Research paperPrevalence of major depressive disorder in children and adolescents in China: A systematic review and meta-analysis
Introduction
Depression, a leading cause of global disease burden, often begins in adolescence (Avenevoli et al., 2015, Hankin et al., 1998). Over half of individuals who experienced depression in adolescence have at least one recurrence in adulthood (Hankin et al., 1998, Rutter et al., 2006). Adolescent depression has negative outcomes, such as poor educational achievement, social impairment, insomnia, smoking and substance abuse (Buysse et al., 2008, Fergusson and Woodward, 2002, Lewinsohn et al., 1998). Moreover, depression is a major risk factor for suicide that constitutes the second most common cause of death in adolescents (World Health Organization, 2009). In order to implement preventive measures and appropriate mental health services, it is important to systematically examine the pattern of depression in this vulnerable age group.
Apart from the standard diagnostic criteria of the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM), socio-culturally sensitive local diagnostic criteria of major depressive disorder (MDD) have been developed, such as the Chinese Classification of Mental Disorder, Version 3 (CCMD-3) which was devised by the Chinese Society of Psychiatry (Chen, 2002).
Findings of a number of epidemiological studies conducted on the prevalence of MDD in children and adolescents have been diverse (Costello et al., 2003, Ford et al., 2003, Hankin et al., 1998). This is partly due to the different age groups studied; for example, the estimated prevalence of MDD is less than 1% in children (Kessler et al., 2001), but it increases to 5% by late adolescence (Costello et al., 2006, Merikangas et al., 2009, Thapar et al., 2012). Differences have also been observed across the time of the survey: the one-year prevalence of MDD in American adolescents increased from 8.7% in 2005 to 11.3% in 2014 (Mojtabai et al., 2016). Additionally, different sampling methods, measurement tools and sociocultural context also contribute to the inconsistencies.
In China, there are approximately 245 million persons aged 5-19 years (China Statistics Bureau, 2010), but no nationwide survey on the prevalence of MDD in children and adolescents has been published. Regional surveys on prevalence of MDD have been conducted with greatly varying results ranging from 0% to 4.82% (Fan et al., 2007, Gu et al., 2007, Tang et al., 2003). While a meta-analysis of the prevalence of depressive symptoms in Chinese children and adolescents (15.4%) has been reported (Li et al., 2016), no meta-analysis on MDD in this population has been published.
Thus, a systematic review and meta-analysis of the pooled prevalence of MDD in children and adolescents in China was conducted and its associated factors were also explored.
Section snippets
Methods
The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42018095372).
Study characteristics
Of the 12,642 articles initially identified, eventually 14 studies met the inclusion criteria and were entered in the meta-analyses (Fig. 1). The study characteristics are shown in Table 1. The pooled sample size comprised 82,592 children and adolescents with a range from 494 to 19,711. Only one was a broad community-based study (Zhong et al., 2013), while all the others were conducted in schools. Seven provinces and 3 municipality cities were the study sites. The year of survey ranged between
Discussion
To the best of our knowledge, this was the first systematic review and meta-analysis of the pooled prevalence of MDD in children and adolescents in China.
Unlike the prevalence of MDD in adults in China that is usually lower than the figures from other countries (Ma et al., 2009), the pooled point prevalence of MDD of 1.3% in Chinese children and adolescents was identical with the global prevalence of MDD (1.3%) in children and adolescents aged 6–18 years according to a meta-analysis of 41
Funding
This study was funded by the University of Macau (MYRG2015-00230-FHS; MYRG2016-00005-FHS).
Contributors
Study Design: Dan-Dan Xu, Wen-Wang Rao, Ling Zhang, Yu-Tao Xiang. Analysis and interpretation of data: Dan-Dan Xu, Wen-Wang Rao, Xiao-Lan Cao, Si-Ying Wen, Weng-Ian Che. Drafting of the manuscript: Dan-Dan Xu, Yu-Tao Xiang. Critical revision of the manuscript: Chee H. Ng, Gabor S. Ungvari, Yasong Du. Approval of the final version for publication: All the authors.
Conflict of interest
There is no conflict of interest related to conducting this study and preparing this manuscript.
Acknowledgments
None.
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These authors contributed equally to the work.