Depression hurts, depression costs: The medical spending attributable to depression and depressive symptoms in China

The mediating role of childhood emotional neglect in the association between childhood neighborhood quality and adult depression outcomes: A nationwide longitudinal analysis

BACKGROUND

Depression is a prevalent mental health disorder with personal and societal costs. Childhood experiences, including neighborhood quality and emotional neglect, may influence adult depression risk.

OBJECTIVE

To examine the relationships between childhood neighborhood quality (CNQ), childhood emotional neglect (CEN), and adult depressive symptoms, and investigate the potential mediating role of CEN.

PARTICIPANTS AND SETTING

15,730 Chinese adults aged 45 and above from the China Health and Retirement Longitudinal Study (CHARLS).

METHODS

Weighted multiple regression, Karlson-Holm-Breen (KHB) mediation and Bootstrap mediation analyses were conducted to assess the relationships between CNQ, CEN, and adult depressive symptoms and depression risk, using longitudinal data.

RESULTS

Higher CNQ was associated with lower depressive symptoms (β = -0.316, p < 0.001) and depression risk (β = -0.084, p < 0.001). Higher CEN was associated with increased depressive symptoms (β = 0.084, p < 0.01) and depression risk (β = 0.020, p > 0.05). CEN partially mediated the relationship between CNQ and depressive symptoms (KHB: β = -0.010, p < 0.01; Bootstrap: β = -0.007, p < 0.05) and depression risk (KHB: β = -0.003, p < 0.05; Bootstrap: β = -0.002, p > 0.05), accounting for 3.50 % (KHB) and 2.36 % (bootstrap) of the total effects for depressive symptoms, and 3.82 % (KHB) and 1.97 % (bootstrap) for depression risk.

CONCLUSIONS

Both CNQ and CEN independently influence adult depression, with CEN partially mediating the CNQ-depression relationship. These findings suggest that interventions targeting both neighborhood conditions and family environments may be crucial for preventing adult depression.

Long-term impacts of childhood neighborhood quality on depression in later midlife mediated by childhood domestic violence: A nationwide longitudinal analysis

BACKGROUND

Depression affects 264 million people globally, with a high prevalence in China. Adverse childhood experiences, such as poor neighborhood quality and domestic violence, significantly contribute to depression in later midlife.

OBJECTIVE

This study aimed to examine the impact of childhood neighborhood quality (CNQ) and childhood domestic violence (CDV) on depression in later midlife and explore the mediating role of domestic violence.

PARTICIPANTS AND SETTING

Data from the China Health and Retirement Longitudinal Study (CHARLS), involving 10,139 participants aged 45 and older, were analyzed.

METHODS

CNQ and CDV were assessed through surveys, and depressive symptoms were measured using the CES-D-10 scale. Multiple regression and Karlson-Holm-Breen method were conducted.

RESULTS

Higher CNQ was associated with lower depressive symptoms (β = -0.317, p < 0.001) and depression risk (β = -0.083, p < 0.001), while higher CDV was linked to increased depressive symptoms (β = 0.235, p < 0.001) and depression risk (β = 0.073, p < 0.001). KHB analysis showed that childhood domestic violence partially mediated the relationship between CNQ and depressive symptoms (β = -0.032, p < 0.001) and depression risk (β = -0.011, p < 0.001).

CONCLUSION

Improving neighborhood conditions and reducing domestic violence during childhood may mitigate the long-term risk of depression in later midlife. Community-level interventions and early support services are crucial.

The trend of suicide and self-harm in the Chinese population from 2018 to 2022 based on ambulance medical emergency cases: a retrospective study

Objective

This study investigates the trends of suicide and self-harm in Nanjing, China, through 4 years of data collection, aiming to provide valuable information for developing effective suicide prevention strategies.

Methods

This descriptive study analyzed Nanjing Emergency Medical Center (NEMC) ambulance records from Nanjing (2018-2022) to investigate suicide and self-harm events. Out of 689,305 records, 4,261 cases were included after exclusions. The study categorized incidents into 4,103 suicide events and 158 self-harm cases. Descriptive statistics and content analysis were conducted to identify characteristics and themes related to these events, with age groups defined according to American Medical Association standards.

Results

The study highlights drug poisoning as the leading method, accounting for 63.56% of the 4,103 suicide events. It notes significant trends by age, gender, and season, with males showing higher rates of self-harm. The study emphasizes the need for targeted prevention strategies, particularly focusing on drug-related suicides among adults and adolescents, as well as the prevalence of various self-harming behaviors.

Conclusion

To reduce self-harm and suicide, interventions must be strengthened for women, who experience higher rates. Key strategies include regulating pesticides and psychotropic drugs, increasing access to mental health resources, and launching community awareness campaigns. Additionally, training healthcare providers and promoting family education can enhance support for women facing mental health challenges.

Chinese burden of depressive disorders from 1990 to 2021 and prediction for 2030: analysis of data from the global burden of disease study 2021

BACKGROUND

This study aims to examine the temporal changes in the incidence, prevalence, and disability-adjusted life years (DALYs) of depressive disorders as well as its association with age, period, and birth cohort among Chinese from 1990 to 2021, and forecast the future trends of incidence rates and numbers from 2022 to 2030.

METHODS

Data for analysis were obtained from the Global Burden of Disease (GBD) 2021. Joinpoint analysis was used to calculate the annual percentage change (APC) and average annual percent change (AAPC) to describe the rates of depressive disorders. Age, period, and cohort model was utilized to disentangle age, period, and birth cohort effects on rates of depressive disorders. Bayesian age-period-cohort (BAPC) analysis was capitalized to forecast the incidence rates and numbers for different sexes and age groups from 2022 to 2030.

RESULTS

The age-standardized incidence (ASIR, AAPC: -0.35 [95%CI: -0.65, -0.04]), prevalence (ASPR, AAPC: -0.20 [95%CI: -0.24, -0.16]), and DAYLs (AAPC: -0.28 [95%CI: -0.51, -0.05]) rates of both sexes showed a downward trend from 1990 to 2021, despite a volatility growth in recent years (APC in 2019-2021 of ASPR: 0.96 [95%CI: 0.70, 1.23]). Females exhibited a higher burden of depressive disorders compared to males but experienced a more rapid rate of reduction changes. The burden of depressive disorders was most owing to the age effect and period effect in recent years. The ASIR was predicted to decrease in the whole population (males in 2030: 1,546.3 per 100,000 people; females in 2030: 2,465.8 per 100,000 people), but in children, adolescents, and the elderly demonstrate unfavorable trends in the future.

CONCLUSION

The burden of depressive disorders decreased in China from 1990 to 2021 in terms of age-standardized rates, but increased in recent years. Children, adolescents, and the elderly are the risk groups for future depressive disorders. Considering the large population, the increasing fewer children, and the aging trend, as well as the possible long-term effects of COVID-19 on human psychological burden, more sex-age-sensitive social healthcare programs should be considered in the future to minimize the burden of depressive disorders in China.

Depression status and risk factors analysis based on the 'individual-social-health system' dimension: evidence from middle-aged and elderly people in China

BACKGROUND

Depression, as a common mental illness, is harmful and burdensome. As a country with a large elderly population, China has a heavy burden of depression going in the future. The study aims to portray the current situation of depression occurrence in middle-aged and elderly people in China and capture the risk triggers, in order to provide a theoretical basis for the improvement of the mental health status of middle-aged and elderly people, and the development of depression prevention, control and intervention strategies.

METHOD

The study used 2020 China Health and Retirement Longitudinal Study (CHARLS) data and 18 950 respondents aged >45 years as the study sample. Depression status was calculated according to the simplified version of the Depression Scale (CES-D10) and logistic regression analysis was used to explore the factors affecting depression.

RESULT

There were 34.14% of the 18 950 respondents who were depressed. The results of logistic regression showed that factors such as being under 65 years of age, female, living in rural areas, having low education, and poor health status were risk factors for depression.

CONCLUSION

The mental health of the middle-aged and elderly population is poor and affected by multidimensional factors. The Chinese government should continue to strengthen its efforts to prevent and treat depression in the middle-aged and elderly population, and establish individualised and comprehensive strategies and measures to enhance the operational effectiveness of the policy.

Evaluation of the quality of depression-related information on Chinese websites and video platforms: a cross-sectional comparative analysis

Objectives

We aimed to assess the quality of information regarding depression on Chinese websites and popular video platforms.

Methods

We conducted searches on website platforms (Baidu, Bing) and video platforms (Bilibili, Douyin) using search terms "depression", "depressive disorder", "depression treatment", "depressive anxiety", "depressed patient", and "depressive symptoms". We collected the first 50 results with each search term in each platform. Each website and video included in this study was assessed using The DISCERN instrument (DISCERN), Journal of American Medical Association benchmark criteria (JAMA), Hexagonal Radar Schema (HRS), and Global Quality Scores (GQS).

