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Randomized Trials Published in Chinese or Western Journals: Comparative Empirical Analysis

Purgato, Marianna PsyD; Cipriani, Andrea MD, PhD; Barbui, Corrado MD

Journal of Clinical Psychopharmacology: June 2012 - Volume 32 - Issue 3 - p 354–361
doi: 10.1097/JCP.0b013e3182546ef6
Original Contributions

Abstract: A major concern to the inclusion in systematic reviews of studies originating in China and published in Chinese journals refers to the quality of study reporting. In this systematic survey of randomized trials, we compared the characteristics of studies published in Chinese journals with those of studies published in Western journals. We included 69 studies comparing citalopram with other antidepressant drugs in the treatment of major depression. Of these, 37 (54%) were published in Chinese journals. The standard of reporting was generally poor in both Western and Chinese studies. In some Chinese studies, the generation of the randomization sequence raised concern about their experimental nature, and in almost all included studies, the concealment of allocation was not properly described. Blinding was seldom adopted in Chinese studies, and the risk of sponsorship bias was uncertain because Chinese studies did not report any financial support. In most Western studies, outcome data were selectively and incompletely reported. Pooling together all trials revealed that citalopram was similarly effective in comparison with all other antidepressant drugs both in Western studies (standardized mean difference, −0.04; 95% confidence interval, −0.15 to 0.06) and in Chinese studies (standardized mean difference, −0.08, 95% confidence interval, −0.18 to 0.02). Randomized controlled trials published in Chinese journals represent most of the studies included in this review. This suggests that omitting to search biomedical databases originating from China would systematically exclude a relevant proportion of randomized trials published in Chinese journals, with a risk of random error or bias. The increasing inclusion of Chinese studies in systematic reviews reinforces the need to check the quality of randomized trials that are meta-analyzed.

From the Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Verona, Italy.

Received March 28, 2011; accepted after revision September 15, 2011.

Reprints: Marianna Purgato, PsyD, World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Policlinico “G.B. Rossi” Piazzale L.A. Scuro, 10—37134 Verona, Italy (e-mail:

This study has no source of support.

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© 2012 Lippincott Williams & Wilkins, Inc.