parental mental health may be the key to improving retention, RTW, & wellbeing
Shannon Malloy | Lead Research & Data Associate | Ovia Health
Allison Gabriel, PhD, MSIO | Professor & University Distinguished Scholar, Management & Organizations | Eller College of Management, University of Arizona
Laura Little, PhD, MBA | Synovus Director of the Institute for Leadership Advancement, Associate Professor, Management | University of Georgia
One of the workforce’s most vulnerable populations is women, and particularly working moms. With external conditions as they are, employers need to focus on improving and strengthening the internal programs and policies they have control over to keep existing and new employees — especially female talent — engaged, supported and employed.
One area of focus employers can easily impact and improve is return to work (RTW) and parental leave planning. Data indicate that postpartum and perinatal depression (PPD) drastically reduces RTW rates, but exactly how is still in question. So, what can organizations do to help reduce PPD, and improve RTW rates for working parents?
In this episode, we review a new study that better identifies the drivers behind PPD, how it discourages women from returning to work, and how to prevent it.
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parental mental health may be the key to improving retention, RTW, & wellbeing
Shanon Malloy [00:00:44] Hello, everyone, and welcome to another episode of the Ovia Asks podcast. I'm Shannon Malloy, a clinical researcher here out of your health and your host. And I'm so thrilled to tell you about today's episode. It's centered on a group of people who are a crucial component of Ovia's audience. New parents. So today we're going to dive into parental mental health, specifically perinatal depression and new moms, and how this has tremendous rippling effects on return to work.
So why is it important to pay attention to parental mental health? Well, the reasons are pretty clear. The COVID 19 pandemic has uncovered what society has successfully repressed for far too long. Parents and specifically working moms are under pressure and their mental health is suffering the most. And this has manifested in ugly ways in the employment market and landscape and a tsunami of employee departures. The great resignation, the big quit, or as I like to think of it, the great reassessment. It's real and it's not going away, and it's disproportionately stealing away employees who are also moms. Since March 2020, millions of working moms have left the workforce. Mental health conditions like postpartum depression or PPD are partially to blame for these departures. So if your workforce is looking to retain and attract top talent (like working women) or if you're a health plan trying to improve mental health for your members, you need to look at the moments that matter most to your populations.
Growing your family is one of those moments. New parents, especially moms, face many challenges that are unique, and many describe those first few weeks with a new little one overwhelming, bittersweet, disorienting and more. It can also change their outlook on life and put a new perspective on what matters.
If you want to keep working parents, you need to help them understand and take care of their physical and mental health and transition back to work after parental leave in a way that's manageable by making parental leave easy and understandable and ultimately making sure they know that employees aren't going to be forced to choose between their family and their career.
So what can organizations do to help reduce postpartum depression and improve return to work rates for working parents? In this episode, we review a new research effort that better identifies the drivers behind postpartum depression, how it discourages women from returning to work and how to prevent it. So thanks again for being here, Allie and Laura, we've worked together for a while, but I'd love it if you could tell listeners about yourselves as well.
Allie Gabriel [00:04:10] So again, hi, everyone. My name is Allie Gabriel, and I am the McClellan professor of management and organizations and university distinguished scholar in the College of Management at the University of Arizona. And I'm an organizational psychologist by training and primarily study employee wellbeing. And lately, the focus has really been on how we can best support and build the well-being of working women and particularly mothers in the workforce.
Laura Little [00:04:38] Hi, I'm Dr. Laura Little. I'm so happy to be here and talking about these important issues. I'm an associate professor at the University of Georgia and also the senior west director of the Institute for Leadership Advancement. I study a variety of work family issues, and I particularly look at women dealing with pregnancy in the workplace.
Shanon Malloy [00:05:17] Great. Thanks for those introductions. So let's just dove right in and talk about return to work. Laura, do you know why this is so difficult today? And also, how has it changed post-pandemic?
Laura Little [00:05:30] Absolutely. So return to work is is absolutely a challenging time for women who are navigating the workforce, navigating a new child. They are also navigating a new identity where they are new mothers. Even if they've had a child before and have navigated work family issues and returning to work before, it still can be challenging because anybody that has more than one kid knows children are different and they can present very different challenges as you return to work.
