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Depression, Anxiety, and Cardiovascular Disease in Chinese: A Review for a Bigger Picture

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      Abstract

      Cardiovascular disease (CVD) and depression and anxiety contribute substantially to the current disease burden worldwide as well as in China. Both depression and anxiety are highly prevalent among patients with CVD. We systematically reviewed the literature to disentangle the role of depression and anxiety disorders in the onset and prognosis of CVD with an emphasis on cohort studies conducted in the Chinese population. Despite the lack of large-scale prospective studies in China, the available evidence implies that both depression and anxiety are closely associated with the onset and prognosis of CVD, including ischemic heart disease and stroke, in Chinese adults. Putative behavioral and biological mechanisms are implicated in the link between depression/anxiety and CVD. Timely screening and diagnosis followed by proper treatment should be implemented for depression and anxiety in both the general population and patients with CVD. Current standard treatments such as selective serotonin reuptake inhibitors and psychotherapies are recommended for CVD patients with depression, although their efficacy for reducing CVD morbidity and mortality remains uncertain. In conclusion, prospective studies on the link between depression/anxiety and the onset and prognosis of CVD are urgently needed in the Chinese population, and more efforts are warranted to examine the efficacy of depression and anxiety treatments for CVD patients, particularly the integrated care model of including psychiatrists in a multidisciplinary clinical group.

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      Rapid health transition in China, 1990-2010: findings from the Global Burden of Disease Study 2010.

      China has undergone rapid demographic and epidemiological changes in the past few decades, including striking declines in fertility and child mortality and increases in life expectancy at birth. Popular discontent with the health system has led to major reforms. To help inform these reforms, we did a comprehensive assessment of disease burden in China, how it changed between 1990 and 2010, and how China's health burden compares with other nations. We used results of the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) for 1990 and 2010 for China and 18 other countries in the G20 to assess rates and trends in mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE). We present results for 231 diseases and injuries and for 67 risk factors or clusters of risk factors relevant to China. We assessed relative performance of China against G20 countries (significantly better, worse, or indistinguishable from the G20 mean) with age-standardised rates and 95% uncertainty intervals. The leading causes of death in China in 2010 were stroke (1·7 million deaths, 95% UI 1·5-1·8 million), ischaemic heart disease (948,700 deaths, 774,500-1,024,600), and chronic obstructive pulmonary disease (934,000 deaths, 846,600-1,032,300). Age-standardised YLLs in China were lower in 2010 than all emerging economies in the G20, and only slightly higher than noted in the USA. China had the lowest age-standardised YLD rate in the G20 in 2010. China also ranked tenth (95% UI eighth to tenth) for HALE and 12th (11th to 13th) for life expectancy. YLLs from neonatal causes, infectious diseases, and injuries in children declined substantially between 1990 and 2010. Mental and behavioural disorders, substance use disorders, and musculoskeletal disorders were responsible for almost half of all YLDs. The fraction of DALYs from YLDs rose from 28·1% (95% UI 24·2-32·5) in 1990 to 39·4% (34·9-43·8) in 2010. Leading causes of DALYs in 2010 were cardiovascular diseases (stroke and ischaemic heart disease), cancers (lung and liver cancer), low back pain, and depression. Dietary risk factors, high blood pressure, and tobacco exposure are the risk factors that constituted the largest number of attributable DALYs in China. Ambient air pollution ranked fourth (third to fifth; the second highest in the G20) and household air pollution ranked fifth (fourth to sixth; the third highest in the G20) in terms of the age-standardised DALY rate in 2010. The rapid rise of non-communicable diseases driven by urbanisation, rising incomes, and ageing poses major challenges for China's health system, as does a shift to chronic disability. Reduction of population exposures from poor diet, high blood pressure, tobacco use, cholesterol, and fasting blood glucose are public policy priorities for China, as are the control of ambient and household air pollution. These changes will require an integrated government response to improve primary care and undertake required multisectoral action to tackle key risks. Analyses of disease burden provide a useful framework to guide policy responses to the changing disease spectrum in China. Bill & Melinda Gates Foundation. Copyright © 2013 Elsevier Ltd. All rights reserved.
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        Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001-05: an epidemiological survey.

        In China and other middle-income countries, neuropsychiatric conditions are the most important cause of ill health in men and women, but efforts to scale up mental health services have been hampered by the absence of high-quality, country-specific data for the prevalence, treatment, and associated disability of different types of mental disorders. We therefore estimated these variables from a series of epidemiological studies that were done in four provinces in China. We used multistage stratified random sampling methods to identify 96 urban and 267 rural primary sampling sites in four provinces of China; the sampling frame of 113 million individuals aged 18 years or older included 12% of the adult population in China. 63 004 individuals, identified with simple random selection methods at the sampling sites, were screened with an expanded version of the General Health Questionnaire and 16,577 were administered a Chinese version of the Structured Clinical Interview for Diagnostic and Statistical Manual (DSM)-IV axis I disorders by a psychiatrist. The adjusted 1-month prevalence of any mental disorder was 17.5% (95% CI 16.6-18.5). The prevalence of mood disorders was 6.1% (5.7-6.6), anxiety disorders was 5.6% (5.0-6.3), substance abuse disorders was 5.9% (5.3-6.5), and psychotic disorders was 1.0% (0.8-1.1). Mood disorders and anxiety disorders were more prevalent in women than in men, and in individuals 40 years and older than in those younger than 40 years. Alcohol use disorders were 48 times more prevalent in men than in women. Rural residents were more likely to have depressive disorders and alcohol dependence than were urban residents. Among individuals with a diagnosable mental illness, 24% were moderately or severely disabled by their illness, 8% had ever sought professional help, and 5% had ever seen a mental health professional. Substantial differences between our results and prevalence, disability, and treatment rate estimates used in the analysis of global burden of disease for China draw attention to the need for low-income and middle-income countries to do detailed, country-specific situation analyses before they scale up mental health services. China Medical Board of New York, WHO, and Shandong Provincial Bureau of Health.
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          Cause-specific mortality for 240 causes in China during 1990-2013: a systematic subnational analysis for the Global Burden of Disease Study 2013.

          China has experienced a remarkable epidemiological and demographic transition during the past three decades. Far less is known about this transition at the subnational level. Timely and accurate assessment of the provincial burden of disease is needed for evidence-based priority setting at the local level in China.
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            Author and article information

            Affiliations
            1Department of Epidemiology and Biostatistics Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
            2Department of Health Care, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
            Author notes
            Correspondence: An Pan, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan 430030, China, Tel.: +86-27-83627309, E-mail: panan@ 123456hust.edu.cn
            Journal
            CVIA
            Cardiovascular Innovations and Applications
            CVIA
            Compuscript (Ireland )
            2009-8782
            2009-8618
            February 2017
            June 2017
            : 2
            : 2
            : 237-251
            cvia20160059
            10.15212/CVIA.2016.0059
            Copyright © 2017 Cardiovascular Innovations and Applications

            This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

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