Generous Parental Leave Reduces the Risk of Mental Illness – But Many Are Left Behind
A generous and well-paid parental leave can reduce the risk of mental illness among new parents. However, according to a new doctoral thesis at Stockholm University and Karolinska Institutet, many people with prior health problems are excluded from the most advantageous benefits – often just when they need support the most. This is shown in a new thesis in public health science that Amy Heshmati at the CHESS research centre (a collaboration between Stockholm University and Karolinska Institutet) will defend on Friday, 22 August.
“Parental leave is a family policy measure that can help reduce financial stress during the transition to parenthood and support mental health. But not all parents have equal access to generous compensation,” says Amy Heshmati from the research center CHESS (Centre for Health Equity Studies), a collaboration between the Department of Public Health Sciences at Stockholm University and Karolinska Institutet.
In her thesis Designed for equity? Studies on parental leave and the mental health of parents, which she is defending on August 22, Heshmati explores the link between parental leave and mental health among new mothers and fathers.
Parental leave is not only a cornerstone of family policy but also a public health tool.
A vulnerable period in life
Becoming a parent is a profound life change that brings both joy and challenges. The arrival of a child is a unique event, but it is often accompanied by stress, emotional strain, and financial uncertainty. Globally, about 17% of mothers and 9% of fathers experience mental health problems such as postnatal depression, highlighting the vulnerability of this period.
Parental leave is a family policy that can reduce economic stress for parents and help support mental health. But in Sweden, as in many other countries, the most generous benefits are reserved for parents with stable employment, often leaving those with poorer health or insecure jobs with much less support – just when they need it most.
Examining the fairness of the system
In her thesis, Heshmati examines to what extent existing parental leave systems – particularly the Swedish one – are fair, and how they impact parents’ mental health. While parental leave policy is designed to give parents paid time off to care for their children, she argues that access to the most generous forms of support is unevenly distributed.
Drawing on both international literature and Swedish population register data, her research shows that generous parental leave – characterized by longer time off, paid rather than unpaid leave, or higher compensation levels – is linked to better parental mental health. But her findings also reveal inequities in the system. Parents with prior health problems are less likely to qualify for the more generous benefits in the parental insurance scheme.
Many of those who are ill before pregnancy are excluded
In one of the studies, Health before pregnancy and eligibility for parental leave benefits: a Swedish total population cohort study, Heshmati and her colleagues examined whether current work and income requirements for generous parental leave benefits unintentionally disadvantage women with poorer health. The study found that mothers who had received inpatient or outpatient care for any health issue before pregnancy were less likely to meet the requirements for more generous parental leave.
The gap was especially pronounced among women who had received care for mental health problems, particularly if the care had lasted for two consecutive years before pregnancy.
Women who have experienced mental illness or chronic health conditions before pregnancy therefore often find themselves excluded from the most extensive parental leave benefits – a structural barrier that can increase the risk of mental illness after childbirth.
“Even though generous parental leave benefits support mothers’ mental health after childbirth, our results show that current eligibility rules can exclude exactly those women who need support the most,” says Heshmati.
Parental leave a public health tool
The thesis concludes that parental leave is not only a cornerstone of family policy but also a public health tool. Heshmati argues that policymakers should keep this in mind when designing or reforming parental leave systems.
In April 2025, the Swedish government’s proposal to tighten eligibility requirements for social benefits including parental leave is particularly relevant for ongoing debates. The proposed change would require individuals to have resided in Sweden continuously for at least five years over a fifteen-year period to qualify for benefits.
“If this proposal implemented, this may further increase inequalities not only prior to childbirth, but also in the postpartum period,” says Heshmati. “Supporting stable, secure employment for everyone and easing the strict work-related requirements for generous parental leave can help more families begin parenthood on equal footing – and support the mental health of all new parents, not just the healthiest or those with stable jobs.”
Heshmati´s research contributes to the ongoing discussion of how social policy can promote both equality and health – especially during life transitions as significant as becoming a parent.
Håkan Soold
Facts
Amy Heshmati is defending her thesis Designed for equity? Studies on parental leave and the mental health of parents at Karolinska Institutet, Stockholm, on August 22.
The thesis consists of the following four studies:
Study I reviewed international literature on the effects of generous parental leave on parents’ postnatal mental health. Overall, mothers experienced better mental health both during infancy and later in life with more generous parental leave – such as paid leave and longer leave – compared with shorter or unpaid leave. Results for fathers were less clear due to fewer studies, but existing evidence suggests fathers also benefit from policies offering adequate wage replacement or incentives such as individual quotas. The review identified several important knowledge gaps that guided the subsequent empirical studies in the thesis.
The effect of parental leave on parents' mental health: a systematic review – Heshmati A, Honkaniemi H, Juárez SP – The Lancet Public Health (2023)
Study II examined whether first-time mothers with poor health before pregnancy were less likely to be eligible for more generous parental leave benefits in Sweden. It found that mothers with pre-pregnancy health problems – especially those with mental disorders or chronic diseases (except musculoskeletal disorders) – were less likely to qualify for more generous paid leave. These results suggest that there is health-related selection into parental leave benefits and that strict work requirements for eligibility may unintentionally reinforce socioeconomic disparities between mothers with and without prior health problems.
Health before pregnancy and eligibility for parental leave benefits: a Swedish total population cohort study – Heshmati A, Dunlavy A, Mussino E, Fritzell S, Juárez SP – BMC Public Health (2025)
Studies III and IV evaluated the relationship between levels of paid parental leave and postnatal mental health (measured via varying severity levels and healthcare utilization) among first-time mothers (Study III) and fathers (Study IV) in Sweden. Overall, both mothers and fathers who received higher levels of paid leave generally experienced better postnatal mental health than those who received the basic level, even after accounting for factors that affect the ability to receive higher benefits: prior mental illness, income, and employment status. Mothers receiving higher parental benefits were less likely to require care for moderate to severe mental illnesses, while fathers were less likely to receive any psychiatric care, regardless of severity, compared with those receiving the basic level. These results suggest that more generous parental leave can promote postnatal mental health for both mothers and fathers.
Parental leave benefits and maternal postpartum mental health in Sweden – Heshmati A, Honkaniemi H, Fritzell S, Juárez SP – JAMA Network Open (2025)
Parental leave benefits and paternal mental health: a Swedish register-based cohort study – Heshmati A, Juárez SP – (Not published yet. Manuscript)
Last updated: August 21, 2025
Source: Department of Public Health Sciences