The prevalence of depressive symptoms and its determinants among adults in mainland China: Results from a national household survey

Association between workplace health promotion service utilisation and depressive symptoms among workers: a nationwide survey

OBJECTIVES

Workplace-related factors are associated with the risk of depression. Despite implementation of workplace health promotion (WHP) programmes in China to promote the physical and mental well-being of workers, the relationship between WHP and depression has received limited attention. This study investigated the association between WHP service utilisation and depressive symptoms among workers.

STUDY DESIGN

This was a cross-sectional survey.

METHODS

A researcher-designed questionnaire was used to collect information on socio-demographic and occupational characteristics, WHP service utilisation, and mental health status. The Lasso method was used for variable selection to achieve dimension reduction, and logistic regression was used to assess the association between WHP service utilisation and depressive symptoms.

RESULTS

The analysis included 11,710 workers, of whom 17.0% had depressive symptoms. Lasso regression resulted in 6 of 18 WHP services showing significant negative associations with depressive symptoms, including occupational safety training, mental health services, health check-ups, sports activities, fitness rooms, and healthy canteens. The logistic regression results showed that, after adjusting for sociodemographic and occupational factors, utilisation of these six services was associated with a decreased likelihood of depressive symptoms. The adjusted odds ratio (aOR) was 0.84 (95% confidence interval [CI]: 0.73-0.96) for occupational safety training, aOR: 0.82 (95% CI: 0.68-0.99) for mental health services, aOR: 0.80 (95% CI: 0.71-0.90) for health check-ups, aOR: 0.68 (95% CI: 0.57-0.80) for sports activities, aOR: 0.59 (95% CI: 0.47-0.74) for fitness rooms and aOR: 0.72 (95% CI: 0.59-0.87) for healthy canteens.

CONCLUSIONS

Utilisation of WHP services was associated with a lower prevalence of depressive symptoms. Implementation of WHP services and the provision of a supportive workplace environment should be prioritised to benefit the mental health of workers.

Patterns of gender inequality perception and depressive symptoms among Chinese adults: The mediating role of marital life satisfaction

OBJECTIVES

As one of the most severe public health issues, depressive symptoms have attracted wide attention around the world. This study aims to investigate the mediating role of marital life satisfaction in the relationship between gender inequality perception and depressive symptoms.

METHODS

Data were obtained from the China Family Panel Studies (CFPS) conducted in 2020. This study incorporated a total of 13,409 married residents aged 20 and above.

RESULTS

The residents with middle (B = 0.19, 95 % CI = 0.01, 0.40) or high perception of gender inequality (B = 0.55, 95 % CI = 0.34, 0.75) were more likely to develop depressive symptoms. Marital life satisfaction plays a mediating effect in the relationship between patterns of gender inequality perception and depressive symptoms, and the mediating effect accounted for 4.89 % or 1.37 % of the total impact in the residents with middle or high patterns of gender inequality perception.

LIMITATIONS

Further studies need to understand the mechanisms of perceived patterns of gender inequality and depressive symptoms, because the cross-sectional design in this study cannot draw causal inferences.

CONCLUSION

Patterns of gender inequality perception are significantly associated with depressive symptoms. Marital life satisfaction plays a mediating role in the relationship between patterns of gender inequality perception and depressive symptoms. It is plausible that nurturing healthy marital relationships could mitigate depressive symptoms in individuals who perceive high degrees of gender disparity.

Sibling Availability, Sibling Sorting, and Subjective Health Among Chinese Adults

Despite rising numbers of only children in China, little is known about their family dynamics and well-being in adulthood-for example, how often they marry other only children and whether those in siblingless families have worse or better health than others. Theoretical expectations produce opposing predictions: siblings might provide social and emotional support and reduce parental caregiving pressures, but only children might receive more support from parents and grandparents. Using the 2010 China Family Panel Study, we examine marital sorting on Chinese adults' number of siblings and test whether sibling availability and sibling sorting are associated with subjective physical and mental health. Despite general perceptions that China has an exceedingly high prevalence of adults with no siblings that might produce very small families, results demonstrate a low prevalence of siblingless couples (i.e., both spouses are only children). Married adults with no siblings or siblings-in-law have better subjective physical health but similar levels of subjective mental health relative to their counterparts with siblings. The health advantages of siblingless marital unions are greater for rural and female adults. Declining sibling prevalence in China will shape future family demographic dynamics but appears less detrimental to population health than sometimes assumed.

The interaction of occupational stress and job burnout on depressive symptoms in railway workers in Fuzhou city

BACKGROUND

To explore the relationship between occupational stress, burnout and depressive symptoms among railroad workers in Fuzhou, and to analyze the interaction of burnout and occupational stress on depressive symptoms.

