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.

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.

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

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.

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 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/).

目的:描述中国社区成人心境障碍功能残疾现况并探讨残疾发生的危险因素,为精神残疾康复政策的制定提供科学依据.方法:本研究为中国精神卫生调查数据的深入分析,计算包含身心共病和单一心境障碍的12月加权功能残疾率和致残率、对正常工作和生活的损失天数的影响;运用方差分析比较各组世界卫生组织残疾评定量表-2.0得分的差异,运用复杂抽样数据多重线性回归分析心境障碍共病其他精神障碍和躯体疾病及人口学因素对功能残疾程度的影响.结果:心境障碍12月患病人数为1136例,其中功能残疾人数为537例,包含身心共病的心境障碍功能残疾率为1.7％、致残率为42.0％,第四级残疾构成比最高(77.1％).单一心境障碍功能残疾率为0.2％、致残率为16.0％.各类心境障碍所致部分影响正常生活和工作的中位天数在0～4.75 d之间.多重线性回归显示,心境障碍共病其他精神障碍和躯体疾病及除居住地以外的人口学因素均与WHODAS 2.0得分呈正关联.结论:心境障碍共病躯体疾病增加功能残疾发生的易患性和严重程度.受教育程度和收入水平低、高龄、非在婚、男性群体是心境障碍功能残疾的高危人群,需要重点关注.

Background Associations between adverse childhood experiences (ACEs) and common psychiatric disorders among older Chinese individuals have not been well reported. The objectives of this study are to examine the prevalence of ACEs and the associations of ACEs with common psychiatric disorders among older adults in China. Methods The study used data from the China Mental Health Survey (CMHS), a nationally representative epidemiological survey, which used computer-assisted personal interviewing (CAPI), logistic regression models were used to examine community-based adult psychiatric disorders and associated risk factors. Finally, 2,317 individuals aged 60 years or over were included in the CMHS. The national prevalence of ACEs in older adults were estimated and logistic regression were used to analyse the association between ACEs and past-year psychiatric disorders. Results Prevalence of ACEs among older adults in China was 18.1%. The three most common types of ACEs were neglect (11.6%), domestic violence (9.2%), and parental loss (9.1%). This study proved the association between ACEs and common past-year psychiatric disorders in older adults. ACEs increased the risk of past-year psychiatric disorders in older adults. After adjustment for age, sex, marital status, employment status, education, rural or urban residence, region, and physical diseases, the association between ACEs and past-year psychiatric disorders were still significant. Conclusions ACEs are linked to an increased risk for past-year psychiatric disorders in older adults. ACEs may have long-term effects on older adults’ mental well-being. Preventing ACEs may help reduce possible adverse health outcomes in later life.

Post-traumatic stress disorder (PTSD) is one of the most severe sequelae of trauma. But a nationally representative epidemiological data for PTSD and trauma events (TEs) was unavailable in China. This article firstly demonstrated detailed epidemiological information on PTSD, TEs, and related comorbidities in the national-wide community-based mental health survey in China. A total of 9,378 participants completed the PTSD-related interview of the CIDI 3.0. Lifetime prevalence and 12-month prevalence of PTSD in total respondents were 0.3% and 0.2%. while the conditional lifetime and 12-month prevalence of PTSD after trauma exposure were 1.8% and 1.1%. The prevalence of exposure to any type of TE was 17.2%. Among individuals with the exposed to TEs, younger, without regular work (being a homemaker or retried), and intimate relationship breakdown (separated/Widowed/Divorced), living rurally were associated with either the lifetime PTSD or the 12-month PTSD, while the count of a specific TE, the unexpected death of loved one, was related to both. Alcohol dependence was the most common comorbidity among male participants with PTSD but major depressive disorder (MDD) for female counterparts. Our study can provide a reliable reference for future identification and intervention for people with PTSD.

