The Prevalence and Risk Factors for Depression Symptoms in a Rural Chinese Sample Population

et al. (2014) The Prevalence and Risk Factors for Depression Symptoms in a Rural Chinese Sample Population. PLoS ONE 9(6): e99692. doi:10.1371/journal.pone.0099692 The Prevalence and Risk Factors for Depression Symptoms in a Rural Chinese Sample Population Xinghu Zhou 0 Bo Bi 0 Liqiang Zheng 0 Zhao Li 0 Hongmei Yang 0 Hongjie Song 0 Yingxian Sun 0 Harry Zhang, Old Dominion University, United States of America 0 1 Department of Cardiology, The First Hospital of China Medical University , Shenyang city, Liaoning province, China , 2 Department of Psychology, The First Hospital of China Medical University , Shenyang city, Liaoning province, China , 3 Department of Clinical Epidemiology, Shenjing Hospital of China Medical University , Shenyang city, Liaoning province , China Background: It is essential to understand how we can prevent and treat the epidemic of depression. Several studies have reported the prevalence of depressive symptoms in the urban population in China, but there is a lack of information regarding the prevalence of depression in rural populations. Objective: To understand the prevalence of depression in a rural Chinese population and to analyze the risk factors for depression. Methods: This study used a cross-sectional approach. A total of 11,473 subjects were surveyed and completed the Patient Health Questionnaire-9 (PHQ-9) and the World Health Organization Quality of Life Brief scales. Living conditions, per capita income, marital status, and information about dietary health and chronic disease status were assessed. Results: The prevalence of depressive symptoms in the population was 5.9%. The prevalence in women (8.1%) was higher compared with men (3.5%) and also increased with age. The per capita income level, amount of sleep obtained per day, education level, weekly consumption of meat and beans or bean products, salt intake, and chronic disease status were associated with depressive symptoms. The quality of life of individuals with a score less than 10 points on the PHQ-9 was significantly better compared with individuals with a score greater than 10. Conclusion: The prevalence of depressive symptoms among rural population is higher than some southern cities in China. Dietary patterns may be an important risk factor linked to this disorder in the Chinese rural population. - Funding: This study was supported by grants from the Twelfth Five-Year project funds (National Science and Technology Support Program of China, grant #2012BAJ18B02) that Pro Yingxian Sun responsible for enable the project completion. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. Depression is a world-wide public health issue, and its prevalence increases each year. It is essential to understand depression in order to discover ways to prevent and treat it. Epidemiological studies of mental disorders in China were initiated later compared with western countries. Over the past few decades, several large-scale epidemiological studies have been conducted under the leadership of the government, and there have also been regional epidemiological investigations. However, because of the different diagnostic and screening tools and criteria, epidemiological data are significantly affected by regional factors; thus, the results across studies are different. Although several epidemiological studies on mental disorders have been conducted, there are large differences in the prevalence of depression across different countries and regions [14]. Many epidemiological studies have shown that the prevalence of depression in females is two times higher compared with males [5,6]. Most studies that examined the prevalence of depression in China in recent years have focused on populations in cities of China or rural elderly individuals [712]. Few studies have examined the middle-aged population. Further, more than half of the population lives in rural areas in China, poverty, engages in heavy physical labor, left behind and inadequate investment in health care were common feature of this group. More epidemiological investigations in the rural communities are needed, which would provide reliable information for depression prevention and control in China. The purpose of this study was to investigate the prevalence of depressive symptoms in individuals over 35 years of age in country-side areas in China and to analyze the influencing factors of depressive symptoms in order to verify whether the risk factors for depression that have been identified in other studies are also applicable to China. Study Population Liaoning Province is located in northeast China. From July 2012 to August 2013, a representative sample aged $35 years was selected to determine the prevalence, incidence and natural history of cardiovascular risk factors in rural areas of Liaoning Province. The study adopted a multi-stage, randomly stratified clustersampling scheme. In the first stage, 3 counties (Dawa, Zhangwu, and Liaoyang County) were selected from the eastern, southern, and northern regions of Liaoning province. In the second stage, one township was randomly selected from each county (a total of 3 townships). In the third stage, 810 rural villages from each township were randomly selected (a total of 26 rural villages). All eligible permanent residents aged $35 years from each village were invited to participate in the study (a total of 14,016 participants). Of this sample, 11,956 participants agreed to participate and completed the study (response rate: 85.3%). The study was approved by the Ethics Committee of China Medical University (Shenyang, China). All procedures were performed in accordance with ethical standards. Written consent was obtained from all participants after they had been informed of the objectives, benefits, medical items and confidentiality agreement regarding personal information. If the participants were illiterate, we obtained the written informed consents from their proxies. The study was completed with the support of the local government and the health administrative departments. Data Collection and Measurements Data were collected during a single clinic visit by a doctor and trained nurses using a standard questionnaire administered via face-to-face interview. Before the survey was administered, all eligible investigators attended a training that included the purpose of this study, how to administer the questionnaire, the standard method of measurement, the importance of standardization, and the study procedures. A test was administered after the training, and only individuals who scored perfectly on the test were eligible to become investigators. During data collection, the investigators received further instructions and support. Data on the demographic characteristics, lifestyle risk factors, dietary habits, family income, fa (...truncated)