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Sun KS, Lam TP, Wu D, Chan TH, Browne G, Chan SWC. A Chinese help-seeking model for psychological distress in primary care: An adaptation of Andersen's Behavioral Model of Health Services Use. Transcult Psychiatry 2024; 61:182-193. [PMID: 38233734 DOI: 10.1177/13634615231225130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Help-seeking for depression and anxiety disorders from primary care physicians in Western countries is at three times the rate of China. Western help-seeking models for common mental disorders have limitations in the Chinese settings. This article argues that an adapted model based on Andersen's Behavioral Model of Health Services Use could be an appropriate tool to better understand patients' help-seeking behaviors and improve outcomes. We applied a narrative review approach to integrate research findings from China into Andersen's model to generate a model that fits the Chinese context. We found 39 relevant articles in PubMed, MEDLINE, and Chinese journal databases from 1999 to 2022. Findings were mapped onto predisposing, enabling, and need factors of the model. This model emphasizes that predisposing factors including demographics, social norms, and health beliefs influence help-seeking preferences. Mental health service users in China tend to be older and female. Chinese generally have high concern about psychotropic medications, and social norms that consider psychological distress a personal weakness may discourage help-seeking. However, help-seeking can be enhanced by enabling factors in the health system, including training of primary care physicians, longer consultation time, and continuity of care. Need factors for treatment increase with the severity of distress symptoms, and doctor's skills and attitudes in recognizing psychosomatic symptoms. While predisposing factors are relatively hard to change, enabling factors in the health system and need factors for treatment can be targeted by enhancing the role of family doctors and training in mental health.
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Affiliation(s)
- Kai Sing Sun
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Tai Pong Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Dan Wu
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK
| | - Tak Hon Chan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Graeme Browne
- Faculty of Health, Southern Cross University, Sydney, Australia
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Ma Y, Shi X, Sznajder KK, Zhao Y, Wan Q, Chai P, Yang X. Outpatient depression current care expenditure changes in Liaoning Province from 2015 to 2020: a study based on the "system of health accounts 2011". Front Pharmacol 2024; 15:1092580. [PMID: 38318143 PMCID: PMC10839069 DOI: 10.3389/fphar.2024.1092580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/08/2024] [Indexed: 02/07/2024] Open
Abstract
Introduction: Depression is the leading cause of disability worldwide and has become a health issue of global concern. Based on the "System of Health Accounts 2011" (SHA 2011) for patients with depression, this paper studies the changes in the current curative expenditure (CCE) of outpatient depression in Liaoning Province, China, and provides policy recommendations. Method: A stratified multistage random sample of 56,994 patients with depression included from 1,227 healthcare facilities in Liaoning Province were included. The significance of differences in variables within groups was analyzed by univariate analysis (including descriptive statistics analysis, Mann-Whitney U test and Kruskal-Wallis H test), and factors influencing depression outpatient CCE were analyzed by multiple linear regression analysis and constructing structural equation models (SEM). Results: The CCE of outpatient depression was ranging from CNY 75.57 million to CNY 100.53 million in 2015-2020, with the highest of CNY 100.53 million in 2018, CNY 103.28 million in 2019. Medical expenditures are mainly concentrated in general hospitals and provincial healthcare institutions, accounting for about 90% of all provincial scope expenditures. The multiple regression results show that provincial healthcare institutions, purchase of drug, select medical treatment for depression, general hospitals and urban employees' health insurance are the main influencing factors for depression outpatient CCE. The results of SEM show that insurance status negative impact outpatient expenditure. Conclusion: Health insurance is an important factor in equitable access to healthcare resources for patients, and medication expenditure is the influential factor affecting the high expenditure of outpatient clinics. It is of great importance to reduce the medical burden of patients by increasing the coverage of medical insurance, increasing the proportion of bills that are eligible for reimbursement, and improving the system by guaranteeing the supply of psychotropic medication.