METHODS

In this study, 861 railway employees of Fuzhou railway bureau were randomly selected from January to April, 2022. Occupational stress inventory revised edition (OSI-R), China job burnout inventory (CMBI) and Symptom Checklist-90 (SCL-90) were used to investigate the occupational stress, job burnout and depressive symptoms of railway workers. Interactions associated with depressive symptoms were assessed by linear hierarchical regression analysis and SPSS macros (PROCESS).

RESULTS

Occupational stress, job burnout and depressive symptoms accounted for 50.58%, 93.47%, and 11.19% of the study population, respectively. There were intergroup differences between age, marriage status, and length of service (P < 0.05). Occupational stress and job burnout are the main risk factors for depressive symptoms (OR: 2.01, 95% CI: 1.17-3.45; 1.94, 1.69-2.23, respectively). More importantly, further analysis of the interaction between occupational stress and job burnout showed that those with high levels of job burnout had a high-risk effect on depressive symptoms at high levels of occupational stress.

CONCLUSION

Occupational stress and job burnout are risk factors for depressive symptoms among railroad workers in Fuzhou City. The interaction of job burnout and occupational stress increases the risk of depressive symptoms.

Familial genetic and environmental transmission of depression: A multi-informant twin family study

The phenomenon of familial clustering in depression is well established, yet the mechanisms by which depression is transmitted within families remain poorly understood. In the current study, we investigate the familial genetic and environmental transmission of depression by incorporating data from both adolescent twins and their parents. A total of 987 twin families were recruited from the Beijing Twin Study. Depression assessments were conducted for both adolescents and their parents. Twins' depression was assessed through reports from both the twins themselves and their parents, while parental depression was assessed by parental self-report. We employed a nuclear twin family model to examine genetic and environmental influences on adolescent depression. Our results, based on both self- and parent-report, demonstrate significant additive and dominant genetic influences on depression. We also found mild yet significant sibling environmental influences, while familial environmental influences were absent. Notably, parent-reported depression showed higher heritability but lower unique environmental influences compared with self-reported depression. These results highlight the important role of genetic transmission and sibling environmental transmission in explaining depression. Our study delineates the underlying mechanism of familial transmission in depression and can inform early treatments to halt transmission during adolescence.

Relationship between social inequality perception patterns and depressive symptoms among Chinese adults: A national representative longitudinal study

BACKGROUND

The rising prevalence of depressive symptoms presents a pressing global public health concern, exacerbated by prevailing social inequality.

AIM

This study seeks to identify latent profiles of social inequality perception and explore their associations with depressive symptoms.

METHODS

Data were obtained from the China Family Panel Studies (CFPS) involving 10,529 residents aged 18 years and above. Latent profile analysis (LPA) was used to identify different patterns of social inequality perception. Multiple linear regression analysis examined the links between these patterns and depressive symptoms.

RESULTS

Three distinct patterns of social inequality perception were identified: the disappointed pattern (TDP), the neutral pattern (TNP), and the positive pattern (TPP). Perceived social inequality was significantly associated with short-term and long-term depressive symptoms (β = .51, 95% CI [0.29, 0.72] vs. β = .51, 95% CI [0.27, 0.74]). Increases in social inequality perception patterns were also related to more severe depressive symptoms (β = .55, 95% CI [0.36, 0.74]).

CONCLUSIONS

Increasing perceived social inequality is closely linked to elevated depressive symptoms in Chinese adults. This underscores the need for tailored strategies aimed at addressing heightened perceptions of social inequality to reduce the risk of depressive symptoms.

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.

Urban-rural disparities in the prevalence and trends of depressive symptoms among Chinese elderly and their associated factors

BACKGROUND

This study aimed to examine urban-rural disparities in the prevalence and trends of depressive symptoms (DS) among Chinese elderly and associated factors.

METHODS

A total of 8025, 7808, and 4887 respondents aged 60 years and above were selected from the China Family Panel Studies (CFPS) in 2016, 2018, and 2020, respectively. DS was assessed using a short version of Center for Epidemiologic Studies Depression Scale (CES-D). Twenty-two associated factors from six categories were included in random forest (RF) models. All urban-rural comparisons were conducted based on good model performance.

RESULTS

The DS prevalence among all rural elderly was significantly higher than corresponding urban elderly. This disparity continued to widen among younger elderly, while it continued to narrow among older elderly. The top 10 common leading factors were sleep quality, self-rated health, life satisfaction, memory ability, child relationship, IADL disability, marital status, educational level, and gender. Urban-rural disparities in sleep quality, interpersonal trust, and child relationship continued to widen, while disparities in multimorbidity, hospitalization status, and frequency of family dinner continued to narrow.

LIMITATION

This study may exist recall bias and lacks causal explanation.

CONCLUSIONS

Significant and continuing disparities in the DS prevalence were observed between urban and rural elderly in China, showing opposite trends in younger and older elderly. The top 10 leading associated factors for DS were nearly consistent across urban and rural elderly, with sleep quality having strongest contribution. Urban-rural disparities in associated factors also showed different trends. This study provides a reference for mental health promotion among Chinese elderly.

