Associations of educational attainment, occupation, social class and major depressive disorder among Han Chinese women.
BACKGROUND
The prevalence of major depressive disorder (MDD) is higher in those with low levels of educational attainment, the unemployed and those with low social status. However the extent to which these factors cause MDD is unclear. Most of the available data comes from studies in developed countries, and these findings may not extrapolate to developing countries. Examining the relationship between MDD and socio economic status in China is likely to add to the debate because of the radical economic and social changes occurring in China over the last 30 years.


RESULTS
We report results from 3,639 Chinese women with recurrent MDD and 3,800 controls. Highly significant odds ratios (ORs) were observed between MDD and full time employment (OR = 0.36, 95% CI = 0.25-0.46, logP = 78), social status (OR = 0.83, 95% CI = 0.77-0.87, logP = 13.3) and education attainment (OR = 0.90, 95% CI = 0.86-0.90, logP = 6.8). We found a monotonic relationship between increasing age and increasing levels of educational attainment. Those with only primary school education have significantly more episodes of MDD (mean 6.5, P-value = 0.009) and have a clinically more severe disorder, while those with higher educational attainment are likely to manifest more comorbid anxiety disorders.


CONCLUSIONS
In China lower socioeconomic position is associated with increased rates of MDD, as it is elsewhere in the world. Significantly more episodes of MDD occur among those with lower educational attainment (rather than longer episodes of disease), consistent with the hypothesis that the lower socioeconomic position increases the likelihood of developing MDD. The phenomenology of MDD varies according to the degree of educational attainment: higher educational attainment not only appears to protect against MDD but alters its presentation, to a more anxious phenotype.
Xian Mental Health Center, New Qujiang District, Xian, Shaanxi, People's Republic of China ; The Affiliated Mental Health Institute of Xi'an School of Medicine, Xian, Shaanxi, People's Republic of China.
Jianguo
J
Shi
Xian Mental Health Center, New Qujiang District, Xian, Shaanxi, People's Republic of China ; The Affiliated Mental Health Institute of Xi'an School of Medicine, Xian, Shaanxi, People's Republic of China.
Yan
Y
Zhang
Xian Mental Health Center, New Qujiang District, Xian, Shaanxi, People's Republic of China ; The Affiliated Mental Health Institute of Xi'an School of Medicine, Xian, Shaanxi, People's Republic of China.
Feihu
F
Liu
Xian Mental Health Center, New Qujiang District, Xian, Shaanxi, People's Republic of China ; The Affiliated Mental Health Institute of Xi'an School of Medicine, Xian, Shaanxi, People's Republic of China.
Yajuan
Y
Li
Xian Mental Health Center, New Qujiang District, Xian, Shaanxi, People's Republic of China ; The Affiliated Mental Health Institute of Xi'an School of Medicine, Xian, Shaanxi, People's Republic of China.
Junhui
J
Wang
Wellcome Trust Centre for Human Genetics, Oxford, United Kindgom.
Jonathan
J
Flint
Chinese Traditional Hospital of Zhejiang, Hangzhou, Zhejiang, People's Republic of China.
Jingfang
J
Gao
No.1 Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
Youhui
Y
Li
Xinhua Hospital of Zhejiang Province, Hangzhou, Zhejiang, People's Republic of China.
Ming
M
Tao
No.1 Hospital of Shanxi Medical University, Taiyuan, Shanxi, People's Republic of China.
Kerang
K
Zhang
ShengJing Hospital of China Medical University, Heping District, Shenyang, Liaoning, People's Republic of China.
Xumei
X
Wang
No. 1 Hospital of Medical College of Xian Jiaotong University, Xian, Shaanxi, People's Republic of China.
Chengge
C
Gao
Jilin Brain Hospital, Siping, Jilin, People's Republic of China.
Lijun
L
Yang
Mental Hospital of Jiangxi Province, Nanchang, Jiangxi, People's Republic of China.
Kan
K
Li
Shanghai Mental Health Center, Shanghai, People's Republic of China.
Shenxun
S
Shi
Beijing Anding Hospital of Capital University of Medical Sciences, Deshengmen wai, Xicheng District, Beijing, People's Republic of China.
Gang
G
Wang
Shandong Mental Health Center, Jinan, Shandong, People's Republic of China.
Lanfen
L
Liu
No. 3 Hospital of Sun Yat-sen University, Tianhe District, Guangzhou, Guangdong, People's Republic of China.
Jinbei
J
Zhang
Hebei Mental Health Center, Baoding, Hebei, People's Republic of China.
Bo
B
Du
Chongqing Mental Health Center, Jiangbei District, Chongqing, People's Republic of China.
Guoqing
G
Jiang
Tianjin Anding Hospital, Hexi District, Tianjin, People's Republic of China.
Jianhua
J
Shen
No.4 Hospital of Jiangsu University, Zhenjiang, Jiangsu, People's Republic of China.
Zhen
Z
Zhang
Psychiatric Hospital of Henan Province, Xinxiang, Henan, People's Republic of China.
Wei
W
Liang
Nanjing Brain Hospital, Nanjing, Jiangsu, People's Republic of China.
Jing
J
Sun
Harbin Medical University, Nangang District, Haerbin, Heilongjiang, People's Republic of China.
