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The epidemiology of depression in metropolitan China

Published online by Cambridge University Press:  20 August 2008

S. Lee ,
A. Tsang ,
Y.-Q. Huang ,
Y.-L. He ,
Z. R. Liu ,
M.-Y. Zhang ,
Y.-C. Shen  and
R. C. Kessler
S. Lee*
Affiliation:
Department of Psychiatry, The Chinese University of Hong Kong, HKSAR, PRC
A. Tsang
Affiliation:
Hong Kong Mood Disorders Center, The Chinese University of Hong Kong, HKSAR, PRC
Y.-Q. Huang
Affiliation:
Institute of Mental Health, Peking University, PRC
Y.-L. He
Affiliation:
Shanghai Mental Health Center, PRC
Z. R. Liu
Affiliation:
Institute of Mental Health, Peking University, PRC
M.-Y. Zhang
Affiliation:
Shanghai Mental Health Center, PRC
Y.-C. Shen
Affiliation:
Institute of Mental Health, Peking University, PRC
R. C. Kessler
Affiliation:
Department of Health Care Policy, Harvard Medical School, MA, USA
*
*Address for correspondence: Professor S. Lee, Director, Hong Kong Mood Disorders Center, 7A, Block E, Staff Quarters, Prince of Wales Hospital, Shatin, NT, Hong Kong. (Email: [email protected])
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Abstract

Background

Previous surveys on depression in China focused on prevalence estimates without providing a detailed epidemiological profile.

Method

Face-to-face household interviews were conducted with a multi-stage household probability sample of 2633 adults (age ⩾18 years) in Beijing and 2568 in Shanghai between November 2001 and February 2002. The World Health Organization Composite International Diagnostic Interview (CIDI) was used to assess major depressive episode (MDE) according to Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria.

Results

The lifetime prevalence and 1-year prevalence estimates of DSM-IV/CIDI MDE were 3.6% [95% confidence interval (CI) 2.8–4.4%] and 1.8% (95% CI 1.2–2.4%) respectively. No significant gender difference was found in these estimates. Respondents born in 1967 or later were at elevated lifetime risk compared with respondents born in earlier cohorts. The mean age of onset was 30.3 years. Among those reporting 1-year MDE, 15.7, 51.8, 25.3 and 6.4% reported mild, moderate, severe and very severe symptoms respectively; 4.8, 2.6 and 3.2% reported suicidal ideation, plans, and recent attempts in the same year respectively. Respondents with 1-year MDE reported a mean of 27.5 days out of role owing to their depression in the year before interview. Significant co-morbidity was found between MDE and other mental disorders [odds ratio (OR) 22.0] and chronic physical disorders (OR 3.2). Only 22.7% of respondents with 1-year MDE sought treatment.

Conclusions

The low prevalence and insignificant gender difference, but not patterns of onset, course, co-morbidity, and impairment, distinguish the epidemiological profile of MDE in metropolitan China from those in other countries.

Keywords

Co-morbidityepidemiologymajor depressionmetropolitan Chinasuicidetreatment
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 5 , May 2009 , pp. 735 - 747
Copyright
Copyright © Cambridge University Press 2008

