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| | Epidemiology of Psychiatry in China | | 2008-8-6 0:22:53 Chinese Society of Psychiatry Zou YiZhuang M.D,Ph.D;Jin Liu M.D,Ph.D |  In the late 1950s and 1970s, some cities in China had done survey on mental disabled, but the result was not based on international standard criteria and tools, so was not comparable internationally. The result causes the awareness of mental health in the Country, which help the government to set up policy for mental health and promote the Chinese psychiatry. In June 1980, the first WHO promoted epidemiology workshop was hold in Beijing and training researchers using standard tools in epidemiological survey.
In 1993, a national study with 23333 samples from 7 areas of China, based on PSE and ICD-9 (Zhang WX 1998), by the Epidemic center in Beijing Institute of Mental Health, shows that the time point prevalence and life prevalence for all psychosis are respectively 1.118% and1.347%; for schizophrenia 0.531% and 0.655%; for mood disorder 0.052% and 0.083%; for neurosis 1.511%; for mental retardation 0.294% (life prevalence is not available); for elderly psychosis 1.497% and 1.946%; for alcohol dependence 0.068% and 0.068%; for drug dependence 0.047% and 0.052%. The standardized suicide rate was 22.2 per 100,000 people.
A resent survey covered 24000 samples of Hebei province (2004-2005 use DSM-IV and SCID-I/P, Li KQ, 2007) showed time and life prevalence for all psychosis are 16.243% and 18.512%, about 14 times higher than 14 years ago. We may have to reconsider the difference caused by methodology. But anyway, it is showed that the prevalence of mental disorders is very high and getting higher in China, and at the same time, the mental health loading is getting higher too.
The prevalence rate of mood disorder in 1993’s survey was very low (0.083%, W Zhang, 1997), which may because the culture difference on the way of expression depression and therefore the relatively low sensitivity of Western tools in the survey. The meaning of symptoms could be different in China, for example, there are much more somatic complaints instead of emotional complaints in Chinese depressive patients, especially in the elderly. This may help to explain the extremely low prevalence of depression, the Western depression scales based on emotional symptoms may loss many cases in the study. The recent Hebei survey with 24000 samples (Cui LJ, 2007) and Beijing survey with 5926 samples (CIDI-1.0. ICD-10, by Ma X, 2007) showed time and life prevalence of depression are 2.701%, 4.747% in Hebei and 3.310%, 6.870% in Beijing, more than 50 times higher than the 7 areas data in 1993.
In April 1987, there was a national survey on mentally disabled covered 340,000 families and 1,600,000 population and five types of disabilities (include psychiatric disability and intelligent disabled) were investigated by trained interviewers and doctors. The result showed national psychiatric disabled rate was 1.84% (include 1.67% disabled because of schizophrenia); intelligent disabled rate was 9.65% According to the rate, China has 2,392,000 psychiatric disabled people (out of 16,000,000 psychiatric patients) and 12,545,000 intelligent disabled people. Schizophrenia played important role in psychiatric disabled people 82.5%, according to another survey in 1993.
Epidemic investigations
Zhang et al (1998) used the Chinese Scale Of Mental Disability And Intellectual Impairment and found the point prevalence and lifetime prevalence of all disorders to be 11.2% and 13.5%, respectively. An increase in the prevalence of all mental disorders, particularly alcohol use disorders, Alzheimers Disease and affective disorders was noted but the rate of neurotic disorders did not increase.
A number of studies (e.g. Wang et al, 2000) have examined the prevalence of dementia in different regions in large samples (>1000) using a two-stage procedure in which the initial screening was done with MMSE and diagnosis was confirmed by clinical interviews. The prevalence rates were in the range of 1.0% to 4.2%. Dementia was more common in women and the prevalence rate increased with age. Zhang et al (2001) assessed 5913 subjects over the age of 55 years from urban and rural communities selected through a stratified multiple stage cluster sampling method using a three-phase strategy in which the final evaluation was done by neurologists or psychiatrists using the DSM-IV, NINCDS-ADRDA, and NINCDS-AIREN criteria. The age-standardized prevalence was 4.2% for dementia (all causes), 2.0% for Alzheimers Disease and 1.5% for vascular dementia. The rate of Alzheimers Disease doubled for every 5-year age group, though that of vascular dementia increased little with age. Yan et al (2002) reported that the annual incidence rate of senile dementia was 0.9% in those above 60 years of age. The rate increased in almost each 5-year age groups to reach 5.1% in the 90 years (and above) age group.
