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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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Chen Q, Huang S, Xu H, Peng J, Wang P, Li S, Zhao J, Shi X, Zhang W, Shi L, Peng Y, Tang X. The burden of mental disorders in Asian countries, 1990-2019: an analysis for the global burden of disease study 2019. Transl Psychiatry 2024; 14:167. [PMID: 38548717 PMCID: PMC10978857 DOI: 10.1038/s41398-024-02864-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 04/01/2024] Open
Abstract
Mental disorders are the leading contributors to the globally nonfatal burden of disease. This study was aimed to estimate the burden of mental disorders in Asian countries. Based on GBD 2019, the prevalence and disability-adjusted life of years (DALYs) rates with 95% uncertainty intervals (UI) were estimated in Asian countries. Predictions for the future burden of 8 selected countries, ranks of the burden of mental disorders and correlations with Sociodemographic Index (SDI) were also estimated. During the past 3 decades, while the number of DALYs of mental disorders increased from 43.9 million (95% UI: 32.5-57.2) to 69.0 million (95% UI: 51.0-89.7), the age-standardized rates of DALYs of mental disorders remained largely consistent from 1452.2 (95% UI: 1080.16-1888.53) per 100,000 population in 1990 to 1434.82 (95% UI: 1065.02-1867.27) per 100,000 population in 2019, ranked as the eighth most significant disease burden in Asia in 2019. Depressive disorders (37.2%) were the leading contributors to the age-standardized DALY rates of mental disorders in Asia, followed by anxiety disorders (21.5%). The age-standardized DALY rates in females were higher than their male counterparts, both peaked at 30-34 years. The age-standardized DALY rates were predicted to remain stable, with the number of DALYs presented an upward trend in the future. There was no significant correlation between the burden of mental disorders and SDI. All mental disorders ranked higher in 2019, compared in 1990. To reduce this burden, urgent measures for prevention, treatment, and rehabilitation for mental disorders need to be taken by Asian governments.
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Affiliation(s)
- Qi Chen
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Shu Huang
- Department of Gastroenterology, Lianshui County People' Hospital, Huaian, China
- Department of Gastroenterology, Lianshui People' Hospital of Kangda College Affiliated to Nanjing Medical University, Huaian, China
| | - Huan Xu
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Jieyu Peng
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Ping Wang
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Shiqi Li
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Jinxi Zhao
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Xiaomin Shi
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Wei Zhang
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Lei Shi
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Yan Peng
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Xiaowei Tang
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, China.
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China.
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Lavi R, Stokes MA. Reliability and validity of the Autism Screen for Kids and Youth. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:1968-1982. [PMID: 36688323 DOI: 10.1177/13623613221149542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
LAY ABSTRACT It is important that autistic children be diagnosed as early as possible so their needs can be met and their families can gain important insights into their behavior and interact with them appropriately. However, very few autism screening instruments are appropriate for children who have outgrown early childhood. The Autism Screen for Kids and Youth (ASKY) presents parents of children aged 4-18 years with 30 items that relate to autistic behaviors as defined by the current clinical diagnostic criteria for autism spectrum disorder (DSM-5 ASD). We evaluated the Hebrew instrument's performance on 167 autistic and non-autistic children and adolescents. We found that the ASKY algorithm correctly identified 92% of the autistic individuals as "probable ASD" and correctly identified 72% of the non-autistic individuals as "probable non-ASD," with these classifications showing excellent stability over time. Using total questionnaire score instead of the algorithm improved the ASKY's ability to correctly identify autistic individuals as "probable ASD" and non-autistic individuals as "probable non-ASD" to 93% and 78%, respectively. Overall, the ASKY is a promising instrument for ASD screening of older children.
