BACKGROUND:Recent studies suggest that intermittent explosive disorder (IED) may be more prevalent than previously recognized, but its comorbidities and functional impacts, particularly in non-Western populations, are not well understood. This study estimates the prevalence of psychiatric comorbidities in IED and explores its relationships with other mental disorders, suicidality, and functional impairment in a nationally representative sample from mainland China. METHODS:Data from the China Mental Health Survey (2013-2015) were analyzed, including 28,140 adults. IED was assessed using the Composite International Diagnostic Interview, and five behavioral subtypes were identified. Logistic regression explored the associations between these subtypes and lifetime comorbidity, suicidality, and 12-month functional impairment. RESULTS:The weighted 12-month and lifetime prevalence of IED were 1.23% and 1.54%, respectively. Comorbidity was common, with 61.87% of individuals with IED having at least one comorbid disorder, most notably mood disorders (55.1%). The highest likelihood of comorbidity was observed in the "destroy property and hurt people" subtype (OR: 17.2; 95% CI: 7.4-41.8). Of the 391 individuals, 4.77% had ever consulted a medical doctor or other professional about their anger attacks, and 7.27% accessed mental health services. Approximately 4.45% (SE: 1.49) reported suicidal ideation, 1.79% (SE: 0.91) had a suicidal plan, and 0.88% (SE: 0.51) reported suicide attempts or gestures. Among those with 12-month IED, 10.57% reported severe functional impairment. CONCLUSION:IED is common in China but has low service utilization and high comorbidity, potentially leading to underreported impairment. These findings highlight the need for increased awareness, research, and culturally sensitive management.

BackgroundDepressive disorders pose a significant public health burden, particularly among older adults. However, their prevalence, associated factors, role impairment, and mental health service utilization patterns among community-dwelling older ay -30dults in China remain understudied.MethodsThe data for this study were obtained from the China Mental Health Survey (CMHS) among participants aged 60 years and older. The World Health Organization Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) was administered to generate mental disorder diagnoses consistent with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). We calculated weighted prevalence of depressive disorders and applied multivariable logistic regression to identify associated factors, with further analyses of role impairment and mental health service utilization.ResultsThe final sample encompassed 7,454 older adults. The weighted lifetime and 12-month prevalence of depressive disorders among Chinese community-dwelling older adults were 7.9% (95% CI: 6.4%-9.5%) and 4.1% (95% CI: 3.2%-4.9%), respectively. Multivariable logistic regression analysis showed that older adults with three or more physical illnesses exhibited greater odds of past-year depressive disorders (OR = 11.4, 95% CI: 7.0-18.6). Elevated odds were also observed among those with comorbid anxiety and substance use disorders (OR = 8.4, 95% CI: 5.5-12.8; OR = 8.9, 95% CI: 3.9-20.0, respectively). Among respondents with 12-month depressive disorders, 67.9% had role impairment in household duties, 73.2% in work, 62.2% in relationships, and 60.7% in social life. Only 11.3% of those diagnosed with depressive disorders in the past 12 months utilized any form of mental health service.ConclusionsDepressive disorders are prevalent among community-dwelling Chinese older adults and are associated with various factors. Patients commonly experienced multi-domain role impairment, whereas mental health service uptake was low, calling for strengthened screening, intervention and accessible care for older adults.

Background: Dementia is a major global mortality cause and key driver of disability in older adults, imposing multidimensional burdens. As China's population ages, accurate prevalence estimates and care need assessments are essential for equitable policy planning. This study investigates young- and late-onset dementia prevalence while comparing health service utilization and unmet care needs between affected and unaffected populations.Methods: Utilizing China Mental Health Survey data (2013-2015) with multistage probability sampling, we identified 12,663 nationally representative adults aged ≥55 years. Of these, 10,839 completed Stage I assessments and 2,261 received Stage II evaluations, supplemented by psychiatric assessments of initial non-participants (n=197). Dementia diagnosis followed DSM-IV criteria via validated cognitive/functional instruments. Health service utilization and multidimensional care needs (ADLs/IADLs/safety) were quantified through participant/informant interviews.Results: Among 2 458 participants assessed, dementia prevalence was 2.65% (55-64y) and 5.56% (≥65y). Rural residents showed consistently higher rates than urban counterparts across age groups. Significant education gradients emerged, with urban prevalence decreasing with higher education while rural patterns differed. Individual living with dementia required substantially more care for both samples (55-64 years: 37.4% vs 11..9%, +81.3 monthly hours; 65+ years: 62.6% vs 13.4%, +88.8 monthly hours) without increased health service utilization.Conclusion: This national study reveals substantial dementia burden in China, exposing systemic healthcare deficiencies through misaligned functional care needs and medical engagement. The neglect of chronic disability management in aging populations necessitates urgent integration of prevention strategies and tailored support frameworks within primary care systems.