Exploring the reciprocal relationship between activities of daily living disability and depressive symptoms among middle-aged and older Chinese people: a four-wave, cross-lagged model

BACKGROUND

Early studies have shown a relationship between activities of daily living (ADL) disability and depressive symptoms in older people. However, discussions on the direction of this relationship are insufficient. The study's objective was to assess the reciprocal relationship between ADL disability and depressive symptoms among middle-aged and older Chinese people.

METHOD

Data was collected in four waves of a nationwide survey, the China Health and Retirement Longitudinal Study (CHARLS), which was carried out in 2011, 2013, 2015, and 2018. In total, this study included 4,124 participants aged ≥ 45 years at baseline. A summing score of the eleven items for basic activities of daily living (BADL) and instrumental activities of daily living (IADL) was calculated to indicate the degree of ADL disability. The 10-item Centre for Epidemiological Studies Depression Scale (CESD-10) was adopted to measure depressive symptoms. The reciprocal relationship between ADL disability and depressive symptoms was tested by cross-lagged models.

RESULT

At baseline, 911 (22.1%) participants were classified as having difficulties with ADL, and the prevalence of depressive symptoms was 34.4% (1,418). Among middle-aged and older people in China, there was a significant reciprocal and longitudinal relationship between ADL disability and depressive symptoms. People who had difficulty with ADL faced a higher risk of depressive symptoms, and those who suffered from depressive symptoms were accompanied by an increase in ADL disability in the following years. The subgroup analysis on age also showed that ADL disability was reciprocally and longitudinally related to depressive symptoms. However, only women showed similar results in the subgroup analysis on gender.

CONCLUSION

This study shows that ADL disability is bi-directionally related to depressive symptoms in middle-aged and older Chinese people over time. The results suggest we should identify ADL disability and bad psychological conditions in time to prevent subsequent mutual damage among middle-aged and older Chinese people, a vulnerable group rising in the future.

The moderation of satisfaction with working conditions in the association between workload and mental health among healthcare workers collecting test samples in the post-COVID-19 era

Background

This study aimed to examine the associations between workload and satisfaction with working conditions and mental health (i.e., anxiety disorder, depression, and somatization) of healthcare workers collecting test samples during the local outbreaks of COVID-19, and explore satisfaction with working conditions as a moderator of these relationships.

Methods

A total of 1,349 participants were obtained via an online survey in Zhengzhou, Henan Province, China. Multivariate regression was used to assess the associations between workload and satisfaction with working conditions and anxiety disorder, depression, and somatization. The simple slope analysis and Johnson-Neyman technique were used to assess the effect value and change trend of the moderator.

Results

The prevalence of anxiety disorder, depression, and somatization were 8.6, 6.9, and 19.2% of healthcare workers collecting test samples, respectively. High levels of workload were associated with an increased risk of an anxiety disorder (OR = 1.81, 95%CI = 1.17-2.78), depression (OR = 1.92, 95%CI = 1.19-3.10), and somatization (OR = 1.90, 95%CI = 1.40-2.57), while high satisfaction of working conditions was associated with a reduction in the risk of these outcomes, and ORs (95%CI) were 0.35 (0.20-0.64), 0.27 (0.13-0.56), and 0.32 (0.21-0.48), respectively. The findings also indicated that a weaker association between workload and anxiety disorder, as well as depression and somatization, has been reported in those with a high level of satisfaction with working conditions.

Conclusion

Workload significantly increased the risk of healthcare workers suffering from psychological problems, while satisfaction with working conditions alleviated these negative effects, and effective resource support was crucial for healthcare workers.

Longitudinal relationship between body mass index and depressive symptoms among Chinese adults: The moderating roles of lifestyle factors and age

OBJECTIVE

This study aims to verify the moderating roles of lifestyle factors and age between body mass index (BMI), BMI trajectory and depressive symptoms of Chinese adults through a prospective design.

METHODS

The participants who are 18 years old and above from the China Family Panel Studies (CFPS) were included in the 2016 baseline and 2018 follow-up research. BMI was calculated according to self-report weight (kilogram) and height (centimeter). Depressive symptoms were evaluated via the Center for Epidemiologic Studies Depression (CESD-20) scale. Inverse probability-of-censoring weighted estimation (IPCW) was used to check whether selection bias existed. Modified Poisson regression was performed to calculate prevalence and risk ratios as well as 95% confidence intervals.

RESULTS

After adjustment, it was found that the positive associations of persistent underweight (RR = 1.154, P < 0.001) and normal weight → underweight (RR = 1.143, P < 0.001) with 2018 depressive symptoms were significant among middle-aged people, while the negative association of persistent overweight/obesity (RR = 0.972, P < 0.001) was significant in young adults. Notably, smoking moderated the relationship between baseline BMI and subsequent depressive symptoms (interaction P = 0.028). Also, exercise regularly and exercise duration weekly moderated the relationships of baseline BMI (interaction P = 0.004 and 0.015) and trajectories of BMI (interaction P = 0.008 and 0.011) with depressive symptoms among Chinese adults, respectively.

