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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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“In China, the incidence rate of depression among women is notably higher than that among men, with a relatively low treatment rate [14].”
Urban environment, mindfulness meditation and mental health: a bibliometric review
Yang, H., Lu, C., Guo, Y., Jiang, Y., Xia, X., Fan, H., & Zhang, Y. (2026) · Open House International · doi:10.1108/ohi-10-2025-0332 · Cited by 1
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“%) received adequate treatment [76], underscoring a substantial treatment gap and the urgent need to strengthen mental-health service provision in China.”
Liu, L., Gao, B., Li, Q., Ren, H., Pan, M., Zhong, P., Li, S., Zhang, C., Zhang, X., & Liao, J. (2026) · JMIR Formative Research · doi:10.2196/83299 · Cited by 1
“[4].”
Self-citationHuang, L., Wang, J., Tian, H.-D., Wang, W., Nie, Z., Cui, X.-H., Zhang, L.-L., Jin, Y., Ding, Y., Liu, Z.-C., et al. (2026) · iScience · doi:10.1016/j.isci.2026.116003 · Cited by 1
“27 While residual confounding cannot be entirely excluded, these re-sults strengthen the inference that depression may contribute to the initiation of colorectal neoplasia, warranting further investigation into the underlying biological mechanisms.”
Wu, S., Zuo, X., Liu, L., Yang, M., Li, X., & Li, S. (2026) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2026.1828777 · Cited by 1
“MDD ranks 13th among all diseases in terms of global disease burden and 11th in China (Lu et al., 2021).”
InfluentialSelf-citationPeptide-Propofol Prodrug with Self-Assembly and Triggered Release for Antidepressant Therapy
Wang, D., Yuan, Z., Sun, X., Shen, L., Yuan, Y., Jia, Y., & Yao, H. (2026) · ACS Applied Materials & Interfaces · doi:10.1021/acsami.6c06335 · Cited by 1
Self-citationSex differences in disease burden in China from 1990 to 2023 triangulating GBD and CHARLS
Liu, T., Zhang, Z., Lv, W., Zhou, W., Chen, Z., & Zheng, J. (2026) · iScience · doi:10.1016/j.isci.2026.116553 · Cited by 1
“9,10 Although previous studies have described sex differences in selected conditions such as cancer, cardiovascular disease, and mental disorders in China, 7,11,12 a systematic assessment of how the leading causes of health loss differ between females and males remains limited.”
Tang, E., Zhang, X.-M., Li, J., Liu, Y., Shen, Z., & Chen, H. (2026) · Depression and Anxiety · doi:10.1155/da/7518415 · Cited by 1
Self-citationXia, F., Mao, S., Wang, J., Chen, B., Li, Y., & Zheng, M. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1817598 · Cited by 1
“It is a risk factor for healthy life expectancy (Lu et al., 2021).”
Flexible ACEK-Enhanced Capacitive Aptasensor for Rapid Cortisol Detection in Sweat
Wang, J., Lv, X., Yang, M., Lin, X., Wang, Z., & Wu, J. J. (2026) · Micromachines · doi:10.3390/mi17070800 · Cited by 1
“Mental health has become a critical determinant of overall well-being in modern society, where increasing life pressures contribute to stress-related disorders [1,2].”
Self-citationXie, C., Zhang, X., Xu, Y., Yu, T., He, J., Huang, J., & Qiu, B. (2026) · Psychiatry Research · doi:10.1016/j.psychres.2026.117323 · Cited by 2
Self-citationExtreme heat exposure and depressive symptoms among adolescents: evidence from China
Wang, J., Xia, Q.-F., Liu, Y., & Chen, J. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1910951 · Cited by 1
Borges, A. R., Venâncio, P. E. M., Silva, P. H. D. A., Cosme, A. S. M., & Soares, V. (2022) · Research Society and Development · doi:10.33448/rsd-v11i9.31363 · Cited by 1
“It has a global prevalence of up to 27% (Wang et al., 2017), and mainly affects females (Lu et al., 2021).”
