Purpose: China has the highest excess of male births in the world at 118 to every 100 female, with a current excess of 20 million men of reproductive age. The impact on the psychological well-being of the large numbers of men who will never marry is unclear. This study was carried out to test the hypothesis that older never-married men are more predisposed to depression, low self-esteem and aggression.
Methods: The study was a cross-sectional survey using a self-completion questionnaire conducted in high sex ratio rural areas of Yunnan and Guizhou provinces. The tools used were the Beck Depression Inventory, Rosenberg's Self-Esteem Scale and the Bryant-Smith Aggression questionnaire.
Results: A total of 1,059 never-married men and 1,066 married men aged 30-40 completed questionnaires. Never-married men were financially poorer and had lower education levels than married ones. After adjusting for age, education and income, never-married men were significantly more likely to have lower self-esteem scores (P < 0.001), higher depression scores (P < 0.001), higher aggression scores (P < 0.001) and were more likely to have suicidal thoughts or wishes (P < 0.001) than married men.
Conclusion: The high prevalence of severe depression and suicide ideation in these men is of particular concern. In rural China mental health services are currently very sparse, but rural doctors could be trained to use a check score to identify severe depression, and refer as appropriate to specialist services.