Results

A total of 177 websites, 216 Bilibili videos, and 244 Douyin videos were included. Among all the platforms, websites had the highest median scores on DISCERN and HRS, at 33 and 2 respectively, but were still classified as "poor" and "very poor" according to the classification. Bilibili, Douyin, and websites had median scores of 3, 2, and 2 respectively in JAMA, indicating a moderate level of quality. Bilibili, Douyin, and websites all had a median score of 2 for GQS, and were of poor quality. Only the percentage score for JAMA was more than half of the weighted score, while none of the other scales reached half of the score. The median percentage scores of the websites in DISCERN, HRS, and GQS were higher than those of Bilibili and Douyin (P < 0.001). Compared to other sources, news media on websites and medical organizations on videos demonstrated higher quality (all P values < 0.05).

Conclusions

The findings of the study indicated an overall low quality of online depression information. Collaborative efforts between platforms and professionals are necessary to improve the comprehensiveness and quality of depression-related information available online. In addition, the platform needs to prioritize optimizing the algorithm of recommendations and present real high-quality health information to the audience.

Mental health help-seeking in China

BACKGROUND

In China, mental health disorders are considered the leading causes of disability, yet treatment-seeking behaviors among individuals with mental health problems are deficient.

AIMS

This study sought to examine attitudes and participant characteristics associated with help-seeking among adults residing in China's Shanghai metropolitan area.

METHODS

This study employed a convenience cross-sectional sampling strategy and recruited 500 participants in public places in Shanghai. The survey administered in Mandarin was comprised of two sections: a series of demographic questions and standardized instruments measuring stigma and help-seeking attitudes.

RESULTS

Findings indicate that beliefs about seeking professional help for mental health are influenced by knowing someone with a mental health problem. In addition, men who were older, had a child, and were married endorsed more openness to help-seeking for mental health needs, underscoring the importance of life experience as an essential variable when considering attitudes toward help-seeking.

CONCLUSIONS

Findings support future research identifying the mechanisms by which these life experiences impact individuals' help-seeking attitudes.

Gender Differences in the Association Between Childhood Neighborhood Quality and Depressive Symptoms Trajectory in Middle-Aged and Elderly Chinese: A Seven-Year Longitudinal Study

This study aimed to examine the role of childhood neighborhood quality on trajectories of depressive symptoms throughout later life based on a nationally representative sample, and to explore the role of gender in the association. Linear mixed-effects model analysis was performed to investigate a longitudinal association of childhood neighborhood quality with depressive symptoms. A total of 7,016 participants aged 45 and above were included in this study. Depressive symptoms progression was significantly faster (β [95% confidence interval, CI]: 0.13 [0.01, 0.25]; P = .027) in the low childhood neighborhood quality when compared with the high childhood neighborhood quality. The quality of childhood neighborhood was significantly associated with a change in depressive symptoms over time in females (β [95% CI]: 0.19 [0.02, 0.36]; P = .029) but not in males (β [95% CI]: 0.09 [-0.06, 0.25]; P = .224). Targeted interventions should be developed to prevent depressive symptoms for those vulnerable groups.

Assessing the accuracy of self-reported health expenditure data: Evidence from two public surveys in China

This paper utilizes Benford's law, the distribution that the first significant digit of numbers in certain datasets should follow, to assess the accuracy of self-reported health expenditure data known for measurement errors. We provide both simulation and real data evidence supporting the validity assumption that genuine health expenditure data conform to Benford's law. We then conduct a Benford analysis of health expenditure variables from two widely utilized public datasets, the China Health and Nutrition Survey and the China Family Panel Studies. Our findings show that health expenditure data in both datasets exhibit inconsistencies with Benford's law, with the former dataset tending to be less prone to reporting errors. These results remain robust while accounting for variations in survey design, recall periods, and sample sizes. Moreover, we demonstrate that data accuracy improves with a shorter time interval between hospitalization and interviews, when the data is self-reported as opposed to proxy responses, and at the household level. We find no compelling evidence that enumerators' assessments of respondents' credibility or urgency to end interviews are indicative of data accuracy. This paper contributes to literature by introducing an easy-to-implement analytical framework for scrutinizing and comparing the reporting accuracy of health expenditure data.

Association of the intergenerational structure with the onset of depressive symptoms among middle-aged and older adults in China

BACKGROUND

Chinese family structure has undergone tremendous changes over the past few decades. Moreover, the association of the intergenerational structure with depression remains controversial.

AIMS

This study aimed to find out the association of the intergenerational structure and the onset of depressive symptoms among Chinese middle-aged and older adults.

METHODS

This study included 4,868 participants of the China Health and Retirement Longitudinal Study (CHARLS), who were enrolled in 2011 without depressive symptoms and followed up at least once later in 2013, 2015, 2018, and 2020. Taking the time-varying confounding effect into account, the time-dependent Cox regression models were used to estimate the association of the intergenerational structure and the onset of depressive symptoms.

RESULTS

Among the studied middle-aged and older adults, compared to one-generation households, higher hazard ratios (HR) of developing depressive symptoms were found in three-generation households in the study population (HR = 1.21, 95% CI [1.08, 1.36]). Further, for female participants, skipping-generation households (HR = 1.38, 95% CI [1.05, 1.83]) and three-generation lineal households (HR = 1.21, 95% CI [1.02, 1.43]) were found to be significantly associated with new-onset depressive symptoms compared to empty-nest couples. For male participants, living alone (HR = 1.65, 95% CI [1.30, 2.11]), living in standardized nuclear households (HR = 1.27, 95% CI [1.06, 1.54]), impaired nuclear households (HR = 1.80, 95% CI [1.18, 2.76]), or three-generation lineal households (HR = 1.34, 95% CI [1.12, 1.60]) were found to have a significant association with the onset of depressive symptoms.

CONCLUSIONS

This study found that males living alone, with unmarried children, or in three-generation lineal households, and females living with grandchildren were more likely to suffer from depressive symptoms. Therefore, special attention should be paid to people in these intergenerational structure subtypes.

The impact of family urban integration on migrant worker mental health in China

Background

As China has undergone the processes of urbanization and economic development, a large migrant population has emerged, creating new family migration trends. Family migration brings about changes in urban integration costs and benefits, affecting health investment.

Objective

The primary objective of this research is to investigate the influence of urban integration of migrant workers' families on their mental wellbeing, with the aim of offering policy recommendations conducive to the realization of a comprehensive public health strategy in China.

Methods

This paper uses multi-dimensional indexes to measure family urban integration, covering economic, social and psychological dimensions, which may consider the complexity of integration. Utilizing a machine learning clustering algorithm, the research endeavors to assess the level of urban integration experienced by migrant workers and their respective families. The analysis discerns three distinct clusters denoting varying degrees of urban integration within these familial units, namely high-level, medium-level, and low-level urban integration. We applied binary logit regression models to analyze the influence of family urban integration on the mental health among migrant workers. Then we conducted a series of robustness tests.

Results

The results show that family urban integration decreases the probability of depressive symptoms by 14.6 percentage points. Further mechanism tests show that family economic integration enhances the psychological wellbeing of migrant workers by elevating their income status. Family social integration decreases depressive symptoms by increasing social status. Family psychological integration increases the psychological health of migrant workers by making them more satisfied with their lives. The heterogeneity test shows that family urban integration and its different dimensions have a strong impact on the depressive symptoms of women, first-generation, and less-educated groups.

Conclusions

This study finds that family urban integration and its economic, social, and psychological dimensions significantly reduced the depressive symptoms of migrant workers. The results of this study lead the authors to recommend formulating a family-centered policy for migrant workers to reside in urban areas, optimizing the allocation of medical resources and public services, and improving family urban integration among migrant workers in order to avoid mental health problems in the process of urban integration.

Socioeconomic inequalities in the relationship between internet usage patterns and depressive symptoms: Evidence from a Chinese longitudinal study

Background

The increasing prevalence of depressive symptoms has emerged as a critical public health issue globally, highlighting the need for analyses of the factors contributing to depressive symptoms within the Chinese population and the development of targeted recommendations for improving mental well-being. We aimed to explore the correlation between internet use and depressive symptoms and the role of socioeconomic inequalities in this association.

Methods

We included data on 8019 residents aged 18 years and above, which we retrieved from the 2018 and 2020 waves of the China Family Panel Studies. We used latent profile analysis to categorise individuals' internet usage patterns and multiple linear regression to determine their association with depressive symptoms.

Results

Higher socioeconomic status (SES) was associated with fewer depressive symptoms (τ = -0.08; 95% confidence interval (CI) = -0.36, -0.18). Individuals in the high-dependence group presented a greater likelihood of developing depressive symptoms (τ = 0.04; 95% CI = 0.007, 0.66). We observed no significant difference in the interaction effect between individual-level SES and the four patterns of internet usage. However, compared with urban-dwelling respondents, those in rural areas had a stronger association between internet usage patterns and depressive symptoms, especially those in the high-dependence group (τ = -0.07; 95% CI = -1.47, -0.20).

Conclusions

Our findings indicate a significant association between depressive symptoms and internet usage patterns, indicating a need for interventions related to internet use, especially those targeted at reducing the risk of depressive symptoms in individuals of lower SES.

