Wang Xuanping, Zhou Fang-Yue, Hao Yanhui, Wu Jiaying, Su Kaizhen, Chen Si-Yue, Yu Wen, Zhang Chen, Wu Yan-Ting, Huang He-Feng
The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China.
Depress Anxiety. 2025 Feb 20;2025:8835118. doi: 10.1155/da/8835118. eCollection 2025.
Many studies have explored the relationship between education and postpartum depression (PPD), with inconsistent results. Our study is to identify which education-related factors (education attainment, qualifications, cognitive performance) played the predominant role in PPD using Mendelian randomization (MR) analysis. Then, we explored the factors that may mediate the effect of education on PPD. We performed two-sample multivariable Mendelian randomization (MVMR) to assess the independent impact of education-related factors on PPD. Based on the literature review, three mediating factors that may play a role in the path of education attainment and PPD were involved in mediation analysis, including childbearing age, neuroticism score, and average total household income before tax. Then, we used two-step MR and MVMR to estimate the indirect effect of these mediators. We identified genetically predicted 1-SD (3.71 years) higher education attainment (OR: 0.632; [95% confidential interval (CI): 0.464-0.860]); qualifications (OR: 0.418; [95% CI: 0.245-0.714]); or cognitive performance (OR: 0.770; [95% CI: 0.652-0.909]) was associated with lower risk of PPD, and the causal effects of education attainment (OR: 0.407; [95% CI: 0.214-0.773]) on PPD were independent of qualifications and cognition. Childbearing age (: -0.497; [95% CI: -0.788-0.238]; < 0.001) and neuroticism score (: -0.07; [95% CI: -0.120-0.030]; < 0.001) were identified as mediators of the association between education attainment and PPD. These results suggested the predominant impact of education attainment on PPD independent of qualifications and cognition. Education level mainly affects PPD by changing the childbearing age. Chinese Clinical Trial Registry identifier: ChiCTR2000033433.
许多研究探讨了教育与产后抑郁症（PPD）之间的关系，结果并不一致。我们的研究旨在使用孟德尔随机化（MR）分析确定哪些与教育相关的因素（教育程度、资格、认知表现）在产后抑郁症中起主要作用。然后，我们探讨了可能介导教育对产后抑郁症影响的因素。我们进行了两样本多变量孟德尔随机化（MVMR），以评估与教育相关的因素对产后抑郁症的独立影响。基于文献综述，在中介分析中纳入了三个可能在教育程度与产后抑郁症之间起作用的中介因素，包括生育年龄、神经质得分和税前家庭平均总收入。然后，我们使用两步MR和MVMR来估计这些中介因素的间接效应。我们发现，基因预测的教育程度每提高1个标准差（3.71岁）（比值比：0.632；[95%置信区间（CI）：0.464 - 0.860]）；资格（比值比：0.418；[95% CI：0.245 - 0.714]）；或认知表现（比值比：0.770；[95% CI：0.652 - 0.909]）与产后抑郁症风险降低相关，并且教育程度对产后抑郁症的因果效应（比值比：0.407；[95% CI：0.214 - 0.773]）独立于资格和认知。生育年龄（β： - 0.497；[95% CI： - 0.788 - 0.238]；P < 0.001）和神经质得分（β： - 0.07；[95% CI： - 0.120 - 0.030]；P < 0.001）被确定为教育程度与产后抑郁症之间关联的中介因素。这些结果表明，教育程度对产后抑郁症有主要影响，独立于资格和认知。教育水平主要通过改变生育年龄来影响产后抑郁症。中国临床试验注册标识符：ChiCTR2000033433。