BackgroundLi, S., Guo, X., Liu, Z., Liu, S., & Liu, Z. (2022) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2022.2156480 · Cited by 1
“It has been discovered that depressive disorder could lead to severe consequences such as the increased risk of cognitive impairment, Alzheimer’s disease, and even suicidal tendencies (Lu et al., 2021; Perin et al., 2022).”
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“China is a country with a huge number of patients with mental disorders but mental Lu et al., 2021), so the prevention and control of mental disorders is of great medical and economic value.”
Self-citationRasch analysis of the Hospital Anxiety and Depression Scale (HADS) in patients with major depression
Huang, X., Ma, H.-Y., Wang, X., Zhong, J., Chen, Y., & Xu, M. (2023) · Anales de Psicología · doi:10.6018/analesps.550551 · Cited by 1
“In China, the 12-month prevalence of depressive disorders among adults is 3.6%, and that of major depression is 2.1% (Lu et al., 2021).”
InfluentialUrbanisation and Declining Suicide Rates in China Between 2005 and 2017
Harford, P., Agaciak, M., Looi, J. C., Smith, D., Allison, S. C., Chan, S. K. W., & Bastiampillai, T. J. (2023) · East Asian Archives of Psychiatry · doi:10.12809/eaap2326 · Cited by 1
Nurture-Preparedness Assessment for the Childless Adults in China
Miao, W., & Chen, Z. (2023) · Lecture Notes in Education Psychology and Public Media · doi:10.54254/2753-7048/30/20231631 · Cited by 1
Development and validation of a prediction nomogram for depressive symptoms in gout patients
Hao, X., & Wang, A. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1356814 · Cited by 1
Tang, T., Fu, Z., Li, Y., Zhu, R., & Jiang, J. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.08.037 · Cited by 1
Luan, D., Li, S.-Z., Zhang, C., & Ye, B. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e37504 · Cited by 1
“The utilization rate of health services among MDD patients is 11.6 %, while the rate of adequate treatment is as low as 0.8 % [3].”
InfluentialSelf-citationChallenges for esketamine nasal spray in China: use and management
Wu, J., Gu, J., Qiu, L., Jin, X., & Zhou, Z. (2024) · Frontiers in Pharmacology · doi:10.3389/fphar.2024.1429435 · Cited by 1
“It is also one of the primary causes of disability and is considered the second leading cause of life disability in China (Lu et al., 2021).”
BackgroundSocioeconomic and gender disparities in depression among elderly Chinese individuals
Tang, Y., & Li, Y. (2024) · Chinese Journal of Sociology · doi:10.1177/2057150x241269279 · Cited by 1
“As a consequence of the aging population worldwide, the study of depression among elderly individuals is also growing (Lu et al., 2021; Ren et al., 2020), as aging is associated with poor health, poor functioning, chronic medical conditions, and other diseases that affect not only individuals but…”
Luo, T., & Liu, C. (2024) · Chinese Science Bulletin (Chinese Version) · doi:10.1360/tb-2024-0468 · Cited by 1
Zhang, H., Sun, P., Wang, X., Yang, X., He, Y., Yang, T., Su, Y., Fu, Y., Li, Q., Sun, J., et al. (2024) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s476484 · Cited by 1
Self-citationLevels and influencing variables of adaptation of students in medical university
Zhu, L.-Y., Huang, H., Kuang, Y., Huang, D., & Tang, C. (2024) · Work · doi:10.1177/10519815241289680 · Cited by 1
“4 According to Lattie et al. , 5 college students have been more likely than ever to exhibit signs of anxiety, sadness, and other mental problems in recent years.”
Wang, J., Du, Y., Peng, Y., Deng, Y., Ge, Y., Liu, Z., Lv, J., Hu, G., Zhao, Z., & Li, Y. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.01.144 · Cited by 1
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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