Optimal dose and type of exercise to improve depressive symptoms in older adults: a systematic review and network meta-analysis

BACKGROUND

Depression is a prevalent issue among older adults, affecting their quality of life and overall well-being. Exercise is an effective means of relieving depressive symptoms in older adults, but the optimal dose for different exercise types remains unclear. As such, the aim of this meta-analysis was to examine the dose-response relationship between overall and specific types of exercise with depression symptoms in older adults.

METHODS

This systematic review and network meta-analysis included a search of PubMed, Medline, Embase, PsycINFO, Cochrane library, and Web of Science for randomized controlled trials of exercise in older adults with depression symptoms from inception to 15 July 2023. Comprehensive data extraction covered dose, treatment regimen, demographics and study duration. Dosage metrics, encompassing METs-min/week, were scrutinized in correlation with the Minimal Clinically Importance Difference (MCID).

RESULTS

A total of 47 studies involving 2895 participants and 7 kinds of exercise were included in the review. Without considering the dose, the results of our network meta-analysis indicated that Walking was the most effective in alleviating depression in older adults, in addition to Aerobic exercise (AE), Yoga, Qigong, Resistance training (RT), and Tai Chi (TC), which were equally effective. However, the results of the dose-response analysis found that Aerobic exercise was most effective at a dose of 1000 METs-min/week. It is noteworthy that Walking is significantly effective in alleviating depressive symptoms in older adults at very low doses. In terms of clinical benefits, we found that overall exercise doses in the range of 600 ~ 970 METs-min/week were clinically effective. Considering the specific types of exercise, Aerobic exercise, Resistance training, Walking, and Yoga were found to be effective at doses ranging from 820 ~ 1000 METs-min/week, 520 ~ 1000 METs-min/week, 650 ~ 1000 METs-min/week, 680 ~ 1000 METs-min/week, respectively. At the same time, we found that when the age exceeded 81 years, even when participating in exercise, it did not achieve the effect of alleviating depressive symptoms in older adults.

CONCLUSIONS

In conclusion, including Walking, AE, Yoga, Qigong, RT, and TC, effectively alleviate depressive symptoms in older adults. Furthermore, we established statistically and clinically significant threshold doses for various exercise types. Early initiation of exercise is beneficial, but its efficacy diminishes from the age of 80, and beyond 81, exercise no longer significantly alleviates depressive symptoms.

Health insurance and subjective well-being: evidence from integrating medical insurance across urban and rural areas in China

Health insurance coverage and the risk protection it provides may improve enrollees' subjective well-being (SWB), as demonstrated, e.g. by Oregon Medicaid's randomized expansion significantly improving enrollees' mental health and happiness. Yet little evidence from low- and middle-income countries documents the link between insurance coverage and SWB. We analyse individual-level data on a large natural experiment in China: the integration of the rural and urban resident health insurance programmes. This reform, expanded nationally since 2016, is recognized as a vital step towards attaining the goal of providing affordable and equitable basic healthcare in China, because integration raises the level of healthcare coverage for rural residents to that enjoyed by their urban counterparts. This study is the first to investigate the impact of urban-rural health insurance integration on the SWB of the Chinese population. Analysing 2011-18 data from the China Health and Retirement Longitudinal Study in a difference-in-difference framework with variation in the treatment timing, we find that the integration policy significantly improved the life satisfaction of rural residents, especially among low-income and elderly individuals. The positive impact of the integration on SWB appears to stem from the improvement of rural residents' mental health (decrease in depressive symptoms) and associated increases in some health behaviours, as well as a mild increase in outpatient care utilization and financial risk protection. There was no discernible impact of the integration on SWB among urban residents, suggesting that the reform reduced inequality in healthcare access and health outcomes for poorer rural residents without negative spillovers on their urban counterparts.

Interpreting the Mechanism of Active Ingredients in Polygonati Rhizoma in Treating Depression by Combining Systemic Pharmacology and In Vitro Experiments

Polygonati Rhizoma (PR) has certain neuroprotective effects as a homology of medicine and food. In this study, systematic pharmacology, molecular docking, and in vitro experiments were integrated to verify the antidepressant active ingredients in PR and their mechanisms. A total of seven compounds in PR were found to be associated with 45 targets of depression. Preliminarily, DFV docking with cyclooxygenase 2 (COX2) showed good affinity. In vitro, DFV inhibited lipopolysaccharide (LPS)-induced inflammation of BV-2 cells, reversed amoeba-like morphological changes, and increased mitochondrial membrane potential. DFV reversed the malondialdehyde (MDA) overexpression and superoxide dismutase (SOD) expression inhibition in LPS-induced BV-2 cells and decreased interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and IL-6 mRNA expression levels in a dose-dependent manner. DFV inhibited both mRNA and protein expression levels of COX2 induced by LPS, and the activation of NACHT, LRR, and PYD domains-containing protein 3 (NLRP3) and caspase1 was suppressed, thus exerting an antidepressant effect. This study proves that DFV may be an important component basis for PR to play an antidepressant role.

Occupational differences in the effects of retirement on hospitalizations for mental illness among female workers: Evidence from administrative data in China

Retirement, a major transition in the life course, may affect many aspects of retirees' well-being, including health and health care utilization. Leveraging differential statutory retirement age (SRA) by occupation for China's urban female workers, we provide some of the first evidence on the causal effect of retirement on hospitalizations attributable to mental illness and its heterogeneity. To address endogeneity in retirement decisions, we take advantage of exogeneity of the differing SRA cut-offs for blue-collar (age 50) and white-collar (age 55) female urban employees. We apply a Fuzzy Regression Discontinuity Design (RDD) around the SRA cut-offs using nationally representative hospital inpatient claims data that cover these workers. We show that blue-collar females incur more hospitalizations for mental illness after retirement, while no similar change is found for white-collar females. Conditional on blue-collar females being hospitalized, probabilities of overall and ER admissions due to mental illness increase by 2.3 and 1.2 percentage points upon retirement, respectively. The effects are primarily driven by patients within the categories of schizophrenia, schizotypal and delusional disorders; and neurotic, stress-related and somatoform disorders. Moreover, the 'Donut' RDD estimates suggest that pent-up demand at retirement unlikely dominates our findings for blue-collar females. Rather, our results lend support to their worsening mental health at retirement. These findings suggest that occupational differences in mental illness and related health care utilization at retirement should be considered when optimizing retirement policy schemes.

Assessing the Impact of Internet Skills on Depressive Symptoms Among Chinese Middle-Aged and Older Adults: Cross-Sectional Instrumental Variables Analysis

Background

The potential benefits of IT for the well-being of older adults have been widely anticipated. However, findings regarding the impact of internet use on depressive symptoms are inconsistent. As a result of IT's exponential growth, internet skills have supplanted internet access as the source of the digital divide.

Objective

This study evaluates the effect of internet skills on depressive symptoms through an instrumental variables (IV) approach.

Methods

Data from the China Health and Retirement Longitudinal Study's wave 4 (2018) were used. This included 16,949 community residents aged 45 years and older. To overcome the endogeneity issue, we used an IV approach.

Results

Our results reveal the emergence of a second-level digital divide, the disparity in internet skills, among Chinese middle-aged and older adults. Liner regression suggests that a 1% increase in internet skills is associated with a 0.037% decrease in depressive symptoms (β=-.037, SE 0.009), which underestimates the causal effect. As expected, internet skills are an endogenous variable (F test P value <.001). IV regressions indicate that a 1% increase in internet skills reduces 1.135% (SE 0.471) to 1.741% (SE 0.297) of depressive symptoms. These 2 IV are neither weak (F-1=16.7 and 28.5; both >10) nor endogenous (Wu-Hausman test P value of .10; >.05 or >.01).

Conclusions

Better mental health is predicted through improved and higher internet skills. Consequently, residents and policy makers in China should focus on bridging the digital divide in internet skills among middle-aged and older adults.

Physical activity and its fluctuations in relation to depressive symptoms: A national longitudinal study among Chinese adults

BACKGROUND

Physical activity (PA) may prevent depressive symptoms, however, PA fluctuations may have different effects. Using three waves of nationally representative data, this study aimed to examine the effects of PA fluctuations on depressive symptoms.

METHODS

Participants comprised 7633 adults free of depressive symptoms at the first two waves (Mage = 45.26, 54.70 % males). They completed the China Family Panel Study in 2016 (T1), 2018 (T2), and 2020 (T3), respectively. Depressive symptoms were measured by the Center for Epidemiologic Studies Depression (CES-D) scale using a cutoff of 16. Participants' PA levels were split into regular PA or infrequent PA groups. Changes in PA levels between T1 and T2 were classified into four groups: maintained infrequent PA, initiated regular PA, ceased regular PA, and persisted regular PA.

