Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Sep 5, 2022
Date Accepted: May 26, 2023
Association of Catastrophic Health Expenditure with the Risk of Depression in Chinese Adults: Population-based Cohort Study
ABSTRACT
Background:
Depression is one of the most common mental illnesses, and it may bring out a lasting influence during the whole life. As a form of financial hardship, catastrophic health expenditure (CHE) may be associated with depression. However, current evidence about the relationship between CHE and risk of depression is insufficient.
Objective:
The objective of this study is to explore the relationship between household CHE and risk of depression among household heads.
Methods:
Three waves of the China Family Panel Studies (CFPS) for 2012, 2016 and 2018 were used in this study. The CFPS is a nationally-representative follow-up interview study covering 25 out of 34 provinces in China, and representing nearly 94.5% of the total population. We chose eligible household heads as participants, divided them into two groups by CHE events at baseline (exposed group: with CHE; unexposed group: without CHE) and followed up. We firstly described the CHE prevalence and the incidence of depression (identified by 8-item Centre for Epidemiological Studies Depression Scale), then used Cox proportional hazard models to estimate adjusted hazard ratios (aHRs) and 95% confident intervals (CIs) of depression among participants with CHE, compared with those without CHE, and finally analyzed subgroup difference of the association between CHE and depression.
Results:
Of 13315 household heads in CFPS, 9629 were eligible for analysis. The prevalence of CHE at baseline was 12.91%. The depression incidence of participants with CHE (1.41 per 1000 person-month) was higher than those without CHE (0.73 per 1000 person-month). Multivariable adjusted analysis revealed that participants with CHE had a 33% increased risk (aHR=1.33, 95%CI: 1.08-1.64) of depression than those without. This association was appeared to be greater in participants without outpatient services (P for interaction=.048).
Conclusions:
Nearly one of ten households in China incurred CHE, and CHE had a detrimental impact on depression. Concentrated work should be done to monitor CHE, and more efforts about financial protection needed to be made for preventing depression, especially for people with demand of health care. Clinical Trial: None
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