CONCLUSION

Weight management strategies for underweight and normal weight → underweight adults should pay attention to the role of exercise in maintaining normal weight and improving depressive symptoms.

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.

Temporal trend and subgroup disparities in the prevalence and treatment of those who screen positive for depression in China: A population-based study

Background

In China, improving mental health has been far behind its accomplishments for other diseases. With depression as one of the most prevalent mental disorders, the aim of this study was to evaluate temporal trends in the prevalence and treatment of those who screen positive for depression in China, by age, gender, and province.

Methods

We used data from three nationally representative sample surveys: the China Health and Retirement Longitudinal Study (CHARLS), the China Family Panel Studies (CFPS), and the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Depression was judged by the Centre for Epidemiologic Studies Depression Scale. Access to treatment was judged by two items: if respondents received any treatment like anti-depressants, or if respondents received counselling from a mental health professional. Survey-specific weighted regressions were fitted to estimate the temporal trend and subgroup disparities, and then pooled by meta-analysis.

Results

In total 168,887 respondents were investigated. The overall prevalence of China populations who screen positive for depression was 25.7% (95% CI 25.2-26.2) during 2016-2018, decreased from 32.2% (95% CI 31.6-32.8) during 2011-2012. The gender gap increased with age and had no significant improvement from 2011-2012 to 2016-2018. The prevalence of depression in developed areas is more likely to show a lower value and decreasing trend, while the prevalence in underdeveloped areas is more likely to show a higher value and increasing trend, from 2011-2012 to 2016-2018. The overall proportion of those who received any needed treatment or counselling from a mental health professional slightly increased from 2011 (0.5%, 95% CI 0.4-0.7) to 2018 (0.9%, 95% CI 0.7-1.2), and mainly occurred for older adults aged 75 and above.

Conclusion

The prevalence of those who screen positive for depression decreased by about 6.5% from 2011-2012 to 2016-2018 in China, but only tiny improvements were made in accessibility to mental health care. Corresponding disparities were identified in age, gender, and province.

Prevalence and gender disparity of those who screen positive for depression in China by the classification of the employer and industry: a cross-sectional, population-based study

BACKGROUND

The important role of mental health in sustainable economic development is gradually being recognized. This study aimed to evaluate the prevalence and gender disparity of those who screen positive for depression in China by the employer and industrial classification.

METHODS

We used data from a nationally representative survey, the China Family Panel Studies. Depression was judged by the Centre for Epidemiologic Studies Depression Scale. Employer classifications were categorized according to the local characteristics of Mainland China. Industrial classifications were defined using level-1 of the China version of the International Standard Industrial Classification of All Economic Activities. Weighted logistic regressions were fitted to estimate the gender disparities, controlling for confounders.

RESULTS

Forty eight thousand six hundred twenty eight adults were included. 18.7% (95%CI 18.1-19.4) of sampled adults were screened positive for depression symptoms, with 16.6% (95%CI 15.8-17.5) in males vs 21.0% (95%CI 20.1-22.0) in females. By classification of the employer, the prevalence was lowest among those employed by Government/party organisations (11.8%, 95%CI 8.9-15.4), and highest in those self-employed (21.8%, 95%CI 20.8-22.9); the gender disparity was mainly found in those employed by Sole proprietorship (Adjusted odds ratio [AOR] = 1.95, 95%CI 1.19-3.19) and Private enterprise (AOR = 1.34, 95%CI 1.13-1.59), as well as those self-employed (AOR = 1.49, 95%CI 1.3-1.17). By industrial classification, the prevalence was lowest among those who worked in the industry of Real estate (7.2%, 95%CI 4.8-10.6), and highest among those who worked in the industry of Agriculture, forestry, animal husbandry and fishing (22.9%, 95%CI 15.5-32.4); the gender disparity was mainly found in those who worked in the industry of Agriculture, forestry, animal husbandry and fishing (AOR = 3.29, 95%CI 1.18-9.15), Manufacturing (AOR = 1.41, 95% CI 1.09-1.82), Wholesale and retail trade (AOR = 1.48, 95% CI 1.07-2.06), and Accommodation and food service (AOR = 1.91, 95% CI 1.15-3.18).

CONCLUSION

The prevalence of depression in China had a wide variation by classifications of the employer and industry. Gender disparities were identified among workers from Sole proprietorship, Private enterprise, and self-employed, or workers from the industry of Agriculture, forestry, animal husbandry and fishing, Manufacturing, Wholesale and retail trade, and Accommodation and food service.

