Population burden of depressive symptoms attributable to educational level in the Peruvian population: a counterfactual analysis. Education and depressive burden
e202611092
DOI:
https://doi.org/10.67113/resp.v100i1.1659Keywords:
Depression, Population education, Social Determinants of Health, Health impact assessment, Analytical epidemiologyAbstract
BACKGROUND // Educational inequalities may contribute substantially to the population burden of depression. The aim of this paper was to estimate the population-level impact of educational attainment on depressive symptoms using a counterfactual approach in the Peruvian population.
METHODS // An analytical study based on the 2024 National Demographic and Health Survey was carried out, including 31,917 participants with complete information on depressive symptoms, educational level, and covariates. The exposure was educational attainment (basic vs. higher education). Depressive symptoms were assessed using the PHQ-9, analyzed as a continuous score and as clinical depression (PHQ-9≥10). G-computation adjusted for age, sex, marital status, mother tongue, and ethnic identification was applied to estimate the average treatment effect (ATE) for the continuous outcome, absolute risk difference, and population attributable fraction (PAF), with analyses stratified by sex.
RESULTS // In the population-level counterfactual analysis, higher education was associated with a lower burden of depressive symptoms and a lower prevalence of clinical depression compared with basic education. The mean PHQ-9 score decreased by -0.75 points, and the prevalence of clinical depression was reduced by 3.3 percentage points. Under a counterfactual scenario of universal higher education, approximately 30% of clinical depression cases were estimated to be attributable to the observed distribution of educational attainment, under the assumptions of the model. In stratified analyses, the average treatment effect was greater in women (-0.82 points; RD:-4.1%) than in men (-0.69 points; RD:-2.6%), although the population attributable fraction was higher in men.
CONCLUSIONS // Counterfactual analysis suggests an association between higher education and a lower population burden of depression, as a potential non-causal estimate.
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