BACKGROUND:The symptoms that patients with major depressive disorder (MDD) experience are the dominant contributing factors to its heavy disease burden. This study sought to identify key symptoms leading to disability in patients with MDD.METHODS:Subjects consisted of patients who had a 12-month MDD diagnosis based on the China Mental Health Survey (CMHS). World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) was used to assess the degree of disability. The associations between depressive symptoms and disability were analyzed using a linear regression and logistic regression with a complex sampling design.RESULTS:Of the 32,552 community residents, 655 patients were diagnosed with 12-month MDD. The disability rate due to MDD was 1.06% (95% CI: 0.85%-1.28%) among adults in Chinese community and 50.7% (95% CI: 44.3%-57.1%) among MDD patients. Depression was associated with all functional losses measured by the WHODAS. Feelings of worthlessness in life or inappropriate guilt, and psychomotor agitation or retardation were the key symptoms related to disability. Economic status, co-morbidity of physical diseases or anxiety disorders were correlates of disability scores.LIMITATIONS:The disability rate might be underestimated due to the exclusion of MDD patients living in hospitals. The effect of treatments on disability was excluded.CONCLUSIONS:Psychological symptoms, not somatic symptoms, contribute to disability in MDD patients. Disability worsens when physical diseases or anxiety disorders are present. More attention could be paid to psychological symptoms, physical diseases, and anxiety disorders in MDD patients with disabilities.

Background: Comorbidity of mental disorders hampers diagnosis and treatment of mental disorders which leaves the heavier disease burden, but little is known about its prevalence and contributing factors in China among general population. Method: China Mental Health Survey (CMHS), a cross-sectional epidemiological face-to-face household survey, was organized by Peking University Sixth Hospital in cooperation with 43 institutes across 31 provinces in China, from July 2013 to March 2015. The trained lay interviewers conducted the computer assisted personal interview of the Composite International Diagnostic (CIDI) diagnosed by The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) covering 26 mental disorders, assembled into four mental disorder classes - mood disorders class, anxiety disorders class, impulse control disorders class, substance use disorders class. The number of respondents above 18 years old completed the CIDI was 28,140 with response rate 72·90%, conforming to the valid sample size estimation. The weighted data base on post-stratification adjustment weights, non-response adjustment weight and sampling design weights. Main outcome measures include the lifetime and 12-month epidemiological comorbidity of mental disorders in China, namely their prevalence, correlation and potential contributing factors.Findings: The weighted epidemiological comorbidity prevalence of mental disorders was 4·62% (95% CI 4·38-4·88) for lifetime, and 2·42% (95% CI 2·24-2·60) for the past 12 months among Chinese general population. One quarter of those participants suffering mental disorder had at least one other comorbid mental disorder across whole life, and 22% for 12-month prevalence by the weighted estimation. For the comorbidity of specific mental disorders class, the impulse control disorders class took striking place reaching 76·38% (95% CI 72·31-80·45) with the weighted lifetime prevalence and the weighted 12- month prevalence 65·30% (95% CI 59·93-70·67); Mood disorders class comorbid with anxiety disorders class was the most common combination. We found strongly positive correlation between substance use disorders class and mood disorders class, as well as substance use disorders class and anxiety disorders class. The risk factors of mental disorders class comorbidity involved age > 50, alcohol use and chronic disease; and potential protective factors included married, working status, and higher educational level.Interpretation: Among general population in China, Comorbidity of mental disorders class is common as expected, in need of more medical resources to address it. The mechanism of mental disorders comorbidity needs further investigation to drive precise diagnosis and better treatment outcome hinted by correlations and potential contributing factors of mental disorders comorbidity. Popularizing the knowledge of mental disorders comorbidity among general population is more beneficial to its prevention, thereby relieve the public's disease burden.Funding Information: The study was funded by the special research project for non-profit public service of the Chinese Ministry of Health (grant number 201202022), the national twelfth five-year plan for science and technology support of 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).Declaration of Interests: All authors declare no competing interests.Ethics Approval Statement: CMHS was approved by the Ethical Committee of the Sixth Hospital of Peking University (IMHIRB2013–13–1). All procedures involving human participants were in accordance with the ethical standards of the institutional or national research committee and with the 1964 Helsinki declaration and its later amendments or similar ethical standards. Written informed consent was obtained from all participants for data use.