We recently did a study on Return to Work, and we found that mothers are also critical members during this time, meaning that they carry the lion's share of the work in the family and so are more responsible at home, but also trying to adjust to the workplace that they're returning to. And one of our participants in one of our studies actually called this latent work, which I really liked a lot because it is work that is not always visible, you know, stuff that's constantly going in your brain or physical work like breastfeeding. And it's it's not always something that people realize you're engaged in, but it can be really draining and time consuming.
If you think about the physical aspects of caring for any child, I mentioned breastfeeding, but also the cognitive aspects of understanding new divisions of labor and how to handle all of that in the workplace. The emotional aspects of leaving your new child with with, you know, potentially another caregiver. And you know, you're coming back to work after being gone for a while, and you may have quite a lot of accumulated work that hasn't been taken care of. And so there's just a wide variety of stressors at this time that can make it quite difficult for women to return.
Shanon Malloy [00:07:23] Thanks for that important background, Laura. So, Allie, why is it important to address postpartum depression and what impact does it have on health, productivity and quality of life?
Allie Gabriel [00:07:38] So when we think about the things that can happen to women postpartum, it's estimated that at least 15 percent of mothers are going to be diagnosed with PPD after birth. And that actually means that postpartum depression is one of the most common complications of childbirth. And I know when I first saw that statistic, that was pretty astounding to me to think about it in that way.
And the effects of PPD are just pretty profound. It affects women's emotions, their cognition, how they're thinking about their own life, their child, their family and then the behaviors. And these really culminate in their ability to not only maintain their own well-being, but also maintain the well-being of their children. Right? And also just maintain high quality relationships with the people around them. And so while they're on parental leave, that could be obviously their immediate family unit. Then we could start to think about this down the road during the return to work of how that might affect relationships with coworkers, for instance.
Shanon Malloy [00:08:37] Wow, that's a shocking proportion of new moms, and also I love how you phrased that as a complication of birth, you know, normally we think about complications as being physical manifestations like caesarean section or preeclampsia, but the mental adverse outcomes are just as important and impactful. So can you help me better understand how PPD is different from general depression?
Allie Gabriel [00:09:00] That's a really good question. So, what makes PPD different and really impactful compared to generalized depression (which is also really important to understand how it's going to affect people in the workforce) but PPD, it's it's the suddenness and then the coinciding with childbirth that make it really profound.
First of all, the onset can be really, really quick. So it can be, you know, minutes after childbirth. Some people feel that hormonal shift immeditely. It could also build over the first one to three weeks or so that women are home with their children. That sadness is pretty shocking and jarring in a lot of cases, but it's also coinciding with this period where they have a new child, and it's supposed to be this really joyous occasion, right? It's supposed to be full of joy and happiness. And all of a sudden, you have all of these depressive thoughts and episodes co-occurring with that. So that juxtaposition of really happy, joyful time in your life paired with extreme depression is what makes PPD really, really impactful for women and really important to try to study and understand.
Shanon Malloy [00:10:07] That makes sense. So how does PPD relate to return to work?
Allie Gabriel [00:10:14] Yes, it's a timing piece, right? So there's estimates that the onset of the symptoms that are going to really cue somebody up, that something is wrong, that maybe they're experiencing PPD beyond just the baby blues kind of feeling low during those first weeks. It's happening in the first one to three weeks. And for most women, they're going to be going back to work sometime in six to 12 weeks postpartum, which is just so soon in of itself.
So that means that reentry women are not only coping with the newness of being a mother, even if you are a mother of multiples, you're still going back now and you have two kids or three kids and you're trying to reconfigure all of those things. So you're dealing with all of those common struggles of being a working mother of child care, of the new routines, of finding clothes that fit in. Now you're trying to manage PPD symptoms on top of that. So it's just kind of like to think of it as like this layering effect that under good circumstances, the return to work is going to be really, really challenging emotionally and just draining for women. And now you've layered this really traumatic mental health experience on top of that that women need to process and cope with.
Shanon Malloy [00:12:46] Wow, that is a lot to balance right after having just given birth, so it makes sense why you're doing this research. So speaking of, can you tell us a little bit about what's already known about PPD and returned to work today and maybe what your study contributes on top of that?
Allie Gabriel [00:13:06] Sure. So the focus when we started going to the literature to try to understand what is already out there, organizational research on postpartum depression to date had really focused on how different elements of work, mostly different sources of social support, for instance, or on the negative side of that pregnancy discrimination, how that relates to the incidence of postpartum depression or symptoms associated with postpartum depression. But really, PPD was kind of the end point for a lot of the studies. We didn't really know or we weren't seeing a lot of research on what happens for women when they return to work and they do have postpartum depression. Are they still coping with those symptoms?
