Undiagnosed probable depression among middle-aged and older adults in China: a two-wave national comparison using CHARLS, 2011 and 2020

Vollständiger Abstract

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Abstract Background Population based evidence comparing physician recognition of probable depression among Chinese middle aged and older adults across national survey waves remains limited. Methods Data were drawn from two waves of the China Health and Retirement Longitudinal Study (CHARLS), including 10,546 wave-specific observations from 8,754 unique respondents aged 45 years and older in 2011 and 2020. Probable depression was defined as a score of 10 or higher on the ten-item Center for Epidemiologic Studies Depression Scale. Undiagnosed probable depression was defined as a CES-D-10 score of 10 or higher without self-reported physician recognition of an emotional, nervous, or psychiatric problem. Survey-weighted logistic regression accounting for village/community-level clustering was used to examine the association between survey year and undiagnosed probable depression. Models adjusted for predisposing, enabling, and need-related characteristics. Results Among observations with probable depression, the survey-weighted proportion without self-reported physician recognition was 98.23% (95% CI, 97.76%–98.60%) in 2011 and 95.61% (95% CI, 94.67%–96.39%) in 2020, corresponding to an absolute decrease of 2.62% points. After multivariable adjustment, the odds of lacking self-reported physician recognition were lower in 2020 than in 2011 (OR, 0.45; 95% CI, 0.32–0.64; P < 0.001). Conclusion These findings indicate a substantial recognition gap among middle-aged and older adults in China and a modestly lower proportion of undiagnosed probable depression in 2020 than in 2011. This persistent recognition gap warrants continued attention in research and public health practice.