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References

Andrade, L, Caraveo-Anduaga, JJ, Berglund, P, Bijl, RV, De Graaf, R, Vollebergh, W, Dragomirecka, E, Kohn, R, Keller, M, Kessler, RC, Kawakami, N, Kiliç, C, Offord, D, Ustun, TB, Wittchen, HU (2003). The epidemiology of major depressive episodes: results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys. International Journal of Methods in Psychiatric Research 12, 3–21.CrossRefGoogle Scholar
Chang, SM, Hahm, BJ, Lee, JY, Shin, MS, Jeon, HJ, Hong, JP, Lee, HB, Lee, DW, Cho, MJ (2008). Cross-national difference in the prevalence of depression caused by the diagnostic threshold. Journal of Affective Disorders 106, 159–167.CrossRefGoogle ScholarPubMed
Chen, CN, Wong, J, Lee, N, Chan-Ho, MW, Lau, JTF, Fung, M (1993). The Shatin Community Mental Health Survey in Hong Kong: II. Major findings. Archives of General Psychiatry 50, 125–133.CrossRefGoogle Scholar
Cheng, ZR, Gao, H, Zhang, X, Tang, ZR, Lu, YW, Yang, WQ, Cai, T, Hu, CY, Li, H, Li, YP, Zhang, YP, Huang, XZ (1999). The epidemiological survey of mental disorders in Shenzhen [in Chinese]. Medical Journal of Chinese Civil Administration 11, 32–35.Google Scholar
Demyttenaere, K, Bruffaerts, R, Posada-Villa, J, Gasquet, I, Kovess, V, Lepine, JP, Angermeyer, MC, Bernert, S, Girolamo, G, Morosini, P, Polidori, G, Kikkawa, T, Kawakami, N, Ono, Y, Takeshima, T, Uda, H, Karam, EG, Fayyad, JA, Karam, AN, Mneimneh, ZN, Medina-Mora, ME, Borges, G, Lara, G, Graaf, R, Ormel, J, Gureje, O, Shen, Y, Huang, Y, Zhang, M, Alonso, J, Haro, JM, Vilagut, G, Bromet, EJ, Gluzman, S, Webb, C, Kessler, RC, Merikangas, KR, Anthony, JC, Korff, MRV, Wang, PS, Alonso, J, Brugha, TS, Aguilar-Gaxiola, S, Lee, S, Heeringa, S, Pennell, BE, Zaslavsky, AM, Ustun, TB, Chatterji, S (2004). Prevalence, severity and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. Journal of the American Medical Association 291, 2581–2590.Google ScholarPubMed
Efron, B (1988). Logistic regression, survival analysis, and the Kaplan–Meier curve. Journal of the American Statistical Association 83, 414–425.CrossRefGoogle Scholar
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (2002). Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Non-patient Edition (SCID-I/NP). New York State Research Institute: New York.Google Scholar
Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 56–61.CrossRefGoogle ScholarPubMed
Henderson, S, Andrews, G (2008). The yield from national surveys of mental health. International Psychiatry 5, 16–18.CrossRefGoogle ScholarPubMed
Huang, YQ, Liu, ZR, Zhang, MY, Shen, YC, Tsang, A, He, YL, Lee, S (2008). Mental Disorders and Service Use in China. In World Health Organization World Mental Health Survey Series Volume One – Patterns of Mental Illness in the WMH Surveys (ed. Kessler, R. C. and Üstün, T. S.), pp. 447–473. Cambridge University Press: New York.Google Scholar
Hwu, HG, Yeh, EK, Chang, LY (1989). Prevalence of psychiatric disorders in Taiwan defined by the Chinese diagnostic interview schedule. Acta Psychiatrica Scandinavica 79, 136–147.CrossRefGoogle ScholarPubMed
Kendler, KS, Gallagher, TJ, Abelson, JM, Kessler, RC (1996). Lifetime prevalence, demographic risk factors, and diagnostic validity on nonaffective pyschosis as assessed in a US community sample: the National Comorbidity Survey. Archives of General Psychiatry 53, 1022–1031.CrossRefGoogle Scholar
