Skip to main content
×
×
Home

Early-life exposure to severe famine and subsequent risk of depressive symptoms in late adulthood: the China Health and Retirement Longitudinal Study

  • Changwei Li (a1), Toni Miles (a2), Luqi Shen (a3), Ye Shen (a4), Tingting Liu (a5), Mengxi Zhang (a6), Shengxu Li (a7) and Cheng Huang (a8)...
Abstract
Background

The Chinese Great Famine caused widespread starvation in 1959–1961. Its long-term association with depressive symptoms has not been studied.

Aims

To estimate the burden of depressive symptoms and the association of famine exposure with depressive symptoms.

Method

The China Health and Retirement Longitudinal Study is a nationwide representative survey of 17 708 Chinese adults aged ≥45. Propensity score matching and modified Poisson regression were used to evaluate the association between self-reported famine exposure in early life and depressive symptoms among the overall participants. Such associations were also assessed by developmental stage using modified Poisson regression and logistic regression.

Results

The prevalence of depressive symptoms was 26.2% (95% CI 25.1–27.3%) in 2011. As defined by loss of family members because of starvation, 11.6% (95% CI 10.1–13.1%) of this population experienced severe famine. When compared with participants who did not experience starvation, those who had experienced severe famine during fetal, mid-childhood, young-teenage and early-adulthood stages had 1.87 (95% CI 1.36–2.55), 1.54 (95% CI 1.23–1.94), 1.47 (95% CI 1.09–2.00) and 1.77 (95% CI 1.42–2.21) times higher odds of having depressive symptoms in late adulthood, respectively. The first two trimesters of pregnancy were a critical time window during the fetal stage when severe famine had a stronger association with depressive symptoms. Famine during infant, toddler, preschool or teenage stages was not associated with depressive symptoms. Overall, famine contributed to 13.6% of the depressive symptom burden in this population.

Conclusions

The Chinese Great Famine contributed substantially to the burden of depressive symptoms in China.

Declaration of interest

None.