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Sun KS, Lam TP, Cai J, Lam KF, Wu D, Kwok KW, Zhou X. Impact of training on primary care physicians' management of depression and anxiety disorders in rural China. Int J Soc Psychiatry 2023; 69:388-395. [PMID: 35549586 DOI: 10.1177/00207640221094957] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Primary care physicians (PCPs) in rural township health centers are the most easily accessible doctors to the residents in rural China, which covers 35% of the population. High prevalence of depression was reported among rural left-behind elderly and children as many workers had migrated to urban cities. AIM This study explored mental health care provision by PCPs in rural China and the association with their training background. METHODS Rural township health centers in both developed and less developed counties of Zhejiang Province, China were chosen as the study sites. A total of 697 PCPs completed questionnaires between December 2019 and January 2020, and the number of valid questionnaires was 673, with a valid response rate of 79.3%. RESULTS The rural PCPs reported a median range of seeing 1 to 5 mental health patients per week. Over two-thirds (68.2%) of the respondents had never received any training on treating common mental health disorders (depression and anxiety) while 20.3% received at most 2 days of training; 6.4% received 3 to 20 days of training; and 5.1% received over 20 days of training. PCPs with mental health training were significantly associated with better mental health care in terms of confidence and practice characteristics (e.g. having patients who brought up mental health issues, providing follow-up), while years of practice made a difference in practice but not confidence. CONCLUSIONS Training is the key determinant of the practice of mental health care by the PCPs in rural China. Our findings have implications for national policy to target two-thirds of rural PCPs who received no mental health training.
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Affiliation(s)
- Kai Sing Sun
- Department of Family Medicine and Primary Care, The University of Hong Kong, P.R. China.,JC School of Public Health and Primary Care, The Chinese University of Hong Kong, P.R. China
| | - Tai Pong Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, P.R. China
| | - Jingjing Cai
- The Institute of Social and Family Medicine, Zhejiang University School of Medicine, Hangzhou, P.R. China
| | - Kwok Fai Lam
- Department of Statistics and Actuarial Science, The University of Hong Kong, P.R. China
| | - Dan Wu
- International Diagnostic Centre, Clinical Research Department, London School of Hygiene & Tropical Medicine, UK
| | - Kit Wing Kwok
- Department of Family Medicine and Primary Care, The University of Hong Kong, P.R. China
| | - Xudong Zhou
- The Institute of Social and Family Medicine, Zhejiang University School of Medicine, Hangzhou, P.R. China.,The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, P.R.China
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Wu X, Xu L, Li P, Tang T, Huang C. Multipurpose Mobile Apps for Mental Health in Chinese App Stores: Content Analysis and Quality Evaluation. JMIR Mhealth Uhealth 2022; 10:e34054. [PMID: 34982717 PMCID: PMC8767465 DOI: 10.2196/34054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/30/2021] [Indexed: 01/05/2023] Open
Abstract
Background Mental disorders impose varying degrees of burden on patients and their surroundings. However, people are reluctant to take the initiative to seek mental health services because of the uneven distribution of resources and stigmatization. Thus, mobile apps are considered an effective way to eliminate these obstacles and improve mental health awareness. Objective This study aims to evaluate the quality, function, privacy measures, and evidence-based and professional background of multipurpose mental health apps in Chinese commercial app stores. Methods A systematic search was conducted on iOS and Android platforms in China to identify multipurpose mental health apps. Two independent reviewers evaluated the identified mobile apps using the Mobile App Rating Scale (MARS). Each app was downloaded, and the general characteristics, privacy and security measures, development background, and functional characteristics of each app were evaluated. Results A total of 40 apps were analyzed, of which 35 (87.5%) were developed by companies and 33 (82.5%) provided links to access the privacy policy; 21 (52.5%) apps did not mention the involvement of relevant professionals or the guidance of a scientific basis in the app development process. The main built-in functions of these apps include psychological education (38/40, 95%), self-assessment (34/40, 85%), and counseling (33/40, 82.5%). The overall quality average MARS score of the 40 apps was 3.54 (SD 0.39), and the total score was between 2.96 and 4.30. The total MARS score was significantly positively correlated with the scores of each subscale (r=0.62-0.88, P<.001). However, the user score of the app market was not significantly correlated with the total MARS score (r=0.17, P=.33). Conclusions The quality of multipurpose mental health apps in China’s main app market is generally good. However, health professionals are less involved in the development of these apps, and the privacy protection policy of the apps also needs to be described in more detail. This study provides a reference for the development of multipurpose mental health apps.