BACKGROUND:Role impairment due to health problems is a public health issue. China Mental Health Survey (CMHS) is a national epidemiological study in China, providing plenty of information on mental disorders and physical diseases.This study focused on the association between mental disorders and physical diseases with role impairment. METHODS:This study was based on CMHS, a cross-sectional study in a large-scale nationally representative sample across China from 2012 to 2015. Trained interviewers carried out face-to-face interviews with 28,140 respondents using the Composite International Diagnostic Interview-3.0 (CIDI-3.0). The prevalence of mental disorders and physical diseases was assessed. In addition, each respondent reported information about the number of days in the past month being totally and partially unable to work or carry out their other normal daily activities because of problems with either mental disorders or physical diseases. Associations of role impairment with physical diseases and mental disorders were analyzed by multiple regression. RESULTS:Overall, the weighted rate of role impairment was 3.68% in patients with any mental disorders and 8.75% in those with any physical diseases. Chronic pain ( β = 0.07, P <0.001) became the main physical disease associated with role impairment, while depressive disorder ( β = 0.12, P <0.001) became the main mental disorder associated with role impairment. Patients with more mental disorders or physical diseases experienced more days with role impairment. CONCLUSIONS:Common mental disorders and physical diseases account for a large proportion of the number of days out of role. It should be addressed to substantially increase the level of mental health in China.

Background: Utilisation of health services is low and delayed among individuals with mood mental disorders and anxiety disorders, despite high disease burdens and available effective treatments. This study aims to examine patterns and delays in help-seeking and associated factors among individuals with lifetime disorder of mood disorders and/or anxiety disorders. Methods: We used data from the China Mental Health Survey (CMHS), a nationally representative multistage clustered-area probability sample study across 31 provinces. We assessed lifetime mental disorders and helpseeking behaviour using the Composite International Diagnostic Interview (CIDI). Logistic regression analyses were used to examine sociodemographic and clinical correlates of delay to seek health care. Results: Among 32,552 participants, we identified 3075 patients with lifetime mood and/or anxiety disorders; 486 (15.5 % [95 % CI: 13.6-17.5 %]) have sought health care. Of these, 163 (4.8 % [95 % CI: 3.7-6.3]) ever sought specialized mental health services. The delays to initial health care were 1.0 (IQR: 0-7.1), 1.9 (0-10.0), and 10.0 (1.0-22.1) years for depressive, bipolar, and anxiety disorders. Patients with comorbidities, later age of onset, and living in urban areas showed a higher propensity for help-seeking (all p < 0.05). Older cohort was associated with longer delays in seeking health care, while a later age of onset was associated with shorter delays (all p < 0.05). Limitations: The cross-sectional retrospective design and self-assessment approach may add bias. Conclusions: Failure and delays in help-seeking are common in China. National strategies are needed to promote health care utilisation.

China, with the world’s largest population of individuals with dementia, faces a significant suicide rate among older adults, which remains a public health concern. Although previous studies suggest an association between dementia and suicidal ideation, the specific role of cognitive domains in this relationship is not well understood. This study aims to fill this gap by examining the association between cognitive domains and suicidal ideation in older adults with mild dementia. This cross-sectional study included 4,289 adults aged ≥ 65 years from Tongliao City, Inner Mongolia. Cognitive domains were assessed using the Clinical Dementia Rating (CDR) scale, and suicidal ideation was evaluated using the Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) package. Multiple logistic regression and network analyses were conducted to examine the relationships between cognitive domains and suicidal ideation. The prevalence of suicidal ideation was significantly higher in mild dementia patients (10.6

