Previous reports of mental health disorders in China may have substantially underestimated the true disease burden—new estimates suggest that 173 million adults in China have a current mental disorder and 158 million of them have never received any type of professional help for their condition. These are the findings of a new large-scale survey in four provinces, representative of 12% of China's adult population, published in an Article in this week's issue of The Lancet.
In China and other middle-income countries, neuropsychiatric conditions are the leading cause of ill health in men and women, with a disease burden far exceeding that of infectious diseases or cardiovascular disease. However, efforts in China to redistribute resources and improve services to people who are mentally ill have been slow and hampered by a lack of high-quality, country-specific data. Previous global burden of disease estimates for prevalence, disability, and treatment rates are based on projections, expert opinion, and unrepresentative studies.
To provide more evidence, Michael Phillips and colleagues used random sampling methods to identify 96 urban and 267 rural sites in four geographically and economically diverse provinces in China—Shandong, Zhejiang, Qinghai, and Gansu. The sampling frame included 113 million individuals aged 18 years or older. 63 004 individuals were randomly selected and screened with an expanded version of the General Health Questionnaire (GHQ) and, of these, 16 577 were also given a semistructured diagnostic interview administered by a psychiatrist. Data were gathered between 2001 and 2005.
Overall, findings showed that the one-month prevalence of at least one current mental disorder in adults was 17.5%. This is substantially higher than previous studies done in China between 1982 and 2004 which reported overall prevalence of mental disorders to range from 1.1% to 9.1%.
Mood and anxiety disorders were more common in women than men and in individuals aged 40 years and older. Alcohol use disorders were 48 times more prevalent in men than in women, and people from rural areas were more likely to have depressive disorders and alcohol dependence than those from urban areas.
The researchers also found that, among people with mental illness, 24% reported being moderately or severely disabled by their illness. Yet only 8% of those with mental illness had ever sought any type of professional help, and only 5% reported ever seeing a mental health professional.
The authors point out the substantial differences between these findings and those used in the global burden of disease analysis for China and highlight: "The need for low-income and middle-income countries to recompute the disability-adjusted life years for neuropsychiatric conditions with detailed, up to date, country-specific epidemiological data."
They conclude: "A major redistribution of societal and health resources is needed to address a problem of this size and this will only happen with the active participation (or, at least, concordance) of powerful political, economic, social, and professional stakeholders in the community."
In an accompanying Comment, Lawrence Yang and Bruce Link from Columbia University, New York, USA, say this survey provides: "An invaluable glimpse into the nature and distribution of mental disorders in China."
In particular they commend the two-stage design of the survey where psychiatric diagnoses were established by a clinician familiar with the local cultural context, allowing for flexible rephrasing of questions about symptoms and about effects of symptoms on functioning, which they say is particularly important when interviewing illiterate, rural respondents who might speak one of many Chinese regional dialects.
An Editorial in this week's Lancet discusses both the findings of the China Article and a recent US report into mental health of parents, which found 1 in 5 parents with children aged under 18 years suffer depression in a given year. The Editorial concludes: "Identification, treatment, and prevention of mental health can no longer be the sole responsibility of medical-care providers. One solution could be to treat mental health disorders as a social issue that requires recognition and support from family, friends, and the community. Education at school, in the workplace, and through the media should highlight the range of treatment services available and how to access them. In turn, medical-care providers might adopt a more family-focused model of care, as recommended by the report on depression in parents. The latest findings from China should give us pause to reconsider our attitudes and responses to mental ill health."
Professor Michael Phillips, Beijing Hui Long Guan Hospital, Beijing, China. T) +86 1342 633 6546 E) phillipschina@yahoo.com
Dr Lawrence Yang, Columbia University, New York, USA. T) +1 212 305 4747 E) Lhy2001@columbia.edu
The Lancet Press Office T) +44 (0) 20 7424 4949 E) pressoffice@lancet.com
For full Article, Comment, and Editorial see: http://press.thelancet.com/chinamental.pdf
Journal
The Lancet