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Affiliation(s)
- Xiaoqian Wu
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
- Medical Data Science Academy, Chongqing Medical University, Chongqing, China
| | - Lin Xu
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
- Medical Data Science Academy, Chongqing Medical University, Chongqing, China
| | - PengFei Li
- School of Public Health, Weifang Medical University, Weifang, China
| | - TingTing Tang
- The Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Cheng Huang
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
- Medical Data Science Academy, Chongqing Medical University, Chongqing, China
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Duan D, Yang L, Zhang M, Song X, Ren W. Depression and Associated Factors in Chinese Patients With Chronic Kidney Disease Without Dialysis: A Cross-Sectional Study. Front Public Health 2021; 9:605651. [PMID: 34123983 PMCID: PMC8192721 DOI: 10.3389/fpubh.2021.605651] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 04/19/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Chronic kidney disease (CKD) has been a globally public health problem over the past decades. The maintenance of physical and mental health is of importance for patients nowadays. Notably, depression is prevalent and associated with various adverse events in CKD patients without dialysis. Prior studies have reported that pain, negative illness perception, pain, and low self-esteem are potential risk factors of depression, while few studies have comprehensively investigated the mechanisms among these factors and depression among this population. Purpose: This study aims to investigate the prevalence of depression and further explore the factors associated with depression among CKD patients without dialysis in China. Design and Methods: We conducted a cross-sectional study in patients with diagnosed CKD to investigate the prevalence of depression was by the Beck Depression Inventory-II (BDI-II). The data on pain interference, illness perception, and self-esteem were also collected via self-administered questionnaires. A structural equation model (SEM) was used to examine the factors associated with depression. Main Findings: From June to October 2019, we successfully interviewed 334 CKD patients at the outpatient clinics. Their mean age was 45.6 years (ranging from 19 to 74 years), and 48.5% were male. Most respondents were at early CKD stages (77.5% stage 1–3) and the prevalence of depression was 22.2%. We found a moderate association between illness perception and depression, which was modified by self-esteem. Similar but weaker association was found between pain interference and depression. Conclusion and Recommendations: Negative illness perception, low self-esteem and severe pain interference were associated with depression among Chinese CKD patients without dialysis. Future studies are warranted to investigate the underlying mechanism and formulate the intervention strategies for this high-risk population.
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Affiliation(s)
- Difei Duan
- Department of Nephrology, West China Hospital, Sichuan University, Sichuan, China.,School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.,West China School of Nursing, Sichuan University, Sichuan, China
| | - Lin Yang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Min Zhang
- Department of Nephrology, West China Hospital, Sichuan University, Sichuan, China
| | - Xiaoli Song
- Department of Nephrology, West China Hospital, Sichuan University, Sichuan, China
| | - Wen Ren
- Department of Nephrology, West China Hospital, Sichuan University, Sichuan, China
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Wong JPH, Jia CX, Vahabi M, Liu JJW, Li ATW, Cong X, Poon MKL, Yamada J, Ning X, Gao J, Cheng S, Sun G, Wang X, Fung KPL. Promoting the Mental Health of University Students in China: Protocol for Contextual Assessment to Inform Intervention Design and Adaptation. JMIR Res Protoc 2021; 10:e25009. [PMID: 33973869 PMCID: PMC8150405 DOI: 10.2196/25009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/10/2021] [Accepted: 04/12/2021] [Indexed: 11/28/2022] Open
Abstract
Background Chinese students are extremely vulnerable to developing mental illness. The stigma associated with mental illness presents a barrier to seeking help for their mental health. Objective The Linking Hearts—Linking Youth and ‘Xin’ (hearts) project is an implementation science project that seeks to reduce mental illness stigma and promote the mental health of university students in Jinan, China. The Linking Hearts project consists of 3 components. In this paper, we outline the protocol for the first component, that is, the contextual assessment and analysis of the mental health needs of university students as the first step to inform the adaptation of an evidence-based intervention to be implemented in Jinan, China. Methods Six local universities will participate in the Linking Hearts project. A total of 100 students from each university (n=600) will engage in the contextual assessment through self-report surveys on depression, anxiety, stress, mental health knowledge, and mental health stigma. Quantitative data will be