Copyright
Corresponding author
Correspondence: Cheng Huang, School of Economics and Management, Harbin Institute of Technology (Shenzhen), Building E Room 412, Nanshan District, Shenzhen 518055, Guangdong, China. Email: pkuteach@gmail.com
References
Hide All
1Charlson, FJ, Baxter, AJ, Cheng, HG, Shidhaye, R, Whiteford, HA. The burden of mental, neurological, and substance use disorders in China and India: a systematic analysis of community representative epidemiological studies. Lancet 2016; 388: 376–89.
2St Clair, D, Xu, M, Wang, P, Yu, Y, Fang, Y, Zhang, F, et al. Rates of adult schizophrenia following prenatal exposure to the Chinese famine of 1959-1961. JAMA 2005; 294: 557–62.
3Whitaker, RC, Phillips, SM, Orzol, SM. Food insecurity and the risks of depression and anxiety in mothers and behavior problems in their preschool-aged children. Pediatrics 2006; 118: e85968.
4de Rooij, SR, Painter, RC, Phillips, DI, Räikkönen, K, Schene, AH, Roseboom, TJ. Self-reported depression and anxiety after prenatal famine exposure: mediation by cardio-metabolic pathology? J Dev Orig Health Dis 2011; 2: 136–43.
5Stein, AD, Pierik, FH, Verrips, GH, Susser, ES, Lumey, LH. Maternal exposure to the Dutch famine before conception and during pregnancy: quality of life and depressive symptoms in adult offspring. Epidemiology 2009; 20: 909–15.
6Huang, C, Guo, C, Nichols, C, Chen, S, Martorell, R. Elevated levels of protein in urine in adulthood after exposure to the Chinese famine of 1959–61 during gestation and the early postnatal period. Int J Epidemiol 2014; 43: 1806–14.
7Zhao, Y, Hu, Y, Smith, JP, Strauss, J, Yang, G. Cohort profile: the China Health and Retirement Longitudinal Study (CHARLS). Int J Epidemiol 2014; 43: 61–8.
8Li, C, Liu, T, Sun, W, Wu, L, Zou, ZY, Li, C, et al. Prevalence and risk factors of arthritis in a middle-aged and older Chinese population: the China health and retirement longitudinal study. Rheumatology 2015; 54: 697706.
9Feng, XL, Pang, M, Beard, J. Health system strengthening and hypertension awareness, treatment and control: data from the China Health and Retirement Longitudinal Study. Bull World Health Org 2014; 92: 2941.
10Zhao, Y, Strauss, J, Yang, G, Giles, J, Hu, P, Hu, Y, et al. China Health and Retirement Longitudinal Study - 2011-2012 National Baseline Users’ Guide. Peking University, 2013.
11Kohout, FJ, Berkman, LF, Evans, DA, Cornoni-Huntley, J. Two shorter forms of the CES-D (Center for Epidemiological Studies Depression) depression symptoms index. J Aging Health 1993; 5: 179–93.
12Chen, H, Mui, AC. Factorial validity of the Center for Epidemiologic Studies Depression Scale short form in older population in China. Int Psychogeriatr 2014; 26: 4957.
13Stuart, EA. Matching methods for causal inference: a review and a look forward. Stat Sci 2010; 25: 1.
14Burgette, L, Griffin, BA, McCaffrey, D. Propensity Scores for Multiple Treatments: A Tutorial for the MNPS Function in the Twang Package. R package Rand Corporation, 2017.
15McCaffrey, DF, Griffin, BA, Almirall, D, Slaughter, ME, Ramchand, R, Burgette, LF. A tutorial on propensity score estimation for multiple treatments using generalized boosted models. Stat Med 2013; 32: 3388–414.
16Zou, G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol 2004; 159: 702–6.
17Walter, SD. The estimation and interpretation of attributable risk in health research. Biometrics 1976; 32: 829–49.
18Guo, H, Zhu, P, Yan, L, Li, R, Hu, B, Lian, Y, et al. The DNA methylation landscape of human early embryos. Nature 2014; 511: 606–10.
19Tobi, EW, Goeman, JJ, Monajemi, R, Gu, H, Putter, H, Zhang, Y, et al. DNA methylation signatures link prenatal famine exposure to growth and metabolism. Nat Commun 2014; 5: 5592.
20Tobi, EW, Lumey, LH, Talens, RP, Kremer, D, Putter, H, Stein, AD, et al. DNA methylation differences after exposure to prenatal famine are common and timing- and sex-specific. Hum Mol Genet 2009; 18: 4046–53.
21Heijmans, BT, Tobi, EW, Stein, AD, Putter, H, Blauw, GJ, Susser, ES, et al. Persistent epigenetic differences associated with prenatal exposure to famine in humans. Proc Natl Acad Sci USA 2008; 105: 17046–9.
22Córdova-Palomera, A, Fatjó-Vilas, M, Gastó, C, Navarro, V, Krebs, MO, Fañanás, L. Genome-wide methylation study on depression: differential methylation and variable methylation in monozygotic twins. Transl Psychiatry 2015; 5: e557.
23Nemoda, Z, Massart, R, Suderman, M, Hallett, M, Li, T, Coote, M, et al. Maternal depression is associated with DNA methylation changes in cord blood T lymphocytes and adult hippocampi. Transl Psychiatry 2015; 5: e545.
24Haartsen, R, Jones, EJ, Johnson, MH. Human brain development over the early years. Curr Opin Behav Sci 2016; 10: 149–54.
25Eccles, JS. The development of children ages 6 to 14. Future Child 1999; 9: 3044.
26Hayden, EP, Olino, TM, Mackrell, SV, Jordan, PL, Desjardins, J, Katsiroumbas, P. Cognitive vulnerability to depression during middle childhood: stability and associations with maternal affective styles and parental depression. Pers Individ Dif 2013; 55: 892–7.
27Gispert-Llaurado, M, Perez-Garcia, M, Escribano, J, Closa-Monasterolo, R, Luque, V, Grote, V, et al. Fish consumption in mid-childhood and its relationship to neuropsychological outcomes measured in 7–9 year old children using a NUTRIMENTHE neuropsychological battery. Clin Nutr 2016; 35: 1301–7.
28McNeely, C, Blanchard, J. The Teen Years Explained: A Guide to Healthy Adolescent Development. Johns Hopkins University, 2010.
29Fergusson, DM, Horwood, LJ, Ridder, EM, Beautrais, AL. Subthreshold depression in adolescence and mental health outcomes in adulthood. Arch Gen Psychiatry 2005; 62: 6672.
30Phillips, MR, Zhang, J, Shi, Q, Song, Z, Ding, Z, Pang, S, et al. Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001-05: an epidemiological survey. Lancet 2009; 373: 2041–53.
31Li, D, Zhang, DJ, Shao, JJ, Qi, XD, Tian, L. A meta-analysis of the prevalence of depressive symptoms in Chinese older adults. Arch Gerontol Geriatr 2014; 58: 19.
32Gu, L, Xie, J, Long, J, Chen, Q, Pan, R, Yan, Y, et al. Epidemiology of major depressive disorder in mainland china: a systematic review. PLoS One 2013; 8: e65356.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Type Description Title
WORD
Supplementary materials

Li et al. supplementary material
Tables S1-S4 and Figures S1 and S2

 Word (171 KB)
171 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 13
Total number of PDF views: 54 *
Loading metrics...

Abstract views

Total abstract views: 581 *
Loading metrics...

* Views captured on Cambridge Core between 3rd July 2018 - 20th August 2018. This data will be updated every 24 hours.

Early-life exposure to severe famine and subsequent risk of depressive symptoms in late adulthood: the China Health and Retirement Longitudinal Study

  • Changwei Li (a1), Toni Miles (a2), Luqi Shen (a3), Ye Shen (a4), Tingting Liu (a5), Mengxi Zhang (a6), Shengxu Li (a7) and Cheng Huang (a8)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *