Ethnic Disparities in Mental Health Among Adults in China

There are significant gaps in the research on ethnic disparities in mental health status among adults nationwide in China. Evidence is needed to fill these gaps.

To examine the mental health status by ethnic group in China and to explore the sociodemographic and health-related factors associated with these mental health disparities.

This cross-sectional study used data from a multicenter, population-based survey conducted from June to August 2023. Participants were required to be aged 18 years or older and Chinese nationals and permanent residents. After quota sampling based on Chinese population statistics, 30 054 questionnaires were included in final analyses. Data were analyzed from March to April 2024.

Ethnicity, categorized as Han or minority group (ie, Achang, Bai, Blang, Bonan, Buyei, Dai, Daur, Deang, Derung, Dong, Dongxiang, Ewenki, Gaoshan, Gelao, Gin, Hani, Hezhen, Hui, Jingpo, Jino, Kazak, Kirgiz, Korean, Lahu, Lhoba, Li, Lisu, Man, Maonan, Miao, Monba, Mongol, Mulao, Naxi, Nu, Oroqen, Pumi, Qiang, Russ, Salar, She, Sui, Tajik, Tatar, Tibetan, Tu, Tujia, Uyghur, Uzbek, Va, Xibe, Yao, Yi, Yugur, and Zhuang), as well as unrecognized ethnic groups in China, ie, populations in the People's Republic of China that have been assimilated into the Han or other recognized ethnic groups but have not yet been officially identified).

Depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7-item scale. Any positive (≥1) response to the ninth item of Patient Health Questionnaire-9 was considered as having suicidal ideation.

Among the 30 054 eligible participants (median [IQR] age, 43 [29-54] years; 15 043 [50.1%] female), 27 299 (90.8%) were from the Han ethnic group and 2755 (9.2%) were from ethnic minority groups. Compared with Han participants, participants from ethnic minority groups had significantly higher prevalence of moderate to major depression symptoms (25.5% vs 19.0%; P < .001), moderate to severe anxiety symptoms (17.4% vs 12.3%; P < .001), and suicidal ideation (29.4% vs 20.9%; P < .001). Participants from ethnic minority groups had higher odds of these outcomes even after adjusting for sociodemographic and behavioral factors (moderate to major depression symptoms: adjusted odds ratio [aOR], 1.18; 95% CI, 1.07-1.29; moderate to severe anxiety symptoms: aOR, 1.23; 95% CI, 1.10-1.37; suicidal ideation: aOR, 1.34; 95% CI, 1.22-1.46]). For members of ethnic minority groups, having 2 or more chronic conditions was associated with a higher likelihood of moderate to severe anxiety symptoms (aOR, 1.57; 95% CI, 1.13-2.18) and suicidal ideation (aOR, 1.73; 95% CI, 1.30-2.29).

In this cross-sectional study in China, significant disparities of mental health were observed between Han and ethnic minority populations. Members of ethnic minority groups were at a significantly higher risk for experiencing moderate to major depression symptoms, moderate to severe anxiety, and suicidal ideation, particularly when exposed to specific risk factors, such as chronic health conditions and social stressors. Targeted public health interventions are needed to address the mental health needs of ethnic minority populations.