title: Patterns and correlates of major depression in Chinese adults: a cross-sectional study of 0.5 million men and women.
abstract: BACKGROUND
  Worldwide 350 million people suffer from major depression, with the majority of cases occurring in low- and middle-income countries. We examined the patterns, correlates and care-seeking behaviour of adults suffering from major depressive episode (MDE) in China.
  
  
  METHODS
  A nationwide study recruited 512 891 adults aged 30-79 years from 10 provinces across China during 2004-2008. The 12-month prevalence of MDE was assessed by the Modified Composite International Diagnostic Interview-short form. Logistic regression yielded adjusted odds ratios (ORs) of MDE associated with socio-economic, lifestyle and health-related factors and major stressful life events.
  
  
  RESULTS
  Overall, 0.7% of participants had MDE and a further 2.4% had major depressive symptoms. Stressful life events were strongly associated with MDE [adjusted OR 14.7, 95% confidence interval (CI) 13.7-15.7], with a dose-response relationship with the number of such events experienced. Family conflict had the highest OR for MDE (18.9, 95% CI 16.8-21.2) among the 10 stressful life events. The risk of MDE was also positively associated with rural residency (OR 1.5, 95% CI 1.4-1.7), low income (OR 2.3, 95% CI 2.1-2.4), living alone (OR 2.6, 95% CI 2.3-3.0), smoking (OR 1.4, 95% CI 1.3-1.6) and certain other mental disorders (e.g. anxiety, phobia). Similar, albeit weaker, associations were observed with depressive symptoms. Among those with MDE, about 15% sought medical help or took psychiatric medication, 15% reported having suicidal ideation and 6% reported attempting suicide.
  
  
  CONCLUSIONS
  Among Chinese adults, the patterns and correlates of MDE were generally consistent with those observed in the West. The low rates of seeking professional help and treatment highlight the great gap in mental health services in China.
authors.affiliation: Nuffield Department of Population Health,Medical Research Council Population Health Research Unit (MRC PHRU) & Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU),University of Oxford,Oxford,UK.
authors.forename: Y
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Nuffield Department of Population Health,Medical Research Council Population Health Research Unit (MRC PHRU) & Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU),University of Oxford,Oxford,UK.
authors.forename: D
authors.initials: D
authors.lastname: Bennett
authors.affiliation: Nuffield Department of Population Health,Medical Research Council Population Health Research Unit (MRC PHRU) & Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU),University of Oxford,Oxford,UK.
authors.forename: R
authors.initials: R
authors.lastname: Clarke
authors.affiliation: Chinese Academy of Medical Sciences, Dong Cheng District,Beijing,People's Republic of China.
authors.forename: Y
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Chinese Academy of Medical Sciences, Dong Cheng District,Beijing,People's Republic of China.
authors.forename: C
authors.initials: C
authors.lastname: Yu
authors.affiliation: Chinese Academy of Medical Sciences, Dong Cheng District,Beijing,People's Republic of China.
authors.forename: Z
authors.initials: Z
authors.lastname: Bian
authors.affiliation: Suzhou CDC,72 Sanxiang Road, Suzhou,People's Republic of China.
authors.forename: L
authors.initials: L
authors.lastname: Ma
authors.affiliation: Guanxi Provincial CDC,18 Jinzhou Road, Nanning, Guanxi,People's Republic of China.
authors.forename: Y
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Pengzhou CDC,331 Longta Road, Pengzhou, Sichuan,People's Republic of China.
authors.forename: Q
authors.initials: Q
authors.lastname: Sun
authors.affiliation: Sichuan Provincial CDC,6 Chendu City Middle School Road, Chendu,People's Republic of China.
authors.forename: N
authors.initials: N
authors.lastname: Zhang
authors.affiliation: Meilan CDC,70 Meilan District, Haikou,People's Republic of China.
authors.forename: X
authors.initials: X
authors.lastname: Zheng
authors.affiliation: China National Center for Food Safety Risk Assessment,Chaoyang District, Beijing,People's Republic of China.
authors.forename: J
authors.initials: J
authors.lastname: Chen
authors.affiliation: Nuffield Department of Population Health,Medical Research Council Population Health Research Unit (MRC PHRU) & Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU),University of Oxford,Oxford,UK.
authors.forename: R
authors.initials: R
authors.lastname: Peto
authors.affiliation: Department of Psychiatry,Virginia Commonwealth University, Virginia Institute for Psychiatric and Behavioural Genetics,Richmond, VA,USA.
authors.forename: K S
authors.initials: KS
authors.lastname: Kendler
authors.affiliation: Chinese Academy of Medical Sciences, Dong Cheng District,Beijing,People's Republic of China.
authors.forename: L
authors.initials: L
authors.lastname: Li
authors.affiliation: Nuffield Department of Population Health,Medical Research Council Population Health Research Unit (MRC PHRU) & Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU),University of Oxford,Oxford,UK.
authors.forename: Z
authors.initials: Z
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D002681:China; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000453:epidemiology*; D054541:Family Conflict; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000453:epidemiology*
keywords: China rural regions; family conflict; living alone; major depressive disorder; stressful life events