Kessler, RC, Bergland, P, Chiu, WT, Demler, O, Heeringa, S, Hiripi, E, Jin, R, Pennel, B-E, Walters, EE, Zaslavsky, A, Zheng, H (2004). The US National Comorbidity Survey Replication (NCS-R): design and field procedures. International Journal of Methods of Psychiatric Research 13, 69–92.CrossRefGoogle ScholarPubMed
Kessler, RC, Berglund, P, Demler, O, Jin, R, Koretz, D, Merikangas, KR, Rush, AJ, Walters, EE, Wang, PS (2003). The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). Journal of the American Medical Association 283, 3095–3105.CrossRefGoogle Scholar
Kessler, RC, Berglund, P, Demler, O, Jin, R, Walters, E (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 593–602.CrossRefGoogle ScholarPubMed
Kessler, RC, Üstün, TB (2004). The World Mental Health (WMH) Survey Initiative Version of the World Mental Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods of Psychiatric Research 13, 93–121.CrossRefGoogle ScholarPubMed
Kleinman, A (1982). Neurasthenia and depression: a study of somatization and culture in China. Culture, Medicine and Psychiatry 6, 117–190.CrossRefGoogle ScholarPubMed
Kriegsman, DM, Penninx, BW, Van Eijk, JT, Boeke, AJ, Deeg, DJ (1996). Self-reports and general practitioner information on the presence of chronic diseases in community dwelling elderly. Journal of Clinical Epidemiology 49, 1407–1417.CrossRefGoogle ScholarPubMed
Lee, S, Tsang, A, Kwok, K (2007 a). Twelve-month prevalence, correlates, and treatment preference of adults with DSM-IV major depressive episode in Hong Kong. Journal of Affective Disorders 98, 129–136.CrossRefGoogle ScholarPubMed
Lee, S, Tsang, A, Zhang, MY, Huang, YQ, He, YL, Liu, ZR, Shen, YC, Kessler, RC (2007 b). Lifetime prevalence and inter-cohort variation in DSM-IV disorders in metropolitan China. Psychological Medicine 37, 61–71.CrossRefGoogle ScholarPubMed
Leon, AC, Olfson, M, Portera, L, Farber, L, Sheehand, DV (1997). Assessing psychiatric impairment in primary care with the Sheehan Disability Scale. International Journal of Methods of Psychiatric Research 27, 93–105.Google ScholarPubMed
Lu, J, Ruan, Y, Huang, Y, Yao, J, Dang, W, Gao, C (2008). Major depression in Kunming: prevalence, correlates and co-morbidity in a south-western city of China. Journal of Affective Disorders. Published online: 28 March 2008. doi: 10.1016/j.jad.2008.02.018.CrossRefGoogle Scholar
Marcus, SM, Young, EA, Kerbera, KB, Kornstein, S, Farabaugh, AH, Mitchell, J, Wisniewski, SR, Balasubramani, GK, Trivedi, MH, Rush, AJ (2005). Gender differences in depression: findings from the STAR*D study. Journal of Affective Disorders 87, 141–150.CrossRefGoogle ScholarPubMed
Pan, GW, Jiang, C, Yang, XL, Na, J, Fu, ZG, Yu, QF, Yu, CY, Liu, MJ, Liu, F, Wang, P, Li, N, Yan, TM, Zhang, SJ (2006). Epidemiological survey of mental disorders in urban and rural areas of Liaoning province [in Chinese]. Chinese Journal of Public Health 22, 1505–1507.Google Scholar
Parker, G, Chan, B, Hadzi-Pavlovic, D (2007). Lower rates of depression in westernised Chinese in the US. Journal of Affective Disorders 104, 175–178.CrossRefGoogle ScholarPubMed
Radat, F, Swendsen, J (2005). Psychiatric comorbidity in migraine: a review. Cephalalgia 25, 165–178.CrossRefGoogle ScholarPubMed
Rush, AJ, Carmody, T, Relmiz, P-E (2000). The Inventory of Depressive Symptomatology (IDS). International Journal of Methods of Psychiatric Research 9, 45–59.CrossRefGoogle Scholar
