Depression is rising in China

Depressive symptoms are on the increase in China, both over the life course and across cohorts. As Tingshuai Ge, Frans Johannes van Leeuwen, Quanbao Jiang and Liliya Leopold indicate, disparities in depressive symptoms by gender, education, and household registration status (hukou) have increased with age but narrowed across cohorts.

In China, mental health is rapidly emerging as a significant public health concern. The lifetime prevalence of mental disorders in China is about 17 percent, and over 90 percent of the people concerned never receive treatment (Huang et al., 2019; Lu et al., 2021). However, the Chinese sociocultural context appears increasingly challenging for mental health.

Challenges to mental health seem to accumulate throughout the life course of Chinese people. During adolescence, academic pressure constitutes a primary stressor. Upon leaving university, college students face intense competition in the job market. At the career stages, they contend with elevated work-related stress and financial pressures. As individuals progress into middle age, this stress coincides with the onset of physical health decline and burdensome familial obligations. In older age, people experience an accumulation of chronic diseases and disabilities.

Cohorts born under different sociohistorical conditions may face unique stressors. The early life of generations born before 1949 was marked by periods of ongoing war, while the cohorts born between 1959 and 1961 spent their formative years during one of the country’s most severe famines. The cohorts born between 1962 and 1965 belonged to the Chinese baby boom generation, those born between 1966 and 1976 experienced educational disruptions, and those born in 1978 and thereafter grew up in a context of rapid advancement of marketization, urbanization, and globalization. In 1980, the one-child policy was officially implemented. Those growing up since the 1990s have experienced increasing competition in education and employment.

In a recent study (Ge et al., 2025), we used data from a nationally representative longitudinal survey to investigate the life course trajectories and social change in mental health in China, while also looking at differences in these processes by gender, education, and household registration (hukou) status.

Data and methods

We analyzed data from four waves of the China Family Panel Studies (CFPS), conducted from 2012 to 2020 across 25 provinces (municipalities or autonomous regions) in China. Mental health was assessed using six negative mental states experienced by individuals in the previous week, such as feeling depressed, having difficulty doing anything, poor sleep, feeling lonely, feeling sad, and feeling unable to keep up with their lives. Each question offered four options ranging from “Almost never” (0) to “Most of the time” (3). The depressive symptoms score (0-18) was derived by summing the total scores of the six questions and was standardized, with a higher score indicating higher levels of symptoms. Hierarchical linear regression models were employed in this study.

Age, cohort and gender patterns

As visible from the left panel in Figure 1, depressive symptoms gradually increased over the life course and across cohorts. The average increase with age over the observation period (2012-2020) was 26 percent of a standard deviation across all cohorts. Yet, age-related increase in depressive symptoms has intensified across cohorts.

Men showed lower levels and a slightly slower rate of increase in depressive symptoms compared to women over the life course (right panel of Figure 1). As a result, gender differences in depressive symptoms grew with age. However, this pattern lessened across cohorts: while clearly visible among earlier cohorts (i.e., 1947, 1952, and 1962), women’s and men’s trajectories became increasingly parallel, and average differences narrowed in more recent cohorts.

Education and hukou differences

Figure 2 shows educational differences for women and men. In terms of life course trajectories, the gaps between education groups grew with age, as depressive symptoms increased more steeply among people with lower levels of education compared to those with higher levels. Across cohorts, while depressive symptoms increased among each education group, the divergent pattern in depressive symptoms by education lessened.

Differences in depressive symptoms by hukou status were similar to findings on education (Figure 3). Disparities between hukou groups grew with age, as depressive symptoms among rural residents increased at a faster rate with age compared to their urban counterparts. However, the divergent pattern in depressive symptoms with age lessened across cohorts, and almost disappeared in the most recent ones. Yet, the reduction in population differences in depressive symptoms by hukou status—similar to the results for differences by education—occurred at higher overall levels.

Conclusions

In sum, we found an increase in depressive symptoms with age and across cohorts in China. Disparities by gender, education, and hukou status increase with age, less so across cohorts, though at higher overall levels of depressive symptoms. Our results suggest that the mental health of Chinese people is continuously challenged throughout the life course. With the profound transformation of Chinese society, the younger generations have encountered a heightened array of mental health challenges. Differences in available resources may contribute to increasing mental health inequalities with age, while China’s recent policies on gender equality, educational opportunities, and urban-rural resources have helped narrow such inequalities in recent cohorts.

These findings also reveal that mental health shows very different patterns in China compared to what we know from Western countries, particularly in terms of life course patterns and disparities based on gender and rural–urban divisions.

Reference

Ge, Tingshuai, Frans Johannes Van Leeuwen, Quanbao Jiang, and Liliya Leopold. (2025). Mental Health in China: Social Change in Life Course Trajectories. Population and Development Review, https://doi.org/10.1111/padr.12684.

Huang, Yueqin, Yu Wang, Hong Wang, Zhaorui Liu, Xin Yu, Jie Yan, Yaqin Yu, et al. (2019). Prevalence of Mental Disorders in China: A Cross-Sectional Epidemiological Study. The Lancet Psychiatry 6 (3): 211–24.

Lu, Jin, Xiufeng Xu, Yueqin Huang, Tao Li, Chao Ma, Guangming Xu, Huifang Yin, et al. (2021). Prevalence of Depressive Disorders and Treatment in China: A Cross-Sectional Epidemiological Study. The Lancet Psychiatry 8 (11): 981–90.