Current needs for the improved management of depressive disorder in community healthcare centres, Shenzhen, China: a view from primary care medical leaders

Abstract

Background: The prevalence of depressive disorder in Shenzhen is higher than for any other city in China. Despite national health system reform to integrate mental health into primary care, the majority of depression cases continue to go unrecognized and untreated. Qualitative research was conducted with primary care medical leaders to describe the current clinical practice of depressive disorder in community healthcare centres (CHC) in Shenzhen and to explore the participants' perceptions of psychological, organizational and societal barriers and enablers to current practice with a view to identifying current needs for the improved care of depressive disorder in the community. Methods: Seventeen semi-structured, audio-recorded interviews (approx. 1 h long) were conducted in Melbourne (n = 7) and Shenzhen (n = 10) with a convenience sample of primary care medical leaders who currently work in community healthcare centres (CHC) in Shenzhen and completed any one of the 3-month long, Melbourne-based, "Monash-Shenzhen Primary Healthcare Leaders Programs" conducted between 2015 and 2017. The interview guide was developed using the Theoretical Domain's Framework (TDF) and a directed content analysis (using Nvivo 11 software) was performed using English translations. Results: Despite primary care medical leaders being aware of a mental health treatment gap and the benefits of early depression care for community wellbeing, depressive disorder was not perceived as a treatment priority in CHCs. Instead, hospital specialists were identified as holding primary responsibility for formal diagnosis and treatment initiation with primary care doctors providing early assessment and basic health education. Current needs for improved depression care included: (i) Improved professional development for primary care doctors with better access to diagnostic guidelines and tools, case-sharing and improved connection with mentors to overcome current low levels of treatment confidence. (ii) An improved consulting environment (e.g. allocated mental health resource; longer and private consultations; developed medical referral system; better access to antidepressants) which embraces mental health initiatives (e.g. development of mental health departments in local hospitals; future use of e-mental health; reimbursement for patients; doctors' incentives). (iii) Improved health literacy to overcome substantive mental health stigma in society and specific stigma directed towards the only public psychiatric hospital. Conclusions: Whilst a multi-faceted approach is needed to improve depression care in community health centres in Shenzhen, this study highlights how appropriate mental health training is central to developing a robust workforce which can act as key agents in national healthcare reform. The cultural adaption of the depression component of the

Cultural adaptation of the mental health first aid guidelines for depression used in English-speaking countries for China: a Delphi expert consensus study

“…The questionnaire for Round 1 was developed as follows: Firstly, the original statements endorsed from the English-language questionnaire were translated into Mandarin, with some of the translated statements modified to better reflect the Chinese context. For example, 'to see a GP' was replaced with 'to see a mental health specialist', as in China the number of GPs is limited and they typically lack the skills to manage people with mental health problems [39]; rather, mental health specialists are responsible for providing the majority of mental health services. In addition, all phrases referring to contacting a 'mental health crisis team' in the guidelines for English-speaking countries were revised to 'contact the police' as this is the common practice in China.…”

Under detection of depression in primary care settings in low and middle-income countries: a systematic review and meta-analysis

“…The focus of primary care clinicians on ensuring that their overall decision making is right rather than on diagnosis may be partly the reason for the low detection and the type of care provided [ 10 ]. However, the belief that depression and other mental disorders are the responsibility of the specialist, the lack of the right tools, such as diagnostic and treatment guidelines, the low level of confidence to deal with depression, the clinical environment, and user level barriers are also critical barriers to the detection and treatment of depression [ 11 ].…”

Cultural adaptation of the mental health first aid guidelines for depression used in English-speaking countries for China: a Delphi expert consensus study

“…The questionnaire for Round 1 was developed as follows: Firstly, the original statements endorsed from the English-language questionnaire were translated into Mandarin, with some of the translated statements modified to better reflect the Chinese context. For example, 'to see a GP' was replaced with 'to see a mental health specialist', as in China the number of GPs is limited and they typically lack the skills to manage people with mental health problems [43]; rather, mental health specialists are responsible for providing the majority of mental health services. In addition, all phrases referring to contacting a 'mental health crisis team' in the guidelines for English-speaking countries were revised to 'contact the police' as this is the common practice in China.…”