Elevated Depressive Symptoms and Reported Mental Health Care Among Middle-Aged and Older Adults in China: A Pooled CHARLS Analysis

Objective To estimate reported mental health-related diagnosis and treatment frequencies among middle-aged and older adults in China with elevated depressive symptoms, including those with recent general medical contact. Method Respondent-wave observations were pooled from four Harmonized China Health and Retirement Longitudinal Study (CHARLS) waves (2011-2018) among adults aged 45 or older. Elevated symptoms were defined as a 10-item Center for Epidemiologic Studies Depression Scale score ≥10. Proportions used wave-specific respondent weights; 95% confidence intervals used community-cluster bootstrap resampling. Pooled logistic regression used community-clustered robust standard errors; sensitivity analyses used respondent-clustered and normalized-weight models. Results Among 67,472 observations from 23,619 individuals, weighted symptom prevalence was 32.4% (95% CI = 31.1%-33.6%). Among symptom-positive observations with outcome data, a doctor diagnosis of emotional, nervous, or psychiatric problems was reported in 3.3% (95% CI = 2.9%-3.7%), and related treatment in 1.3% (95% CI = 1.1%-1.6%). Among 719 symptom-positive observations with reported diagnosis and positive weights, 557 had treatment data; 37.7% (95% CI = 32.1%-43.9%) of these reported treatment. Among symptom-positive observations with recent outpatient or inpatient contact, 4.3% included a reported diagnosis and 1.8% included treatment. Of 5013 respondents with elevated symptoms but no reported diagnosis or treatment in 2011, 76.3% reported elevated symptoms during follow-up; 3.9% later reported diagnosis and 1.3% reported treatment. Conclusions Reported mental health-related diagnosis and treatment were uncommon among symptom-positive observations, even after recent medical contact. Questionnaire routing and missing treatment data limit interpretation of the apparent gap. Because symptoms and care were self-reported, these estimates should not be interpreted as clinical treatment rates for depressive disorders.