BackgroundThe management of severe mental disorder (SMD) patients in communities is an important initiative of healthcare reform in China. Yet the effects in terms of risk behavior of patients are unclear, particularly in rural areas. This study aims to examine high risk behaviors, changing trends, and possible associated factors among SMD patients in the rural areas of western China.MethodsThis analysis examined incidence rate (IR) of high risk behavior of 121,830 managed SMD patients in rural area of Sichuan province, based on data from the national system from 2006 to 2013. Register rate, high risk behavior IR, and time distribution and area distribution of high risk behavior were described. Two-level Poisson regression model was used to analyze associates of high risk behavior of patients, which include demographic characteristics at individual level, socio-economic condition and health system indicators at region level.ResultsIt was revealed that 6804 (5.58%) of managed patients were involved in 17,220 high risk behavior events, which gave an overall IR of 0.0998 (per person year) on the basis of 172,564 person years of follow-up. The IR varied widely across municipalities, in the range of 0.0305–0.3397. The IR of high risk behavior in the cohort had increased since 2006, and peaked by 2011, at 0.2392. At the individual level, males aged 25 to 44, who were unmarried and in poverty, illiterate or semiliterate, had a family history of mental disorders and antipsychotic treatments, longer duration illnesses, were associated with an increased IR risk. At the regional level, higher psychiatric practitioner visits and the lower annual net income of rural residents per capita, were associated with an increased IR risk.ConclusionsThis is the first large prospective study that revealed the current situation of the register rate, high risk behavior incidence rate in SMD patients in rural area of western China, and examined associates and the differences of high risk behavior of patients among municipalities. The findings may provide evidences that lead to guide prevention and control for risk behavior in SMD patients in rural areas of China, as well as to improve mental health services for this population. It could provide some reference for other developing countries too.

BackgroundViolence to others (hereinafter referred to as “violence-TO”) is common in individuals with schizophrenia. The reported prevalence of violence-TO among schizophrenics ranges widely in existing studies. Improved prevalence estimates and identification of moderators are needed to guide future management and research.MethodsWe searched EBSCO, EMBASE, Medline, PubMed, Science Direct, Web of Science, CNKI, VIP, WANFANG data, and CBM for relevant articles published before June 5, 2022. Meanwhile, violence-TO was summarized into four categories: (a) violence-TO on the reviews of official criminal or psychiatric records (type I); (b) less serious forms of violence-TO (type II); (c) physical acts causing demonstrable harm to victims (type III); (d) homicide (type IV). We did meta-analysis for the above types of violence-TO, respectively, and applied subgroup analyses and meta-regression analyses to investigate the source of heterogeneity.ResultsA total of 56 studies were eligible in this study and 34 of them were high-quality. The prevalence of type I to type IV in individuals with schizophrenia in China was 23.83% (95% CI: 18.38–29.75%), 23.16% (95% CI: 8.04–42.97%), 17.19% (95%CI: 8.52–28.04%), and 0.62% (95% CI: 0.08–1.54%) respectively. The results of the subgroup analysis showed that the prevalence of type I was higher among subjects in the inland than in the coastal non-economic zone, while the prevalence of type III was the highest in the coastal economic zone, followed by the inland region and the lowest in the coastal non-economic zone. The results of multivariate meta-regression analyses showed that: patient source in type I (β = 0.15, P < 0.01), patient source (β = 0.47, P < 0.01), and proportion of male (β = 0.19, P < 0.01) in type II, age (β = 0.25, P < 0.01), and GDP per capita (β = 0.05, P = 0.01) in type III were statistically significant.ConclusionThe prevalence of different types of violence-TO and their influencing factors varied. Therefore, the authorities should take different management measures. In addition to individual factors, regional factors may also affect violence-TO, which suggests the need for a multi-sectorial approach to prevention and treatment for subjects in different regions and adopting targeted control strategies.Systematic Review Registration[www.ClinicalTrials.gov], identifier [CRD42021269767].

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Objective Children of parents with mental illness (COPMI) are vulnerable during the COVID-19 pandemic. The study aimed to assess the psychosocial impacts of the pandemic and identify potential factors influencing their mental health. Method 665 COPMI from six sites including Wuhan in China were enrolled. COPMI's mental health and the impacts of COVID-19 were assessed by an online survey. Univariate and multivariate analyses were performed to examine the association between impact factors and participants’ mental health. Results 16.1 % of participants were in abnormal range of mental health, with interpersonal relationship being the most common problem. 48.6 % of participants reported quite worried about the epidemic. All aspects of adverse effects of COVID-19 were more prevalent among COPMI in Wuhan than in other sites. Concerns about COVID-19 (OR = 1.7, p = 0.02), decreased family income (OR = 2.0, p = 0.02), being physically abused (OR = 2.1, p = 0.04), witnessing family members being physically abused (OR = 2.0, p = 0.03), and needs for promoting family members' mental health (OR = 2.2, p < 0.01) were independent risk factors for participants' mental health. Conclusion The findings raise our awareness of the impacts of COVID-19 pandemic on the wellbeing of COPMI. Multifaceted psychosocial support for COPMI is urgently needed to support them live through the pandemic.

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