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Depression in Older People in Rural China
Ruoling Chen, MD, PhD;
Li Wei, MD, PhD;
Zhi Hu, MD, MSc;
Xia Qin, BSc;
John R. M. Copeland, MD, FRCP;
Harry Hemingway, MD, FRCP
Arch Intern Med. 2005;165:2019-2025.
Background In Western countries depression is the most common psychiatric condition in older persons and related to low socioeconomic status and low social supports. Along with social deprivation, the rural communities in China retain many Chinese traditions that involve high levels of social supports. Studying such a population might offer insights into the cause and prevention of depression that may be applicable in developing and developed countries.
Methods Using a cross-sectional, household-based, community survey in rural China, we aimed to determine the prevalence of and risk factors for depression among older people who had a low income (mean annual per capita income of about US $280) and high social support in 16 villages in Anhui Province. Participants included 754 men and 846 women aged 60 years or older. Depression was diagnosed using the Geriatric Mental State and the Automated Geriatric Examination for Computer Assisted Taxonomy. Risk factors, collected from the standard questionnaire and physical measurements, were examined in a stepwise multiple logistic regression model.
Results The prevalence of depression (world age standardized) was 6.0% (95% confidence interval [CI], 4.8%-7.3%). Of all persons, 1374 older persons (85.9%) living with family members. Depression was significantly and independently associated with female gender, low family income, lack of social support, relationship problems, poor health status, and adverse life events in the past 2 years. The risk of depression increased in those eating meat less than once a week (multiple-adjusted odds ratio, 2.20; 95% CI, 1.20-4.03), not watching television (odds ratio, 1.76; 95% confidence interval, 1.03-3.00), and having undetected hypertension (odds ratio, 1.78; 95% CI, 1.05-3.01).
Conclusions Older people in rural China have a lower risk of depression than those in Western countries. Low socioeconomic status showed a "dose-response" relationship with depression, and social supports were much more common, which were protective for depression. Further exploration of Chinese culture and tradition may yield universal insights into preventive factors for depression in older people.
Author Affiliations: Department of Epidemiology and Public Health, Royal Free and University College Medical School, University College London, London (Drs Chen and Hemingway), and Department of Psychiatry, University of Liverpool, Liverpool (Dr Copeland), England; Medicines Monitoring Unit, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland (Dr Wei); and School of Health Administration, Anhui Medical University, Anhui, Hefei, China (Drs Chen and Hu and Ms Qin).
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