sessions and weekly therapy sessions.

Overall, 3.2% of participants were mothers, 15.8% were nonmother matches, 13.5% were fathers and 67.5% were nonfather matches.

Mothers experienced a 76.7% decrease in therapy session attendance at 1 month postpartum compared with 10 months before giving birth (–0.0712 fewer sessions; 95% CI, –0.0846 to –0.0579). Fathers experienced a 47.5% decrease in therapy session attendance during the month of birth compared with 10 months before childbirth (–0.0154 fewer sessions; 95% CI, –0.0194 to –0.0114). By 4 months postpartum, researchers observed no differences in therapy attendance between mothers, fathers and their matches.

Mothers with a history of two or more therapy sessions before pregnancy had a 77.4% decrease in therapy attendance, from a mean of 0.7098 sessions 10 months before birth to 0.1601 sessions 1 month postpartum. Fathers with a history of two or more therapy sessions before becoming a parent had a 73.1% decrease in therapy attendance, from a mean of 0.4994 sessions 10 months before birth to 0.1343 sessions 1 month after birth.

Weekly therapy attendance increased by 0.555 percentage points when mothers returned to work after 6 weeks of maternity leave and 0.953 percentage points after 12 weeks of maternity leave.

“Findings suggest that both mothers and fathers could benefit from more accessible treatment, such as at-home mental health services,” the researchers wrote.