title: The role of basic health insurance on depression: an epidemiological cohort study of a randomized community sample in northwest China.
abstract: BACKGROUND
  Little research has focused on the relationship between health insurance and mental health in the community. The objective of this study is to determine how the basic health insurance system influences depression in Northwest China.
  
  
  METHODS
  Participants were selected from 32 communities in two northwestern Chinese cities through a three-stage random sampling. Three waves of interviews were completed in April 2006, December 2006, and January 2008. The baseline survey was completed by 4,079 participants. Subsequently, 2,220 participants completed the first follow-up, and 1,888 completed the second follow-up. Depression symptoms were measured by the Center for Epidemiologic Studies Depression Scale (CES-D).
  
  
  RESULTS
  A total of 40.0% of participants had at least one form of health insurance. The percentages of participants with severe depressive symptoms in the three waves were 21.7%, 22.0%, and 17.6%. Depressive symptoms were found to be more severe among participants without health insurance in the follow-up surveys. After adjusting for confounders, participants without health insurance were found to experience a higher risk of developing severe depressive symptoms than participants with health insurance (7 months: OR, 1.40; 95% CI, 1.09-1.82; p = 0.01; 20 months: OR, 1.89; 95% CI, 1.37-2.61; p < 0.001).
  
  
  CONCLUSIONS
  A lack of basic health insurance can dramatically increase the risk of depression based on northwestern Chinese community samples.
authors.affiliation: School of Social Development and Public Policy, Beijing Normal University, 19 Xinjiekouwai St, Beijing, China.
authors.forename: Donghua
authors.initials: D
authors.lastname: Tian
authors.forename: Zhiyong
authors.initials: Z
authors.lastname: Qu
authors.forename: Xiaohua
authors.initials: X
authors.lastname: Wang
authors.forename: Jing
authors.initials: J
authors.lastname: Guo
authors.forename: Fan
authors.initials: F
authors.lastname: Xu
authors.forename: Xiulan
authors.initials: X
authors.lastname: Zhang
authors.forename: Cecilia Lai-Wan
authors.initials: CL
authors.lastname: Chan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D003866:Depressive Disorder / Q000191:economics / Q000453:epidemiology*; D005260:Female; D006306:Health Surveys / Q000191:economics / Q000379:methods; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000191:economics; D011569:Psychiatric Status Rating Scales; D012306:Risk; D012720:Severity of Illness Index; D014505:Urban Population; D055815:Young Adult