This was really the impetus for our study. How did the emotional and the cognitive, physical and behavioral symptoms associated with PPD affect women's work and their non-work their family lives and in what ways? For me, this was personally meaningful because I was a I am a new mom. Well, I'm not new anymore. It was March 2020. But she's closing in on almost being two.
And I had PPD. And these were questions that I was asking myself. How is how am I going to make sense of my work now? How am I going to make sense of my family? How am I going to restructure things to fit together and make sense for me? And that was when I actually reached out to Laura and her other colleagues on this project (Jamie Ladge, Rebecca MacGowan, and Ellie Stillwell) kind of out of the blue just to see if they would have any interest in trying to help me make sense of my own experience and then just study a broader group of women to build out what we think is a really important narrative.
So what we decided to do was to conduct interviews. So we have interviews of 41 women who were diagnosed with PPD in the last five years or so. And they also had to be working at the time of the diagnosis. And what was nice is that we have a wide range of applications, different types of jobs, both full time and part time work being represented here. And then we each of these interviews lasted an hour. Then we ran these interviews, these stories, by different key stakeholders, Ovia being one of those, to really make sense of our model and to see how representative it might be of women's experiences.
Shanon Malloy [00:15:31] And what do the preliminary data say from those interviews?
Allie Gabriel [00:15:36] Yeah, so there's a lot to unpack his results, and I think it speaks to the complexity of PPD and how it affects women at work, so our results as they stand right now suggest that the symptoms associated with having postpartum depression ultimately culminate in an event or a series of events that trigger women to seek help, to get a diagnosis, to obtain treatment, to come up with a care plan.
And that's really, really important that diagnosis for women in our sample really was that kind of aha moment of realizing, Hey, you know, the way I'm feeling, it doesn't have to be like this. You know, here's what it is. It's PPD. It's not just me. You know, I can come up with ways to feel better. And that also just related to a lot of complex sense making that women went ahead and had to sort through.
So, we were trying to figure out how are their work roles going to fit together with being a mother and having this identity now as being somebody who has postpartum depression. How is that identity going to shape them. The ways that they approach their work and their non-work goals and everything that is really important for these women. How are they going to build up resilience and coping skills that can actually help them reenter the workforce more powerful than they were before?
That's the really nice takeaway of this. Even though PPD is really difficult and certainly has a lot of hardship that comes with it, the women in our sample felt really empowered to kind of reclaim aspects of their lives. To say, "I really want to lean into this element of my work." or "I want to become a mental health advocate in my workplace and break down the taboos of not talking about mental health."
I want to talk about it, and I want to help other people and support other people who might be suffering at work. And also women. We're talking about really prioritizing their well-being. A lot of the women in our study said, you know, I finally realized I need to put me first, right? That's self-care. I hear this all the time and some of the podcasts I listen to. Self-care is not selfish, right? And I think having this diagnosis and kind of the rattling that comes with that of processing, it helps women really reclaim that.
So in a lot of ways, then PPD does contribute to women. Having that rock bottom moment of this is a really low point in my life, in my motherhood experience. But it can have this possible bright side of generating a lot of strength that allows women to reenter the workforce and then really kind of reclaim who they want to be in a variety of aspects of their life.
Shanon Malloy [00:18:20] I love that you are building upon that narrative where the literature just stopped at the diagnosis, but you're actually sharing that the diagnosis is the pivotal moment where these women are experiencing drastic change and of course comes alongside with negative implications, but also positive change too. So that's really, really powerful from this study. So after interviewing these 41 women and their diverse experiences and building out this new framework for understanding PPD and how it relates to return to work, what's the next step for your research?
Laura Little [00:18:55] The question so, you know what, as Allie mentioned, one of the things that we found so interesting was this this idea that the diagnosis was so important, you know, conducting these interviews was was it at times difficult because it was heart wrenching and women were suffering quite a bit in that the pain that they were in and the things that they were going through was was really, you know, heart wrenching.
And so one of the things that we want to understand better is what happens when there's not a diagnosis, what happens when people have the symptoms of PPD, but they don't actually get diagnosed since that was such a pivotal part of our original study.
So we're going to go on to collect some quantitative data. We hope to really study this at a larger scale. We're going to look at both from a quantitative perspective, looking at what the diagnosis can mean more long term. We'll be working out what the diagnosis can mean in terms of other work outcomes. But then importantly, I think study women who have not been diagnosed but who do have symptoms and how they're dealing with that and how we can better support them in organizations.
