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Prevalence of depressive disorders and treatment in China: a cross-sectional epidemiological study
Abstract
Background 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.Methods 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.Findings 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.Interpretation 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.Funding National Health Commission and Ministry of Science and Technology of People's Republic of China.Translation For the Chinese translation of the abstract see Supplementary Materials section.
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“However, mental health services are few and still underutilized globally [4-6].”
From Conversational Agent Interventions for Mental Health Problems: Systematic Review and Meta-analysis of Randomized Controlled Trials (2023) · cites this paper as [4]
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Li, C., Long, C., Wu, H., Zhu, G., Liu, D., Zhang, C., & Shi, L. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.09.037 · Cited by 14
Huang, S., Zhang, D., Shi, X., Zhang, Y., Wang, X., She, Y.-F., Liang, C., Li, X., & Zaslawski, C. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1495418 · Cited by 14
“Women are at a higher risk of experiencing depression compared to men (62).”
Self-citationLou, F., Long, H., Luo, S., Liu, Y., Pu, J., Wang, H., Ji, P., & Jin, X. (2022) · Experimental Neurology · doi:10.1016/j.expneurol.2022.114268 · Cited by 14
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“Since mental health resources in China are concentrated in large psychiatric hospitals in large eastern and central cities [9].”
BackgroundThe influence of perceived stress and income on mental health in China and Germany
Li, R., Liu, S., Huang, C., Darabi, D., Zhao, M., & Heinzel, S. (2023) · Heliyon · doi:10.1016/j.heliyon.2023.e17344 · Cited by 19
Fan, Y., Nashan, B., Wu, X., Zhang, H., & Shi, Y. (2023) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2023.111443 · Cited by 12
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“5% of respondents with depressive disorders received adequate treatment in China, a number significantly lower in PHC context [62].”
BackgroundWang, Y., Liu, L., Li, C., Yang, Y., He, X., Jiang, M., Quan, D., Ren, Y., Zhao, H., Jiang, J., et al. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.10.022 · Cited by 12
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“This indicates that depression has become a prominent problem and a serious disease burden for society in China [12].”
BackgroundSelf-citationComprehensively Strengthen and Improve Students’ Mental Health System in the New Era
Yuan, W., Jiang, Z., Liu, Y., Chen, Z., Chu, X., & Song, Y. (2024) · China CDC Weekly · doi:10.46234/ccdcw2024.162 · Cited by 15
MDDR: Multi-modal Dual-Attention aggregation for Depression Recognition
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“However, due to factors such as social stigma and a significant imbalance between the number of doctors and patients, over 50 percent of individuals with depression do not receive relevant mental health services, missing the optimal time for intervention [2, 3].”
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“Major depressive disorder (MDD) is a highly prevalent and burdensome mental disorder, with its onset commonly occurring during adolescence and high rates of chroni fi cation in later life leading to a tremendous burden of disease [1 – 3].”
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“However, according to the China Mental Health Survey, very few people with a depressive disorder receive adequate treatment (Lu et al., 2021).”
Fu, J., Cai, X., Huang, S., Qiu, X., Li, Z., Hong, H., Qu, S., & Huang, Y. (2023) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2023.10.040 · Cited by 12
Self-citationZhang, C., Zhao, Y., Li, X., Guo, Y., Peng, R., Wan, X., Zhou, Q., Yang, J., Wu, S., & Feng, H. (2024) · Geriatric Nursing · doi:10.1016/j.gerinurse.2024.07.033 · Cited by 11
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“In China, depression affects approximately 54 million individuals, with lifetime and 12-month prevalence rates estimated to be 6.8% and 3.6%, respectively [3].”
InfluentialSelf-citationAdvances in the prevalence and treatment of depression for adolescents: a review
Yin, C., Xu, M., & Zong, Z. (2025) · Frontiers in Pharmacology · doi:10.3389/fphar.2025.1574574 · Cited by 13
“A 2012 – 2015 epidemiological survey showed an increase in depression and suicide rates, especially among female adolescents (Lu et al., 2021).”
Shen, J., Zhang, Y., Yuan, Y., Yang, Y., & Hu, C. (2025) · Environmental Pollution · doi:10.1016/j.envpol.2025.126913 · Cited by 11
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“Given China’s massive population, coupled with the high prevalence of depression (11), and the relative scarcity of psychiatric workers as compared with other developed countries (12), the Chinese psychiatry medical system was under severe strain.”