Background:Anxiety disorders (ADs) and depressive disorders (DDs) are prevalent among older adults with non-communicable diseases (NCDs), yet nationally representative epidemiological data from China remain limited. This study, as a part of the 2013-2015 China Mental Health Survey (CMHS), aimed to assess the prevalence of ADs and DDs and identify associated factors among older adults with NCDs in China. Method:A total of 5,428 patients aged 60 years and above with reported NCDs were selected from the CMHS. The Composite International Diagnostic Interview (CIDI) was used to diagnose ADs, DDs, and alcohol use disorders (AUDs) in order to assess their disease status and the lifetime and 12-month prevalence. Data were weighted by age, sex, and residential distribution from the 2010 Chinese census to correct for selection probabilities and response rates, and were post-stratified for national representativeness. Univariate and multivariate logistic regression was used to identify factors associated with 12-month ADs and DDs. Result:The lifetime prevalence of ADs was 8.3% and the 12-month prevalence of ADs was 5.8%. The two most prevalent ADs were specific phobia (SP; lifetime prevalence of 4.2% and 12-month prevalence of 3.1%) and obsessive-compulsive disorder (OCD; lifetime prevalence of 2.8% and 12-month prevalence of 2.1%). The lifetime prevalence of DDs was 10.1%, while the 12-month prevalence was 5.4%. The two most common DDs were major depressive disorder (MDD; lifetime prevalence of 7.2% and 12-month prevalence of 4.4%) and dysthymia (lifetime prevalence of 2.8% and 12-month prevalence of 2.2%). ADs are most common in individuals with heart attacks (12%), chronic lung disease (11.2%), and other chronic pain (11%). DDs are most commonly linked to heart attacks (13.8%), other chronic pain (13.2%), and cancer (13.1%). Female gender, alcohol use disorder, and comorbid with three or more NCDs were found to be risk factors associated with ADs and DDs. Conclusion:The co- occurrence of mental disorders among older adults with NCDs has become a growing public health concern in China. Primary health care institutions and clinicians should simultaneously enhance the management of chronic NCDs and mental health care among older adults.

The epidemiological research on mental health in China has undergone decades of development, transitioning from multi-regional surveys to nationally representative studies. In 1982, Academician Shen Yucun led a team to complete the first national survey in 12 regions, revealing a point prevalence rate of 10.54‰. In 1993, the point prevalence rate in the second national survey in 7 regions rose to 11.18‰. In 2002, the Composite International Diagnostic Interview (CIDI)-3.0 and Diagnostic and Statistical Manual of Mental Disorders, Fouth Edition (DSM-Ⅳ) standards were first applied in the surveys in urban Beijing and Shanghai to achieve international standards, but the representativeness of urban samples was limited. Subsequent regional studies contributed methodological insights toward a nationally representative survey. From 2013 to 2015, a research team led by Professor Huang Yueqin, in collaboration with 43 institutions, completed the China Mental Health Survey (CMHS), covering 32 552 community adults in 157 counties/districts in 31 provinces/autonomous. This study represents the first nationally representative epidemiological survey of mental disorders in China. The main results showed that the lifetime prevalence of mental disorders among adults in Chinese communities with depressive disorders was 16.6%, including 7.4% for mood disorders and 7.6% for anxiety disorders. Only 9.5% of patients with depressive disorders received treatment, and the full treatment rate was as low as 0.5%. Further surveys based on the CMHS framework in regions such as Ningxia, Urumqi, and Inner Mongolia confirmed the high risk of disease among rural women in western China and the widespread phenomenon of inadequate treatment. The results of CMHS methodology was transformed into the national Guidelines and Technical Standards for Epidemiological Investigation of Community Mental Disorders (2015 Edition) and software copyright, and the main data had been published in The Lancet Psychiatry. It has been used to guide the formulation of policies such as the Healthy China Action (2019-2030). CMHS establishing a complete process from scientific investigation to policy translation, filling the data gap at the national level, providing a replicable paradigm for the world, especially for developing countries, and marking a new stage of evidence-based decision-making in China's mental health epidemiological research.

