Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, China; The Fourth People's Hospital in Urumqi, Urumqi, China.
Lancet Psychiatry. 2021 Nov;8(11):981-990. doi: 10.1016/S2215-0366(21)00251-0. Epub 2021 Sep 21.
In China, depressive disorders have been estimated to be the second leading cause of years lived with disability. However, nationally representative epidemiological data for depressive disorders, in particular use of mental health services by adults with these disorders, are unavailable in China. The present study, part of the China Mental Health Survey, 2012-15, aims to describe the socioeconomic characteristics and the use of mental health services in people with depressive disorders in China.
The China Mental Health Survey was a cross-sectional epidemiological survey of mental disorders in a multistage clustered-area probability sample of adults of Chinese nationality (≥18 years) from 157 nationwide representative population-based disease surveillance points in 31 provinces across China. Trained investigators interviewed the participants with the Composite International Diagnostic Interview 3.0 to ascertain the presence of lifetime and 12-month depressive disorders according to DSM-IV criteria, including major depressive disorder, dysthymic disorder, and depressive disorder not otherwise specified. Participants with 12-month depressive disorders were asked whether they received any treatment for their emotional problems during the past 12 months and, if so, the specific types of treatment providers. The Sheehan Disability Scale (SDS) was used to assess impairments associated with 12-month depressive symptoms. Data-quality control procedures included logic check by computers, sequential recording check, and phone-call check by the quality controllers, and reinterview check by the psychiatrists. Data were weighted according to the age-sex-residence distribution data from China's 2010 census population survey to adjust for differential probabilities of selection and differential response, as well as to post-stratify the sample to match the population distribution.
28 140 respondents (12 537 [44·6%] men and 15 603 [55·4%] women) completed the survey between July 22, 2013, and March 5, 2015. Ethnicity data (Han or non-Han) were collected for only a subsample. Prevalence of any depressive disorders was higher in women than men (lifetime prevalence odds ratio [OR] 1·44 [95% CI 1·20-1·72] and 12-month prevalence OR 1·41 [1·12-1·78]), in unemployed people than employed people (lifetime OR 2·38 [95% CI 1·68-3·38] and 12-month OR 2·80 [95% CI 1·88-4·18]), and in people who were separated, widowed, or divorced compared with those who were married or cohabiting (lifetime OR 1·87 [95% CI 1·39-2·51] and 12-month OR 1·85 [95% CI 1·40-2·46]). Overall, 574 (weighted % 75·9%) of 744 people with 12-month depressive disorders had role impairment of any SDS domain: 439 (83·6%) of 534 respondents with major depressive disorder, 207 (79·8%) of 254 respondents with dysthymic disorder, and 122 (59·9%) of 189 respondents with depressive disorder not otherwise specified. Only an estimated 84 (weighted % 9·5%) of 1007 participants with 12-month depressive disorders were treated in any treatment sector: 38 (3·6%) in speciality mental health, 20 (1·5%) in general medical, two (0·3%) in human services, and 21 (2·7%) in complementary and alternative medicine. Only 12 (0·5%) of 1007 participants with depressive disorders were treated adequately.
Depressive disorders in China were more prevalent in women than men, unemployed people than employed, and those who were separated, widowed, or divorced than people who were married or cohabiting. Most people with depressive disorders reported social impairment. Treatment rates were very low, and few people received adequate treatment. National programmes are needed to remove barriers to availability, accessibility, and acceptability of care for depression in China.
National Health Commission and Ministry of Science and Technology of People's Republic of China.
For the Chinese translation of the abstract see Supplementary Materials section.
在中国，抑郁障碍估计是导致伤残调整生命年（DALY）的第二大主要原因。然而，目前中国尚无抑郁障碍的全国代表性流行病学数据，特别是成年人抑郁障碍患者使用精神卫生服务的数据。本研究作为中国精神卫生调查（China Mental Health Survey，CMHS）的一部分，旨在描述中国抑郁障碍患者的社会经济特征和精神卫生服务使用情况。
CMHS 是一项在全国范围内进行的多阶段聚类地区概率抽样的横断面流行病学精神障碍调查，对象为中国国籍的成年（≥18 岁）人群，来自全国 31 个省的 157 个具有代表性的疾病监测点。经过培训的调查员使用复合国际诊断访谈 3.0（Composite International Diagnostic Interview 3.0，CIDI 3.0）工具，根据 DSM-IV 标准确定终生和 12 个月抑郁障碍的存在情况，包括重性抑郁障碍、心境恶劣障碍和未特定的抑郁障碍。在过去 12 个月中患有 12 个月抑郁障碍的参与者被问及他们是否接受过任何针对情绪问题的治疗，如果有，他们接受的是哪种类型的治疗提供者。使用 Sheehan 残疾量表（Sheehan Disability Scale，SDS）评估与 12 个月抑郁症状相关的残疾情况。数据质量控制程序包括计算机逻辑检查、连续记录检查、质量控制员电话检查和精神科医生重新访谈检查。根据中国 2010 年人口普查的年龄-性别-居住地分布数据对数据进行加权，以调整选择和反应的差异概率，并对样本进行后分层，以匹配人口分布。
2013 年 7 月 22 日至 2015 年 3 月 5 日期间，共有 28140 名受访者（12537 名男性[44.6%]和 15603 名女性[55.4%]）完成了调查。仅对部分受访者收集了民族（汉族或非汉族）数据。任何抑郁障碍的患病率在女性中均高于男性（终生患病率比值比[odds ratio，OR]1.44[95%置信区间 1.20-1.72]和 12 个月患病率 OR 1.41[1.12-1.78]），在失业者中高于就业者（终生 OR 2.38[95%置信区间 1.68-3.38]和 12 个月 OR 2.80[95%置信区间 1.88-4.18]），在离异、丧偶或离婚者中高于已婚或同居者（终生 OR 1.87[95%置信区间 1.39-2.51]和 12 个月 OR 1.85[95%置信区间 1.40-2.46]）。总体而言，744 名 12 个月抑郁障碍患者中有 574 名（加权%75.9%）在任何 SDS 域都有角色功能障碍：534 名重性抑郁障碍患者中有 439 名（83.6%）、254 名心境恶劣障碍患者中有 207 名（79.8%）、189 名未特定的抑郁障碍患者中有 122 名（59.9%）。仅有估计 1007 名 12 个月抑郁障碍患者中的 84 名（加权%9.5%）接受过任何治疗部门的治疗：38 名（3.6%）在专业精神卫生机构、20 名（1.5%）在一般医疗保健机构、2 名（0.3%）在人类服务机构和 21 名（2.7%）在补充和替代医学机构。仅有 12 名（0.5%）的抑郁障碍患者接受了充分的治疗。
在中国，女性中抑郁障碍比男性更常见，失业者比就业者更常见，离异、丧偶或离婚者比已婚或同居者更常见。大多数抑郁障碍患者都有社交障碍。治疗率非常低，很少有人接受充分的治疗。中国需要制定国家方案，消除获取、可及性和接受精神卫生保健服务的障碍。
中华人民共和国国家卫生健康委员会和科学技术部。