Shanon Malloy [00:20:52] That makes sense that you want to build upon better understanding diagnosis and more importantly, women who aren't diagnosed because we know that there are so many disparities in women who are under screened and underdiagnosed for postpartum depression, and that has rippling effects on not only themselves, but their families. And we know that the current guideline is one screening for postpartum depression at your six week postpartum visit.
But we know that as I mentioned earlier, the symptoms of PPD can begin to present, you know, minutes after birth or much later than six weeks. So if you're not presenting those symptoms at that time of the screener, you're falling through the cracks. So it's really important to understand this kind of shadow under diagnosed population.
So given that, what opportunity does this new research present to organizations looking to improve parental mental health?
Laura Little [00:21:48] It is probably twofold here, at least twofold.
First of all, as we've been talking about the last few minutes, diagnosis is so important, and that's what we're seeing in organizations certainly can help with that. And can they provide some resources to help women get diagnosed if they're suffering. And, as you mentioned, people can have these symptoms when they're back to work. It can come on, you know, after those screening checkups and so they could be back at work showing symptoms and organizations might be able to recognize that and to be able to help.
I think the other thing that's important that relates back to what Allie said earlier: women are sense-making during this process, and as they do so, they are reconsidering some of their values, some of their beliefs. When organizations aren't aligned with those, we have seen that some women will leave that organization or want to move on to other types of work. So I think it's a really important time for organizations to work with women in this sense making process and work with them to try to help support them as they go through these moments. As Allie said, there's some really hard things that come out of a PPD diagnosis, but there's also the silver lining.
And for organizations, if they can encourage that and help support that, they can really build that commitment in women who will stay within their organization and thrive and not only thrive themselves, but help other people who may be also suffering. And so I think that's a big lesson in organizations to be aware and to be understanding, and it can be a great benefit for them to do so.
Shanon Malloy [00:23:30] Yes, and PPD has been around for a very long time. But the pandemic is layered on this new job market where we have record levels of job openings, record levels of people leaving their jobs for things other than just income, you know, they're not happy with their employer. They're not happy with the benefits. They're not happy with with the culture. Their employer isn't family friendly and these women have options and they're leaving.
So that is really important to know. That they have the power to do so and that employers should really be paying attention to, like you said, sense-making with their employees during this time rather than abandoning them to experience it on their own. I love that.
So given that, what are the most important things for employers to do to reduce the risk of their employees developing PPE or exacerbating it? I mean, we know that there are indicators for PPD that are beyond their control. But are there things that they can do to identify these issues and connect to care?
Allie Gabriel [00:24:37] I think so. And we actually ask the women because they're the ones going through it, and so the concluding question we had as part of our study was what they would recommend.
What would they tell organizations and managers and even coworkers to do to help better support women who have returned to work generally, but of course, with more specifically? So there were a few unique suggestions that they brought up that I haven't seen discussed as frequently, although this first one is related. So leave - paid leave - to take the financial burden off of women could be a huge, huge improvement.
But what was interesting is, I think going into this research, I had the assumption that the answer was going to be more leave, right? So longer durations of leave. And that's actually not what we were hearing. They were saying no, it's it's about having access to leave and unique configurations of the so kind of a staggered return to work. Hey, I want to come back and I'm going to try this out for a couple of days, but I may then need to take a few days off. And so having kind of that flexibility to maybe come into the office more part time still have time to recuperate and care for themselves and their child. That was really, really helpful to really let women ease back in versus what we see for a lot of full time jobs, which is if you have access to you, leave the second, it's over. You are just back, right and you are back full throttle. So that easing in would be really, really helpful.
Some other pieces, though, were creating touch points with women while they're on leave. So I think there is kind of this assumption that when women are on parental leave that we should not talk to them and not engage them right and separate say like, you're not here, you're not employed right now with us. But that's actually the opposite. A lot of women said, you know, it'd be nice to have had somebody check in on me and just see how I'm feeling. Talk to me, listen to me, validate me as this new mom and just hear how I'm doing to really feel still connected to their coworkers and their organization. But also maybe for somebody else to hear them and say, you know, "Hey, it sounds like having a really hard time. Have you thought about trying to access some resources? Here are some things maybe we could do to support your well-being and your transition back to work."