The Relationship between Job Satisfaction and Depressive Symptoms among Chinese Adults Aged 35-60 Years: The Mediating Role of Subjective Well-Being and Life Satisfaction

The purpose of this study was to assess the serial multiple mediating effects of subjective well-being and life satisfaction between job satisfaction and depressive symptoms among Chinese adults aged 35-60 years. According to the 2018 China Family Panel Study (CFPS), we finally selected 10,609 respondents (5202 females, and 5407 males) aged 35-60 years old as samples for the study. Correlation analysis was carried out to examine the relationship among job satisfaction, subjective well-being, life satisfaction, and depressive symptoms. Linear regression models were established to analyze the relationship between job satisfaction and depressive symptoms. Serial multiple mediation analysis was conducted by the SPSS macro PROCESS program. The results suggested that job satisfaction was negatively correlated with depressive symptoms among Chinese adults aged 35-60 years. Subjective well-being and life satisfaction mediated the relationships between them, respectively. Furthermore, job satisfaction also had indirect impacts on depressive symptoms through the serial mediating effects of subjective well-being and life satisfaction. The findings revealed that increasing job satisfaction could decrease depressive symptoms through promoting subjective well-being and life satisfaction. The study may offer some meaningful implications for improving the mental health and reducing the risk of depressive symptoms among Chinese adults aged 35-60 years.

Social support profiles correlate with depressive symptoms among Chinese parents during the COVID-19 pandemic: A latent profile analysis

This study explored pandemic-related social support profiles and investigated their relationships with depressive symptoms among Chinese parents during the COVID-19 pandemic. The hypotheses were evaluated in an online cross-sectional survey of 1286 parents. Latent profile analysis identified two profiles of received social support (isolated and integrated support). Three convergent profiles (high, moderate, and low support) and one divergent profile were found in perceived social support. The results revealed that the distribution of age, region, income and educational level varied across these profiles. Only the "high" (β = -0.11, p < 0.01) and "divergent" (β = -0.12, p < 0.01) profiles of perceived social support were negatively associated with parents' depressive symptoms. These findings highlight the importance of developing better-targeted intervention programs aimed at optimizing the allocation and improving the quantity and quality of supportive resources for parents.

The relationship between Chinese adults' self-assessments of family social status in childhood and depression: A moderated mediation model

BACKGROUND

Using the data from a large-scale Chinese national survey, this study aimed to explore the underlying mechanisms between Chinese adults' self-assessments of family social status in childhood and depression.

METHODS

The research data was from the China Family Panel Studies (CFPS) in 2020. We selected 13,430 Chinese adults aged 16-60 as participants, and used the PROCESS macro program to conduct moderated mediation analysis.

RESULTS

Chinese adults' self-assessments of family social status in childhood had a statistically significant negative predictive effect on depression. The sharing frequency of WeChat Moments played a partial mediating role in the relationship between self-assessment of family social status in childhood and depression. Furthermore, social trust moderated the direct effect of mediation model. Age moderated the second half of the mediation model, and the effect was statistically significant in the younger population (young people), but not in the older population (middle-aged people).

LIMITATIONS

This was a cross-sectional study and no causal conclusions could be drawn.

CONCLUSIONS

Chinese adults' self-assessment of family social status in childhood could affect depression in adulthood through sharing frequency of WeChat Moments. People with higher social trust can effectively buffer the adverse effect of self-assessed low family social status in childhood on depression. Age moderated the relationship between sharing frequency of WeChat Moments and depression, but this moderating effect was only significant in the younger population.

The influence of perceived government corruption on depressive symptoms with social status as a moderator

Perceived government corruption is an important indicator of depressive symptoms. Recent studies have explored the relationship between perceived government corruption and depressive symptoms in a cross-cultural context, but the underlying mechanisms need further research. This paper examines the impact of perceived government corruption on depressive symptoms in China and the moderating role of social status. Based on the 2018 wave of China Family Panel Studies (CFPS2018), 14,116 respondents aged between 16 and 96 were selected. The results revealed: (1) Perceived government corruption was significantly positively correlated with depressive symptoms. (2) Social class had an inhibitory effect in moderating the relationship between perceived government corruption and depressive symptoms. (3) The moderating effect was only significant for respondents who received education between junior high school and a bachelor's degree. The findings provide policy implications for developing countries and transitional societies like China. To build a more psychologically healthy society, we need to strengthen anti-corruption, stimulate social mobility, and improve people's sense of gain in the future.

