Research report
Prevalence and geographic disparity of depressive symptoms among middle-aged and elderly in China

https://doi.org/10.1016/j.jad.2007.05.003Get rights and content

Abstract

Background

To evaluate the prevalence of and risk factors for depressive symptoms among middle-aged and elderly Chinese in northern and southern China.

Methods

A population-based cross-sectional survey was performed in Beijing and Shanghai. Participants included 3289 community residents aged 50–70. Socio-demographic, lifestyle and health-related information were obtained by a standardized questionnaire. Clinically relevant depressive symptoms were assessed by the Center for Epidemiological Studies of Depression Scale (CES-D).

Results

The prevalence of depressive symptoms in the total study population was 9.5% (6.7% for men and 11.7% for women), and it was significantly higher in participants from Beijing than those from Shanghai (14.9% vs. 4.1%, P < 0.001). Multivariate logistic regression analyses indicated that this geographic disparity was independent of gender, age, marital status, living status, education level, health status, mobility, social activities and medical insurance (odds ratio, 3.94; 95% confidence interval, 2.86–5.40).

Limitations

No clinical diagnostic validation was performed and the prevalence might be underestimated due to our exclusion criteria.

Conclusions

Approximately one in ten middle-aged and elderly Chinese might suffer from depressive symptoms. Furthermore, the prevalence is substantially higher among residents in the north of China compared to the south. Prospective studies are required to confirm the results and identify the major risk factors contributing to this geographic disparity.

Introduction

Depression is a mental disorder significantly associated with lower quality-adjusted life years (Unutzer et al., 2000), adverse health outcomes and poor prognosis (Cole and Bellavance, 1997), all-cause mortality (Kouzis et al., 1995, Zheng et al., 1997), death from suicide (Henriksson et al., 1993) and medical illness (Ariyo et al., 2000, Everson et al., 1998). According to the Global Burden of Disease study, major depression was the fourth leading cause of disease burden in 2000 and is projected to become the second leading cause by 2020 (Lopez and Murray, 1998, Ustun et al., 2004).

Low rates of depression and mental disorders have been noted for a long time in the Chinese population. A large survey conducted in seven regions of China in 1993 found a significantly lower lifetime and point prevalence of affective disorders (1.3% and 1.1%, respectively) (Zhang et al., 1998) compared to that observed in the United States (50% and 30%, respectively) (Kessler et al., 1994). The World Mental Health Survey also found lower prevalence of mental disorders in China compared to most other Western countries (e.g. 4.3% in Shanghai versus 26.4% in the United States) (The WHO World Mental Health Survey Consortium, 2004). Several explanations have been offered for the low prevalence (Parker et al., 2001), such as the reluctance to seek help from health professionals due to the stigma imposed on mental illnesses in the traditional Chinese culture (Lee, 1994), lack of standardized diagnostic criteria (Liu, 1989), relatively slow life pace and high social support from traditional Chinese society (e.g. lifetime employment, living with family members, close relationship between members within the community) (Parker et al., 2001).

On the other hand, paralleling the rapid socioeconomic transition in the last two decades, there is an increased awareness of depression among policy makers, medical professionals and the general public. Indeed, the newly released diagnostic criteria clearly classified depression as a mental disorder, increasing the likelihood that this condition is viewed and treated like any other health problem. It is also expected that the reporting and hence the prevalence of depression in China will increase continuously in the near future due to both loss of traditional protective factors and an increment in deleterious factors such as increasing working pressure and quickening pace of life (Chen et al., 1999). Meanwhile, depression is prevalent in elderly people (Blazer, 1993) and with the rapid growth of the aging population, mental health is quickly becoming a major health concern in China.

Scarce data is available regarding the prevalence and distribution of depression in Mainland China. Therefore, the aim of the present study was to investigate the prevalence and risk factors of this mental health problem in middle-aged and elderly Chinese. In addition, we also wanted to determine whether the prevalence of depressive symptoms varied in different geographic locations by selecting Beijing and Shanghai to represent northern and southern China, respectively.

