Psychosomatic Medicine
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Published online before print September 24, 2009, 10.1097/PSY.0b013e3181baa65e
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Psychosomatic Medicine 71:886-893 (2009)
© 2009 American Psychosomatic Society

ORIGINAL ARTICLES

Impaired Role Functioning and Treatment Rates for Mental Disorders and Chronic Physical Disorders in Metropolitan China

Sing Lee, MB, BS, FRCPsych, Wan-jun Guo, MD, PhD, Adley Tsang, BSocSci, Yan-ling He, MD, Yue-qin Huang, MD, MPH, PhD, Zhao-rui Liu, MD, MPH, Ming-yuan Zhang, MD, Yu-cun Shen, MD and Ronald C. Kessler, PhD

From the Department of Psychiatry (S.L., W.-j.G.), Hong Kong Mood Disorders Center (A.T.), The Chinese University of Hong Kong, HKSAR, P.R. China; Shanghai Mental Health Center (Y.-l.H., M.-y.Z.), P.R. China; Institute of Mental Health (Y.-q.H., Z.-r.L., Y.-c.S.), Peking University, P.R. China; Department of Health Care Policy (R.C.K.), Harvard Medical School, Boston, Massachusetts.

Address correspondence and reprint requests to Sing Lee, Hong Kong Mood Disorders Center, 7A, Block E, Staff Quarters, Prince of Wales Hospital, Shatin, N.T., Hong Kong. E-mail: singlee{at}cuhk.edu.hk

Objectives: To compare impairments in role functioning and treatment rate of mental disorders and chronic physical disorders in the general population of metropolitan China.

Method: Face-to-face household interviews of 5201 people aged 18 to 70 years in Beijing and Shanghai were conducted from November 2001 to February 2002, using a multistage household probability sampling method. The World Mental Health version of the Composite International Diagnostic Interview (WMH-CIDI) was used for assessing sociodemographic characteristics, diagnoses, and treatment. The Sheehan Disability Scale (SDS) was used to measure disorder-specific role impairment.

Results: Respondents generally attributed greater impairment to mental disorders than to chronic physical disorders, although there were some variations among specific disorders. This general pattern was supported by within-person comparison of impairment associated with a mental disorder versus any chronic physical disorder. Depression, generalized anxiety disorder, and specific phobia were the most impairing mental disorders. Diabetes, headaches, and asthma were the most impairing physical disorders. Comorbid mental and physical disorders were associated with more severe impairment. A much lower percentage of respondents with mental disorders (3.0%) than chronic physical disorders (42.8%) received treatment in the previous 12 months.

Conclusion: Common mental disorders were associated with greater impairment than chronic physical disorders but were markedly undertreated. They warrant prioritization in the allocation of healthcare resources in China.

Key Words: role impairment • treatment • mental disorder • physical disorder • China

Abbreviations: DALYs = Disability Adjusted Life Years; WMH = World Mental Health Survey Initiative; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; CIDI = Composite International Diagnostic Interview; SDS = Sheehan Disability Scale.






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