Elsevier

Public Health

Volume 147, June 2017, Pages 30-38
Public Health

Original Research
Relationships between depression, pain and sleep quality with doctor visits among community-based adults in north-west China

https://doi.org/10.1016/j.puhe.2017.01.031Get rights and content

Highlights

  • Older age, unemployment, physical illness, higher educational level and higher income are associated with doctor visits.

  • Perceived physical pain and poor sleep quality have effects on use of healthcare services.

  • Depression is not associated with doctor visits when pain, sleep quality and potentially confounding factors are adjusted for.

Abstract

Objectives

Previous studies have suggested that the high rates of unmet need for mental health services in China among depressed people are related to a cultural tendency to deny mental and emotional symptoms and instead express them somatically. Such somatization may lead a sufferer to a consultation with a healthcare professional but rarely leads to appropriate mental health treatment. This study aimed to elucidate the relationships of depression, sleep quality and perceived physical pain with doctor visits among community-based adults in China, and thus to help guide the development of clinical practices aimed at reducing unmet mental health service need.

Study design

Cross-sectional study.

Methods

In total, 7602 north-west Chinese adults aged >40 years were included in the survey. The Center for Epidemiologic Studies Depression Scale–Chinese Edition was used to assess depressive symptoms. Subjective sleep quality was evaluated using the Pittsburgh Sleep Quality Index. The Brief Pain Inventory–Chinese Version was used to measure pain severity and pain interference.

Results

In this study, 16.2% of people reported physical pain, and 20.0% of those who reported poor sleep quality had seen a doctor in the past month. Only 14.4% of those with depression had seen a doctor. The results of the logistic regression analyses indicated that subjects with pain were significantly more likely to have seen a doctor than subjects without pain (odds ratio [OR] 1.61; 95% confidence interval [CI] 1.32–1.97). Poor sleep quality was significantly associated with doctor visits (OR 1.76, 95% CI 1.40–2.21). Depression was not associated with doctor visits after adjusting for pain, sleep quality and potentially confounding factors.

Conclusion

When attempting to screen for depression and risk of depression in middle-aged and older adults in China, mental health professionals should focus on perceived physical pain and poor sleep quality.

Introduction

Psychiatric morbidity is an important cause of disability and is associated with the use of health services and costs to the community.1 However, fewer than 6% of those suffering from depression, substance abuse or other mental health problems seek therapy in China.2 Moreover, many studies have indicated that Chinese people tend to deny depression or express it somatically,3, 4 being inclined to express their emotional feelings in terms of body parts.5 This somatic expression of depression leads patients with mood disorders to seek help from primary healthcare professionals rather than mental health professionals. Thus, research examining the relationship between depression and the use of general healthcare services is needed to help public health workers and policy makers to understand the barriers to the use of mental health services and identification of depression.

Physical pain is a major reason for seeking health care, accounting for hundreds of billions of dollars in healthcare costs worldwide.6 People with depression often present with a complex set of overlapping symptoms, including medically unexplained physical pain that may be linked to emotional issues.7 The severity of depressive symptoms is associated with the frequency of pain complaints.8 Theoretical models of help-seeking behaviour suggest that individuals progress through several stages before seeking mental health treatment. These stages include experiencing symptoms, evaluating the severity and consequences of the symptoms, assessing whether treatment is required, assessing the feasibility of and options for treatment and deciding whether to seek treatment.9 Pain may be a reason for people with depression to seek health services. However, few studies have examined the relationships of depression and pain with health service utilization at the community level.

Prior studies have shown there are complex correlations between depression, pain and poor sleep quality. Poor sleep quality is a common and key symptom among depressives and is commonly reported by patients with chronic pain.10 In addition, previous surveys have reported that between 5% and 36% of those with poor sleep quality have consulted a physician specifically for sleep problems, whereas 27–55% have discussed sleep problems in the course of a medical consultation for another problem.11 Given that poor sleep quality is an important reason for seeking health care, and the complex correlations of these three variables, it is crucial to gather more information on, and examine the use of health services by, people with depression, pain and poor sleep quality in comparison with the general population.

The aim of this study was to examine the relationship of doctor visits with depression, sleep quality and pain in China. The research findings will have important implications for identifying how to reduce unmet need for mental health services.

Section snippets

Study design

This was a cross-sectional study. The data used in this study were derived from the Chinese Urban Social Protection Survey, which was conducted in July and August 2011 by China's Provincial Civil Affairs Sector and Beijing Normal University's School of Social Development and Public Policy. Recruitment and data collection were completed during that period.

Three-stage cluster sampling was used to select households for the survey in one rural town and three cities in north-west China (Pingliang

Descriptive analysis

Overall, the participants were mainly female (52.6%), middle-aged (60.4%) and of Han ethnicity (93.6%). The mean age of the participants was 57.6 years (range 40.0–99.4 years, standard deviation 11.99). Among the non-responders, refusal to participate and being unavailable were the two main reasons for not responding. Almost 10% of subjects could not be visited because they were away from home, and 1% of those selected refused to participate in the survey.

In this study, 16.7% of the

Discussion

This study sought to examine the relationships of depression, poor sleep quality and pain with doctor visits in north-west China. The survey found that 16.2% of respondents reporting pain had seen a doctor. Among those reporting pain, 41.7% reported severe pain, and 21.1% of these had seen a doctor. Among those reporting depression, only 14.4% had seen a doctor, whereas 20.0% of those with poor sleep quality had seen a doctor. It should be noted that rates of unmet need for mental health

Acknowledgements

The authors wish to thank Ms Cordelia Fuller for her careful edit of the paper, and thank all those who helped to collect the data and those who kindly volunteered to participate in the study.

Ethical approval

This study was approved by the Ethics Committee of the School of Social Development and Public Policy at Beijing Normal University. All participants gave informed consent.

Funding

The study was supported by The Fundamental Research Funds for the Central Universities, HUST: 2016AE012. The funders had no role in

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