Paid Family Leave and Mental Health in the U.S.: A Quasi-Experimental Study of State Policies

  • Amanda M. Irish
    UCSF Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California
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  • Justin S. White
    UCSF Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California

    UCSF Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
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  • Sepideh Modrek
    Health Equity Institute, San Francisco State University, San Francisco, California
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  • Rita Hamad
    Address correspondence to: Rita Hamad, MD, PhD, Department of Family and Community Medicine, University of California San Francisco, 995 Potrero Avenue, Building 80, Ward 83, San Francisco CA 94110.
    UCSF Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California

    Department of Family and Community Medicine, University of California San Francisco, San Francisco, California
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      Several U.S. states have implemented paid family leave policies for new parents. Few studies have evaluated the impacts of U.S. paid family leave policies on families’ health. This study tests the hypothesis that paid family leave policies in California and New Jersey improved parent and child mental health.


      Using national data from the 1997–2016 waves of the National Health Interview Survey, the study assessed changes in parental psychological distress (measured using the Kessler 6 score, n=28,638) and child behavioral problems (measured using the Mental Health Indicator score, n=15,987) using difference-in-differences analysis, a quasi-experimental method that compared outcomes before and after the implementation of paid family leave policies in California and New Jersey while accounting for secular trends in states without paid family leave policies. Secondary analyses were conducted to assess differential responses among prespecified subgroups. Data analysis was conducted in 2018–2021.


      Exposure to paid family leave policies was associated with decreased psychological distress among parents (−0.49, 95% CI= −0.77, −0.21). There was no association between the paid family leave policies and children's behavioral problems (−0.06, 95% CI= −0.13, 0.012). Associations varied by demographic and socioeconomic characteristics, with some subgroups experiencing benefits, whereas others were negatively impacted.


      Study findings suggest that state paid family leave policies improved mental health among parents, with mixed findings among children, including positive, negative, or no changes in mental health, depending on the subgroup. Future work should clarify how more recent state policies, some of which provide more generous benefits and job protections for low-income parents, influence health among affected families.
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