analyzed using several descriptive and inferential analyses via SPSS. A small number of participants (144 students and 144 service providers) will also be engaged in focus groups to assess the socio-environmental contexts of university students’ health and availability of mental health resources. Qualitative data will be transcribed verbatim and NVivo will be used for data management. Social network analysis will also be performed using EgoNet. Results Linking Hearts was funded in January 2018 for 5 years. The protocol of Linking Hearts and its 3 components was approved by the research ethics boards of all participating institutions in China in November 2018. Canadian institutions that gave approval were Ryerson University (REB2018-455) in January 2019, University of Alberta (Pro00089364), York University (e2019-162) in May 2019, and University of Toronto (RIS37724) in August 2019. Data collection took place upon ethics approval and was completed in January 2020. A total of 600 students were surveyed. An additional 147 students and 138 service providers took part in focus groups. Data analysis is ongoing. Results will be published in 2021. Conclusions Findings from this contextual assessment and analysis will generate new knowledge on university students’ mental health status, mental health knowledge, and resources available for them. These findings will be used to adapt and refine the Acceptance and Commitment to Empowerment-Linking Youth N’ Xin intervention model. The results of this contextual assessment will be used to inform the adaptation and refinement of the mental health intervention to promote the mental health of Chinese university students in Jinan. International Registered Report Identifier (IRRID) RR1-10.2196/25009
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Affiliation(s)
| | - Cun-Xian Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Shandong, China
| | - Mandana Vahabi
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada
| | - Jenny Jing Wen Liu
- Psychiatry/Community Mental Health, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | | | - Xiaofeng Cong
- Department of Social Work, School of Political Science and Law, University of Jinan, Shandong, China
| | | | - Janet Yamada
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada
| | - Xuan Ning
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada
| | - Jianguo Gao
- Department of Social Work, School of Philosophy and Social Development, Shandong University, Shandong, China
| | - Shengli Cheng
- Department of Social Work, School of Philosophy and Social Development, Shandong University, Shandong, China
| | - Guoxiao Sun
- School of Physical Education, Shandong University, Shandong, China
| | - Xinting Wang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Shandong, China
| | - Kenneth Po-Lun Fung
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Wang M, Wang Y, Xu J, Meng N, Li X, Liu Z, Huang J. Individual-level socioeconomic status and contact or familiarity with people with mental illness: a cross-sectional study in Wuhou District, Chengdu, Southwest China. BMC FAMILY PRACTICE 2021; 22:71. [PMID: 33836653 PMCID: PMC8035729 DOI: 10.1186/s12875-021-01422-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/19/2021] [Indexed: 02/08/2023]
Abstract
Background People with mental illness (PWMI) often suffer from public stigma, which can make them unwilling to seek help and reduce access to early treatment. The aims of this study were to determine attitudes towards PWMI among the general public in a Chinese sample and to explore the relationships with sociodemographic characteristics. Methods A community-based, cross-sectional study was conducted from March to June 2019. The participants’ attitudes towards PWMI were evaluated by the Chinese version of the Social Distance Scale (SDSC). An independent-sample T-test and one-way ANOVA were used to determine the association of categorical variables with the outcome variable. Multiple linear regression and Spearman correlations were computed to explore the correlation between SDSC scores and individual-level socioeconomic status (SES). Results A total of 1437 participants were recruited, and their total SDSC score was 12.53 (SD: 3.11). Univariate analysis results showed that age, education level, educational attainment, and individual-level SES as well as whether they were caregivers/family members of PWMI were correlated with SDSC scores. The results of regression analysis showed a significant effect caused by contact or familiarity with PWMI (B = -1.134, β = -.190, P < 0.001), as well as for individual-level SES (B = -.339, β = -.110, P < 0.001). Spearman correlation results showed that SDSC scores were negatively correlated with individual-level SES (r = -.078, p < 0.01) and contact or familiarity with PWMI (r = -.168, p < 0.001). Conclusion This study reveals that public stigma towards PWMI is common in Southwest China. Individuals who are not a family member or a caregiver of PWMI or have low education level or low individual-level SES need to be provided more anti-stigma interventions. Contacting with PWMI is also a potentially beneficial measure to reduce social distance. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01422-y.
