Relationships between depression, pain and sleep quality with doctor visits among community-based adults in north-west China

- Older age, unemployment, physical illness, higher educational level and higher income are associated with doctor visits.
- Perceived physical pain and poor sleep quality have effects on use of healthcare services.
- Depression is not associated with doctor visits when pain, sleep quality and potentially confounding factors are adjusted for.

ObjectivesPrevious studies have suggested that the high rates of unmet need for mental health services in China among depressed people are related to a cultural tendency to deny mental and emotional symptoms and instead express them somatically. Such somatization may lead a sufferer to a consultation with a healthcare professional but rarely leads to appropriate mental health treatment. This study aimed to elucidate the relationships of depression, sleep quality and perceived physical pain with doctor visits among community-based adults in China, and thus to help guide the development of clinical practices aimed at reducing unmet mental health service need.Study designCross-sectional study.MethodsIn total, 7602 north-west Chinese adults aged >40 years were included in the survey. The Center for Epidemiologic Studies Depression Scale-Chinese Edition was used to assess depressive symptoms. Subjective sleep quality was evaluated using the Pittsburgh Sleep Quality Index. The Brief Pain Inventory-Chinese Version was used to measure pain severity and pain interference.ResultsIn this study, 16.2% of people reported physical pain, and 20.0% of those who reported poor sleep quality had seen a doctor in the past month. Only 14.4% of those with depression had seen a doctor. The results of the logistic regression analyses indicated that subjects with pain were significantly more likely to have seen a doctor than subjects without pain (odds ratio [OR] 1.61; 95% confidence interval [CI] 1.32-1.97). Poor sleep quality was significantly associated with doctor visits (OR 1.76, 95% CI 1.40-2.21). Depression was not associated with doctor visits after adjusting for pain, sleep quality and potentially confounding factors.ConclusionWhen attempting to screen for depression and risk of depression in middle-aged and older adults in China, mental health professionals should focus on perceived physical pain and poor sleep quality.