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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 3  |  Issue : 3  |  Page : 176-182

Disability Attributed to Mental Disorders in China


Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China

Date of Submission22-Nov-2021
Date of Decision25-Nov-2021
Date of Acceptance10-Dec-2021
Date of Web Publication23-Dec-2021

Correspondence Address:
Prof. Yueqin Huang
Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), No. 51 Hua Yuan Bei Road, Beijing 100191
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/wsp.wsp_66_21

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  Abstract 


Objectives: The objective of the study was to describe the prevalence and characteristics of disabilities attributed to mental disorders and their distributions in China, and to explore the determinants of disabilities attributed to the mental disorders. Methods: The current study is secondary data analysis for the Second National Sample Survey on Disability. The determinants of disability were assessed by applying the univariate and multivariable regression analysis. Results: Among 2,526,145 participants sampled in the survey, 15,928 participants were diagnosed as having disabilities attributed to mental disorders. The prevalence of disability attributed to mental disorders was 0.63%. Among 46,886 participants with single physical disability, 446 had comorbid mental disability, and the rate of physical disability with comorbid mental disability was 0.94%. The risk factors associated with coexisting mental disability in persons with physical disability included female gender, 30–44 and 45–59 years age groups, being unmarried, widowed or divorced, and urban background. Schizophrenia, autism spectrum disorder, and mental and behavioral disorders due to psychoactive substance were the main disorders associated with mental disability. Conclusions: Disabilities attributed to mental disorders in China should receive more attention. It is important to treat mental disorders for preventing the associated disability and develop related rehabilitation in China.

Keywords: Comorbidity, disability, mental disorder, prevalence


How to cite this article:
Huang Y, Liu Z, Liu Y, Ji N, Zhang T, Wang Y, Wu W, Li Y. Disability Attributed to Mental Disorders in China. World Soc Psychiatry 2021;3:176-82

How to cite this URL:
Huang Y, Liu Z, Liu Y, Ji N, Zhang T, Wang Y, Wu W, Li Y. Disability Attributed to Mental Disorders in China. World Soc Psychiatry [serial online] 2021 [cited 2022 Sep 27];3:176-82. Available from: https://www.worldsocpsychiatry.org/text.asp?2021/3/3/176/333430




  Introduction Top


Mental disorders affect patients, their families, and the society. Disabilities attributed to mental disorders are a social problem that cannot be ignored. According to the World Health Organization (WHO) Global Burden of Disease study of 2019, mental disorders resulted in 125 million global DALYs in 2019, equivalent to 4.9% of the total.[1] More than half of the patients with mental disorders have permanent functional damages.[2],[3],[4] Among various mental disorders, the most common is schizophrenia, which has a chronic course and high disability rate.[5] In addition, autism spectrum disorders (ASD) and behavioral syndromes associated with physiological disturbances and physical factors also impose a heavy disease burden. Up to now, there have been two national sampling surveys on disabilities in China, the first in 1986 and the second in 2006. The First National Sampling Survey on disabilities reported 2907 persons with mental disabilities, accounting for 3.76% of all disabilities.[6] The data from the Second National Sampling Survey on disabilities shows six types of disabilities.[7] Due to the long-term loss or limitation of motor function, patients with mental disorders may develop mental disabilities, which will affect their quality of life seriously.

The current study analyzed the data of the Second National Sample Survey on Disability in China. The study describes the prevalence, characteristics, and distributions of disabilities attributed to mental disorders. The proportion of mental disability comorbidity in physical disability in China has also been investigated by exploring the role of demographic factors affecting mental disability and risk factors for comorbidity of mental and physical disabilities. Such analysis utilizing the large population-based survey enables in providing scientific evidence for framing policies and regulations pertaining to the burden of disability in China.


  Methods Top


Sample

The Second China National Sample Survey on Disabilities was carried out from April 1 to May 31, 2006. A representative sample across the country was selected by planning and implementing multistage stratified clustered probability sampling (excluding Taiwan, Hong Kong, and Macao). In total, 2,526,145 participants from 734 counties, 2980 towns, and 5964 communities were sampled for the survey. Details of the survey protocol and sampling procedures are detailed elsewhere.[8] The current study population constituted survey participants aged 18 and over.