RESULTS

The incidence of depressive symptoms was 20.22 % (19.05 % possible and 1.17 % severe depression). After multivariate adjustment, Poisson regression showed that persistent regular PA had 17.8 % (95 % CI: 0.724, 0.934) lower risks of incident depressive symptoms compared to maintained infrequent PA. And adults who ceased regular PA were more likely to experience depressive symptoms than those who persisted in regular PA (RR = 1.188, 95 % CI: 1.010, 1.398).

LIMITATIONS

All items were self-reported. CES-D only examined self-diagnosed depressive symptoms, not medical diagnoses.

CONCLUSION

Adults who persisted in regular PA may have a lower possibility of developing depressive symptoms. The finding might serve as an empirical reference to depression prevention.

Outpatient depression current care expenditure changes in Liaoning Province from 2015 to 2020: a study based on the "system of health accounts 2011"

Introduction: Depression is the leading cause of disability worldwide and has become a health issue of global concern. Based on the "System of Health Accounts 2011" (SHA 2011) for patients with depression, this paper studies the changes in the current curative expenditure (CCE) of outpatient depression in Liaoning Province, China, and provides policy recommendations. Method: A stratified multistage random sample of 56,994 patients with depression included from 1,227 healthcare facilities in Liaoning Province were included. The significance of differences in variables within groups was analyzed by univariate analysis (including descriptive statistics analysis, Mann-Whitney U test and Kruskal-Wallis H test), and factors influencing depression outpatient CCE were analyzed by multiple linear regression analysis and constructing structural equation models (SEM). Results: The CCE of outpatient depression was ranging from CNY 75.57 million to CNY 100.53 million in 2015-2020, with the highest of CNY 100.53 million in 2018, CNY 103.28 million in 2019. Medical expenditures are mainly concentrated in general hospitals and provincial healthcare institutions, accounting for about 90% of all provincial scope expenditures. The multiple regression results show that provincial healthcare institutions, purchase of drug, select medical treatment for depression, general hospitals and urban employees' health insurance are the main influencing factors for depression outpatient CCE. The results of SEM show that insurance status negative impact outpatient expenditure. Conclusion: Health insurance is an important factor in equitable access to healthcare resources for patients, and medication expenditure is the influential factor affecting the high expenditure of outpatient clinics. It is of great importance to reduce the medical burden of patients by increasing the coverage of medical insurance, increasing the proportion of bills that are eligible for reimbursement, and improving the system by guaranteeing the supply of psychotropic medication.

Short-term exposure to ambient nitrogen dioxide and increased hospitalization burden for depression in China: a multicity analysis

Evidence for the increased hospitalization burden, including admissions, expenditures and length of hospital stay (LOS) for depression attributable to ambient nitrogen dioxide (NO2) is lacking. We investigated the associations between short-term exposure to ambient NO2 and attributable admissions, hospitalization expenditures and LOS for depression in 57 Chinese cities during 2013-2017 using a well-established two-stage time-series study approach. Short-term exposure to ambient NO2 was associated with significantly increased admissions, hospitalization expenditures and LOS for depression, and the attributable fractions were 6.87% (95% CI: 2.90%, 10.65%), 7.12% (3.01%, 11.04%) and 6.12% (2.59%, 9.50%) at lag02, respectively. The projected total attributable admissions, hospitalization expenditures and LOS for depression related to ambient NO2 at the national level were 23,335 (9,863, 36,181) admissions, 318.70 (134.43, 492.21) million CNY and 539.55 (227.99, 836.99) thousand days during the study period, respectively. Short-term exposure to ambient NO2 is associated with increased hospitalization burden for depression.

Astroglial Connexin 43-Mediated Gap Junctions and Hemichannels: Potential Antidepressant Mechanisms and the Link to Neuroinflammation

Major depression disorder (MDD) is a neuropsychiatric disorder associated with a high suicide rate and a higher disability rate than any other disease. Evidence suggests that the pathological mechanism of MDD is related to astrocyte dysfunction. Depression is mainly associated with the expression of connexin 43 (Cx43) and the function of Cx43-mediated gap junctions and hemichannels in astrocytes. Moreover, neuroinflammation has been a hotspot in research on the pathology of depression, and Cx43-mediated functions are thought to be involved in neuroinflammation-related depression. However, the specific mechanism of Cx43-mediated functions in neuroinflammation-related depression pathology remains unclear. Therefore, this review summarizes and discusses Cx43 expression, the role of gap junction intercellular communication, and its relationship with neuroinflammation in depression. This review also focuses on the effects of antidepressant drugs (e.g., monoamine antidepressants, psychotropic drugs, and N-methyl-D-aspartate receptor antagonists) on Cx43-mediated function and provides evidence for Cx43 as a novel target for the treatment of MDD. The pathogenesis of MDD is related to astrocyte dysfunction, with reduced Cx43 expression, GJ dysfunction, decreased GJIC and reduced BDNF expression in the depressed brain. The effect of Cx43 on neuroinflammation-related depression involving inflammatory cytokines, glutamate excitotoxicity, and HPA axis dysregulation. Antidepressant drugs targeting Cx43 can effectively relieve depressive symptoms.

A Link between Prenatal Stage of Life during the Great Chinese Famine and Subsequent Depressive Symptoms among Middle-Aged and Older Adults

Prenatal malnutrition may increase the risk of depressive symptoms in adulthood. This study investigated the association between prenatal exposure to malnutrition with risk of depressive symptoms in middle-aged and older adults using the Chinese Great Famine of 1959-1961 as a natural experiment. Data were obtained from the China Health and Retirement Longitudinal Study baseline survey (2011). A total of 5391 individuals born from 1956 to 1965 were included in the study. Depressive symptoms were ascertained via the Center for Epidemiological Studies Depression Scale short form. Famine severity was measured using the cohort size shrinkage index. Difference-in-differences models were used to explore the association between prenatal famine exposure and later-life depressive symptoms. Compared with the post-famine cohort (1963-1965), famine cohorts (1959-1962) were 4.74 times (95% CI = 1.28-8.20) as likely to develop depressive symptoms. The stratified analysis found that prenatal exposure to famine was associated with depressive symptoms in rural residents but not those living in urban areas. In rural females, prenatal malnutrition was associated with a higher risk of depressive symptoms. However, there was no significant association between prenatal malnutrition and depressive symptoms in rural males. Our results indicated that prenatal malnutrition may contribute to a higher risk for depressive symptoms in later life among female rural residents.

Prevalence and determinants of depressive symptoms among community-dwelling older adults in China based on differences in living arrangements: a cross-sectional study

BACKGROUND

Older adults with different living arrangements may have different mental health statuses and different factors that influence their mental health. The aim of the present study is to investigate the prevalence and determinants of depressive symptoms among community-dwelling older adults in China based on differences in their living arrangements.

METHODS

Participants were 6,055 older adults from the 2015 China Health and Retirement Longitudinal Study. Depressive symptoms and their determinants were evaluated using the 10-item Center for Epidemiologic Studies Depression Scale and multivariate logistic regression analysis, respectively.

RESULTS

The prevalence of depressive symptoms among older adults living alone, as a couple, and with children was 47.8%, 33.2%, and 39.5%, respectively. The common risk factors for depressive symptoms were shorter sleep duration, poorer activities of daily living, and poorer self-rated health. Women, those with lower educational levels, and those suffering from chronic diseases had a higher risk of depressive symptoms among older adults living as a couple and those living with children. Smoking and participation in economic activities were also risk factors of depressive symptoms among older adults living with children and those living alone, respectively.

CONCLUSIONS

The findings suggest that older adults living as couples had the lowest prevalence of depressive symptoms, while those living alone had the highest prevalence of depressive symptoms. The determinants of depressive symptoms differed by living arrangement; hence, they should be considered in future interventions.

The shattered "Iron Rice Bowl": effects of Chinese state-owned enterprise reform on depressive symptoms in later life

OBJECTIVES

The SOE reform was the first time that economic insecurity was introduced since 1949 in China, with hundreds of million employees affected by the laid off. This study took the State-Owned Enterprises (SOE) reform in China as a natural experiment to explore the impact of economic insecurity on depressive symptoms in later life.

METHODS

Data were obtained from the China Health and Retirement Longitudinal Survey (CHARLS), 2014 and 2015. CHARLS is a nationally representative survey covering 28 provinces in China. CHARLS used the probabilities proportional to size (PPS) sampling method and involved 450 villages/resident committees, 150 counties/districts and 12,400 households. A total of 5113 urban dwellers born earlier than 1971 (aged 25 years old and above at the start of the SOE reform, 1995) were involved. Using the province-level  economic loss from the layoffs, we examined the impact of economic insecurity exposure on the score of depressive symptoms using a difference-in-differences model (DID).

RESULTS

Individuals with economic insecurity exposure had a significantly increased risk of higher depressive symptoms scores, in which a 1 percentage point increase in expected economic loss would increase the CESD-10 score by 0.10. For an individual at the median distribution (CESD-10 = 5), this implies a shift to the 58th percentile (CESD-10 = 6). Given that the average intensity of expected economic loss is 10.22% and the mean CESD-10 is 6.92, exposure to the SOE reform led to an average increase in the CESD-10 score by 1.02 and by at least 14.74%. The heterogeneity analyses showed that the role of SOE reform in depressive symptoms scores was robust in both female and male groups and groups with different educational attainment.

