Healthcare Utilization of Older Adults in China with Depression Symptoms
Alongside rapid economic growth and social change in recent decades, China has witnessed a significant increase in the incidence of mental disorders. An estimated 173 million Chinese citizens suffer from diagnosable mental disorders, and approximately 16 million are affected by severe mental illness. According to World Health Organization estimates in 2000, neuropsychiatric disorders ranked first among all diseases in China in terms of disease burden, at 31.3 million disability adjusted life years. Despite the existence of effective treatments for mental disorders, approximately 90% of Chinese with a common mental disorder have not received formal mental health services. Those who do use services tend to be hospitalized for severe mental disorders.
This study investigates the issue of disease burden of mental disorders in China from a health systems standpoint. It aims to examine the independent and combined impact of depression on the health service utilization of older adults in China. Studies in western countries have shown that individuals with depression use a higher number of physical health services, even after controlling for age and co-morbid health conditions. However, there have been no studies to date that have looked at this question for China.
Methods:
Using representative survey data from the 2012 China Health and Retirement and Longitudinal Study (CHARLS) (n=2,518), this study used Poisson and logistic regression models to examine the impact of depression and co-occurring chronic health conditions on the healthcare use of the general population of older adults (age 45 and older) in China.
Depressive symptoms were measured by the 10-item Center for Epidemiologic Studies Depression Scale (CES-D 10). A threshold score of 12 has been validated as suggestive of a clinically significant level of depression in the older adult Chinese population.
Individuals were classified as having chronic health conditions if they had ever received a diagnosis of any of the following: cardiovascular disease; diabetes and complications of chronic diabetes; chronic respiratory disease; cancer; digestive and liver disorder; arthritis or rheumatism, and memory-related disease.
Outpatient health service utilization was defined as the number of outpatient health service visits in the four-week period preceding survey participation. Service utilization was measured across hospitals (including Chinese medicine hospitals), community healthcare centers, village clinics, and private clinics.
Results:
Controlling for socio-demographic factors, the presence of depression symptoms was positively associated with outpatient health service utilization (b= .020, p < .001). Individuals with a clinically significant level of depression and co-occurring chronic conditions were more likely to use health services than either individuals with health conditions alone (OR = 1.359, p= .011) or individuals with depression alone (OR= 1.574, p= .001). Notably, health service visits were made for physical conditions, not mental health conditions. Of the 542 individuals with clinically significant depression levels, fewer than 1% reported receiving psychiatric and/or psychological treatment.
Implications:
Findings on the healthcare usage patterns of this population may have implications for future mental health interventions, particularly in general healthcare settings. Treatment of depression in primary care could potentially reduce “excessive” physical health care utilization.