Rush, AJ, Trivedl, MH, Ibrahim, HM, Carmody, TJ, Arnow, B, Klein, DN, Markowiz, JC, Ninan, PT, Kornstein, S, Manber, R, Thase, ME, Kocsis, JH, Keller, MB (2003). The 16 item Quick Inventory of Depressive Symptomatology (QIDS) Clinician Rating (QIDS-C) and Self-Report (QIDS-SR). Biological Psychiatry 54, 573–583.Google ScholarPubMed
Shen, YC, Zhang, MY, Huang, YQ, He, YL, Liu, ZR, Cheng, H, Tsang, A, Lee, S, Kessler, RC (2006). Twelve month prevalence, severity, and unmet need for treatment of mental disorders in metropolitan China. Psychological Medicine 26, 257–267.CrossRefGoogle Scholar
Shi, QC, Zhang, JM, Xu, FZ, Phillips, M, Xu, Y, Fu, YL, Yuan, W, Zhou, XJ, Wang, XM, Zhang, Y, Yu, M (2005). Epidemiological survey of mental illnesses in the people aged 15 and older in Zhejiang Province, China [in Chinese]. Chinese Journal of Preventive Medicine 39, 229–236.Google ScholarPubMed
Takeuchi, D, Chung, CYR, Lin, MK, Shen, HK, Kurasaki, K, Chun, CA, Sue, S (1998). Lifetime and twelve-month prevalence rates of major depressive episodes and dysthymia among Chinese Americans in Los Angeles. American Journal of Psychiatry 155, 1407–1414.CrossRefGoogle ScholarPubMed
Twelve Region Psychiatric Epidemiological Study Work Group (1986). A national 12-region psychiatric epidemiological study – methodology and results [in Chinese]. Chinese Journal of Neurology and Psychiatry 19, 65–69.Google Scholar
Wang, J, Wang, D, Shen, Y, Zhang, W, Li, S, Chen, C, Huang, Y, Tu, J, Ning, Z, Fu, L, Ji, L, Liu, Z, Wu, H, Luo, K, Zhai, S, Yan, H, Meng, G (1998). Epidemiological survey on affective disorder in 7 areas of China [in Chinese]. Chinese Journal of Psychiatry 31, 75–78.Google Scholar
Wang, PS, Aguilar-Gaxiola, E, Alonso, J, Angermeyer, MA, Borges, G, Bromet, EJ, Bruffaerts, R, de Girolamo, G, de Graaf, R, Gureje, O, Haro, JM, Karam, EG, Kessler, RC, Kovess, V, Lane, MC, Lee, S, Levinson, D, Ono, Y, Petukhova, M, Posada-Villa, J, Seedat, S, Wells, JE (2007). Worldwide use of mental health services for anxiety, mood, and substance disorders: results from 17 countries in the WHO World Mental Health (WMH) Surveys. Lancet 370, 841–850.CrossRefGoogle Scholar
Wells, JE, Horwood, LJ (2004). How accurate is recall of key symptoms of depression? A comparison of recall and longitudinal reports. Psychological Medicine 34, 1001–1011.CrossRefGoogle ScholarPubMed
Weissman, MM, Bland, RC, Canino, GJ, Faravelli, C, Greenwald, S, Hwu, HG, Joyce, PR, Karam, EG, Lee, CK, Lellouch, J, Lepine, JP, Newman, SC, Rubio-Stipec, M, Wells, JE, Wickramaratne, PJ, Wittchen, HU, Yeh, EK (1996). Cross-national epidemiology of major depression and bipolar disorders. Journal of the American Medical Association 276, 293–299.CrossRefGoogle Scholar
Wolter, KM (1985). Introduction to Variance Estimation. Springer-Verlag: New York.Google Scholar
Xie, GR, Shen, JJ, Zhang, JT (1984). Validation of Hamilton and Carrol depression scales between normal people and depressive patients [in Chinese]. Chinese Journal of Nervous and Mental Diseases 10, 346.Google Scholar
Zhang, YP, Li, XY, Wang, ZQ, Man, M, Wang, XQ, Phillips, M (2006). A cross-sectional study of depressive disorders in outpatients of 50 general hospitals in Beijing [in Chinese]. Chinese Journal of Psychiatry 39, 161–164.Google Scholar