56 - Incidence of Postpartum Depression in Active Duty Military Members after Parental Leave Extension

Publication Number: 4055.56

Dakota Tomasini, Brooke Army Medical Center, San Antonio, TX, United States; Peter Easter, Brooke Army Medical Center, San Antonio, TX, United States; Joshua Anchan, Brooke Army Medical Center, San Antonio, TX, United States; Richelle Roelandt L. Homo, Brooke Army Medical Center, San Antonio, TX, United States; Kaitlyn T. Mullin, Brooke Army Medical Center, San Antonio, TX, United States; Jonathan Shapiro, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, San Antonio, TX, United States; Jeanne Krick, Brooke Army Medical Center, San Antonio, TX, United States; Adharsh Ponnapakkam, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX, United States

Background: Postpartum depression (PPD) affects one in eight women in the United States and remains the most common underdiagnosed obstetric complication. Partners are 50% more likely to develop depression when the birthing mother is affected, amplifying the impact on family well-being. Active-duty (AD) service members face additional PPD risk factors, including geographic separation from support systems, partner deployment, mandated return to duty, younger maternal age, and socioeconomic variation between enlisted and officer ranks. PPD can disrupt the parent-infant dyad, impairing bonding and development. In late 2022, military parental leave was extended from 12 to 18-20 weeks of fully paid leave for birthing parents; however, its effect on PPD incidence among AD mothers remains unknown.

Objective: To evaluate whether recent changes in military parental leave policy were associated with PPD incidence among AD mothers delivering at a single military medical center.

Design/Methods: This retrospective, hypothesis-generating cohort study included all viable infants born to AD mothers. Dyads were divided into two epochs: before and after policy implementation. PPD concern was identified using Edinburgh Postnatal Depression Scale (EPDS) scores obtained through four months postpartum at routine well-baby visits. Descriptive statistics summarized cohort characteristics, and Pearson's chi-squared tests compared demographic variables across epochs.

Results: Among 309 infants, no statistically significant differences were observed in overall PPD rates before and after implementation. Patterns differed by rank: in both epochs, officer mothers showed an increase in PPD incidence from 2 to 4 months postpartum, whereas enlisted mothers showed a decrease. Before policy update, PPD incidence increased by 2.9% among officers and decreased by 2.3% among enlisted mothers; after implementation, these changes roughly doubled (+7.6% officers, -6.3% enlisted). Among positive EPDS screenings, before policy implementation mean 4-month scores were higher for officer than enlisted mothers (17.5 vs 11.0), but reversed after (12.2 vs 15.2).

Conclusion(s): Extension of military parental leave was not associated with significant overall changes in PPD incidence but revealed rank-based disparities in both incidence and symptom severity. PPD among AD mothers may affect family well-being and operational readiness, underscoring the need to evaluate policies shaping maternal mental health outcomes. Further research examining the longitudinal and qualitative impact of extended parental leave across military ranks is warranted.

Figure 1. Timeline of military parental leave policy updates and study epochs
Flow diagram illustrating cohort identification of infants born to active duty mothers between February 1, 2022, and June 30, 2023, divided into "Before Policy Update" (February 1-October 3, 2022) and "After Policy Update" (October 4, 2022-June 30, 2023) epochs based on eligibility under Directive-Type Memorandum 23-001, "Expansion of the Military Parental Leave Program."

Table 1. Postpartum depression (PPD) proportions by epoch (unadjusted)
Rates of postpartum depression (PPD) at 2, and 4 months of life for infants born before and after policy implementation. Rates between officer and enlisted members also represented for each epoch at 2 and 4 months. Analyses are complete-case; denominators (n/N) reflect infants with available Edinburgh Postnatal Depression Scale (EPDS) data at each time point.

Figure 2. Mean EPDS scores among positive screenings by epoch and rank
Mean Edinburgh Postnatal Depression Scale (EPDS) scores among active duty mothers with positive screenings at 2 and 4 months postpartum, shown by military rank and policy epoch. Among positive screenings, mean scores at 4 months were significantly higher for officer than enlisted mothers before the policy change (17.5 vs. 11.0), but this pattern reversed after implementation (12.2 vs. 15.2). Despite higher PPD incidence among officers across both epochs, symptom severity appeared to improve following the policy update, while enlisted mothers showed lower incidence but slightly higher symptom scores post-implementation.