Facilitators and barriers in the development and implementation of depression prevention and treatment policies in China: a qualitative study

Abstract

Background Depression is one of the leading causes of avoidable suffering and premature death worldwide, leading to the disease burden among mental disorders. Depression-related deaths can be prevented by developing and implementing good depression prevention and treatment policies. The goal of this study is to provide theoretical direction and useful references for examining the outstanding service work of depression prevention and treatment. It also aims to describe how depression prevention and treatment policies were developed and put into practice in China, along with the associated facilitators and barriers. Methods We integrated two data sources using a case study approach: a document review of relevant policy documents, published articles and reports between 2004 and 2022 (N = 12 papers) and in-depth interviews (N = 41). Participants were drawn from pertinent sectors to managing depression: research and academia, relevant government departments, health care providers, people with depression and their families, and community organisations. Thematic analysis was used to analyse all data. Results A comprehensive programme of work exploring specific services for depression prevention and treatment was developed in China in 2020. Facilitators of policy development and implementation include (1) political commitment and strong leadership, (2) coordination mechanisms, (3) stakeholder enthusiasm and commitment, (4) resources, and (5) the use of digital technologies. The main barriers leading to delays in policy development and implementation include (1) insufficient awareness and lack of depression literacy, (2) lack of resources and (3) stigma and social discrimination (4) lack of united action. Conclusion Although the process of implementing a distinctive service programme for depression prevention and treatment in China has been long, the current policy is in line with current global efforts. Strategies to reduce Stigma and increase knowledge about depression are part of a national and international approach to reducing the burden of depression. Political commitment and the involvement of all stakeholders remain necessary. An adequate response to depression will require the involvement of society as a whole, with joint action to reduce the risk of exposure to adversity and enhance protective factors.

Awareness, Attitudes, and Help-seeking Intention towards Perinatal Depression among Women from Different Ethnic Groups in Western Rural China

“…Conversely, Zhuang women with a family history of mental illness were less likely to seek help, likely due to the stigma attached to mental disorders an concerns about preserving family honor [48][49][50][51][52]. Accordingly, there is an urgent need for educational campaigns and policies that promote the reduction of pervasive stigma against individuals with mental disorders through various means such as utilizing mass media effectively and implementing awareness-raising interventions [53,54].…”

Epidemiology of depressive disorders among youth during Gaokao to college in China: results from Hunan Normal University mental health survey

“…Currently, the Action Plan to Develop Specialized Services for the Prevention and Treatment of Depressive Disorders [ 128 ] in China is a significant policy in the progress of mental health services. However, to implement the Plan, several major challenges need be addressed, such as lack of resources, lack of united action, and insufficient awareness of depression [ 129 , 130 ]. Thus, prevention and treatment for depression, especially the improved access of services is a long-term process cross low-income and middle-income countries [ 131 ], including China [ 129 , 130 ].…”

“…However, to implement the Plan, several major challenges need be addressed, such as lack of resources, lack of united action, and insufficient awareness of depression [ 129 , 130 ]. Thus, prevention and treatment for depression, especially the improved access of services is a long-term process cross low-income and middle-income countries [ 131 ], including China [ 129 , 130 ].…”

The Depressive Tendency Questionnaire for Chinese Middle School Students: Development and Initial Validation

“…4,14 From this perspective, the depressive tendency is important. Meta-analyses have shown that previous studies have mainly defined depressive tendencies based on three aspects: (1) individuals have at least one or two core symptoms of MDD (such as depressed mood or loss of interest), accompanied by one or more other symptoms of MDD, but do not meet all the criteria for MDD, as well as other specific criteria; (2) high scores on self-reported measures of depression, such as at least 16 points on the Centre for Epidemiological Studies Depression Scale (CES-D); (3) The duration of individual corresponding symptom manifestations is 1-2 weeks. 4,15 However, there is still a lack of unified standards and definitions for depressive tendencies.…”

“…To promote the mental health of adolescents, the Chinese government has released multiple policy documents in recent years, proposing to prioritize the prevention and treatment of depression. 1 In 2021, the Ministry of Education explicitly incorporated depression screening into the health examination content for students. Depressive tendency is regarded as an initial stage in the development of depression.…”