Challenges facing China's mental health services in the context of COVID-19

Xiao, Yu; Chen, Tingting; Du, Na

doi:10.1016/j.genhosppsych.2022.10.007

Cited by 4 publications

(5 citation statements)

References 9 publications

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“…The current study firstly examined the real-world effects of establishing a primary psychological healthcare system to control the risks of children and adolescents’ suicide ideation in a lower-middle-income city, and found nearly 40% relative risk reduction after implementing this system at even 1-year follow-up with a consistent adjusted OR. Although integrating primary healthcare and psychological services is considered as one of the most viable options for preventing and solving children and adolescents’ suicide issues, 21 the role of such healthcare system in preventing suicide ideation among children/adolescent is still unclear so far. The supporting evidence drawn from a global meta-analysis reported the significantly decreasing in suicide ideation after integrating psychological healthcare into the primary system which employed a post-primary school-based suicide prevention (PSSP) pattern including awareness programs, screening, and interventions for high-risk children/adolescents.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Compared with typical developing children/adolescents, underprivileged individuals living in disadvantaged socio-cultural environments (e.g., orphans, de facto unattended children/adolescents, "left-behind" children/adolescents, "single-parent" children/adolescents, and children/adolescents in especially difficult circumstances) experience greater psychiatric burdens and suicidal risks, 19 but are more likely to "dropped out" from primary healthcare systems, as the fact that healthcare centers or service providers are geographically limited to economically developed urban areas, as well easily accessed for children/adolescents who are under well-parenting only. 20,21 Therefore, we still need evidence to show whether underprivileged children/adolescents in LMICs equally benefit from psychological healthcare, examining whether such system provides equitable mental health rights int he real-world practices. In June 2022, the Nanchong, one of biggest lower and middle-economic-status city including over 60% children/adolescents who are in underprivileged conditions in the western China, instigated a citywide primary psychological healthcare system (the Psychological Health Guard for Children and Adolescents Project of China, CPHG) for all eligible children/adolescents, especially in five underprivileged cohorts (i.e., children/Adolescents in especially difficult circumstance, CEDC, "Single-parenting" children/adolescents, "Left-behind" children/adolescents, de facto unattended children/adolescents and orphan).…”

Section: Introductionmentioning

confidence: 99%

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The real-world evidence to the effects of primary psychological healthcare system in diluting risks of suicide ideation in underrepresented children/adolescents: an observational, multi-center, population-based, and longitudinal study

Li,

Liu,

Zhang

et al. 2024

Preprint

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Background Establishing primary psychological healthcare system to prevent suicide was eagerly advocated. However, it remains unclear whether such policy-driven and low-cost healthcare systems could be practical, especially with equal benefits for underrepresented children/adolescents. We aimed to examine the real-world practical effects of primary psychological healthcare system in preventing suicide ideation among children/adolescents, particularly underprivileged ones. Method and Findings The study employed an observational, multi-center, population-based and longitudinal design. 19,140 children/adolescents sampled from lower- and middle-income areas of western China (Nanchong) with 1-year followed-ups were included, of which majority to underrepresented underprivileged ones. The primary outcome was the incidence for reporting severe suicide ideation after practicing primary psychological healthcare system at 0.5-year and 1-year follow-ups, as contrasts to baseline. Subgroup analysis was conducted to examine the equal benefits of system for underrepresented children/adolescents. After instigating such system, the risks of reporting suicide ideation for included children/adolescents were found significantly lower compared with the control group at 0.5-year (adjust odds ratios [aOR] 0.28, 95%CI 0.23-0.33; p<0.001) and 1-year follow-ups (aOR 0.28, 95%CI 0.23-0.33; p<0.001). The effects were also observed among underrepresented children/adolescents including “left-behind” children/adolescents, “single-parent” children/adolescents and children/adolescents in especially difficult circumstance (CEDC, all pcorrected < 0.001). The effects in CEDC and “left-behind” children/adolescents were found non-inferior to typical developing cohort (all pcorrected < 0.01). Conclusions Primary psychological healthcare system was practically effective in reducing risks of suicide ideation in children/adolescents in 1-year, at least, but not yet with fully equal benefits for all the underprivileged ones.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The real-world evidence to the effects of primary psychological healthcare system in diluting risks of suicide ideation in underrepresented children/adolescents: an observational, multi-center, population-based, and longitudinal study

Li,

Liu,

Zhang

et al. 2024

Preprint

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“…Mental health services in China suffer not only from a lack of resources, but also from inequita-ble distribution of those resources in urban vs rural areas. [40][41][42] It remains di cult for people with mental health problems to seek medical attention. The government should increase support for the training of psychiatrists and strengthen mental health education for the population.…”

Section: Discussionmentioning

confidence: 99%

Decomposition Analysis of Differences in Depressive Symptoms between Agricultural and Non-Agricultural Workers in China