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Affiliation(s)
- Yuedan Ma
- Department of Traditional Chinese Medicine, School of Graduate Students, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Xiaoxia Shi
- Department of Traditional Chinese Medicine, School of Graduate Students, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Kristin K. Sznajder
- Department of Public Health, School of Medicine, Pennsylvania State University, Hershey, PA, United States
| | - Yue Zhao
- Department of Traditional Chinese Medicine, School of Graduate Students, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Quan Wan
- China National Health Development Research Center, Beijing, China
| | - Peipei Chai
- China National Health Development Research Center, Beijing, China
| | - Xiaoshi Yang
- Department of Social Medicine, School of Health Management, China Medical University, Shenyang, China
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Zhou YH, Leung D, Lin JK, Hu LC, Lin XY, Zhang X, Mak YW. Experiences of seeking and accessing medical care among persons with major depression: A qualitative descriptive study of persons with depression in China. Front Psychiatry 2023; 14:1092711. [PMID: 36846228 PMCID: PMC9950104 DOI: 10.3389/fpsyt.2023.1092711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/24/2023] [Indexed: 02/12/2023] Open
Abstract
INTRODUCTION A large number of people in China are affected by depression, yet tend to delay seeking treatment. This study aims to explore persons living with depression and their journey of diagnoses and seeking professional medical help in China. METHODS Semi-structured interviews were conducted with 20 persons who visiting physicians to be diagnosed and receive professional help from a large mental health center in Guangzhou, Guangdong province, China. Individual interviews were conducted and data were analyzed using content analysis. RESULTS Three themes were identified from the findings: (1) "noticed something was wrong"; (2) negotiated decisions with their own narratives and the personal suggestions of others; and (3) gave new meaning to their experiences of depression, whereby they sought medical treatment. DISCUSSION The findings of the study indicated that the impact of progressive depressive symptoms on the participants' daily lives was a strong motivation for them to seek professional help. The obligation to care for and support their family prevented them from initially disclosing their depressive symptoms to family members, but eventually prompted them to seek professional help and persist in follow-up treatment. Some participants experienced unexpected benefits (e.g., relief at no longer feeling "alone") during their first visit to the hospital for depression or when they were diagnosed with depression. The results suggest a need to continue to actively screen for depression and provide more public education to prevent negative assumptions and reduce public and personal stigmatization of those with mental health problems.
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Affiliation(s)
- Yan Hua Zhou
- School of Nursing, Guangzhou Health Science College, Guangzhou, China
| | - Doris Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Jian Kui Lin
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Li Chan Hu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiao Yang Lin
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xuelin Zhang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Yim Wah Mak
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
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von Gaudecker JR, Agbapuonwu N, Kyololo O, Sathyaseelan M, Oruche U. Barriers and facilitators to treatment seeking behaviors for depression, epilepsy, and schizophrenia in low- and middle-income countries: A systematic review. Arch Psychiatr Nurs 2022; 41:11-19. [PMID: 36428038 DOI: 10.1016/j.apnu.2022.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 05/13/2022] [Accepted: 07/03/2022] [Indexed: 12/22/2022]
Abstract
Despite the severe consequences, the treatment gap for depression, epilepsy, and schizophrenia continues to be a major concern in low and middle-income countries (LMICs). We conducted a systematic review of literature on barriers and facilitators of treatment-seeking behaviors from the perspective of individuals living with depression, epilepsy, and schizophrenia and stakeholders in LMICs. Knowledge deficits, beliefs, and stigma were barriers to treatment-seeking across disorders. The most cited facilitators were demographics, socioeconomic status, and collaboration with traditional healers. Culturally sensitive interventions in collaboration with stakeholders within the community can facilitate treatment-seeking behaviors among people living with depression, epilepsy, and schizophrenia.
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Affiliation(s)
- Jane R von Gaudecker
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46202, USA.
| | - Noreen Agbapuonwu
- Department of Nursing, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria..
| | | | | | - Ukamaka Oruche
- Indiana University School of Nursing, Indianapolis, IN 46202, USA.
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Xu J, Du S, Dong X. Associations of Education Level With Survival Outcomes and Treatment Receipt in Patients With Gastric Adenocarcinoma. Front Public Health 2022; 10:868416. [PMID: 35757623 PMCID: PMC9218109 DOI: 10.3389/fpubh.2022.868416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/25/2022] [Indexed: 11/20/2022] Open
Abstract
Background It remains largely unclear how education level, an important socioeconomic factor, affects prognoses for patients with gastric adenocarcinoma (GAC). We aimed to demonstrate the associations between education level and clinical outcomes in patients with GAC. Methods We included a total of 30,409 patients diagnosed with GAC from the Surveillance, Epidemiology, and End Results 18 registry database. Education level, household income, unemployment rate, poverty rate, insurance status, and marital status were selected as sociodemographic variables for the comprehensive analysis. Cox and logistic regression models, Kaplan–Meier curves, and subgroup analyses were the primary statistical methods employed. Results A low level of education was correlated with less income, higher unemployment rates, and higher poverty rates (all p < 0.001). The multivariate Cox analysis indicated that a high education level was significantly associated with superior overall survival rates and cancer-specific survival rates in patients with GAC (both p < 0.001). We also corroborated favorable survival outcomes by high education level within almost every clinical and demographic subgroup. Furthermore, chemotherapy combined with surgery could markedly prolong the survival for all patients, including patients of stage IV cancer (both p < 0.001). By using multivariable logistic models, patients in counties with high education levels had a higher probability of chemotherapy receipt (p < 0.001). Contrarily, those in the counties with low levels of education were less likely to receive chemotherapy or undergo surgery (p < 0.001). Conclusions Education level was identified and confirmed as an independent predictor of treatment and survival for GAC patients. Efforts are needed to provide effective interventions for those whose educational status is adverse.