Measurements and instruments

The survey was designed in two steps: screening out disabilities and diagnosing disabilities attributed to six types of illnesses. In the screening stage, every family member of the sampled households was interviewed. According to the age of the subject, the screening was taken by two different methods. First, doctors made the health examination for children who were under 7 years of age. Second, if the participant aged 7 years and above, screening scale of disabilities was administered by trained interviewers. If any question about mental disability was positive, the subject was tested in the second stage. The qualified doctors examined whether the subject was disabled and then used the WHO Disability Assessment Schedule Version Ⅱ to assess the severity of mental disability, classified as mild, moderate, severe, or extremely severe, among those psychiatrically disabled persons. Socio-demographic information of the subject, such as the age, gender, residence location, education level, marital status, family annual income, and family size was collected. After that, the psychiatrists used the Checklist of International Classification of Diseases Tenth Edition to confirm the diagnosis of mental disorders.

Data analysis

All statistical analyses were performed using the SPSS v.18.0 (SPSS Inc, Chicago, IL, USA). The two-sided P < 0.05 was considered statistically significant. The prevalence of mental disabilities was estimated by enumerated cases of individuals with specific diagnoses and the total population at risk. In the multistage sampling procedure, the results of the sampled individuals are generalized to the entire population by estimating the probability of selection at every stage and adjusted for the response rate. This provides the sampling weight for every individual used for achieving appropriate numerator and denominator. The summary measures for the descriptive epidemiology was used to analyze the nationwide representative data. The association with various potential predictors of comorbidity and related factors as the independent variable for the dichotomous dependent variable mental disabilities was assessed by binary logistic regression analysis. The usual functional relationship being modeled in the binary logistic regression for the considered dependent and the independent variable is expressed as the logit function and expressed as P (Yi = 1 | Xi) = 1/1 + exp(-Z), where Z is the linear combination of intercept term, and the multiplier of regression coefficient and values of the independent variable (i = 1, 2, 3,…., n). The term Yi = 1 refers to the i-th individual being labeled as diseased. The association between the mental disability attributed to psychosis was performed by applying the poisson regression analysis. This analysis is suited when we have count data (discrete outcome) and hypothesize that the mean and variance of the estimated parameters are approximately same and that the probability of occurrence of certain event in the infinitesimally small-time interval is very low. In the Poisson regression analysis the functional relationship being modeled is as Log(Yi) = β0+ β1 × X1+ β2 × X2+………. βn × Xn. In both the regression analysis, the null hypothesis tested against the alternative hypothesis is of the form Ho: β=0 versus Ho: β≠0. In case the estimated value of regression coefficient is positive, the association between the dependent and independent variable is positive, otherwise negative. The statistical comparison for the association was done by performing the Pearson's Chi-square test.


  Results Top


Prevalence of disabilities attributed to mental disorders

Among 2,526,145 participants sampled in the survey, 15,928 participants were diagnosed as having disabilities attributed to mental disorders. The prevalence of disability attributed to mental disorders was 0.63%. The prevalence of disability attributed to mental disorders without other diseases was 0.47% accounting for 74% of disabilities attributed to mental disorders. Of the disability attributed only to mental disorders, 64.58% of disability was attributable to schizophrenia, schizotypal and delusional disorders. The disability attributed to psychotic disorders caused severest impairments of functions in daily and social activities. Dementia caused the severest grade of disability, constituting 44.89%.

Comorbidity and related factors of mental disability in physically disabled persons

A total of 2,049,684 people aged 15 years and above were included in this study, of which 11,632 persons had single mental disability. The prevalence of disability attributed to mental disorders was 0.57%. Among 46,886 participants with single physical disability, 446 had comorbid mental disability, and the rate of physical disability with comorbid mental disability was 0.94%. The comorbidity of individuals with severe disability and functional impairment were higher in physical disability comorbid with mental disability than those in people with physical disability only and mental disability only (P < 0.05).