I can speak from my own experience that that was something that happened here where one of my colleagues talked to me and he could tell I was having a really hard time and he was like, "Hey, have you talked to anybody or have you thought about what this is going to look like? What can we do to make this easier for you?"
And then the other thing that I think is a really big deal is to just talk about these issues. There is a lot of taboo, not just about motherhood. And you know, all these misconceptions that when people have babies, they're less dedicated to their work all of a sudden are less available. But there's also a lot of taboos just about mental health in general. And I think we just need to talk more openly about this.
Women in our study, like I said, talked a lot about how when they return to work, they talked pretty openly sometimes about their own mental health diagnosis because they saw other people suffering in different ways and realize, you know, you don't have PPD, but you're struggling with depression or anxiety or this other huge life issue. And let me tell you about my experience, what I went through, and here's where I am now, and this is why it's OK.
The more we break down the taboo of all of those things, the better organizations are going to get in terms of really holistically caring for people and proactively managing and helping support people's well-being.
Shanon Malloy [00:28:10] Yes. Yes, and I love that all of your tools came straight from the horse's mouth. You took them from the women who are experiencing PPD, and you are using those to inform actionable things that employers can do to support their employees.
Just absolutely love that excellent work. So we have the tools that employers can use to help support their employees who might be experiencing PPD. What impact might using and utilizing these tools have on employee retention or productivity or loyalty to our company?
Laura Little [00:28:46] Well, I think, in short, a great deal, and in fact, I think what we have found from a from a large body of research that has studied various different types of events is that people go through these sort of critical time periods in their work lives or in other lives where they develop a sense of trust and loyalty. So, you know, trust can develop over time. But also we can see these critical moments of important events to people where people's reactions, organizational reactions, supervisor reactions are going to be even more important and really dictate the relationship going forward.
In another study, we found that just the disclosure of pregnancy can be one of these critical instances so that if my supervisor reacts in a positive way, that can improve our relationship for long periods of time. If my supervisor reacts in a less positive way that can have detrimental effects on the relationship.
So we imagine that here with PPD, when women are struggling, it's a critical time period in their lives. It's, you know, an opportunity for organizations to really pay attention. It's that critical moment. Support here in this critical moment is going to really facilitate that commitment.
That loyalty, that retention and a lack of support in these critical moments when women are really suffering is going to have the opposite effect. And so really, I think organizations need to think about these critical moments and be extra attentive and supportive when these moments occur.
Shanon Malloy [00:30:13] Wow. Well, thank you so much, Laura and Ali. This has been probably one of my favorite of the Asks podcast episodes. It's been so fruitful and inspiring, and I'm just really, really grateful that you are digging into this issue very thoughtfully and intentionally, and you're working to empower and uplift working women through your findings. So thank you again. It's been such a joy working with you. And also just hearing your thoughts today.
Allie Gabriel [00:30:44] Thank you so much, and thank you definitely for this partnership and helping support this work and bring it to life. We couldn't do it without this, so we're really, really grateful as well
Laura Little [00:30:55] Yes I just want to echo what Ali said. We really appreciate the partnership and we appreciate all the support they've given us in this process, and we are super excited to be talking about it today. So thanks for having us.
Shanon Malloy [00:31:06] Great. Wow. Well, we covered so much ground today from learning about how and why perinatal depression manifests and how managers and organizations are in a unique position to do their part in reducing it.
The lack of family friendly positions in the workplace, combined with caregiving shortages driven by the pandemic, have created an awful she-cession. We learned that more than three and a half million women have already left the workforce since the pandemic began, which has left a giant talent gap to be filled.
So right now, today women's labor force participation is at a 33 year low. We cannot afford to sink further. We know that one of the workforce's most vulnerable populations is women and particularly working moms. With external conditions as they are, employers need to focus on improving and strengthening the internal programs and policies they have control over to keep existing and new employees, especially female talent, engaged, supported and employed. So now is the time you can easily impact and improve return to work and parental leave planning. Right now, we're celebrating Women's History Month, so help us celebrate by helping your employees or members who are new moms.
Help them understand, identify and address mental health conditions like PPD and support them to have a restorative and re-energizing parental leave experience and make return to work flexible and supportive.
If you're looking for ways to do this that we haven't covered today. Feel free to reach out. Ovia is happy to help you work through these issues. I want to end by thanking you again for listening today to the Ovia Asks Podcast, and I wish everybody a Happy Women's History Month. Until next time.