ResultSelf-citationZhu, Q., Jiang, G., Lang, X., Zhang, J., Fu, Z., Zhang, P., Zheng, Y., & Zhang, X. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.08.103 · Cited by 11
Savior or saboteur? A nationwide study on digital economy and depression in China
Chen, L., Chang, L., Lin, H., Tu, J., Zhou, Y., & Han, Y. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.08.147 · Cited by 12
Metadata
- Authors
- Lu, J., Xu, X., Huang, Y., Li, T., Ma, C., Xu, G., Yin, H., Xu, X., Ma, Y., Wang, L., Huang, Z., Yan, Y., Wang, B., Xiao, S., Zhou, L., Li, L., Zhang, Y., Chen, H., Zhang, T., Yan, J., Ding, H., Yu, Y., Kou, C., Shen, Z., Jiang, L., Wang, Z., Sun, X., Xu, Y., He, Y., Guo, W., Jiang, L., Li, S., Pan, W., Wu, Y., Li, G., Jia, F., Shi, J., Shen, Z., & Zhang, N.
- Affiliations
- Urumqi 4th People's Hospital (CN)
- Peking University (CN)
- Sichuan University (CN)
- Tianjin Anding Hospital (CN)
- Chinese Center For Disease Control and Prevention (CN)
- Air Force Medical University (CN)
- Central South University (CN)
- Jilin University (CN)
- First Affiliated Hospital of Kunming Medical University (CN)
- Ningxia Medical University (CN)
- Shanghai Jiao Tong University (CN)
- Qinghai No.3 People's Hospital (CN)
- Soochow University (CN)
- Nanjing Medical University (CN)
- Hangzhou Seventh Peoples Hospital (CN)
- Nanjing Brain Hospital (CN)
- Corresponding author
- Huang, Yueqin
- ORCID
- Xu, Xiufeng
- Huang, Yueqin
- Li, Tao
- Ma, Chao
- Xu, Guangming
- Yin, Huifang
- Ma, Yanjuan
- Wang, Limin
- Wang, Bo
- Xiao, Shuiyuan
- Zhou, Liang
- Li, Lingjiang
- Zhang, Yan
- Chen, Hongguang
- Zhang, TingTing
- Yan, Jie
- Ding, Hua
- Yu, Yaqin
- Kou, Changgui
- Shen, Zonglin
- Wang, Zhizhong
- Sun, Xian
- Xu, Yifeng
- He, Yanling
- Guo, Wanjun
- Jiang, Lijun
- Li, Shengyan
- Pan, Wen
- Wu, Yue
- Li, Guohua
- Shi, Jianfei
- Shen, Zhongxia
- Zhang, Ning
- Venue
- The Lancet Psychiatry
- Publisher
- Elsevier BV
- Published
- 2021-11
- Volume
- 8
- Issue
- 11
- Pages
- 981-990
- ISSN
- 2215-0366 (ISSN-L)
- OpenAlex
- W3201200719
- Cited by
- 844
- References
- 39
- Citations by year
- 2026: 150 · 2025: 228 · 2024: 211 · 2023: 166 · 2022: 82 · 2021: 7
- FWCI
- 114.04
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- The Lancet Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Key Research and Development Program of China (2017YFC0907800, 2017YFC0907801)
- Center for Mental Health Services
- Ministry of Science and Technology of the People's Republic of China (2012BAI01B01, 2015BAI13B00)
- Ministry of Health of the People's Republic of China (201202022)
- School of Medicine, Shanghai Jiao Tong University
- Peking University
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Disorders
- Keywords
- depressive disorders, prevalence, mental health service utilization, treatment seeking, major depressive disorder, dysthymia, depressive symptoms, socioeconomic factors, unemployment, disability, China, gender differences, lifetime prevalence, 12-month prevalence, treatment providers, Han Chinese, ethnic minorities, mental health policy, mental health service planning, mental health professionals
- MeSH terms
- Global Burden of Disease, Adult, Aged, China, Cross-Sectional Studies, Major Depressive Disorder, Female, Humans, Male, Mental Health Services, Middle Aged, Population Surveillance, Surveys and Questionnaires, Risk Factors, Socioeconomic Factors, Prevalence, Age Distribution, Sex Distribution, Dysthymic Disorder, Diagnostic and Statistical Manual of Mental Disorders
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