The risk factors associated with mental disability coexisting with physical disability included female gender (odds ratio [OR] = 1.60, 95% confidence interval [CI]: 1.31–1.96) age group 30–44 years (OR = 1.98, 95% CI: 1.26–3.10), age group 45–59 years (OR = 1.69, 95% CI: 1.06–2.68), being unmarried (OR = 2.52, 95% CI: 1.85–3.44), being widowed or divorced (OR = 1.53, 95% CI: 1.20–1.95), urban (OR = 1.26, 95% CI: 1.02–1.54), and persons with severe disability (Grade one, R = 2.30, 95% CI: 1.63–3.26; Grade two, OR = 1.76, 95% CI: 1.34–2.30; Grade three, OR = 1.43, 95% CI: 1.14–1.79). The results of the binary logistic regression analysis are depicted in the [Table 1].
Table 1: Unconditional logistic regression analysis of comorbidity and related factors of mental disabilities in physically disabled persons

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Disability attributed to psychosis

The disability attributed to psychosis was 4.16% in the sampled people aged 15 and over. The severity of disability attributed to psychosis was higher than that of nonpsychosis disorders. Female (PR = 1.50), persons with older age (PR for persons aged 30–49, 50–64, and 65 and over were 12.78, 13.90, and 6.56 respectively), persons never married (PR = 11.74), or divorced or widowed (PR = 3.22), and people living in western areas (PR = 1. 09) had higher prevalence, while people from minority ethnic groups (PR = 0.74), finished junior high school (PR = 0.82), and those with nonagriculture household (PR = 0.81) had lower prevalence The results of the Poisson regression analysis are summarized in [Table 2].
Table 2: Poisson regression analysis for factors on mental disability attributed to psychosis

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Disability attributed to autism spectrum disorders

Among 585,679 sampled children and adolescents aged 2–17, there were 124 children and adolescents diagnosed as disability attributable to ASD. The prevalence of disability attributable to ASD in children and adolescents was 2.12/10,000, and the prevalence rates in children aged 2–3, 4–6, and 7–17 years were 1.92/10,000, 5.45/10,000, and 1.48/10,000, respectively. The prevalence of disability in males was significantly higher than that in females (2.81/10,000 vs. 1.48/10,000, P < 0.001). The proportion of disability attributable to ASD was 11.8% among mental disabilities aged 2–17 years. Respectively, 22.1% and 22.4% of mental disability in children aged 2–3 and 4–6 years was attributed to ASD. The bivariate distribution between the disability rate attributed to autism and sociodemographic characteristics and mental and behavioral disorder due to psychoactive substance and sociodemographic distribution are illustrated respectively in [Table 3] and [Table 4].
Table 3: Disability rate attributed to autism and sociodemographic distribution

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Table 4: Disability rate mental disability attributed to mental and behavioral disorders due to psychoactive substance and sociodemographic distribution

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Disability attributed to mental and behavioral disorders due to psychoactive substance

The prevalence rate of disability attributable to mental and behavioral disorders due to psychoactive substance was 0.017%. The prevalence rate in males was 15.5 times higher than that in females. The prevalence rate in the divorced was 7.1 times higher than that in the married. The prevalence rate in the unemployed was 1.8 times higher than that in the employed. The prevalence rate in the illiterate was 3. 7 times higher than that in high school and higher education level. Among the people with disability attributable to mental and behavioral disorders due to psychoactive substance, proportions of mild, moderate, severe and extremely severe of psychiatric disability accounted for 74.2%, 11.5%, 9.2%, and 5.0%, respectively. There were 357 disabled people without multiple disabilities, of which 33.3% had severe and extremely severe impairments in function of daily activities.


  Discussion Top


The Second National Sampling Survey on Disabilities is a nationwide large-scale survey on six types of disabilities. The results of the survey are important for prevention and rehabilitation of disabilities in China. According to this survey, the prevalence of disability attributed to mental disorders in China was 0.63% in 2006, being higher than 0.18% in 1986. Rather than actual increase, this reflects better estimation of the disability. First, the high sensitivity of the survey tools and strict quality control increased the case detection rates. Second, as the welfare of the mental disabilities was improved, the stigma of the disabilities attributed to mental disorders was reduced through health education, leading to the increased rates of reporting. Third, with the development of social economy, the prevalence of mental disorders in China is increasing, leading to an increase in the prevalence of disability attributed to mental disorders. The results suggest that the prevalence of mental disability in China deserves more attention, and the government should invest more resources for the prevention and rehabilitation of mental disability.