Gender and age differences in the associations between personality traits and depressive symptoms among Chinese adults: Based on China Family Panel Study

This study aims to explore the associations between personality traits and depressive symptoms among Chinese adults and analyse the gender and age differences in the associations. A national representative sample of 28,628 adults aged 18 and above were selected from the 2018 China Family Panel Studies (CFPS) data. The short version of the Big Five Inventory (CBF-PI-15) and the Center for Epidemiologic Studies Depression (CES-D 8) were used to measure personality traits and depressive symptoms respectively. Binary logistic regression models were employed to analyse the associations between personality traits and depressive symptoms in the whole participants, different age groups and genders respectively. After adjustment, higher levels of conscientiousness, extraversion and agreeableness were related to lower level of depressive symptoms, while higher levels of openness and neuroticism were related to higher level of depressive symptoms (p < 0.05). A significant interaction between gender and conscientiousness on depressive symptoms was found (interaction p = 0.005), and the association between conscientiousness and depressive symptoms was stronger in males than females (p < 0.001). Significant interactions between age and conscientiousness (interaction p = 0.007), agreeableness (interaction p = 0.001) on depressive symptoms were found respectively. Moreover, the associations of conscientiousness and agreeableness with depressive symptoms were strongest among old group, followed by middle-aged group, and then young group (p < 0.05). In conclusion, conscientiousness, extraversion and agreeableness had negative associations with depressive symptoms, while openness and neuroticism had positive associations with depressive symptoms. The negative association between conscientiousness and depressive symptoms was stronger among males than females, and the negative associations of conscientiousness and agreeableness with depressive symptoms were strongest among old group, followed by middle-aged group, and then young group.

Impacts of menopause hormone therapy on mood disorders among postmenopausal women

OBJECTIVE

This study aimed to explore the modulatory effects of menopause hormone therapy (MHT) on mood disorders among postmenopausal women.

METHODS

A cross-sectional study was conducted to recruit postmenopausal women, including patients (arranged MHT for over 3 years as the medication group) and non-MHT controls. All participants were asked to respond to the Center for Epidemiological Studies Depression Scale (CES-D) and Generalized Anxiety Disorder Screener (GAD-7) questionnaires to assess their depression and anxiety status.

RESULTS

A total of 230 cases from the two groups were determined based on propensity score matching analysis by matching the menopausal age and menopausal durations. We found that MHT served as a favorable modulator in the depression status of postmenopausal women. Among the four factors of the CES-D questionnaire, our data indicated that the differences between the two groups fell primarily into two aspects: depressive emotion, and somatic symptoms or retarded activities. MHT was mainly involved in improving the depression of overweight women. However, no substantial effects of MHT were observed on the regulation of anxiety.

CONCLUSION

Postmenopausal women, especially the overweight population, who have experienced MHT exhibited an improved depressive status but not their anxiety condition.

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.

The reliability, validity and screening effect of the happiness index scale among inpatients in a general hospital

BACKGROUND

The Happiness Index Scale (HIS) is a newly developed scale by our group to screen for common psychological illnesses among general hospital inpatients. This study aimed to analyze the reliability, validity and screening effect of the HIS and to explore its clinical application.

METHODS

From April 1, 2021, to December 31, 2021, a total of 8405 continuous inpatients were enrolled from different departments of a large tertiary general hospital with 1385 inpatient beds in Guangzhou, Guangdong Province, China. Using a cross-sectional survey design, each participant was assessed with the Patient Health Questionnaire 9(PHQ-9), Generalized Anxiety Disorder 7 items(GAD-7), Athens Insomnia Scale (AIS), Columbia Suicide Severity Rating Scale (C-SSRS) and HIS within 24 h of admission. McDonald's ω coefficient, the Guttman split-half coefficient and the test-retest reliability coefficient were used to evaluate the reliability of the HIS and the construct validity and criterion validity of the validity tests. Scores on the PHQ-9, GAD-7, AIS, and C-SSRS were used as the gold standard tools to analyze the screening effect of the HIS.

RESULTS

The HIS exhibited very good reliability, with a McDonald's ω coefficient of 0.825, a Guttman split-half coefficient of 0.920 and a test-retest reliability coefficient of 0.745 (P < 0.05). Confirmatory factor analysis showed a satisfactory model fitting index with a χ²/df = 2.602, a root mean squared error of approximation (RMSEA) of 0.014, a standardized root mean square residual (SRMR) of 0.010, a comparative fit index (CFI) of 0.992, and a Tucker-Lewis index (TLI) of 0.983. The correlation coefficient between the total score of each dimension of the scale and the corresponding criterion was 0.854 ~ 0.949 (P < 0.001). The HIS showed a very good distinguishing effect. The average HIS score of inpatients who screened positive for psychological problems was significantly higher than that of inpatients who screened negative for psychological problems (t = 3790.619, P < 0.001). The effect size was very large (Cohens d = 2.695, 95% CI = 2.630 ~ 2.761). Approximately 90.2% of the positive and negative screening results of the HIS were matched with the gold standard tools, with a kappa value of 0.747 (P < 0.001). The screening effect test showed a sensitivity (true positive rate) of 92.9% and a specificity (true negative rate) of 89.5%.

CONCLUSION

The HIS exhibited satisfactory reliability and validity and a clinically meaningful screening effect with a much shorter version compared to the commonly used screening scales. Thus, it could potentially be useful as the first screening step to rule out psychological conditions for inpatients in general hospitals or to remind medical teams of further psychological concerns.

