Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001–05: an epidemiological survey

BACKGROUND In China and other middle-income countries, neuropsychiatric conditions are the most important cause of ill health in men and women, but efforts to scale up mental health services have been hampered by the absence of high-quality, country-specific data for the prevalence, treatment, and associated disability of different types of mental disorders. We therefore estimated these variables from a series of epidemiological studies that were done in four provinces in China. METHODS We used multistage stratified random sampling methods to identify 96 urban and 267 rural primary sampling sites in four provinces of China; the sampling frame of 113 million individuals aged 18 years or older included 12% of the adult population in China. 63 004 individuals, identified with simple random selection methods at the sampling sites, were screened with an expanded version of the General Health Questionnaire and 16,577 were administered a Chinese version of the Structured Clinical Interview for Diagnostic and Statistical Manual (DSM)-IV axis I disorders by a psychiatrist. FINDINGS The adjusted 1-month prevalence of any mental disorder was 17.5% (95% CI 16.6-18.5). The prevalence of mood disorders was 6.1% (5.7-6.6), anxiety disorders was 5.6% (5.0-6.3), substance abuse disorders was 5.9% (5.3-6.5), and psychotic disorders was 1.0% (0.8-1.1). Mood disorders and anxiety disorders were more prevalent in women than in men, and in individuals 40 years and older than in those younger than 40 years. Alcohol use disorders were 48 times more prevalent in men than in women. Rural residents were more likely to have depressive disorders and alcohol dependence than were urban residents. Among individuals with a diagnosable mental illness, 24% were moderately or severely disabled by their illness, 8% had ever sought professional help, and 5% had ever seen a mental health professional. INTERPRETATION Substantial differences between our results and prevalence, disability, and treatment rate estimates used in the analysis of global burden of disease for China draw attention to the need for low-income and middle-income countries to do detailed, country-specific situation analyses before they scale up mental health services. FUNDING China Medical Board of New York, WHO, and Shandong Provincial Bureau of Health.