CONCLUSIONS

Economic insecurity exposure increased the depressive symptoms score later in life in the context of China. Programs, such as adequate unemployment insurance benefits, can protect individuals against the risk of financial loss, thereby reducing their negative impact on depressive symptoms. Providing mental symptoms surveillance and psychological counseling to those experienced at a time of great uncertainty is important for preventing depression in times of economic insecurity.

Depression and Cost-Related Health Care Utilization Among Persons with Diabetes

The presence of depression among people with diabetes can substantially increase health care costs and reduce health care utilization. This study aimed at further elucidating the factors underlying the relationship between depressive disorders and health care utilization among people with diabetes. Data were obtained from the 2019 Behavioral Risk Factor Surveillance System, and the sample was limited to people with diabetes (n = 22,642). The independent variable was assessed by a lifetime diagnosis of depressive disorder, including depression, major depression, dysthymia, or minor depression. The dependent variable was cost-related health care utilization assessed as a response (yes/no) to whether participants had not seen a doctor due to costs in the past year. Logistic regression models examined the association between depressive disorders and health care utilization, adjusting for covariates incorporating weighting to account for study design. Overall, 25.2% of the people with diabetes reported having had a depressive disorder in their lifetime. People with diabetes who had ever been diagnosed with a depressive disorder were more likely to have reported not seeing a doctor due to costs in the past year (adjusted odds ratio: 1.82 [1.49, 2.28]). Findings from this study suggest a need for further research regarding the relationship between depression and cost-related health care utilization among people with diabetes.

Bidirectional association between depressive symptoms and cardiovascular disease in the middle-aged and elderly Chinese: a 5-year longitudinal study

OBJECTIVE

Depressive symptoms and cardiovascular diseases (CVDs) are important issues affecting the health of the middle-aged and elderly population in China. This study aimed to investigate the bidirectional association between depressive symptoms and CVD in middle-aged and elderly people in China.

DESIGN

A 5-year longitudinal study.

SETTING AND PARTICIPANTS

We included 6702 middle-aged and elderly participants from China Health and Retirement Longitudinal Study (CHARLS), which is a nationwide longitudinal household survey that started in 2011 (T1) and followed up every 2 years in 2013 (T2) and 2015 (T3).

OUTCOME MEASURES

Depressive symptoms were measured by the Center for Epidemiological Studies Depression Scale. Binary logistic regression was used to identify the influencing factors of depressive symptoms and CVD at T1. The cross-lagged panel model was used to analyse the association between depressive symptoms and CVD at T1, T2 and T3.

RESULTS

The CHARLS is a representative longitudinal survey of people aged ≥45 years. Using data extracted from the CHARLS, overall, at T1, 2621 (39.10%) participants had depressive symptoms and 432 (6.4%) had CVD, and at T3, 2423 (36.2%) had depressive symptoms and 760 (11.3%) had CVD, respectively. Depressive symptoms at T1 had a effect on CVD at T2 (β=0.015, p=0.009), and depressive symptoms at T2 had an effect on CVD at T3 (β=0.015, p=0.034). CVD at T1 predicted depressive symptoms at T2 (β=0.036, p=0.002).

CONCLUSIONS

There is a bidirectional predictive effect between depressive symptoms and CVD. The effect of depressive symptoms on CVD is stable, and CVD has an effect on depressive symptoms in a short period of time.

Gender difference in the relationship between personality traits and changes in depressive symptoms before and after the COVID-19 outbreak: A follow-up study among Chinese adults

OBJECTIVES

Increasing depressive symptoms have become an urgent public health concern worldwide. This study aims to explore the correlation between personality traits and changes in depressive symptoms before and after the COVID-19 outbreak and to examine the gender difference in this association further.

METHODS

Data were obtained from the China Family Panel Studies (CFPS, wave in 2018 and 2020). A total of 16,369 residents aged 18 and above were included in this study. Multinomial logistic regression analysis was used to examine whether personality traits were associated with changes in depressive symptoms. We also analyzed whether there was an interaction effect of gender and personality traits on depressive symptoms.

RESULTS

Conscientiousness, extroversion, and agreeableness are negatively associated with depressive symptoms, while neuroticism and openness are positively related. Gender moderates the relationship between personality traits and depressive symptoms. Compared to men, women have demonstrated a stronger association between neuroticism (OR = 0.79; 95 % CI = 0.66, 0.94), conscientiousness (OR = 1.40; 95 % CI = 1.15, 1.69), and persistent depressive symptoms.

LIMITATIONS

Given its longitudinal study design, it is insufficient to draw a causal inference between personality traits and depressive symptoms.

CONCLUSION

Personality traits and their various dimensions are correlated with changes in depressive symptoms. Persistent depressive symptoms are positively related to neuroticism and negatively associated with conscientiousness. Women demonstrate a stronger association between personality traits and persistent depressive symptoms. Thus, in Chinese adults' mental health intervention and prevention programs, personality and gender-specific strategies should be considered, especially in the context of the COVID-19 pandemic.

Excess healthcare costs of psychological distress in young women: Evidence from linked national Medicare claims data

The prevalence of mental health disorders in young adults is increasing, yet there is limited empirical evidence on its economic consequences. We contribute to the literature by estimating the healthcare costs of psychological distress using panel data of young women (aged 18-23 years with a 5-year follow-up) from the Australian Longitudinal Study on Women's Health and linked administrative data from Medicare Australia. Our empirical strategy is based on the classical two-part model of healthcare costs with individual specific fixed-effects. We complement our analysis with a test for selection on unobservables to address potential concerns of endogeneity. We find that young women with psychological distress have 15% higher annual healthcare costs (excluding hospital costs) than women with no psychological distress. A large proportion of these costs is driven by the use of antidepressants and the services of psychiatrists and psychologists. We further find that women with psychological distress have higher out-of-pocket costs on these mental health related services compared to non-mental health specific services. Additionally, we show that the effect of psychological distress on healthcare costs is highest during the first 6 months of onset, which gradually decreases afterwards. The findings justify the importance of policy initiatives towards early prevention and treatment of psychological distress, especially among young women.

Early life climate and adulthood mental health: how birth seasonality influences depressive symptoms in adults

BACKGROUND

Early life in-utero can have long-term influence on the mental health status of individuals in adulthood, such as depression. Age, gender, socio-economic status, education, and geography are demographic factors shown to be particularly vulnerable towards the development of depressive symptoms. In addition, climate risks on depression include sunlight, rain, and temperature. However, whether climate factors in early life have a long-term influence on depression related to demographic vulnerability remains unknown. Here, the present study explored the association between birth seasonality and adulthood depressive symptoms.

METHODS

We employed data from the project of Chinese Labour-forces Dynamic Survey (CLDS) 2016, containing the epidemiological data of depressive symptoms with a probability proportional to size cluster and random cluster sampling method in 29 provinces of China. A final sample size of 16,185 participants was included. Birth seasonality included spring (March, April, and May), summer (June, July, and August), autumn (September, October, and November), and winter (December, January, and February).

RESULTS

We found that born in Autumn peaked lowest rate of having depressive symptoms (16.8%) and born in Summer (vs. Autumn) had a significant higher ratio (OR = 1.14, 95%CI = 1.02, 1.29) when controlling for demographic variables. In addition, demographic odds ratio of having depressive symptoms differed between people born in different seasons, particular for age and geography.

CONCLUSION

Our findings suggest that birth seasonality influences the sensitive link of depressive symptoms with age and geography. It implicates early life climate environment may play a role in the development of adulthood depressive symptoms.

Association of Depressive Symptoms With Health Service Use and Catastrophic Health Expenditure Among Middle-Aged and Older Chinese Adults: Analysis of Population-Based Panel Data

OBJECTIVES

To determine the impact of depressive symptoms on health service use and catastrophic health expenditure, and whether it varied by per-capita household consumption, health insurance schemes, and physical comorbidities.

DESIGN

Population-based panel data analysis.

SETTING AND PARTICIPANTS

Participants were 8585 adults aged 45 years and older in 2011, and had completed a follow-up survey in 2013, 2015, and 2018 from the China Health and Retirement Longitudinal Study (CHARLS).

METHODS

Depressive symptoms were assessed using the short form of the Center for Epidemiologic Studies Depression Scale. The number of outpatient visits and inpatient hospital days were used as proxies for health service use. When households' out-of-pocket spending on health was 40% or above its total expenditure, it was defined as a catastrophic health expenditure. With the panel data approach, random-effects negative binomial regression and logistic regression were used to analyze the effect of depressive symptoms on health service use and health care expenditure, respectively.

