Prevalence and rates of recognition of depressive disorders in internal medicine outpatient departments of 23 general hospitals in Shenyang, China.
BACKGROUND
One important approach to increasing recognition and treatment rates for depression in urban China is to identify persons with depression who have contact with primary health care services, most of which are provided in the outpatient departments of general hospitals. We aim to assess the prevalence, risk factors and rates of recognition of depressive disorders in internal medicine outpatient departments of general hospitals.


METHODS
Outpatients with depression among 5312 consecutive attendees at outpatient internal medicine departments of 23 randomly selected general hospitals in Shenyang are identified by a two-stage screening process using the General Health Questionnaire and the Structured Clinical Interview for DSM-IV-TR Axis I Disorders. Charts of subjects with DSM-IV depressive disorders are reviewed to determine if treating clinicians made a diagnosis of depression or prescribed anti-depressant medications.


RESULTS
The current prevalence of any type of depressive disorder was 11.0% (95% CI: 10.1%-12.1%); and those of major depressive disorder, dysthymia, and depression not otherwise specified were 3.6% (3.1%-4.2%), 2.8% (2.4%-3.4%), and 4.1% (3.5%-4.8%) respectively. Only 4.0% (2.5%-6.1%) of the depressed patients were identified by the treating clinician and only 3.0% (1.6%-4.9%) were provided with antidepressant medication. Older age, female gender, reporting religious beliefs, low educational level, low income level and widowhood were independently associated with the occurrence of depression.


CONCLUSIONS
The prevalence of depression in primary care settings in urban China is lower than that reported in most western countries but the risk factors for depression are similar. The very low rates of recognition and treatment are related both to the low rates of care seeking for psychological problems and to the high-volume collective model of hospital-based primary care delivery. Increasing the recognition and treatment of depression in Chinese general hospitals will require changing the attitudes of patients and clinicians and, more importantly, altering the structure of care delivery.
Qin
Xiaoxia
X
Department of Psychiatry, First Affiliated Hospital, China Medical University, Shenyang, PR China.
Wang
Wei
W
Jin
Qiu
Q
Ai
Li
L
Li
Yueling
Y
Dong
Guanghui
G
Liu
Li
L
Phillips
Michael R
MR
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002681:China / Q000453:epidemiology; D003695:Delivery of Health Care / Q000592:standards; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D019263:Dysthymic Disorder / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care; D015995:Prevalence; D011320:Primary Health Care / Q000592:standards; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012307:Risk Factors; D014505:Urban Population / Q000706:statistics & numerical data