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Affiliation(s)
- Mengmeng Wang
- West China School of Nursing, Sichuan University/Department of Nursing, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ya Wang
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Jiajun Xu
- Mental Health Center, West China Hospital, Sichuan University, Guoxuexiang No.37, Chengdu, 610041, Sichuan, China.
| | - Na Meng
- Mental Health Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Xiaolin Li
- West China School of Nursing, Sichuan University/Department of Nursing, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Zheng Liu
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Junqiang Huang
- Chengdu Dekang Hospital, Sichuan University, Chengdu, 610041, China
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Huang L, Huang R, Fei Y, Liu T, Mellor D, Xu W, Xiong J, Mao R, Chen J, Fang Y, Wu Z, Wang Z. Lower Health Literacy of Mania Than Depression Among Older People: A Random Survey of a Community Healthcare Service Center. Front Psychiatry 2021; 12:512689. [PMID: 33776809 PMCID: PMC7996212 DOI: 10.3389/fpsyt.2021.512689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/15/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose: This study examines health literacy among older outpatients in two Community Healthcare Service Centers in Shanghai, China to facilitate the design of public education programs for the aged population on mood disorders (both depression and mania). Patients and Methods: A total of 173 outpatients aged 60 years or more with a chronic physical illness were randomly sampled. A health literacy questionnaire was used to assess participants' awareness of depression and mania. Participants were then asked to label two vignettes depicting depression and mania and to give their recommendations for how to seek help for those in the vignettes and how mood disorders should be managed. Results: In all, 86.1 and 36.4% of participants had heard of depression and mania, respectively, with the most common source of information being relatives and friends. Over half of the participants attributed the possible causes of mood disorders to psychological trauma, pressure or stress in daily life, taking things too hard, and personality problems. Almost two-thirds of participants correctly labeled the depression vignette, but only 26.6% correctly labeled the mania vignette. The most common methods recommended by the participants as being helpful for the individuals portrayed in the vignettes were "traveling" and help-seeking from a psychological therapist/counselor, a psychiatrist, or a close family member or friend. Conclusion: The older individuals attending community healthcare service settings in Shanghai have good depression literacy but relatively poor mania literacy. However, most participants had a positive attitude toward psychiatric treatment for mood disorders.
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Affiliation(s)
- Leping Huang
- Division of Mood Disorders, Hongkou District Mental Health Center, Shanghai, China
| | - Ruyan Huang
- Division of Mood Disorders, Hongkou District Mental Health Center, Shanghai, China
| | - Yue Fei
- Division of Mood Disorders, Hongkou District Mental Health Center, Shanghai, China
| | - Taosheng Liu
- Department of Psychology, Naval Medical University, Shanghai, China
| | - David Mellor
- School of Psychology, Deakin University, Burwood, VIC, Australia
| | - Weiyun Xu
- Division of Mood Disorders, Hongkou District Mental Health Center, Shanghai, China
| | - Jinxia Xiong
- Division of Mood Disorders, Hongkou District Mental Health Center, Shanghai, China
| | - Rongjie Mao
- Division of Mood Disorders, Hongkou District Mental Health Center, Shanghai, China
| | - Jun Chen
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiru Fang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiguo Wu
- Department of Psychiatry and Neuropsychology, Shanghai Deji Hospital, Qingdao University, Shanghai, China
| | - Zuowei Wang
- Division of Mood Disorders, Hongkou District Mental Health Center, Shanghai, China.,Department of Psychology, Naval Medical University, Shanghai, China.,School of Medicine, Shanghai University, Shanghai, China
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Han X, Jiang F, Zhou H, Needleman J, Guo M, Chen Y, Liu Y, Tang Y. Hospitalization Pattern, Inpatient Service Utilization and Quality of Care in Patients With Alcohol Use Disorder: A Sequence Analysis of Discharge Medical Records. Alcohol Alcohol 2020; 55:179-186. [PMID: 31845973 DOI: 10.1093/alcalc/agz081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 09/02/2019] [Accepted: 09/03/2019] [Indexed: 11/12/2022] Open
Abstract
AIMS To identify and group hospitalization trajectory of alcohol use disorder (AUD) patients and its associations with service utilization, healthcare quality and hospital-level variations. METHODS Inpatients with AUD as the primary diagnosis from 2012 to 2014 in Beijing, China, were identified. Their discharge medical records were extracted and analyzed using the sequence analysis and the cluster analysis. RESULTS Eight-hundred thirty-one patients were included, and their hospitalization patterns were grouped into four clusters: short stay (n = 565 (67.99%)), mean psychiatric length of stay in 3 years: (32.25 ± 18.69), repeated short stay (n = 211 (25.39%), 137.76 ± 88.8 days), repeated long stay (n = 41 (4.93%), 405.44 ± 146.54 days), permanent stay (n = 14 (1.68%), 818.14 ± 225.22 days). The latter two clusters (6.61% patients) used 37.26% of the total psychiatric hospital days and 33.65% of the total psychiatric hospitalization expenses. All the patients in the permanent stay cluster and 41.77% of the patients in the short stay cluster were readmitted at least once within 3 years. Two-hundred thirty-four patients (28.16%) were admitted at least once for non-psychiatric reasons, primarily for diseases of circulatory and digestive systems. Cluster composition varied significantly among different hospitals. CONCLUSION Hospitalization pattern of patients with AUD varies greatly, and while most (>2/3) hospitalizations were short stay, those with repeated long stay and permanent stay used more than one third of the hospital days and expenses. Our findings suggest interventions targeting at certain patients may be more effective in reducing resource utilization.
