Commentary on “Having Two Children Might Be Best for Women’s Mental Health: Evidence From UK Biobank”

Document Type

Article

Publication Date

11-2025

Publisher

Elsevier

Source Publication

Journal of Affective Disorders

Source ISSN

0165-0327

Original Item ID

DOI: 10.1016/j.jad.2025.119687

Abstract

Liu et al. (2025) investigated the cross-sectional association between the number of live births and lifetime prevalence of bipolar disorder and major depression (BDMD) in over 55,000 women (age M = 57.45, SD = 7.96) using UK Biobank data. The study separated individuals into two groups: those with at least one live birth (n = 53,140), and those without a live birth (n = 2569). The authors imputed missing data using random-forest imputation, and used inverse probability treatment weighting (IPTW) to account for differences in group sizes. They ran four models with an increasing number of covariates to validate their findings. They conclude that live births are associated with an overall decreased “risk” for BDMD (OR = 0.71), and that two live births are associated with the lowest “risk” for BDMD. This outcome variable captures self-reported probable lifetime major disorder and bipolar disorder (Smith et al., 2013). Based on these findings, the authors suggest that live births may be a protective factor for BDMD. We appreciate their analyses and agree that pregnancy and childbirth are likely to influence risk for mental illnesses, including BDMD. However, study design issues raise concerns about these findings, their causal interpretations, and the prescriptive guidance on family planning. Maternal mental illness is the leading cause of preventable pregnancy-related death, underscoring the critical need for accurate and reliable research in this area (Gimbel et al., 2024).

Comments

Journal of Affective Disorders, Vol. 389 (November 2025). DOI. 

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