Effect modification of social-context changes on mental disability in China from 1987 to 2006: a multi-level study of 1.9 million people

Zhenjie Wang,Xiaoying Zheng,Chao Guo,Gong Chen,Lihua Pang,Ning Li

doi:10.1186/s12889-017-4066-5

Abstract

BackgroundVery little literature has explored how mental disability in China is connected with inequalities in social and environmental contexts. In the study described herein, we determine whether social-context inequalities were associated with mental disability in China from 1987 to 2006.MethodsData were derived from national representative population-based data from the 1987 and 2006 China National Sample Survey on Disability. Both surveys used multistage, stratified random cluster sampling, with a probability proportionate to size, to derive nationally representative samples. A multilevel logistic regression model was applied to estimate the effects of province-specific contextual characteristics on men and women. We also examined the association with mental disability risk stratified by selected covariates. Study populations were (N = 698,810) in 1987 and (N = 1,260,947) in 2006.ResultMost of the province-level variables in the 1987 and 2006 surveys were unrelated to mental disability risks in either men or women after controlling for individual characteristics. The age-adjusted prevalence of mental disability nearly doubled among men and women from 1987 to 2006. The effects of the province-specific prevalence of agricultural, forestry, animal husbandry and fishery activities and the percentage of the population age 65 and over significantly lowered the risk of mental disability among women in 1987, by 48 and 32%, respectively. Moreover, the number of health professionals modified the association with per capita gross domestic product (GDP) among women but only in 1987.ConclusionTo face the challenges of mental disability and interprovincial inequality, the Chinese government should adjust its strategies not only for health-care systems but also to correct for inequalities in interprovincial development; this action may help prevent mental disability.

Highlights

Very little literature has explored how mental disability in China is connected with inequalities in social and environmental contexts
The surveys were approved by the State Council and conducted in all province-level administrative regions of mainland China by the Leading Group of the China National Sample Survey on Disability and the National Bureau of Statistics; all survey respondents provided consent to participate in these surveys and clinical diagnosis
In the twenty-year period considered in this study, the average annual growth of mental disability cases was 8%

Summary

Introduction

Very little literature has explored how mental disability in China is connected with inequalities in social and environmental contexts. In the study described we determine whether social-context inequalities were associated with mental disability in China from 1987 to 2006. People with disabilities experience worse socioeconomic outcomes than people without disabilities: they experience higher rates of poverty, have lower employment rates and have less education [6] They have unequal access to health-care services and have unmet health-care needs, compared to the general population [6, 7]. An individual’s mental health is associated with local and national factors, such as neighborhood trust and safety, poverty reduction, access to education, and access to health-care, among other factors These factors are important for two reasons: they influence the risk of mental disorders, and they present opportunities for intervening to reduce this risk [5]

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