Regarding overall prevalence of disability attributed to mental disorders, psychotic disorders had poor prognosis and caused severer disabilities among all the mental disorders in the study. Most patients with psychotic disorders had disabilities attributable to the disorder, resulting in more than 40% of secondary or worse disabilities. Most people with psychotic disorders have hallucination, delusion, behavioral disturbances, impairment in thinking, emotion, and volitional activity. This results in frequent conflict with the surrounding environment and individuals, which especially does serious harm to the society.

Among all kinds of mental disabilities, dementia caused the severest grade of disability, constituting 44.89%. Dementia accounted for 13.02% of all mental disabilities including multiple disabilities, while it only accounted for 5.19% of single mental disabilities, suggesting that dementia is more likely to be combined with multiple disabilities compared to other types of mental disabilities. One important reason is that the prevalence of dementia increases with age, and it is a progressive disease with poor treatment outcome.[9] The most significant feature of this disorder is decline in the activities of daily living with increasing age, which eventually develops into the severest disability. The main risk factors of dementia are older age, family history of dementia, being female, and previous traumatic brain injury,[10] which suggests that early detection and treatment for high-risk groups can reduce the prevalence of disability caused by dementia.

Regarding comorbidity and related factors of mental disabilities in physically disabled persons, the prevalence of mental disability attributed to any mental disorder in physical disability was 0.94%, which was higher than that in the general population. Most people with physical disability have no obvious differences with normal people in perception, attention, memory, thinking, etc., However, due to their physical defects, changes in social roles and economic income, as well as discrimination and prejudice, they are more likely to have various psychological problems than others, even leading to serious mental disorders and disabilities.[11],[12],[13] The results show that the degree of physical disability comorbid with mental disability was relatively high. This study found that comorbidity of mental and physical disability aggravates degrees of disability and functional impairment of physical and mental disability. In particular, women with physical disabilities, 30–59 years age group, unmarried, divorced or widowed, urban household, and people with severe physical disabilities are high-risk groups for mental disability. Thus, early screening of mental problems is important in this population.

The prevalence of disability attributed to psychosis of the five categories covered in the study ranked first among all mental disabilities.[14] The results suggest that among disability attributed to psychosis, the most common diagnosis is schizophrenia. There are significant differences in gender, age, ethnicity, education level, marital status, employment status, household registration nature, as well as belonging to eastern, central and western regions. Although population-based epidemiological studies show that the prevalence of schizophrenia and other psychotic disorders are not high in the general population,[15] the highly disabled nature of these disorders results in a relatively higher rate of disability.[16]

Regarding prevalence of disability attributed to ASD, it was found that the prevalence in children aged 4–6 in China was 5.45/10,000, being lower than that in foreign studies.[17],[18],[19],[20],[21],[22] First, it may be due to the inclusion criteria of this survey sample, i.e., all of the study participants were screened for disability, and only those identified as disabled underwent further examination and diagnosis. Second, many diagnostic tools used internationally for autism have not been widely used in China, and there are still some difficulties in training child psychiatrists in the survey for accurate diagnosis. There was a significant difference in gender in the disability prevalence attributable to autism, the prevalence of disability in male was significantly higher than that in female, which is consistent with previous studies, suggesting that male gender may be a risk factor for autism.

The results indicated that the prevalence of disability attributable to mental and behavioral disorders due to psychoactive substance in male was 15.5 times higher than that in female, which is consistent with previous studies. The reason may be that in the Chinese cultural context, men are more easily exposed to psychoactive substances, and men are more eager for stimulation and adventure than women, which may lead to more psychoactive substance-induced mental disorders, causing disability. The study found that the prevalence of disability was higher in the divorced, unemployed, and illiterate. It can be inferred from the results that the frequency of using psychoactive substances such as alcohol and tobacco is high, but the degree of disability is low.

Limitation of the study its cross-sectional design due to which, the causal relationship between physical and mental disability cannot be determined. In addition, due to lack of knowledge, social prejudice, and stigma, the rates of diagnosis may be underestimates.

Financial support and sponsorship

Nil.

Conflict of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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