Niu et al (2000) assessed 991 current smokers from 488 randomly selected nuclear families by using the Fagerstrom Test of Nicotine Dependence (FTND) questionnaire and the Revised Tolerance Questionnaire (RTQ). The prevalence of nicotine dependence as defined by FTND (cut off-7/8) and RTQ (cut off 27/28) were 12.7% and 11.1%, respectively.
Wei et al (1999) assessed 23513 adults and found that the point prevalence of alcohol dependence (DSM-III-R) was 3.4% (males 6.6%, females 0.1%).
Jiang et al (1995) assessed 6567 subjects with a screening questionnaire and Present State Examination. The 1-year prevalence rate of benzodiazepine dependence rate was reported to be 1.63%.
Chen et al (1999) conducted a meta-analysis on 10 cross-sectional studies (n=13565) of depression in elderly subjects. The pooled prevalence of depression was 3.9% (rural 5.1%, urban -2.6%). Zhang et al (1999) assessed women at an antenatal clinic (n=1052) with the Edinburgh Postpartum Depression Scale 7 days after delivery and found a rate of 15% for postpartum depression.
Yucun et al (1998) used the GHQ-12 and Present State Examination in an urban elderly sample. The prevalence of neurosis was 2.1% (3.5% in women and 4.0% in men). The prevalence declined with age. Neurasthenia, depressive and anxiety neurosis were common.
Wang et al (2000) assessed 181 and 157 randomly selected subjects from two earthquake affected villages. Counter-intuitively, subjects from the village that faced greater damage (but received more support) had lower rates of PTSD. The incidence of DSM-IV PTSD within 9 months was 19.8% and 30.3% for the two villages. Zhang et al (1992) studied 509 college freshman. Bulimia, as per Chinese and DSM-III-R criteria, was diagnosed in 1.1% of subjects.
Review of data from different sources (e.g. National Disease Surveillance Point system, Chinese Public Health Annuals) have given varying rates of suicide (4.8 to 19.6 per 100000), but there is unanimity that the rates are greater in women, in rural areas, and in the elderly (e.g. Ji et al, 2001). Jenkins (2002) collated mortality data from the Ministry of Health for the period 1995-99 with an estimated rate of unreported deaths. The annual suicide
rate was estimated at 23/100000, accounting for 3.6% of all deaths. The rate in women was 25% higher than in men, primarily due to large number of suicides in young rural women. Rural suicide rates were three times higher than urban rates across both sexes, for all age-groups, and over time.
Phillips et al (2002) interviewed close associates of people who died due to suicide (n=519) or other injuries (n=536). After adjustment for different socio-demographic variables, the predictors for suicide were: depression score, previous suicide attempt, acute stress at time of death, low quality of life, high chronic stress, severe interpersonal conflict in the 2 days before death, and a blood relative or friend with previous suicidal behavior. Suicide risk increased substantially with exposure to multiple risk factors from 30% for those with 2 or 3 risks to 96% for those with 6 or more risks. Hesketh et al
(2005) administered a self-administered questionnaire to 1576 middle school students and found that the frequency of severe depressive symptoms, suicidal ideation and suicide attempts was 33%, 16% and 9%, respectively.
A number of large (sample size>1000) community studies have been conducted on behavioral problems in school age children and adolescents using a variety of reliable tools (e.g. Liu et al, 2001). The prevalence rate of behavioral problems had been reported to be in the range of 7% to 23%. Boys have more behavioral problems, particularly externalizing problems and girls have more internalizing problems. Leung et al (1996) conducted a two-stage study on 3069 schoolboys and found the prevalence rates for hyperkinetic disorder (ICD 10), ADDH (DSM-III) and ADHD (DSM- III-R) respectively, were 0.8%, 6.1% and 8.9%. Liu et al (2000) assessed 3344 children in the 6-16 years age group and found the overall prevalence of nocturnal enuresis was 4.3%, with a significantly higher prevalence in boys. Zuo et al (1994) assessed 85170 children (<14 years) using the WHO description of mental retardation and standard psychological tests. The prevalence of mental retardation was 1.2%, with the proportion of mild, moderate, severe and profound MR being 60.6%, 22.7%, 9.6%, and 7.1%, respectively.
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(Edited by Tan Shuping,MD) | | [CLOSE] |
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Ministry of Health, (2003) No.013
ICP:No.040657