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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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“…to those without higher education,resultinginanincreasedutilizationofbenzodiazepines et al., 2021; Rezaei et al., 2022; Saragih et al., 2021; Xu et al., 2021) and the “U” shaped correlation between happiness and age suggests thatyoungindividualstendtoexperienceheighteneddepressionwhen…”
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“The weighted-adjusted calculation in the China Mental Health Survey showed that the weighted lifetime prevalence of adult depressive disorders in China was 6.8% ( 95% CI :5.8–7.8), of which the weighted major depressive disorder was 3.4% ( 95% CI :2.9–3.9) 10 .”
MethodInfluentialSelf-citationXie, W., Wang, F., Qian, Y., Qiu, L., Zhou, Q., Shen, Y., & Wu, J. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1434966 · Cited by 2
“Research has shown that women are more vulnerable to external environmental stressors than men, leading to emotional fl uctuations and mental health issues (21), such as anxiety and depression (22).”
Chen, X., Feng, Z., Li, N., Xiao, L., Xu, C., & Zhu, X. (2025) · BMC Psychiatry · doi:10.1186/s12888-024-06418-3 · Cited by 2
Liu, X.-Y., Pan, M., Gao, X., Fu, Z., Liu, L., Li, H., Wang, Y., & Qian, Q. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-091352 · Cited by 2
“Therefore, the total sample size is determined at 48.”
Machine learning-based predictive modeling of depressive symptoms in Chinese adolescents
Ding, L., Wu, Z., Wu, Q., & Li, E. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.119399 · Cited by 4
Li, S. M., Xiao, M., Ma, C.-B., & Yan, X. (2025) · 世界针灸杂志:英文版 · doi:10.1016/j.wjam.2025.06.004 · Cited by 2
Self-citationPotential marker of brain impairment secondary to obstructive sleep apnea: The brain asymmetry
Liao, J., Shi, Y., Zhu, X. Y., Li, Y., & Han, D. (2025) · Sleep Medicine · doi:10.1016/j.sleep.2025.106701 · Cited by 2
Bai, Y., Liu, Y., Zhang, Y., & Tolba, A. K. R. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1468334 · Cited by 3
“According to reports, 6.8% of adults in China experience depressive disorders over their lifetime, and 3.4% suffer from depression (4).”
InfluentialSelf-citationYao, K., Zhong, J., Huang, X., Kuang, J., & Xu, M. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.09.003 · Cited by 2
Xu, Y., Zhang, S., Liu, Y., & Zhou, J. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1638290 · Cited by 2
“In China, approximately 17% of adults experience depressive symptoms during their lifetime, posing significant challenges to public health systems (3).”
Self-citationHe, X., & Gao, X. (2025) · Medicine · doi:10.1097/md.0000000000044663 · Cited by 2
“[3] Regional variations exist: a Shanghai hospital survey (n = 2000) reported higher rates linked to lack of support and burdens, [4] while a Hebei study (n = 14,654) found associations with age 45 to 59, female sex, marriage, higher education, employment, medical conditions, and family history.”
Guo, Q., Yong, W., Guo, L., He, X., Pu, C., Zhang, X., Zhang, H., Chen, B.-Y., Shi, C., & Shang, S. (2025) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2025.104706 · Cited by 2
Dynamic nomogram for predicting depression risk in middle-aged and older adults based on CHARLS
Tan, Y., Zhang, W., Liu, Z.-H., Liang, C., Liang, S.-Z., Dai, W.-B., & Lv, X. (2025) · Scientific Reports · doi:10.1038/s41598-025-19324-9 · Cited by 2
Novel screening tool for psychiatric samples with major depressive disorder: a two-centre study
Liu, N., Hou, G., Li, X., Zhao, B., Cao, Z., Li, G., Ding, S., Shi, J. Q., Bai, Z., Xu, X., et al. (2025) · BMJ Mental Health · doi:10.1136/bmjment-2025-302021 · Cited by 2
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Pozuelo, J. R., Vigo, D., Kazdin, A. E., Harris, M., Stein, D. J., Viana, M. C., Hwang, I. H., Kessler, T. L., Manoukian, S. M., Sampson, N. A., et al. (2025) · International Journal of Mental Health Systems · doi:10.1186/s13033-025-00686-6 · Cited by 2
“This definition of MAT builds upon earlier work [34–37] and has since been widely adopted in subsequent research [16, 23–26, 28, 38, 39], although there has been inconsistency in definitions across some studies [27, 40–43].”
Lai, X., Liu, J., Zhao, Y., Wu, X., Wu, L., He, K., Chu, H., Yan, Y., Liao, Y., Li, C., et al. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.120964 · Cited by 2
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Self-citationEfficacy of iTBS in adolescent depression: effects on anhedonia and exploratory moderation analyses
Qin, Q., Li, J., Guo, Y., & He, K. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.121398 · Cited by 2
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“In addition, only a small proportion of diagnosed patients receive adequate treatment [3].”
Self-citationLin, C., Mi, Y.-W., Zheng, H.-W., Hou, Y.-B., Hu, J.-Q., Mao, J.-X., Dai, N., Fu, C.-L., Li, X., & Ji, Y. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1752933 · Cited by 2
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Association study of selenium-related gene polymorphisms with geriatric depression in China
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“[3,4] The results of the China Mental Health Survey showed that the prevalence of depression was significantly higher in respondents aged 50 years and older than in those aged 18 to 34 years.[5] With a tendency toward population aging, the number of older people aged 65 and above in China is over 190 million, and by 2…”
BackgroundSelf-citationEffects of Dietary Flavonoids on the Metabolism of Vortioxetine and its Potential Mechanism
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“In China, MDD is the second most common cause of disability (2).”
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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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