title: Depressive symptoms in people with chronic physical conditions: prevalence and risk factors in a Hong Kong community sample.
abstract: BACKGROUND
  Depression is predicted to become one of the two most burdensome diseases worldwide by 2020 and is common in people with chronic physical conditions. However, depression is relatively uncommon in Asia. Family support is an important Asian cultural value that we hypothesized could protect people with chronic physical conditions from developing depression. We investigated depressive symptom prevalence and risk factors in a Chinese sample with chronic medical conditions, focusing on the possible protective role of family relationships.
  
  
  METHODS
  Data were obtained from the Hong Kong Jockey Club FAMILY Project cohort study in 2009-2011, which included 6,195 participants (age ≥15) with self-reported chronic conditions. Depressive symptoms were recorded using the Patient Health Questionnaire-9 (PHQ-9). Demographic and lifestyle variables, stressful life events, perceived family support and neighborhood cohesion were assessed. Factors associated with a non-somatic (PHQ-6) depression score were also examined.
  
  
  RESULTS
  The prevalence of depressive symptoms (PHQ-9 scores ≥5) was 17% in those with one or more chronic conditions, and was more prevalent in women than in men (19.7% vs. 13.9%; p < 0.001). In multilevel analyses, life stress, number of chronic conditions and satisfaction with family support explained 43% of the variance in PHQ-9 scores (standardized regression coefficients of 0.46, 0.15, and -0.12 respectively, all p <0.001). Body mass index, problem alcohol drinking, physical activity, and unmarried status were significantly associated with PHQ-9 scores, although these associations were weak. Variables associated with depression explained 35% of the variance in non-somatic (PHQ-6) depression scores. Satisfaction with family support played a stronger protective role against depressive symptoms (both PHQ-9 and PHQ-6 scores) among women than men (p < 0.05).
  
  
  CONCLUSIONS
  Acute life stress and the number of chronic conditions, together with socio-demographic factors, explain most variance in depressive symptoms among chronically ill Chinese individuals. Somatic items in the PHQ-9 increased the depression scores but they did not alter the pattern of predictors. Family support appears to be an important protective factor in Chinese cultures for individuals with chronic conditions.
authors.affiliation: Department of Community Medicine, School of Public Health, The University of Hong Kong, Hong Kong SAR, China. hnan@hku.hk
authors.forename: Hairong
authors.initials: H
authors.lastname: Nan
authors.forename: Paul H
authors.initials: PH
authors.lastname: Lee
authors.forename: Ian
authors.initials: I
authors.lastname: McDowell
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Ni
authors.forename: Sunita M
authors.initials: SM
authors.lastname: Stewart
authors.forename: Tai Hing
authors.initials: TH
authors.lastname: Lam
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000453:epidemiology*; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006304:Health Status; D006723:Hong Kong; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D055815:Young Adult