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Affiliation(s)
- Jiaxuan Xu
- Department of Hematology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Institute of Education, Nanjing University, Nanjing, China
| | - Shuhui Du
- Department of Hematology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Institute of Education, Nanjing University, Nanjing, China
| | - Xiaoqing Dong
- Department of Hematology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Institute of Education, Nanjing University, Nanjing, China
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Cui X, Li M, Li P, Li J, Hou X, Yan G, Li P, Su X, Qin D, Zhang Y, Gu Y, Yin H, Xu G. Help-Seeking Behaviors and Related Factors in Chinese Patients With Major Depressive Disorder: A Community-Based Cross-Sectional Study. Front Psychiatry 2022; 13:934428. [PMID: 35873223 PMCID: PMC9298966 DOI: 10.3389/fpsyt.2022.934428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/09/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Although evidence-based and effective treatments are available for people with major depressive disorder (MDD), a substantial number do not seek or receive help. Therefore, this study aimed to (1) investigate the total help-seeking rate and first-time help-seeking choices; (2) explore the perceived helpfulness of 23 potential sources; and (3) evaluate the factors related to help-seeking behaviors among patients with MDD. MATERIALS AND METHODS Data came from the Tianjin Mental Health Survey (TJMHS), which included a representative sample of adult community residents (n = 11,748) in the Chinese municipality of Tianjin. Of these, 439 individuals were diagnosed with lifetime MDD according to the Diagnostic and Statistical Manual-fourth edition (DSM-IV) and administered a help-seeking questionnaire. RESULTS In a survey, 28.2% of patients with MDD living community reported that they had ever sought any help during their entire lifetime before the interview, with 8.2% seeking help in mental healthcare settings, 8.0% only in other healthcare settings, and 12.0% only in non-healthcare sources (e.g., family, friends, and spiritual advisor). Among help-seekers, the first help mainly was sought in non-healthcare sources (61.3%), followed by healthcare settings (25.8%) and mental healthcare settings (12.9%). The majority of MDD individuals thought the non-healthcare sources were not helpful and mental healthcare settings were helpful or possibly helpful to solve mental problems. Female, having 10-12 or higher education years, comorbid anxiety disorders were associated with increased help-seeking. CONCLUSION A small percentage of individuals with MDD living in community of Tianjin sought help. They preferred non-healthcare sources to healthcare settings. Demographic and clinical features were associated with help-seeking behaviors.
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Affiliation(s)
- Xiaojuan Cui
- Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Minghui Li
- Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Peijun Li
- Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Jinhao Li
- Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Xiaofei Hou
- Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Guoli Yan
- Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Peiyao Li
- Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Xuyang Su
- Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Danni Qin
- Institute of Applied Psychology, Tianjin University, Tianjin, China
| | - Yijiao Zhang
- Institute of Applied Psychology, Tianjin University, Tianjin, China
| | - Yan Gu
- Tianjin Third Central Hospital, Tianjin, China
| | - Huifang Yin
- Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Guangming Xu
- Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, China
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Li N, Shou J. The prevalence and correlates of depression in elderly outpatients in community health centers. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2020.100044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Searle K, Blashki G, Kakuma R, Yang H, Zhao Y, Minas H. Current needs for the improved management of depressive disorder in community healthcare centres, Shenzhen, China: a view from primary care medical leaders. Int J Ment Health Syst 2019; 13:47. [PMID: 31297142 PMCID: PMC6598358 DOI: 10.1186/s13033-019-0300-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 06/11/2019] [Indexed: 01/03/2023] Open
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 work-force which can act as key agents in national healthcare reform. The cultural adaption of the depression component of the World Health Organisation's mental health gap intervention guide (mhGAP-IG.v2) could provide primary care doctors with a future training tool to develop their assessment skills and treatment confidence.
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Affiliation(s)
- Kendall Searle
- 1Global and Cultural Mental Health Unit, Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC 3010 Australia
| | - Grant Blashki
- 2Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC 3010 Australia
| | - Ritsuko Kakuma
- 3London School of Hygiene and Tropical Medicine, London, WC1E 7HTE England UK
| | - Hui Yang
- 4Monash Institute for Health & Clinical Education, School of Primary Health Care, Monash University, Notting Hill, VIC 3168 Australia
| | - Yuanlin Zhao
- 5Faculty of Education, Queen's University, Kingston, ON Canada
| | - Harry Minas
- 1Global and Cultural Mental Health Unit, Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC 3010 Australia
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