RESULTS

Depressive symptoms were associated with increased number of outpatient visits (incidence rate ratio 1.52; 95% CI 1.44-1.60) and days spent in the hospital as an inpatient (1.52; 1.43-1.62). Depressive symptoms were also associated with a significantly increased likelihood of catastrophic health expenditure (odds ratio 1.54; 95% CI 1.43-1.66). Their effect on outpatient visits, inpatient hospital days, and catastrophic health expenditure persisted in different age, per-capita household consumption, and physical comorbidities groups, and across all health insurance programs.

CONCLUSIONS AND IMPLICATIONS

Depressive symptoms were risk indicators that can drive health service use and household financial stress. Given the rapidly aging population in China, there is an urgent need to integrate mental health care into routine physical examinations to alleviate the economic impacts of depressive symptoms on individuals in China. specifically for individuals with physical comorbidities and in poorer socioeconomic conditions.

Urbanization and depressive symptoms among middle-aged and older adults in China

Aims

Urbanization plays an important role in individuals' health. However, it is difficult to isolate healthy migrant effect between urbanization and health. This study examined the effects of urbanization on depressive symptoms and its possible pathways among Chinese middle-aged and older adults independent of the influence of health-selective migration.

Methods

Using the baseline survey of the China Health and Retirement Longitudinal Study, this study compared the depressive symptoms among three groups (urbanized rural residents, rural non-migrants and urban non-migrants). The 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) short form was used to measure depressive symptoms. Logistic regression models and Structural Equation Model (SEM) were applied to examine the association between urbanization and depressive symptoms and the corresponding potential mechanisms.

Results

Our final sample contained 11,156 respondents with an average age of 58.91 (SD = 9.48), with 5,142 males (46.09%) and 6,014 females (53.91%). Compared with urbanized rural residents, rural residents were more likely to have depressive symptoms (OR = 1.19, 95% CI = 1.07, 1.32), and urban residents were associated with a decreased risk of depressive symptoms (OR = 0.81, 95% CI: 0.70, 0.94). A large proportion of the association between urbanization and depressive symptoms were mainly mediated by social participation, income and living conditions.

Conclusions

Planned urbanization had an independent impact on decreased depressive symptoms. Improvements in social participation, income and living conditions are the main drivers behind this relationship. Additionally, urbanization compensates for the negative impact of depressive symptoms from disadvantaged early life conditions, but it cannot eliminate the gap between urbanized rural people and urban non-migrants.

The associations between sleep duration, cognitive function, and depressive symptoms: An analysis of Chinese adolescents from China Family Panel Studies

BACKGROUND

The adverse impact of depressive symptoms on adolescents' physical and psychological health is becoming increasingly prominent. This study aims to examine the association between sleep duration, cognitive function, and depressive symptoms among Chinese adolescents.

METHODS

This study used data on a sample of 3724 adolescents collected from the China Family Panel Studies (CFPS). The multivariate logistic regression was conducted to estimate the association between sleep duration, cognitive function (measured by mathematics and vocabulary), and depressive symptoms among Chinese adolescents; the mediating effects of cognitive function were calculated by mediating model.

RESULTS

The study found that approximately 6.49 % of Chinese adolescents had depressive symptoms, with an average CES-D8 score of 4.27 (SD: 3.11). Adolescents who reported a sleep duration of <6 h/night (OR = 2.34; 95 % CI = 1.30, 4.24) were at a higher risk of depressive symptoms, and the adolescents who had higher mathematics scores (>75 %) were more likely to be at a lower risk of depressive symptoms. Besides, the cognitive function competitively mediated the effect of sleep duration on depressive symptom (indirect effect = 0.043; 95 % CI = 0.023, 0.064).

LIMITATIONS

This is a cross-sectional study; all questions were self-reported; the sleep variable only included the sleep duration.

CONCLUSIONS

Our study highlights that short sleep duration might increase the risk of depressive symptoms, and increasing cognitive function might reduce the occurrence of depressive symptoms in Chinese adolescents. The results displayed that sleep duration had a negatively direct effect on depressive symptoms, but the indirect effects of sleep duration on depressive symptoms via the cognitive function (i.e., mathematics and vocabulary tests) were significantly positive, indicating that the relationship between sleep duration and depressive symptoms was competitively mediated by cognitive function.

The sociodemographic characteristics and clinical features of the late-life depression patients: results from the Beijing Anding Hospital mental health big data platform

BACKGROUND

The sociodemographic characteristics and clinical features of the Late-life depression (LLD) patients in psychiatric hospitals have not been thoroughly studied in China. This study aimed to explore the psychiatric outpatient attendance of LLD patients at a psychiatric hospital in China, with a subgroup analysis, such as with or without anxiety, gender differences.

METHODS

This retrospective study examined outpatients with LLD from January 2013 to August 2019 using data in the Observational Medical Outcomes Partnership Common Data Model (OMOP-CDM) in Beijing Anding Hospital. Age, sex, number of visits, use of drugs and comorbid conditions were extracted from medical records.

RESULTS

In a sample of 47,334 unipolar depression patients, 31,854 (67.30%) were women, and 15,480 (32.70%) were men. The main comorbidities of LDD are generalized anxiety disorder (GAD) (83.62%) and insomnia (74.52%).Among patients with unipolar depression, of which benzodiazepines accounted for the largest proportion (77.77%), Selective serotonin reuptake inhibitors (SSRIs) accounted for 59.00%, a noradrenergic and specific serotonergic antidepressant (NaSSAs) accounted for 36.20%. The average cost of each visit was approximately 646.27 yuan, and the cost of each visit was primarily attributed to Western medicine (22.97%) and Chinese herbal medicine (19.38%). For the cost of outpatient visits, depression comorbid anxiety group had a higher average cost than the non-anxiety group (p < 0.05). There are gender differences in outpatient costs, men spend more than women, for western medicine, men spend more than women, for Chinese herbal medicine, women spend more than men (all p < 0.05). The utilization rate of SSRIs and benzodiazepines in female patients is significantly higher than that in male patients (p < 0.05).

CONCLUSION

LLD patients are more commonly women than men and more commonly used SSRIs and NaSSAs. Elderly patients with depression often have comorbid generalized anxiety. LLD patients spend most of their visits on medicines, and while the examination costs are lower.

Myopia and Depression among Middle School Students in China-Is There a Mediating Role for Wearing Eyeglasses?

Compared with non-myopic students, myopic students face more barriers to learning (e.g., inability to see the blackboard clearly) and socializing (e.g., being victims of teasing, social exclusion and violence), which may lead to increased stress, anxiety and frustration. The high prevalence of myopia and depression among school-age children naturally raises a question of great policy relevance: are myopic students more vulnerable to mental health problems such as depression? This paper sheds some light on this question by analyzing data from the China Education Panel Survey, a large-scale survey of China's middle school students. Our analysis first quantifies the association between myopia and sample students' depression status (measured by the widely adopted CES-D scale) adjusted for potential confounding factors. We then explore whether the myopia-depression relationship is mediated by wearing eyeglasses, a cost-effective means of vision correction. Based on data on 19,299 middle school students, our analysis reveals that myopic students scored 0.12 standard deviations higher on the CES-D scale than their non-myopic counterparts. The adverse effect of myopia is more severe for relatively disadvantaged students: older students (who are more likely to suffer from both myopia and depression), lower-performing students and students from poorer families. Further medication analysis shows that wearing eyeglasses suppresses the myopia-depression relationship but cannot completely offset the adverse effect of myopia.

Factors Associated with Caregiver Burden in Caregivers of Older Patients with Dementia in Indonesia

This cross-sectional study aimed to identify caregiver burden and its determinants in the informal caregivers of older patients with dementia (PWDs) aged ≥ 60 years in Java, Indonesia. Data were collected from 207 caregivers of older PWDs using self-administered questionnaires. The dependent variable was caregiver subjective burden, assessed using the Zarit Burden Interview (ZBI). The independent variables included the socio-demographic characteristics of PWDs and caregivers, the caregiver's perceived social support, and the behavioural and psychological symptoms of dementia (BPSD). Linear regression with a stepwise elimination method was used to identify the factors associated with caregiver burden. This study found that four factors were associated with the caregiver burden, such as the gender of PWDs, the educational level of caregivers, social support, and BPSD (R-squared = 27.78%). Higher burden was reported among the caregivers of female PWDs (β = 5.58; 95%CI = 2.16; 8.99) and PWDs with higher scores of BPSD (β = 0.34; 95%CI = 0.25; 0.43). Meanwhile, the caregivers with higher perceived social support (β = -0.26; 95%CI = -0.42; -0.10) and who completed high school education and above (β = -6.41; 95%CI = -10.07; -2.74) tended to have lower scores of subjective burden. These findings suggest that BPSD management and maintaining the resources of support may provide an opportunity to minimise caregiver burden and improve the quality of life of caregivers and PWDs.

Medical service utilisation and direct medical cost of depression: a cross-sectional analysis of urban medical claims data from China

OBJECTIVES

Depression is becoming a growing cause of disability, suicides and disease burden. It incurred substantial costs to societies all over the world. Estimating the medical costs of depression will provide implications for related policies and interventions. However, there is scarce of evidence on the economic costs of depression in China. The aim of this study is to assess depression-related medical service utilisation, the direct medical costs of depression and potential associated factors.