Zhao,

Lan,

et al. 2024

Preprint

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Background: Chinese workers are confronted with severe mental health issues. This study aimed to investigate the reasons for the differences in depressive symptoms between agricultural and non-agricultural workers in China, and to measure the contribution of relevant influencing factors. Methods: The data used in this study came from the 2018 China Family Panel Studies (CFPS) data. We used the brief 8-item Centre for Epidemiological Studies Depression Scale (CES-D-8) to measure participants’ depressive symptoms, and Fairlie decomposition model was used to analyze the influencing factors for the differences in depressive symptoms between agricultural and non-agricultural workers and their contribution. Results: The percentage of employed people with depressive symptoms was 14.45%. The percentage of agricultural workers (18.71%) with depressive symptoms was higher than that of non-agricultural workers (11.33%).The results of Fairlie decomposition analysis showed that 74.59% of the differences in depressive symptoms between agricultural and non-agricultural workers was due to observed factors, which were education level (39.58%), self-rated health (25.72%), marital status (-23.80%), residence (12.19%), job satisfaction (8.31%), chronic disease (5.64%), gender (5.14%), life satisfaction (3.47%) , and body mass index (-1.26%) (all p<0.05). Conclusions: The percentage of depressive symptoms was higher in agricultural than in non-agricultural workers, which was primarily associated with differences in socioeconomic status and health status factors between agricultural and non-agricultural workers.

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“…Researchers affirm China’s cohesiveness in caring for sick and disabled family members and have also found that changes such as reduced family size and population mobility have contributed to a decrease in members’ willingness and abilities to care for their mentally ill relatives (Chan, 2011; Xiao, 2016). This paper answers whether the conflict between the ‘family-oriented’ ideology and social changes has led to the collapse of traditional family care modes for people with mental disorders in a rural community context.…”

Section: Conclusion and Reflectionmentioning

confidence: 99%

The complex impact of family caregiver kinship type on the rehabilitation of patients with mental disorders in rural communities of China

Sui²,

Wang³

et al. 2023

Int J Soc Psychiatry

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Background: In 2009, the Chinese government incorporated severe mental disorders into the central subsidized local health funding project for the effective management, treatment, and reintegration of patients with severe mental disorders from hospitals into the community (Project 868). The conditions that were classified as ‘severe’ by this project included: schizophrenia, schizoaffective disorders, paranoid disorders, bipolar disorders, mental disorders caused by epilepsy, and mental retardation accompanying mental disorders. Patients in rural communities received better care after project implementation, of which 62.91% were farmers. Objective: This paper attempts to investigate the complex impact of Project 686 on the levels of rehabilitation of patients by their families. Methods: The last follow-up visit of the community psychiatrists in city H in 2020 was used as the time point. Finally, 174 samples were used in the analysis model. The type of kinship between family caregivers and patients with mental disorders was operationalized according to the information provided under the ‘primary caregiver’ item within the basic information section of the follow-up form. The software Stata15 was used to perform descriptive statistics, baseline regression model analysis, and a robustness test on the types of kinship identified and patients’ recovery. Results: The types of kinship, current symptoms, and medication use all affected patients’ recovery, were found to have regression coefficients of −0.148, −1.756, and 0.902, respectively. Parents of patients with mental disorders remain in the caregiver category with the largest proportion. Community acceptance of patients is high; current symptoms, medication use, and types of caregiver-patient relationships influence patients’ recovery levels. Conclusions and discussion: Project 686 has solved some of the rehabilitation and living difficulties of patients with mental disorders in rural communities. The types of kinship between family caregivers and patients with mental disorders in rural communities affect patients’ rehabilitation levels. Patients’ current symptoms and medication use can effectively moderate the impact of kinship type on patients’ recovery in terms of complete self-knowledge, productive work, and life and good social relationships. It is necessary for mental illness prevention-treatment organizations to establish supplemental, replacement, and substitution mechanisms for the life and rehabilitation of patients with mental disorders in rural communities. Furthermore, the sense of reward and concern for family caregivers should be actively enhanced, and greater scientific use of the rehabilitation function of the ‘family care + village doctor management’ model should be made.

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Challenges facing China's mental health services in the context of COVID-19

Cited by 4 publications

References 9 publications

The real-world evidence to the effects of primary psychological healthcare system in diluting risks of suicide ideation in underrepresented children/adolescents: an observational, multi-center, population-based, and longitudinal study

The real-world evidence to the effects of primary psychological healthcare system in diluting risks of suicide ideation in underrepresented children/adolescents: an observational, multi-center, population-based, and longitudinal study

Decomposition Analysis of Differences in Depressive Symptoms between Agricultural and Non-Agricultural Workers in China

The complex impact of family caregiver kinship type on the rehabilitation of patients with mental disorders in rural communities of China

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