Jianguo Shi, Xian Mental Health Center
Yan Zhang, Xian Mental Health Center
Feihu Liu, Xian Mental Health Center
Yajuan Li, Xian Mental Health Center
Junhui Wang, Xian Mental Health Center
Jonathan Flint, Wellcome Trust Centre for Human Genetics
Jingfang Gao, Chinese Traditional Hospital of Zhejiang
Youhui Li, Hospital of Zhengzhou University
Ming Tao, Xinhua Hospital of Zhejiang Province
Kerang Zhang, Hospital of Shanxi Medical University
Xumei Wang, ShengJing Hospital of China Medical University
Chengge Gao, Hospital of Medical College of Xian Jiaotong University
Lijun Yang, Jilin Brain Hospital
Kan Li, Mental Hospital of Jiangxi Province
Shenxun Shi, Shanghai Jiao Tong University
Gang Wang, Capital Medical University
Lanfen Liu, Shandong Mental Health Center
Jinbei Zhang, Sun Yat-sen University
Bo Du, Hebei Mental Health Center
Guoqing Jiang, Chongqing Mental Health Center
Jianhua Shen, Tianjin Anding Hospital
Zhen Zhang, Jiangsu University
Wei Liang, Psychiatric Hospital of Henan Province
Jing Sun, Nanjing Brain Hospital
Jian Hu, Harbin Medical University
Tiebang Liu, Shenzhen Kangning Hospital
Xueyi Wang, The First Hospital of Hebei Medical University
Guodong Miao, Guangzhou Brain Hospital Guangzhou
Huaqing Meng, Hospital of Chongqing Medical University
Yi Li, Dalian No.7 Hospita
Chunmei Hu, Bo. 3 Hospital of Heilongjiang Province
Yi Li, Wuhan Mental Health Center
Guoping Huang, Sichuan Mental Health Center
Gongying Li, Mental Health Institute of Jining Medical College
Baowei Ha, Liaocheng No. 4 Hospital
Hong Deng, Mental Health Center of West China Hospital of Sichuan University
Qiyi Mei, Suzhou Guangji Hospital
Hui Zhong, Anhui Mental Health Center
Shugui Gao, Ningbo Kang Ning Hospital
Hong Sang, Changchun Mental Hospital
Yutang Zhang, No. 2 Hospital of Lanzhou University
Xiang Fang, Fuzhou Psychiatric Hospital
Fengyu Yu, Harbin No. 1 Special Hospital
Donglin Yang, Jining Psychiatric Hospital
Tieqiao Liu, No. 2 Xiangya Hospital of Zhongnan University
Yunchun Chen, Xijing Hospital of No. 4 Military Medical University
Xiaohong Hong, Mental Health Center of Shantou University
Wenyuan Wu, Tongji University Hospital
Guibing Chen, Huaian No. 3 Hospital
Min Cai, Huzhou No. 3 Hospital
Yan Song, Mudanjiang Psychiatric Hospital of Heilongjiang Province
Jiyang Pan, No. 1 Hospital of Jinan University
Jicheng Dong, Qingdao Mental Health Center
Runde Pan, Guangxi Longquanshan Hospital
Wei Zhang, Daqing No. 3 Hospital of Heilongjiang Province
Zhenming Shen, Tangshan No. 5 Hospital
Zhengrong Liu, Anshan Psychiatric Rehabilitation Hospital
Danhua Gu, Weihai Mental Health Center
Xiaoping Wang, Renmin Hospital of Wuhan University
Xiaojuan Liu, Tianjin First Center Hospital
Qiwen Zhang, Hainan Anning Hospital
Yihan Li, Wellcome Trust Centre for Human Genetics
Yiping Chen, Clinical Trial Service Unit
Kenneth S. Kendler, Virginia Commonwealth UniversityFollow

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November 2014



The prevalence of major depressive disorder (MDD) is higher in those with low levels of educational attainment, the unemployed and those with low social status. However the extent to which these factors cause MDD is unclear. Most of the available data comes from studies in developed countries, and these findings may not extrapolate to developing countries. Examining the relationship between MDD and socio economic status in China is likely to add to the debate because of the radical economic and social changes occurring in China over the last 30 years.

Principal findings

We report results from 3,639 Chinese women with recurrent MDD and 3,800 controls. Highly significant odds ratios (ORs) were observed between MDD and full time employment (OR = 0.36, 95% CI = 0.25–0.46, logP = 78), social status (OR = 0.83, 95% CI = 0.77–0.87, logP = 13.3) and education attainment (OR = 0.90, 95% CI = 0.86–0.90, logP = 6.8). We found a monotonic relationship between increasing age and increasing levels of educational attainment. Those with only primary school education have significantly more episodes of MDD (mean 6.5, P-value = 0.009) and have a clinically more severe disorder, while those with higher educational attainment are likely to manifest more comorbid anxiety disorders.


In China lower socioeconomic position is associated with increased rates of MDD, as it is elsewhere in the world. Significantly more episodes of MDD occur among those with lower educational attainment (rather than longer episodes of disease), consistent with the hypothesis that the lower socioeconomic position increases the likelihood of developing MDD. The phenomenology of MDD varies according to the degree of educational attainment: higher educational attainment not only appears to protect against MDD but alters its presentation, to a more anxious phenotype.


Copyright: © 2014 Shi et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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VCU Psychiatry Publications