SETTINGS

This study used data that comprised 5% random sample of claims data from China's Urban Basic Medical Insurance between January 2013 and December 2016. Beneficiaries' demographic information, diagnoses and cost of outpatient and inpatient services were recorded in the data set.

PARTICIPANTS

26 123 patients with depression were identified as the study population in this study.

PRIMARY AND SECONDARY OUTCOME MEASURES

The information on health service utilisation and cost was extracted based on the condition that depression was claimed as the index disease.

RESULTS

From 2013 to 2016, weighted average annual total medical cost of depression in urban China was RMB2706.92, and the annual out-of-pocket cost was RMB786.4. The annual total medical cost of depression among urban residents in China was estimated to be 4.4 billion RMB (95% CI 4.15 to 4.67) (US$ 0.70, 95% CI 0.66 to 0.74). Nearly 65% of medical costs (RMB 1795.7 or US$ 285.0) were accounted by inpatient expenditure, and tertiary hospitals were the main provider of depression treatment. Depression-related medical care utilisation and direct costs were associated with gender, age, insurance status, severity of depression and diagnosis. Medication costs and medical service contributed to 41.7% and 56.6% of the average depression-related medical costs.

CONCLUSION

Depression poses a considerable burden on both the health system and the individual in urban China. Specific policies to strengthen the mental health resources in primary and secondary hospitals are in urgent need, and effective treatment strategies are important to prevent a progression and recurrence of depression, as well as an increase in medical cost.

The Mediating Role of Extra-family Social Relationship Between Personality and Depressive Symptoms Among Chinese Adults

Objectives: This study aims to explore the associations of personality traits and extra-family social relationship with depressive symptoms among Chinese adults.

Methods: A nationally representative sample of 29,810 adults aged 16 and above were selected from 2018 CFPS. Personality and depressive symptoms were measured using CBF-PI-15 and the CES-D8 scale. Extra-family social relationship was assessed through the self-rated evaluation. The multiple regression analysis and the PROCESS macro were used for the mediation analysis.

Results: Extraversion (OR = 0.807, 95% CI = 0.773, 0.842), agreeableness (OR = 0.795, 95% CI = 0.756, 0.835) and extra-family social relationship (OR = 0.927, 95% CI = 0.913, 0.941) had negative associations with depressive symptoms. Extra-family social relationship could mediate between extraversion and depressive symptoms (Indirect effect = −0.049,95% CI = −0.060, −0.039) as well as agreeableness (Indirect effect = −0.056, 95% CI = −0.068, −0.046) and depressive symptoms. Comparing to females, the indirect effect accounts for a higher proportion of total effect in males.

Conclusion: Extra-family social relationship might mediate the association between extraversion and depressive symptoms as well as agreeableness and depressive symptoms.

Does Elderly Chronic Disease Hinder the Sustainability of Borderline Poor Families’ Wellbeing: An Investigation From Catastrophic Health Expenditure in China

Objectives: Health and health expenditure caused by elderly chronic diseases are a global problem. As China has just lifted itself out of poverty in 2020, the sustainable development of Borderline Poor Families’ Wellbeing faces severe challenges. Therefore, it is of great practical significance to explore the impact of elderly chronic diseases on the catastrophic health expenditure of Borderline Poor Families.

Methods: Based on screening 8086 effective samples from China Health and Retirement Longitudinal Study (CHARLS) database and calculating catastrophic health expenditure, this paper uses two-part model and logit regression to discuss the impact of elderly chronic diseases on the sustainable development of Borderline Poor Families’ Wellbeing.

Results: The results showed that stroke, cancer, and liver disease caused the most catastrophic health expenditures and had the greatest impact on the Borderline Poor Families’ Wellbeing.

Conclusion: Therefore, in order to ensure the sustainable development of Borderline Poor Families’ Wellbeing, the government should strengthen the publicity of pre-prevention and post-healthcare of chronic diseases such as stroke, and combine pre-prevention policy with post-guarantee policy.

The reversing trend in suicide rates in Shanghai, China, from 2002 to 2020

BACKGROUND

To explore changing patterns in suicides and provide suggestions for suicide prevention by reviewing all suicide deaths from 2002 to 2020 in Shanghai, China.

METHODS

Suicide-death data were obtained from the Shanghai Death Surveillance System and analyzed in terms of year, sex, age group, area, suicide method, and depression diagnosis. Joinpoint regression analyses were conducted to examine time trends in suicide rates.

RESULTS

The age-adjusted suicide rate was 6.15/100,000 in 2002 and 5.10/100,000 in 2020. The change in this rate was U-shaped, with a downward trend before 2009 followed by an upward trend. The rate initially decreased by 6.33% annually (95% confidence interval [95%CI]: 4.25-8.37%) but, after 2009, increased by 2.60% annually (95%CI: 1.49-3.71%). Similar trends were found for men and women, the 0-29y and 30-49y age groups, and residents of central and suburban areas, respectively. In 2020, jumping from a high place was the leading suicide method (39.54%), and 22.54% of suicide victims had a diagnosis of depression.

LIMITATIONS

Suicides may be misclassified in coding (however, provided misclassification rates remain stable, this should not influence overall trends). Suicides among temporary residents were not included because of inadequate stratified population data. The finding of a higher prevalence of depression may have been impacted by a higher detection rate.

CONCLUSIONS

The post-2002 decline in Shanghai suicide rates reversed in 2009, and the suicide pattern changed greatly from 2002 to 2020. With the current increasing trend in suicide rates, targeted suicide-prevention strategies featuring multi-departmental cooperation are necessary.

What factors are associated with utilisation of health services for the poor elderly? Evidence from a nationally representative longitudinal survey in China

OBJECTIVES

To investigate the status and factors of healthcare service utilisation among the poor elderly in China.

METHODS

We selected the poor elderly from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2015. The main outcome measures include utilisation indicators for the probability and costs of outpatient/inpatient services. Based on modified Andersen behaviour model, a two-part model is designed to analyse the factors of the health service utilisation of the poor elderly.

RESULTS

The visit rate of outpatient services increased from 15.05% in 2011 to 21.26% in 2015, and the hospitalisation rate increased from 7.26% to 14.32%. The median cost of outpatient and inpatient services in 2015 for the poor elderly were 350 RMB and 10 000 RMB, respectively, and the out-of-pocket ratios were 85.2% and 53.3%, respectively. 78.44% of the people who actually needed healthcare did not use health services, and the main reason was financial difficulties (42.32%). The poor elderly who are higher educated, have children, live in central regions and have social security and a poor health status and who do not smoke or drink are more likely to use health services. The need factor plays a crucial role in determining health service utilisation.

CONCLUSIONS

The poor elderly tends to have a worse health status and a heavier medical burden but had a lower utilisation of health services. Predisposing, enabling, need and health behaviour variables should be considered to improve the health service utilisation and the health of the poor elderly.

Attributable risk and economic cost of hospital admissions for depression due to short-exposure to ambient air pollution: A multi-city time-stratified case-crossover study

BACKGROUND

Depression has become the most common mental disease globally and is a strong predictor for suicide. Studies have indicated that exposure to high levels of air pollution increased the risk of depression, but evidence in human populations is still limited. At present, a few studies estimated the impact of multi-pollutants on hospitalization for depression in multi-city in areas with severe air pollution. We aimed to examine the association between short-term exposure to common ambient air pollutants and hospital admissions (HAs) for depression based on statistics of inpatients with depression in multi-city.

METHODS

The 10,459 records of HAs for depression from medical institutions in nine cities/prefectures, Sichuan Province, China, between January 1, 2017 and December 31, 2018 were collected. Air pollutant data including PM_2.5, PM₁₀, SO₂ and NO₂ from provincial ecological environment monitoring stations were obtained. Based on a time-stratified case-crossover design, we estimated the impact on relative risk (RR) of short-term exposure to air pollutants on hospitalization for depression, with stratification by sex, age, and economic level. The cost of illness method was used to further assess hospitalization costs.

RESULTS

The short-term exposure to air pollutants was positively associated with hospitalization for depression. The increase of air particulate matter (PM) had the strongest effect on lag 0 day (PM_2.5:1.037 (95% CI:1.022,1.052), PM₁₀:1.024 (95% CI:1.013,1.036)). The effects of SO₂ reached the peak on lag 2 day (1.317 (95% CI:1.151,1.507)). Women and older people were more likely to be affected by air pollutants and prone to depression (P = 0.013, P = 0.006). During the study period, the economic cost of hospitalization for depression caused by PM pollution was US$ 8.36 million.

LIMITATIONS

The air pollutant concentration level of the monitoring stations in the study area was regarded as personal pollutant exposure, which may not accurately reflect the patient's exposure level, resulting in a certain measurement error.

CONCLUSIONS

Short-term changes to ambient air pollution exposure may increase the risk of hospital admissions for depression and cause economic costs due to hospitalization.