Mental disorders among the elderly are a growing public health concern contributing significantly to disease burden, disability, and mortality. However, there is a lack of nationally representative studies examining the prevalence and correlates of mental disorders among older adults in community settings. Considering 55 years old is the beginning of “young old”, our study targets the population of adults aged 55 years old and above. Using data from the China Mental Health Survey (CMHS), we aim to estimate the prevalence and distribution of mental disorders and to investigate the correlates of mental disorders. Data of study was derived from the CMHS, a nationally representative community-based epidemiological survey. CMHS employed Composite International Diagnostic Interview (CIDI), a structured diagnostic tool, to collect relevant data. A total of 12,667 adults aged 55 and above were included in this survey. Weighted prevalence estimates were calculated, and design-corrected Rao-Scott χ2 test, along with logistic regression model were used to identify correlates of mental disorders. A total of 10,840 participants (85.6

OBJECTIVES:Loneliness affects more than a quarter of older people. The particular sociodemographic characteristics of Chinese society mean that there are growing numbers of older people, with fewer adults of working age to support them. We explored the experience, meaning, and consequences of loneliness for Chinese older adults, as well as the strategies deployed to counteract unmet social needs. METHODS:This qualitative study was nested within the 10/66 DRG LIFE2YEARS study in China. We conducted in-depth interviews with 49 older people and 13 caregivers. Interviews covered experiences of aging, including social life, expectations of health and social care, and psychosocial support. RESULTS:We used thematic analysis and developed three main themes: (a) the interconnection of negative emotions, depression, and social deficits; (b) reasons for social deficits-avoiding "making trouble," social exclusion/isolation, intergenerational strain; and (c) addressing unmet social needs. Older adults experienced loneliness as unexpected pain in later life. They practiced withdrawal behaviors to avoid social embarrassment and perceived risks to health. Older participants described living in communities where they felt increasingly alienated. Whilst some older people described effective strategies for counteracting loneliness, these were only feasible for those who were fit and able. DISCUSSION:Our findings relating to the shame of loneliness and avoiding burdening others are particularly salient against a backdrop of Confucian ideals. Our work highlights the importance of considering cultural expectations and values in loneliness research and the need to ensure those most at-risk of loneliness are not excluded from future research and intervention development.

Background Obsessive-compulsive disorder (OCD) is classified by the World Health Organization as 1 of the 10 most disabling conditions. However, nationally representative epidemiological data on OCD are not yet available in China.Aims To investigate the prevalence, comorbidity, role impairment and healthcare utilisation of OCD in China.Methods The present study used a multistage clustered area probability sample to obtain representative population-based data of adults from 157 nationwide disease surveillance points across 31 provinces in China. Trained interviewers conducted face-to-face interviews with respondents to collect information based on the Composite International Diagnostic Interview 3.0. Data weighting was performed to account for differential selection probabilities and response rates, and to post-stratify the sample to ensure its representativeness of the population in China.Results A total of 28 140 respondents (12 537 (44.55%) males and 15 603 (55.45%) females) completed the diagnostic interview. Two-thirds of the respondents with lifetime OCD had comorbid mental disorders, with OCD typically emerging later than the comorbidities. The most common comorbidities were mood disorders (39.67%, odds ratio (OR): 9.60, 95% confidence interval (CI 7.35 to 12.53) and anxiety disorders (32.75%, OR: 13.33, 95% CI 10.14 to 17.52). Overall, 588 (weighted 58.19%) respondents with obsessions or compulsions experienced role impairment, which was most severe in those reporting unspecified symptoms. Only 46 (6.74%) respondents with lifetime OCD and 28 (6.48%) with 12-month OCD received any healthcare services for their conditions.Conclusions The weighted lifetime and 12-month prevalence of OCD were 2.43% and 1.63%, respectively. Most patients with OCD reported comorbid mental disorders and role impairment, but very few sought healthcare services. National programmes to expand service coverage and increase awareness of OCD are essential to meet healthcare needs in China.

Background: Intrinsic capacity (IC) is vital to the World Health Organization’s healthy ageing framework. This study aims to develop an IC assessment model, and identify its longitudinal trajectories and related factors in old persons. Methods: This was a 15-year three-wave prospective cohort study of the 10/66 dementia series researches in Beijing, China. Totally 2 156 community-dwelling old persons aged 65 years and over were included at baseline to develop an IC assessment model, with 474 completing follow-up surveys for IC trajectory identification. IC was assessed using 11 items of the five domains and bifactor-multidimensional item response theory model. The group-based trajectory model and multivariate logistic regression model were employed to identify longitudinal trajectories and related factors of IC. Results: Three IC trajectories were identified as low baseline IC with rapid descending trajectory (11.39%), medium baseline IC with moderate descending trajectory (75.53%), and high baseline IC with slight descending trajectory (13.08%). Compared to the “slight descending trajectory”, aged 75 years and over (aOR: 9.48), female (aOR: 4.75), and unmarried/non-cohabiting (aOR: 4.73) were positively associated with the “rapid descending trajectory”. Completed secondary school/higher education (aOR: 0.08; aOR: 0.27), more vegetables/fruits intake (aOR: 0.91; aOR: 0.94), and private restricted support network (aOR: 0.17; aOR: 0.37) were negatively associated with the “rapid descending trajectory” and “moderate descending trajectory”. Conclusions: Community-dwelling old persons in Beijing exhibit three IC trajectories, with the majority showing moderate descending trajectory. Interventions should address gender or education inequities and modifiable factors like diet and social support to mitigate IC decline.

