Prevalence and geographic disparity of depressive symptoms among middle-aged and elderly in China

Background: To evaluate the prevalence of and risk factors for depressive symptoms among middle-aged and elderly Chinese in northern and southern China. Methods: A population-based cross-sectional survey was performed in Beijing and Shanghai. Participants included 3289 community residents aged 50-70. Socio-demographic, lifestyle and health-related information were obtained by a standardized questionnaire. Clinically relevant depressive symptoms were assessed by the Center for Epidemiological Studies of Depression Scale (CES-D). Results: The prevalence of depressive symptoms in the total study population was 9.5% (6.7% for men and 11.7% for women), and it was significantly higher in participants from Beijing than those from Shanghai (14.9% vs. 4.1%, P < 0.001). Multivariate logistic regression analyses indicated that this geographic disparity was independent of gender, age, marital status, living status, education level, health status, mobility, social activities and medical insurance (odds ratio, 3.94; 95% confidence interval, 2.86-5.40). Limitations: No clinical diagnostic validation was performed and the prevalence might be underestimated due to our exclusion criteria. Conclusions: Approximately one in ten middle-aged and elderly Chinese might suffer from depressive symptoms. Furthermore, the prevalence is substantially higher among residents in the north of China compared to the south. Prospective studies are required to confirm the results and identify the major risk factors contributing to this geographic disparity.