Given the important role of oxidative stress in the pathogenesis of depression, the potential role of dietary antioxidant supplementation in the prevention of depression has attracted considerable attention. Most studies suggest that dietary carotenoids may play a role in maintaining depressive symptoms due to their antioxidant activity, but some studies concluded the contrary. This study conducted a meta-analysis of observational studies to test the relationship between carotenoid supplements and depressive symptoms. After a comprehensive search of the Cochrane Library, PubMed, Embase Scopus, and Web of Science databases from their inception to 28 July 2022, 12 publications met the inclusion and exclusion criteria, of which 8 were cross-sectional studies, 3 were case–control studies, and 1 was a cohort study, involving a total of 33,466 participants. Pooled meta-analysis found that intake of total carotenoids (OR = 0.61, 95% CI [0.53, 0.71], p < 0.01), beta-carotene (OR = 0.61, 95% CI [0.52, 0.70], p < 0.01), alpha-carotene (OR = 0.71, 95% CI [0.60, 0.83], p < 0.01), lycopene (OR = 0.71, 95% CI [0.55, 0.90], p < 0.01), lutein, and/or corn xanthin (OR = 0.53, 95% CI [0.43, 0.66], p < 0.01) was significantly inversely associated with depressive symptoms, while beta-cryptoxanthin (OR = 1.07, 95% CI [0.52, 2.21], p = 0.86) had no significance. At the same time, this meta-analysis was free of publication bias and heterogeneity. Although further studies are needed to elucidate the causal relationship between carotenoids and depressive symptoms, and to further reveal the mechanism of their association, the results of our meta-analysis suggest that carotenoids are protective factors for depressive symptoms, and dietary intake may help in reducing the risk of depressive symptoms.

目的:了解广东省严重精神障碍社区居住患者的一般人口学特征、临床症状及生活状态,并分析其与医院患者之间的差异,为进一步开展严重精神障碍管理治疗工作提供依据.方法:于2018年12月—2019年2月,采用多阶段分层抽样的方法对广东省下辖11个地级市中精神卫生机构(精神卫生专科机构及社区卫生服务中心)住院或管理的6886例严重精神障碍患者开展调查.结果:与住院患者比较,社区居住患者一般人口学特征、临床症状以及生活状态的分布差异有统计学意义(P<0.05).住院患者在<18岁、18～44岁以及≥60岁年龄段构成比均高于社区居住患者(P<0.05),而在45～59年龄段构成比低于社区患者(P<0.05);住院患者中男性构成比高于社区患者(P<0.05),而女性患者构成比低于社区患者(P<0.05).社区患者中已婚同居者构成比较高(P<0.05),而住院患者中未婚者构成比较高(P<0.05),社区居住患者文化程度水平在小学及以下构成比高于住院患者(P<0.05);社区居住患者出现幻觉、交流困难、猜疑、喜怒无常、行为怪异、兴奋话多、伤人毁物、悲观厌世、无故外走、自娱嬉笑和孤僻懒散等临床症状的构成比以及既往总住院次数均低于住院患者(P<0.05),但首发年龄和患病总持续时间均高于住院患者(P<0.05);对2种来源患者的生活状态进行多因素Logistic回归分析,社区居住患者吸烟[OR(95％CI)=1.968(1.436～2.696)]、现在饮酒[OR(95％CI)=1.776(1.105～3.105)]、危险性评估等级[OR(95％CI)=10.197(4.053～25.654)]和实际睡眠时长[OR(95％CI)=1.855(1.375～2.502)]的构成比均高于住院患者(P<0.05).社区居住患者锻炼频率低于1～2次/周[OR(95％CI)=0.566(0.425～0.755)]和目前正在被关锁[OR(95％CI)=0.205(0.070～0.600)]的构成比均低于住院患者(P<0.05).结论:广东省严重精神障碍社区居住患者较易发生幻觉、交流困难、猜疑、喜怒无常和行为怪异等临床症状以及吸烟、饮酒等不良行为.应加强针对社区居住严重精神障碍患者的治疗管理,特别是综合干预,平衡发展社区与医院的服务功能.

In order to strategy more suitable campus-based coronavirus disease 2019 prevention programs for undergraduate students, it is critical to identify discrepancies in knowledge of COVID-19 prevention among students from different campuses in China.The present study examined the difference in preventive knowledge about COVID-19 pandemic in undergraduate students from two cities of Greater Bay Area (GBA), Macao Special Administrative Region (SAR), which had very few cases of COVID-19 patients, and Zhuhai, which is borders Macao SAR.In August 2020, two cohorts of undergraduate students from universities in Macao (n=977) and Zhuhai (n=2818) were recruited for online, self-rating questionnaire to gain information about their knowledge in COVID-19 prevention.Macao and Zhuhai students had similar correct rates in terms of heat inactivation conditions of COVID-19 virus, SARS-CoV-2, (76.8% vs. 76.9%,P=0.950), etiquette when coughing and sneezing (75.9% vs. 75.0%,P=0.562), and use of disposable masks (92.2% vs. 90.6%,P=0.126).However, students from Macao had significantly higher rates in correct use of disinfectants against SARS-CoV-2 (24.6% vs. 17.5%,P<0.001) and in the route of transmission of SARS-CoV-2 (84.5% vs. 79.6%,P<0.001) than those from Zhuhai.In conclusion, the knowledge level of COVID-19 prevention differs among undergraduate students from Macau and Zhuhai, which warrants an appropriate region-specific health education strategie for COVID-19 prevention.