Trends in the utilization of psychotropic medications in China from 2018 to 2021

Background: Monitoring psychotropic medicine consumption trends can provide information on the extent of pharmacological interventions for mental disorders and availability of psychotropic medicines.

Objectives: This study aimed to illustrate the trends in psychotropic drug utilization in China’s hospitals.

Methods: We retrospectively analyzed the aggregated monthly psychotropic procurement records of 1009 hospitals from 31 provinces in China from January 2018 to September 2021. Total psychotropic medicine consumption included the sales of antipsychotics, antidepressants, anxiolytics, mood stabilizers, and sedatives or hypnotics. Information, including generic name, procurement amount, dosage form, strength, purchase time, and geographical data, was collected. Population-weighted psychotropic utilization was expressed in defined daily dose per 1000 inhabitants per day (DDD/1000/day).

Results: Psychotropic medicine sales increased from 4.5 DDD/1000/day in Q1 2018 to 6.4 DDD/1000/day in Q3 2021; total utilization in China’s hospitals increased by 42.2%. The use of each class of psychotropics showed a gradually increasing trend. Antidepressants were the most consumed psychotropics, accounting for 48.4% of the total psychotropic utilization (3.1/6.4 DDD/1000/day), followed by sedatives or hypnotics (31.3%; 2.0/6.4 DDD/1000/day) and antipsychotics (15.6%; 1.0/6.7 DDD/1000/day). Among all sub-classes of psychotropics, a most significant growth in DDD per 1000 inhabitants per day was seen for selective serotonin reuptake inhibitors (1.2–1.9 DDD/1000/day), whereas the consumption of typical antipsychotics (from 0.1 to 0.09 DDD/1000/day) and tricyclic antidepressants (from 0.05 to 0.03 DDD/1000/day) decreased during the study period. Psychotropic utilization substantially increased between Q1 2018 and Q3 2021 in regions with different economic levels. In Q3 2021, total psychotropic utilization in secondary and tertiary hospitals was 9.4 DDD/1000/day and 6.0 DDD/1000/day, respectively. Sedatives or hypnotics in secondary hospitals accounted for the largest proportion of utilized psychotropics (43.6%; 4.1/9.4 DDD/1000/day), whereas antidepressants were the most commonly used psychotropic in tertiary hospitals (50.0%, 3.0/6.0 DDD/1000/day).

Conclusion: This study showed that despite increases in psychotropic medication use, the consumption of medicines is still much lower than in other countries and regions internationally. With reference to the estimated prevalence of corresponding mental disorders, our study illustrates that a large treatment gap for mental health problems exists in China. In addition, the wide use of psychotropics with weak clinical evidence raises serious concerns regarding rational use. Greater efforts are needed to increase the availability of psychotropic medicines and to facilitate proper psychotropic use.

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 Joint Association Between Multiple Dietary Patterns and Depressive Symptoms in Adults Aged 55 and Over in Northern China

Background

Depression is a common psychiatric disorder in older adults that affects their health-related quality of life. Two percent of adults over the age of 55 suffer from major depression, and the prevalence of depression increases with age. Even in the absence of major depressive disorder, 10–15% of older adults have clinically significant depressive symptoms.

Objectives

Epidemiological studies on the association between different gender eating patterns and depression show inconsistent associations. Our study examined whether different gender eating patterns are related to depression. We consider eating patterns individually and as a joint exposure to predefined eating patterns.

Methods

Principal component analysis (PCA) was performed on the data of the 24-h diet recall dietary intake, and the dietary pattern was determined. Linear regression models are used to explore the relationship between different diets and depression of men and women; weighted quantile sum (WQS) regression, quantile g calculation (qgcomp) and Bayesian kernel machine regression (BKMR) are performed as Secondary analysis.

Results

In the dietary patterns model, we found that the vegetable and fruit-based diet has a significant inhibitory effect in women, and the egg-milk-based diet has a significant inhibitory effect in men. We found that when all dietary factors are above the 55th percentile, there is a significant positive correlation between multiple dietary patterns and depression risk. We also determined a positive correlation between meat and obesity risk and a negative correlation between egg and milk and vegetables and fruits.

Conclusions

In the study population, after controlling for other baseline indicators and predictors of dietary pattern exposure, a fruit and vegetable-based diet was associated with a slightly healthier and lower risk of depression, while a meat-based dietary pattern associated with a higher risk of depression, and this association effect varies between genders.

Association between social capital and oral health among adults aged 50 years and over in China: a cross-sectional study

Background

Social capital has a potential effect in protecting oral health among population. However, no study has explored the association between social capital and oral health in the Chinese context. Due to the unique culture, political, social context in China, it is important to understand their association in the Chinese context. The study aims to investigate the association between cognitive and structural dimensions of social capital with edentulism among adults aged 50 years and over in China.