Association of Dietary Inflammatory Index (DII) and depression in the elderly over 55 years in Northern China: analysis of data from a multicentre, cohort study

OBJECTIVES

Our study aimed to assess the association between the Dietary Inflammatory Index (DII) and depression in the elderly over 55 years in Northern China.

METHODS

We analysed the data of 2022 Chinese adults aged 55 and over from a community-based neurological disease cohort study from 2018 to 2019. A validated semiquantitative food frequency questionnaire was used to assess eating habits at the time of inclusion. Multiple logistic regression was used for analysis, and social demographics, lifestyle and health-related factors were adjusted.

RESULTS

Among the included population, the prevalence of depression was 23.39%. Mean (SD) and range of the DII in the included population were 1.70 (1.42) and -5.20 to +5.68. The risk of depression was significantly higher in participants in the most pro-inflammatory group (quartile 4) than in the participants in the most anti-inflammatory group (quartile 1) (OR 1.53; 1.37 to 1.82; p-trend=0.01). The subgroup analysis of body mass index (BMI) showed that there is a significant association between DII and the risk of depression in overweight and obese people (p＜0.05). The restricted cubic spline results show that the OR value of depression possesses an upward trend with the increase of the DII score.

CONCLUSIONS

Aged patients with depression present a higher potential for dietary inflammation. Pro-inflammatory diets might increase the risk of depressive symptoms. Further research in different populations is crucial to confirm the association between DII and depression.

The economic costs of limited health literacy in China: evidence from China's National Health Literacy Surveillance data

Background

Limited health literacy is a public health challenge contributing to the rising health care costs. We assess the economic costs of limited health literacy in China using data from the National Health Literacy Surveillance survey.

Methods

Our data includes a sample of 6316 residents aged 15–69 years old living in Ningbo, China, in 2019. We use box plots to examine the distribution of out-of-pocket health expenditure by the level of health literacy. We then use the estimates from a two-part model to assess the contribution of limited health literacy to individual medical spending and the aggregate health expenditure at different levels of health literacy for the adult population in Ningbo.

Results

Medical costs of limited health literacy are about 10% (177 CNY or about 25 USD) of the annual medical expense of a resident aged 15–69 living in Ningbo. The medical cost of limited health literacy is greater among the rural, female, and older groups than others. If the proportion of people with adequate health literacy increases from 22 to 30% (the target level by 2030), the aggregate out-of-pocket health expenditure in Ningbo will decrease by 100 million CNY (14 million USD), or 0.88% of the 2019 Ningbo government expenditure on health care.

Conclusions

This paper highlights the direct and indirect economic costs associated with limited health literacy. The results should help policymakers evaluate the cost-effectiveness of relevant programs that aim to improve residents’ health literacy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07795-9.

Does Social Pension Expansion Relieve Depression and Decrease Medical Costs? Evidence From the Rural Elderly in China

Objectives: This study was designed to explore the effect of the New Rural Pension Scheme on depressive symptoms or medical costs induced by depression.

Methods: We used the Logit, OLS and 2SLS models to explore the impact of the pension on depression and medical costs. We also adopt the method of quantile regression and discontinuity regression to verify the causal relationship between the New Rural Pension Scheme and depression or medical costs induced by depression of the rural elderly.

Results: We have found that the New Rural Pension Scheme decreases depressive symptoms of elderly in rural China (OR = 0.90), and the medical costs induced by depressive symptoms by 4.6%. Regression discontinuity results showed that pension significantly reduced the depressive symptoms (depression) and the medical expenditure caused by depressive symptoms (depression) by using parametric and non-parametric methods, and performing a placebo test. The mediating effect results showed that pension may improve mental health by increasing confidence about the future.

Conclusion: We demonstrate that the pension significantly decreased both mental health problems and the medical expenses due to depressive symptoms and depression of elderly in rural China. Therefore, our results suggest that the Chinese government should perfect the New Rural Pension Scheme to eliminate barriers to mental health resources, especially for the rural elderly.

Factors affecting the evolution of Chinese elderly depression: a cross-sectional study

Background

In the past decades, China’s rapid economic growth has been accompanied by rapid changes in lifestyle and an increasing prevalence of mental disorders. This study explored the changes and factors associated with depression among the elderly population of China from 2011 to 2018.

Method

Data were obtained from the China Health and Retirement Longitudinal Study. The total sample size consists of 21,484 individuals aged ≥60 years, and the sample sizes in 2011, 2013, 2015 and 2018 were 5081, 4853, 5207, 6343, respectively. Depressive symptoms were measured by the 10-item Short-Form developed by the Center for Epidemiological Studies Depression.

Result

We found that the tendency in depression rate of the Chinese elderly from 2011 (36.8%) to 2018 (44.5%). The results showed poor health (OR = 3.553), ADL damage (OR = 2.010), multiple chronic diseases (OR = 1.287), and western (OR = 1.777) are risk factors for depression.

Conclusion

The rate of depression of the elderly people in China has risen dramatically. Therefore, additional steps to prevent, treat and care for the affected population are needed, Mental health prevention and treatment strategies should be incorporated into China’s public health policies in a timely manner to mitigate the serious economic burden caused by the increase of depression.

"The better you feel, the harder you fall": Health perception biases and mental health among Chinese adults during the COVID-19 pandemic

The health risks of the current COVID-19 pandemic, together with the drastic mitigation measures taken in many affected nations, pose an obvious threat to public mental health. To assess predictors of poor mental health in the context of the COVID-19 pandemic, this study first implements survey-based measures of health perception biases among Chinese adults during the pandemic. Then, it analyzes their relation to three mental health outcomes: life satisfaction, happiness, and depression (as measured by the CES-D). We show that the health overconfidence displayed by approximately 30% of the survey respondents is a clear risk factor for mental health problems; it is a statistically significant predictor of depression and low levels of happiness and life satisfaction. We also document that these effects are stronger in regions that experienced higher numbers of confirmed COVID-19 cases and deaths. Our results offer clear guidelines for the implementation of effective interventions to temper health overconfidence, particularly in uncontrollable situations like the COVID-19 pandemic.

Energy Poverty and Depression in Rural China: Evidence from the Quantile Regression Approach

Despite the growing awareness and interest in the impact of energy poverty on depression, studies in developing economies are relative limited, and there is a gap of knowledge of such impact among rural individuals in China. In this study, we investigate the impact of energy poverty on depression among rural Chinese individuals aged 16 and above, and our sample includes 13,784 individuals from 6103 households. With data from the 2018 China Family Panel Studies, we apply the instrumental variable (IV) quantile regression approach to address the potential endogeneity of energy poverty and allow for heterogeneous effects of energy poverty on depression across individuals with different levels of depression. Our estimates from the IV quantile regression suggest a strong positive impact of energy poverty on depression at the upper quantile of depression scores, but no impact at the middle and lower quantiles. The primary results are robust and consistent with alternative energy poverty measures, and we find that energy poverty does not affect depression of low-risk individuals (with low depression scores), but it does affect that of high-risk individuals. We also find individual socio-demographic factors of age, gender, household size, religious belief, education, marriage and employment status play roles in affecting depression. The findings of this study generate policy implications for energy poverty alleviation and mental health promotion.

Investigating Associations Between Depressive Symptoms and Anti-/Pro-Inflammatory Nutrients in an Elderly Population in Northern China: A Bayesian Kernel Machine Regression Approach

Backgroud

The potential for dietary inflammation has been shown to be associated with a variety of chronic diseases. The relationship between the potential for dietary inflammation and depression in the elderly is unclear.

Objective

This study aimed to exam the relationship between different nutrients and the risk of depression symptoms in the elderly.

Methods

In total, 1865 elderly in northern China were investigated at baseline from 2018 to 2019 and followed up in 2020. We measured the baseline intake of 22 nutrients and used Least Absolute Shrinkage and Selection Operator(LASSO) regression analysis and Bayesian Kernel Machine Regression (BKMR) to explore the association between exposure to a variety of nutrients with different inflammatory potentials and the risk of depressive symptoms.

Results

A total of 447 individuals (24.0%) were diagnosed with depressive symptoms. Through the lasso regression model, it was found that 11 nutrients are significantly related to the risk of depressive symptoms, of which 6 nutrients are pro-inflammatory nutrients (inflammation effect score>0), and 5 are anti-inflammatory nutrients (inflammation effect score<0). We incorporated the inflammatory effect scores of 11 nutrients into the BKMR model at the same time, and found that the overall inflammatory effect of 11 nutrients increased with the increase of total inflammatory scores, suggesting that the overall effect was pro-inflammatory. BKMR subgroup analysis shows that whether in the pro-inflammatory nutrient group or the anti-inflammatory nutrient group, multiple nutrients have a significant combined effect on depressive symptoms. By comparing the overall and group effects, we found that the inflammatory effects of the pro-inflammatory diet and the anti-inflammatory diet in the study’s diet are offset by each other (P<0.005).

Conclusion

We determined the combined effect of multiple nutrients of different inflammatory potential classifications on depressive symptoms in the elderly.