JMIR Publications

ABSTRACT

Background:

Depression is associated with significant morbidity and human capital costs globally. Early screening for depressive symptoms and timely case identification and intervention have been shown to improve health outcomes and cost-effectiveness among affected individuals. Although China’s public and academic community has reached a consensus on the need to improve access to early screening, diagnosis, and treatment of depression, few studies have been conducted in China related to the screening and prevention of depression in community residents and developing integrated mental health care models connecting primary, hospital, and community care divisions.

Objective:

This study aimed to estimate the screening prevalence and associated factors of subthreshold depressive symptoms among Chinese residents enrolled in an electronic-based integrated mental health care model; to investigate the 12-month incidence and related factors of major depressive disorder (MDD) among those with depressive symptoms.

Methods:

Data were drawn from the Depression Cohort in China (DCC) study (ChiCTR registry number: 1900022145). There were 34 primary health care settings, one general hospital, and one specialized mental health hospital participating in the DCC study. A total of 4,243 community residents aged 18-64 years in the Nanshan district were encouraged to participate in the DCC study in the primary health care settings, and 4,066 residents who met the DCC study criteria were screened for subthreshold depressive symptoms by the Patient Health Questionnaire-9 (PHQ-9). Of these residents, 3,168 were diagnosed with depressive symptoms (PHQ-9 ≥5) and received a diagnosis of incident MDD within 12 months in hospitals. Sleep duration, anxiety symptoms, well-being, insomnia symptoms, and resilience were investigated. The first incident of depressive disorder was assessed by the Mini-International Neuropsychiatric Interview (MINI).

Results:

Anxiety symptoms (Adjusted OR [AOR]=1.63, 95% CI=1.42-1.87) and insomnia symptoms (AOR=1.13, 95% CI=1.05-1.22) were associated with an increased risk of subthreshold depressive symptoms; well-being (AOR=0.93, 95% CI=0.87-0.99) was negatively associated with depressive symptoms. During the referral period, the 12-month incidence rate of MDD among participants with subthreshold depressive symptoms was 6.0%. After incorporating all significant variables, a history of comorbidities was independently associated with an increased risk of incident depressive disorder (adjusted HR [AHR]=1.49, 95% CI=1.04-2.14). Anxiety symptoms (AHR=1.13, 95% CI=1.09-1.17) were positively associated with incident MDD. WHO well-being was associated with a decreased risk of incident MDD (AHR=0.90, 95% CI=0.86-0.94). A linear and positive association between anxiety symptoms and incident MDD was observed.

Conclusions:

Early screening for subthreshold depressive symptoms, especially when complicated by anxiety symptoms and unfavorable general well-being warrant and early intervention, may forestall and prevent incident MDD.