AIMS:To report the prevalence and correlates of anxiety disorders among the elderly population in China; and to describe functional impairment and mental health service utilization due to anxiety disorders. METHODS:Data were derived from the Chinese Mental Health Survey. Weighted prevalence rates of various anxiety disorders were calculated. Logistic regression analyses were conducted to investigate correlates associated with anxiety disorders. Functional impairment and mental health service utilization were also assessed. RESULTS:The weighted lifetime prevalence and 12-month prevalence of any anxiety disorder were 9.2 % and 6.0 %, respectively. Older adults with more chronic physical conditions, comorbid depressive disorders, and substance use disorders were more likely to have anxiety disorders. A substantial proportion of older adults reported functional impairment across different domains. Among respondents with 12-month anxiety disorders, only 11.8 % had sought any mental health services in the past year. CONCLUSIONS:Anxiety disorders are highly prevalent and cause serious impairment in the Chinese elderly population. Some correlates should be considered in the prevention and management of anxiety disorders. Additionally, the notable gap in mental health service utilization for anxiety disorders among the elderly in China highlights the need for improved healthcare services.

Background Over the past three decades, China has experienced significant changes in urban-rural, gender, and age-specific suicide mortality patterns. This study aimed to investigate the long-term trends in suicide mortality in China from 1987 to 2020. Methods Suicide mortality data were obtained from China's National Health Commission. Joinpoint regression analysis was used to examine changes in trends and age-period-cohort modeling to estimate age, period, and cohort effects on suicide mortality from 1987 to 2020. Net drift, local drift, longitudinal age curves, and period relative risks were also calculated. Results Crude and age-standardized suicide mortality in China showed continuing downward trends from 1987 to 2020, with a more pronounced decrease in rural areas (net drift = -7.07%, p<0.01) compared to urban areas (net drift = -3.41%, p<0.01). The decline curve of urban areas could be divided into three substages. Period and cohort effects were more prominent in rural areas. Suicide risk was highest among individuals aged 20-24 and gradually increased after age 60. Females, particularly those of childbearing age, had higher suicide risk than males, with a reversal observed after age 50. This gender reversal showed distinct patterns in urban and rural areas, with a widening gap in urban areas and a relatively stable gap in rural areas. Conclusions Suicide mortality in China has consistently declined over the past three decades. However, disparities in age, gender, and urban-rural settings persist, with new patterns emerging. Targeted suicide prevention programs are urgently needed for high-risk groups, including females of childbearing age and the elderly, and to address the slower decrease and reversing urban-rural gender trends.

Background Adverse childhood experiences (ACEs) are common and associated with mental disorders. However, the prevalence and co-occurrence of ACEs and their association with mental health outcomes among Chinese adults have not been well demonstrated. Methods China Mental Health Survey, a cross-sectional nationally representative survey consisting of 28,140 adults, was conducted from July 2013 to March 2015. Twelve ACEs and mental health outcomes, including mood disorder, anxiety disorder, substance-use disorder, and suicide were measured using the Composite International Diagnostic Interview (CIDI) 3.0 in a weighted representative subsample of 9378 respondents. Latent class analysis was used to identify the co-occurrence profiles of ACEs, and logistic regression was applied to examine the association between ACEs and mental health outcomes. Population-attributable fractions (PAFs) were calculated to quantify the attribution of ACEs to these outcomes. Findings Among the 9378 respondents, the weighted count (proportion) of females was 4642 (49.5%), with a weighted mean (SD) age of 43.0 (15.8) years. In this study, 27.1% of respondents showed at least one ACE, with multiple ACEs common (37.6%) among those affected. Neglect was the most prevalent ACE (11.3%), followed by physical abuse (9.1%). Latent class analysis identified four co-occurrence profiles: low risk of ACEs, maltreatment, caregiver's maladjustment and parental loss. The strongest association with mental health outcomes was found in the caregiver's maladjustment group (OR, 4.9; 95% CI, 3.2-7.6). Estimates of PAFs indicated that all ACEs together explained 39.4% (95% CI, 31.3%-47.4%) of observed mental health outcomes. Gender differences were noted in prevalence and associations with outcomes. Interpretation ACEs are highly prevalent and interrelated in China, attributing to over one-third of the mental disorder burden. In resource-limited settings, prioritizing the reduction of the most prevalent and impactful ACEs through education and policy can more effectively alleviate the disease burden. Funding The National Twelfth Five-Year Plan for Science and Technology Support from the Chinese Ministry of Science and Technology (grant numbers 2012BAI01B01 & 2015BAI13B00), and the National Key R&D Program of China (grant numbers 2017YFC0907800 and 2017YFC0907801). Copyright (c) 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

