No abstract

Eager to build an integrated community-based mental health system, in 2004 China started the '686 Programme', whose purpose was to integrate hospital and community services for patients with serious mental illness. In 2015, the National Mental Health Working Plan (2015-2020) proposed an ambitious strategy for implementing this project. The goal of this review is to assess potential opportunities for and barriers to successful implementation of a community-based mental health system that integrates hospital and community mental health services into the general healthcare system. We examine 7066 sources in both English and Chinese: the academic peer-reviewed literature, the grey literature on mental health policies, and documents from government and policymaking agencies. Although China has proposed a number of innovative programmes to address its mental health burden, several of these proposals have yet to be fully activated, particularly those that focus on integrated care. Integrating mental health services into China's general healthcare system holds great promise for increased access to and quality improvement in mental health services, as well as decreased stigma and more effective management of physical and mental health comorbidities. This article examines the challenges to integrating mental health services into China's general healthcare system, especially in the primary care sphere, including: accurately estimating mental health needs, integrating mental and physical healthcare, increasing workforce development and training, resolving interprofessional issues, financing and funding, developing an affordable and sustainable mental health system, and delivering care to specific subpopulations to meet the needs of China's diverse populace. As China's political commitment to expanding its mental health system is rapidly evolving, we offer suggestions for future directions in addressing China's mental health needs.

Objective No randomized controlled trials (RCTs) for adults have tested the effectiveness of a well-specified psychotherapy compared with a culturally adapted version of the same treatment. This study evaluates the effectiveness of cognitive behavioral therapy (CBT) and culturally adapted CBT (CA-CBT) in treating depressed Chinese American adults. Methods This was a RCT that treated 50 Chinese Americans who met criteria for major depression and sought treatment at community mental health clinics. Participants were screened beginning September 2008, with the last assessment conducted in March 2011. Participants were randomly assigned to 12 sessions of CBT or CA-CBT. Stratified randomization was used for patients who were on and not on antidepressants when they first came to the clinic, and the study did not influence regular prescription practices. The primary outcomes were dropout rates and the Hamilton Depression Rating Scale measured at baseline, session 4, session 8, and session 12. Results Participants in CA-CBT evidenced a greater overall decrease in depressive symptoms than those in CBT, but depression rates remained similarly high at week 12. Differences in dropout rates approached, but did not meet statistical significance (7% CA-CBT and 26% CBT). Conclusions Chinese Americans entered this study with very severe depression. Participants in both CBT and CA-CBT evidenced significant decreases in depressive symptoms, but the majority did not reach remission. Results suggest that these short-term treatments were not sufficient to address such severe depression and that more intensive and longer treatments may be needed. Results also indicate that cultural adaptations may confer additional treatment benefits.

This pilot study tested the effect of cognitive behavioral therapy (CBT) on parent-reported autism symptoms. Nineteen children with autism spectrum disorders and an anxiety disorder (7-11 years old) were randomly assigned to 16 sessions of CBT or a waitlist condition. The CBT program emphasized in vivo exposure supported by parent training and school consultation to promote social communication and emotion regulation skills. Parents completed a standardized autism symptom checklist at baseline and posttreatment/postwaitlist and 3-month follow-up assessments. CBT outperformed the waitlist condition at posttreatment/ postwaitlist on total parent-reported autism symptoms (Cohen's d effect size = .77). Treatment gains were maintained at 3-month follow-up. Further investigation of this intervention modality with larger samples and broader outcome measures appears to be indicated.

Objective We evaluated potential explanations for advantaged mental health status among immigrant Asian American women compared to U.S. born Asian American women. Method In a nationally representative sample of 1030 women (185 U.S. born, 368 early-life immigrants [arrived before age 25], 477 late-life immigrants), we examined the hypothesis that increased exposure to social risk factors mediate nativity-based differences in lifetime prevalence of depression and anxiety disorders. Indicators of social class were also examined as protective factors enjoyed by U.S. born women that may suppress observed nativity-based disparities. We also examined whether there were group differences in reactivity to stress in predicting disorder. Results U.S. born women were twice as likely as late-life immigrants to report lifetime history of depression (O.R. = 2.03, 95% C.I [1.35, 4.54]) and anxiety (O.R. = 2.12, 95% C.I [1.34, 5.19]). Nativity differences in perceived discrimination, family conflict, and cultural conflict explained disparities in rates of disorder. There was no support for the contention that immigrant women were more psychologically hardy or resilient to social stress. Conclusion Findings suggested that the gap in mental health status between U.S. and foreign born Asian American women would be indeed be magnified if differences in social status were accounted for, but also that ready explanations for the so-called immigrant paradox are found in differential levels of reported stress exposure.