Background: In China, depressive disorders have been estimated to be the second leading cause of years lived with disability (YLDs). However, nationally representative epidemiological data for depressive disorders, in particular depressed adults’ mental health services use, are still unavailable in China. The present study is a part of the Chinese National Mental Health Survey (CMHS), 2012–15, which reported the prevalence, treatment, and associated disability of depressive disorders in the Chinese general population. Methods: The CMHS recruited a representative sample of 28140 Chinese residents (≥ 18 years) by using multistage proportional-to-population-size sampling method. Trained investigators interviewed participants with the Composite International Diagnostic Interview 3.0 to ascertain the presence of lifetime and 12-month depressive disorders according to DSM-IV criteria, including major depressive disorder (MDD), dysthymic disorder (DD), and depressive disorder not otherwise specified (DD-NOS). Participants with 12-month depressive disorders were asked whether they ever received any 12-month treatment for their emotional problems and the specific types of treatment providers. The Quick Inventory of Depressive Symptomatology and Sheehan Disability Scale (SDS) were used to evaluate the severity of and role impairments associated with 12-month depressive symptoms. Findings: The weighted lifetime and 12-month prevalence rates of any depressive disorder were 6.8% (95%CI: 5.8-7.8%) and 3.6% (95%CI: 3.0-4.2%), respectively; the corresponding figures were 3.4% (95%CI: 2.0-3.9%) and 2.1% (95%CI: 1.8-2.4%) for MDD, 1.4% (95%CI: 1.1-1.7%) and 1.0% (95%CI: 0.8-1.3%) for DD, and 3.2% (95%CI: 2.6-3.9%) and 1.4% (95%CI: 1.1-1.7%) for DD-NOS. Overall, 77.2% of persons with 12-month depressive disorders had role impairment of any SDS domain: 82.2% for MDD, 81.5% for DD, and 64.6% for DD-NOS. Depressed participants reported an average of 41.0 days out of role in the past year due to depression; the corresponding figures were 49.7 days for MDD, 54.9 days for DD, and 12.2 days for DD-NOS. In total, 88.9% of individuals with 12-month depressive disorders had clinically significant depressive symptoms: 93.7% for MDD, 91.7% for DD, and 77.5% for DD-NOS. MDD and DD had similar proportions of “severe” or “very severe” depressive symptoms (43.0% and 42.1%), which were higher than DD-NOS (13.9%). 9.5% of participants with 12-month depressive disorders were treated in any treatment sector: 3.6% in the specialty mental health (SMH), 1.5% in the general medical (GM), 0.3% in the human services (HS), and 3.3% in the complementary-alternative medical (CAM) sector. Respondents with MDD and DYS had the highest proportion of seeking treatment in SMH sector (4.7% and 3.0%) while those with DD-NOS had the highest proportion of seeking treatment in CAM sector (most treatments were Traditional Chinese Medicine) (3.3%). Only 0.5% of participants with depressive disorders were treated adequately. Rates of treatment adequacy of MDD and DYS in SMH sector were 9.2% and 2.4%, respectively. Both rates in GM sector were 0%.Interpretation: Compared to western countries, our data show a relatively low prevalence of depressive disorders in China. Nevertheless, their associated role impairments, symptom severities, and disabilities are severe. Importantly, the treatment rates are rather low, let alone adequate treatment. Nationwide programs aiming at removing barriers in availability, accessibility, and acceptability to mental healthcare are needed in China.Funding: The study was funded by the Special Research Project for Non-profit Public Service of theChinese Ministry of Health (grant number 201202022), the National Twelfth Five-Year Plan forScience and Technology Support of the Chinese Ministry of Science and Technology (grantnumbers 2012BAI01B01 & 2015BAI13B00) and the National Key R&D Program of China (grant numbers 2017YFC0907800, 2017YFC0907801).Declaration of Interests: The authors have no conflicts of interest to declareEthical Approval: The study protocol of CMHS was approved by the Ethics Committee of the Sixth Hospital ofPeking University (No.: IMH-IRB-2013-13-1).