Jian
J
Hu
Shenzhen Kang Ning Hospital, Luohu District, Shenzhen, Guangdong, People's Republic of China.
Tiebang
T
Liu
First Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
Xueyi
X
Wang
Guangzhou Brain Hospital (Guangzhou Psychiatric Hospital), Liwan District, Guangzhou, Guangdong, People's Republic of China.
Guodong
G
Miao
No.1 Hospital of Chongqing Medical University, Yuzhong District, Chongqing, People's Republic of China.
Huaqing
H
Meng
Dalian No.7 Hospital, Ganjingzi District, Dalian, Liaoning, People's Republic of China.
Yi
Y
Li
No.3 Hospital of Heilongjiang Province, Beian, Heilongjiang, People's Republic of China.
Chunmei
C
Hu
Wuhan Mental Health Center, Wuhan, Hubei, People's Republic of China.
Yi
Y
Li
Sichuan Mental Health Center, Mianyang, Sichuan, People's Republic of China.
Guoping
G
Huang
Mental Health Institute of Jining Medical College, Dai Zhuang, Bei Jiao, Jining, Shandong, People's Republic of China.
Gongying
G
Li
Liaocheng No.4 Hospital, Liaocheng, Shandong, People's Republic of China.
Baowei
B
Ha
Mental Health Center of West China Hospital of Sichuan University, Wuhou District, Chengdu, Sichuan, People's Republic of China.
Hong
H
Deng
Suzhou Guangji Hospital, Suzhou, Jiangsu, People's Republic of China.
Qiyi
Q
Mei
Anhui Mental Health Center, Hefei, Anhui, People's Republic of China.
Hui
H
Zhong
Ningbo Kang Ning Hospital, Zhenhai District, Ningbo, Zhejiang, People's Republic of China.
Shugui
S
Gao
Changchun Mental Hospital, Changchun, Jilin, People's Republic of China.
Hong
H
Sang
No.2 Hospital of Lanzhou University, Lanzhou, Gansu, People's Republic of China.
Yutang
Y
Zhang
Fuzhou Psychiatric Hospital, Cangshan District, Fuzhou, Fujian, People's Republic of China.
Xiang
X
Fang
Harbin No.1 Special Hospital, Haerbin, Heilongjiang, People's Republic of China.
Fengyu
F
Yu
Jining Psychiatric Hospital, North Dai Zhuang,Rencheng District, Jining, Shandong, People's Republic of China.
Donglin
D
Yang
No.2 Xiangya Hospital of Zhongnan University, Furong District, Changsha, Hunan, People's Republic of China.
Tieqiao
T
Liu
Xijing Hospital of No.4 Military Medical University, Xian, Shaanxi, People's Republic of China.
Yunchun
Y
Chen
Mental Health Center of Shantou University, Shantou, Guangdong, People's Republic of China.
Xiaohong
X
Hong
Tongji University Hospital, Shanghai, People's Republic of China.
Wenyuan
W
Wu
Huaian No.3 Hospital, Huaian, Jiangsu, People's Republic of China.
Guibing
G
Chen
Huzhou No.3 Hospital, Huzhou, Zhejiang, People's Republic of China.
Min
M
Cai
Mudanjiang Psychiatric Hospital of Heilongjiang Province, Xinglong, Mudanjiang, Heilongjiang, People's Republic of China.
Yan
Y
Song
No.1 Hospital of Jinan University, Guangzhou, Guangdong, People's Republic of China.
Jiyang
J
Pan
Qingdao Mental Health Center, Shibei District, Qingdao, Shandong, People's Republic of China.
Jicheng
J
Dong
Guangxi Longquanshan Hospital, Yufeng District, Liuzhou, People's Republic of China.
Runde
R
Pan
Daqing No.3 Hospital of Heilongjiang Province, Ranghulu district, Daqing, Heilongjiang, People's Republic of China.
Wei
W
Zhang
Tangshan No.5 Hospital, Lunan District, Tangshan, Hebei, People's Republic of China.
Zhenming
Z
Shen
Anshan Psychiatric Rehabilitation Hospital, Lishan District, Anshan, Liaoning, People's Republic of China.
Zhengrong
Z
Liu
Weihai Mental Health Center, ETDZ, Weihai, Shandong, People's Republic of China.
Danhua
D
Gu
Renmin Hospital of Wuhan University, Wuchang District, Wuhan, Hubei, People's Republic of China.
Xiaoping
X
Wang
Tianjin First Center Hospital, Hedong District, Tianjin, People's Republic of China.
Xiaojuan
X
Liu
Hainan Anning Hospital, Haikou, Hainan, People's Republic of China.
Qiwen
Q
Zhang
Wellcome Trust Centre for Human Genetics, Oxford, United Kindgom.
Yihan
Y
Li
Clinical Trial Service Unit, Richard Doll Building, Oxford, United Kingdom.
Yiping
Y
Chen
Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, United States of America.
Kenneth S
KS
Kendler
D000328:Adult; D001008:Anxiety Disorders / Q000208:ethnology / Q000523:psychology; D044466:Asian People / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D002681:China; D003865:Major Depressive Disorder / Q000208:ethnology / Q000523:psychology*; D004522:Educational Status; D004651:Employment; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009790:Occupations; D016017:Odds Ratio; D012008:Recurrence; D012923:Social Class