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Open Access Highly Accessed Open Badges Research article

The role of basic health insurance on depression: an epidemiological cohort study of a randomized community sample in Northwest China

Donghua Tian12, Zhiyong Qu12*, Xiaohua Wang1, Jing Guo1, Fan Xu2, Xiulan Zhang12 and Cecilia Lai-Wan Chan34

Author affiliations

1 School of Social Development and Public Policy, Beijing Normal University, 19 Xinjiekouwai St, Beijing, China

2 China Institute of Health, Beijing Normal University, 19 Xinjiekouwai St, Beijing, China

3 Center on Behavioral Health, The University of Hong Kong, 5 Sassoon Road, Pokfulam, Hong Kong, China

4 Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong, China

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Citation and License

BMC Psychiatry 2012, 12:151  doi:10.1186/1471-244X-12-151

Published: 20 September 2012



Little research has focused on the relationship between health insurance and mental health in the community. The objective of this study is to determine how the basic health insurance system influences depression in Northwest China.


Participants were selected from 32 communities in two northwestern Chinese cities through a three-stage random sampling. Three waves of interviews were completed in April 2006, December 2006, and January 2008. The baseline survey was completed by 4,079 participants. Subsequently, 2,220 participants completed the first follow-up, and 1,888 completed the second follow-up. Depression symptoms were measured by the Center for Epidemiologic Studies Depression Scale (CES-D).


A total of 40.0% of participants had at least one form of health insurance. The percentages of participants with severe depressive symptoms in the three waves were 21.7%, 22.0%, and 17.6%. Depressive symptoms were found to be more severe among participants without health insurance in the follow-up surveys. After adjusting for confounders, participants without health insurance were found to experience a higher risk of developing severe depressive symptoms than participants with health insurance (7 months: OR, 1.40; 95% CI, 1.09-1.82; pā€‰=ā€‰0.01; 20 months: OR, 1.89; 95% CI, 1.37-2.61; pā€‰<ā€‰0.001).


A lack of basic health insurance can dramatically increase the risk of depression based on northwestern Chinese community samples.

Health insurance; Depression; Poverty