Abstract
Worldwide 350 million people suffer from major depression, with the majority of cases occurring in low- and middle-income countries. We examined the patterns, correlates and care-seeking behaviour of adults suffering from major depressive episode (MDE) in China. A nationwide study recruited 512 891 adults aged 30-79 years from 10 provinces across China during 2004-2008. The 12-month prevalence of MDE was assessed by the Modified Composite International Diagnostic Interview-short form. Logistic regression yielded adjusted odds ratios (ORs) of MDE associated with socio-economic, lifestyle and health-related factors and major stressful life events. Overall, 0.7% of participants had MDE and a further 2.4% had major depressive symptoms. Stressful life events were strongly associated with MDE [adjusted OR 14.7, 95% confidence interval (CI) 13.7-15.7], with a dose-response relationship with the number of such events experienced. Family conflict had the highest OR for MDE (18.9, 95% CI 16.8-21.2) among the 10 stressful life events. The risk of MDE was also positively associated with rural residency (OR 1.5, 95% CI 1.4-1.7), low income (OR 2.3, 95% CI 2.1-2.4), living alone (OR 2.6, 95% CI 2.3-3.0), smoking (OR 1.4, 95% CI 1.3-1.6) and certain other mental disorders (e.g. anxiety, phobia). Similar, albeit weaker, associations were observed with depressive symptoms. Among those with MDE, about 15% sought medical help or took psychiatric medication, 15% reported having suicidal ideation and 6% reported attempting suicide. Among Chinese adults, the patterns and correlates of MDE were generally consistent with those observed in the West. The low rates of seeking professional help and treatment highlight the great gap in mental health services in China.
Highlights
Over 350 million people suffer from major depression (World Health Organization, 2016), which is one of the top 10 causes of years lived with disability in all countries in 2013 (Global Burden of DiseaseStudy 2013 Collaborators, 2015)
Less than 6 years education Annual household income < 10 000 RMB Currently live alone Unemployed Lifestyle factors, % Current regular smoker Problem drinking among current regular drinkers Current regular drinker Physical activity < 10 metabolic equivalents (MET)-h/day Physical measurements: mean (S.D.) SBP, mmHg body mass index (BMI), kg/m2 Waist:hip ratio, % Waist, cm Prior disease, self-rated health and life satisfaction, % Prior chronic disease Poor health Unsatisfied with life Family history of mental disorder, % Parent Sibling Child Any member of the family
S.D., Standard deviation; RMB, renminbi; MET, metabolic equivalents; SBP, systolic blood pressure; BMI, body mass index. a All values are adjusted for age, sex and region where appropriate; all p values for heterogeneity
Summary
Over 350 million people suffer from major depression (World Health Organization, 2016), which is one of the top 10 causes of years lived with disability in all countries in 2013 (Global Burden of DiseaseStudy 2013 Collaborators, 2015). Over 350 million people suffer from major depression (World Health Organization, 2016), which is one of the top 10 causes of years lived with disability in all countries in 2013 In China, the recent Global Burden of Disease Study estimated that depression was one of four leading causes of disabilityadjusted life-years (DALYs) (Hoevenaar-Blom et al 2014). Previous cross-country studies have reported that the prevalence of depression was much lower in Chinese than in Western populations (Parker et al 2001), with lifetime rates of major depressive episode (MDE) being only about 1–2% in Chinese (and other East Asians) compared with 10–20% in Western and Middle East populations (Weissman et al 1996; Andrade et al 2003). Correlates and care-seeking behaviour of adults suffering from major depressive episode (MDE) in China
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