This review introduces the three stages of the development history of mental health epidemiology in China, outlines the diagnosis and classification system of mental disorders, and introduces diagnostic and screening tools for mental disorders such as the Composite International Diagnostic Interview (CIDI) and the Mini International Neuropsychiatric Interview (MINI). Regarding the epidemiological surveys of mental disorders in China and its main results, this review introduces the large-scale epidemiological investigations of mental disorders in China in 1982 and 1993, as well as subsequent investigations in Zhejiang Province, Kunming City, Hebei Province, Shandong Province, Qinghai Province, Tianshui City, etc. It focuses on the "Research on the Burden of Mental Disorders and Health Service Utilization in China" jointly supported by the Ministry of Health and the Ministry of Science and Technology, namely the China mental health survey (CMHS), and analyzes the increasing trend and reasons for the prevalence of most mental disorders in China in the past 30 years. Finally, in the prevention and control of mental disorders, it is necessary to fully utilize population-based research evidence and develop policies and measures that are in line with China's national conditions.

BackgroundHealth workers involved in the fight to prevent the COVID-19 outbreak were exposed to hazards. Detailed information on mental health problems in different medical occupations is crucial. To examined the prevalence of mental health issues in three medical occupations as well as the relationships between mental health problems and correlates in each occupation.MethodsThis study utilizing the Questionnaire Star program was conducted among medical workers working at medical institutions in China from February 17 to 24, 2020. The Self-Reporting Questionnaire (SRQ-20), the Zung Self-rating Anxiety Scale (SAS), and the Zung Self-rating Depression Scale (SDS) were used to assess mental health problems.ResultsThe prevalence of any mental health problems in the three occupations was 43.6, 34.6, and 32.9% for nurses, paramedical workers (PMWs), and doctors, respectively. Three occupations shared some correlates, such as being overworked, not having enough time to rest, support from colleagues, and previous mental health status. There were specific factors for each occupation. For doctors, age, educational level, living status, support from family, and previous physical status were related factors in mental health problems. Working in a designated hospital for treating COVID-19, having COVID-19 event exposures, and receiving support from family were associated with the mental health problems of the nurses. PMWs’ mental health problems was linked to educational level and care from supervisors or heads of department.ConclusionDifferent medical occupations have distinct impacts on mental health issues. Policy makers and mental health professionals working to prepare for potential disease outbreaks should be aware of multiple factors in different occupations.

This study aimed to explore the experience of living with unmet healthcare needs and to understand the underlying mechanisms from the perspectives of older people and family caregivers in China. The study was nested within the 10/66 Dementia Research Group LIFE2YEARS project. We conducted in-depth interviews with 62 participants, using a narrative approach, and carried out thematic analysis. We found that older people’s experiences of unmet needs were inextricably linked to their relationships with their adult children and unfulfilled expectations of filial piety and familial support in older age. Older people desired both emotional and practical support from family members in relation to health and healthcare in order to support their navigation of health systems, which they perceived to be increasingly complex. Family support was the key means of support that older people looked to in order to address their needs for care, which were insufficiently met by the state. Unfortunately, at the same time that older people perceived the health system to be ever more impenetrable, there was a growing dislocation between their expectation of filial piety and the level of emotional, practical and financial support younger generations were able to provide. There is a need to develop community-based support to plug the gaps between what governments and families are able to provide.