Method

The study used data from the WHO SAGE (Study on Global AGEing and Adult Health) wave 1 China component. Structural social capital was operationalized as social participation. Cognitive social capital was operationalized as perceived community trust and perceived community safety. Community-level social capital was measured by aggregating individual-level social capital into community level. Oral health was measured using a final marker of oral health status, self-reported edentulism. A 2-level multilevel logistic regression was used to evaluate the association between different dimensions of social capital and oral health.

Results

In total, 12,856 individuals were included in the study, the overall prevalence of edentulism was 9.1% (95% CI 8.3–10.0). Multilevel logistic analysis revealed that individual-level social capital and community-level social capital are independently associated with edentulism. Individuals with low structural social capital and living in areas with low structural social capital have, respectively, 1.54 (95% CI 1.18–2.01) and 2.14 (95% CI 1.47–3.12) times higher odds for edentulism, after adjustment for potential confounders (age, sex, marital status, residence locality, wealth, education level, chronic conditions) and a potential mediator(smoking).

Conclusions

Living in a community with lower structural social capital and individual with low structural social capital is associated with higher risk for edentulism among adults aged 50 years and over in China.

Prevalence and factors associated with comorbid depressive symptoms among people with low back pain in China: A cross-sectional study

BACKGROUND

Low back pain is a common medical condition among the general population that is associated with many adverse health effects when comorbid with depressive symptoms. However, little is known about depressive symptoms in the population with low back pain in China. Our study evaluated the prevalence of depressive symptoms and analyzed the factors associated with this condition in the Chinese population with low back pain.

METHODS

We conducted a cross-sectional analysis of data from the 2018 China Health and Retirement Longitudinal Study. We collected low back pain information for each participant and identified depressive symptoms using the brief version of the Center for Epidemiologic Studies Depression Scale. A wide range of sociodemographic and health-related characteristics of the subjects were extracted. We measured the prevalence of depressive symptoms comorbid with low back pain and analyzed the associated factors by multiple logistic regression.

RESULTS

A total of 5,779 respondents aged 45 and over with low back pain formed the sample, 41.8% of whom reported depressive symptoms. Multiple logistic regression analysis indicated greater vulnerability to depressive symptoms among females (OR = 1.41, 95% CI, 1.16-1.73), relatively younger persons (60-74 years: OR = 0.72, 95% CI, 0.63-0.83; ≥ 75 years: OR = 0.62, 95% CI, 0.49-0.79, reference: 45-59 years), those from the central and western regions (central: OR = 1.39, 95% CI, 1.18-1.64; western: OR = 1.56, 95% CI, 1.33-1.83), participants with extremely short sleep duration (OR = 2.74, 95% CI, 2.33-3.23), those with poor self-perceived health status (OR = 2.91, 95% CI, 2.34-3.63,), multisite pain (OR = 1.54, 95% CI, 1.20-1.98) and disability in activities of daily living (Basic: OR = 1.70, 95% CI, 1.47-1.98; Instrumental: OR = 1.95, 95% CI, 1.70-2.24).

CONCLUSION

Depressive symptoms were highly prevalent in the Chinese population ≥ 45 years with low back pain. More attention should be paid to the individuals at high-risk confirmed by this study to facilitate early identification and intervention against depressive symptoms.

Prevalence of depressive symptoms and its related factors among China's older adults in 2016

BACKGROUND

Depression seriously threatens Chinese elderly. This study analysis the prevalence of depressive symptoms (DS) and its related factors among China's aging population.

METHODS

All participants were from the PINDEC project. Multi-stage clustered sampling was conducted. A total of 20,019 participants aged 60 or above completed the DS screening in 2016, and among them, 19,420 were taken into analysis. Univariate and multivariate logistic regression analysis were performed to explore the related factors of DS.

RESULTS

Of the 19,420 adults, 9,444 were male (48.63%) and 9,976 were female (51.37%). The prevalence of DS was 15.94%. The risk factors of DS were: female gender (OR=1.198, 1.097-1.308), daily alcohol consumption (OR=1.480, 1.284-1.705), disturbed sleep (OR=1.864, 1.716-2.024), chronic diseases (OR=1.214, 1.181-1.249), greater age (OR=1.012, 1.077-1.018), impaired cognition (OR=2.567,2.202-2.993), poor ADL performance (OR=1.545, 1.380-1.729), and insufficient social communication (OR=1.241, 1.134-1.358). Protective factors of DS included: higher education level, greater BMI (OR=0.986, 0.975-0.997), living in urban areas (OR=0.677, 0.611-0.749), and leisure activities such as playing cards or mahjong (OR=0.816, 0.730-0.912). For the DS risk factors, multiplicative interaction was found between cognition and ADL performance, in addition to cognition and social communication.

LIMITATIONS

Causality cannot be drawn from this cross-sectional survey. And the elderly who were looked after by nannies or living in nursing homes were not taken into analysis.

CONCLUSIONS

DS is prevalent among older adults in China. It is recommended that periodic screening for DS should be conducted for elderly individuals. Furthermore, it is suggested that the elderly adopt healthy lifestyles to prevent DS.