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. Method: 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.

Original languageEnglish
Pages (from-to)958-970
Number of pages13
JournalPsychological Medicine
Issue number5
Early online date6 Dec 2016
Publication statusPublished - 1 Apr 2017
Externally publishedYes

Bibliographical note

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.


Funding Information:
The chief acknowledgment is to the participants, the project staff, and the China National Centre for Disease Control and Prevention (CDC) and its regional offices for access to death and disease registries. The Chinese National Health Insurance Scheme provides electronic linkage to all hospital admission data. The baseline survey was funded by the Kadoorie Charitable Foundation, Hong Kong. Long-term continuation: UK Wellcome Trust, Chinese National Natural Science Foundation (81390541, 81390544), UK Medical Research Council, British Heart Foundation, and Cancer Research UK provide core funding to the Clinical Trial Service Unit and Epidemiological Studies Unit at Oxford University for the project. K.S. K. is supported in part by National Institutes of Health grant MH100549. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Y.C., L.L. and Z.C. had full access to the data. All authors were involved in study design, conduct, longterm follow-up, analysis of data, interpretation or writing the report.


  • China rural regions
  • family conflict
  • living alone
  • major depressive disorder
  • stressful life events

ASJC Scopus subject areas

  • Applied Psychology
  • Psychiatry and Mental health


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