Section snippets

Study population

The present study is part of the “Nutrition and Health of Aging Population in China” project and the detailed study design has been described elsewhere (Ye et al., 2007). The fieldwork of the study was simultaneously conducted from March to June 2005 among non-institutionalized individuals of 50–70 years old who were stable residents for at least 20 years in Beijing or Shanghai. A stratified, multi-stage sampling method was adopted. One rural county and two urban districts representing low,

Characteristics of the respondents

The mean age of the respondents was 58.6 years (standard deviation [SD] = 6.0). Women constituted about 56% of the study participants (Table 1). Participants from Beijing were slightly older, more likely to be smokers and alcohol drinkers, and less likely to have medical insurance and spouses than those from Shanghai (Table 1). More participants from Shanghai had a lower education level, household income and number of chronic diseases and higher self-care ability, mobility and self-rated health

Discussion

The present study showed that the crude prevalence of depressive symptoms among middle-aged and elderly Chinese was 9.5%, being 6.7% for men and 11.7% for women. Female gender, younger age, having no spouse, low mobility, lack of high-level physical ability, absence of social activities and poor self-rated health status were significantly associated with an increased risk of having depressive symptoms.

To our surprise, the prevalence of depressive symptoms was almost four times higher in

Strengths and limitations

To our knowledge, this is the first study to demonstrate the geographic differences in the prevalence of depressive symptoms in northern (Beijing) and southern (Shanghai) China among middle-aged and elderly populations. A main strength of the study was that the study participants were recruited from urban and rural areas in both cities, which constituted a representative sample of the middle-aged and elderly Chinese population. Furthermore, the study was conducted simultaneously in two cities

Conclusions

Approximately one in ten middle-aged and elderly Chinese might suffer from depressive symptoms and the prevalence is almost four times among the residents from northern compared to southern China. Considering the high burden associated with depression and the enormous population size of China, further prospective studies are merited to identify the major risk factors and ultimately to develop effective strategies to hinder the growing trend of mental disorders in Chinese population.

Funding

This study was funded by Grants KSCX2-2-25, 04DZ14007 and 200306 from the Chinese Academy of Sciences, from the Science and Technology Commission of Shanghai Municipality and from the Shanghai-Unilever Research Development Fund.

Acknowledgements

The authors want to express their sincere appreciation to the study participants and to the researchers and the healthcare professionals from the Centers for Disease Control and Prevention in Beijing and in Shanghai. We also want to thank Louise Brown for her valuable comments.

References (38)

  • D. Blazer

    Depression in late life

    (1993)
  • D. Blazer et al.

    The association of age and depression among the elderly: an epidemiologic exploration

    J. Gerontol.

    (1991)
  • R. Chen et al.

    A meta-analysis of epidemiological studies in depression of older people in the People's Republic of China

    Int. J. Geriatr. Psychiatry

    (1999)
  • R. Chen et al.

    A community-based study of depression in older people in Hefei, China—the GMS-AGECAT prevalence, case validation and socio-economic correlates

    Int. J. Geriatr. Psychiatry

    (2004)
  • R. Chen et al.

    Depression in older people in rural China

    Arch. Intern. Med.

    (2005)
  • K.L. Chou et al.

    Prevalence and correlates of depression in Chinese oldest-old

    Int. J. Geriatr. Psychiatry

    (2005)
  • M.G. Cole et al.

    Depression in elderly medical inpatients: a meta-analysis of outcomes

    CMAJ

    (1997)
  • S.A. Everson et al.

    Depressive symptoms and increased risk of stroke mortality over a 29-year period

    Arch. Intern. Med.

    (1998)
  • J. He et al.

    Stroke in the People's Republic of China. I. Geographic variations in incidence and risk factors

    Stroke

    (1995)
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