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Affiliation(s)
- Xueyan Han
- Department of Health Policy and Management, School of public health, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 3 Dong Dan San Tiao, Dongcheng District, Beijing 100730, China
| | - Feng Jiang
- Department of Health Policy and Management, School of public health, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 3 Dong Dan San Tiao, Dongcheng District, Beijing 100730, China
| | - Huixuan Zhou
- Department of Health Policy and Management, School of public health, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 3 Dong Dan San Tiao, Dongcheng District, Beijing 100730, China
| | - Jack Needleman
- Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles Young Dr. S., 31-269 CHS Box, Los Angeles, CA 951772, USA
| | - Moning Guo
- Department of Health Statistics, Beijing Municipal Health Commission Information Centre, No. 277 Zhao Deng Yu Lu, Xicheng District, Beijing 100034, China
| | - Yin Chen
- Administrative Office, Peking University International Hospital, No. 29 Sheng Ming Yuan Lu, Haidian District, Beijing 102206, China
| | - Yuanli Liu
- Department of Health Policy and Management, School of public health, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 3 Dong Dan San Tiao, Dongcheng District, Beijing 100730, China
| | - Yilang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University, 12 Executive Park Drive NE, Suite 300, Atlanta, GA 30329, USA.,Mental Health Service Line, Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA 30033, USA
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11
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Community mental healthcare: new developments and innovative strategies. Curr Opin Psychiatry 2020; 33:491-500. [PMID: 32639361 DOI: 10.1097/yco.0000000000000629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW The aim of this scoping review was to identify and map the available evidence on recent innovations in community mental healthcare across the globe. RECENT FINDINGS This review highlights the different innovative approaches and strategies being currently used in the field of community mental health. Key approaches found in the reviewed studies include collaborative care with the inclusion of peer workers, growing use of e-health and telepsychiatry, improved reforms on national mental health policies and de-institutionalization, modification of outreach models and mental health promotion in the community. The studies reviewed here suggest that continued innovation and implementation of new models and strategies have the potential to reduce the burden of disease and increase the quality of life for patients with mental health issues. SUMMARY Growing body of evidence shows that integrative care is the new standard of care for people with mental illnesses, with necessity of continuity of care from emergency department to community mental health services. Social determinants of rehabilitation and recovery, and peers support remain a new main topic of research in area of treatment of people with severe mental illnesses. E-health tools are becoming prevalent in the processes of promotion, prevention and treatment in mental healthcare.
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Shi W, Shen Z, Wang S, Hall BJ. Barriers to Professional Mental Health Help-Seeking Among Chinese Adults: A Systematic Review. Front Psychiatry 2020; 11:442. [PMID: 32508688 PMCID: PMC7251144 DOI: 10.3389/fpsyt.2020.00442] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/29/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND A large number of Chinese suffer from common mental disorders (e.g., depression, anxiety, stress, and post-traumatic stress disorder), but treatment seeking is typically low in this population. It is unclear what barriers influence professional mental health help-seeking behavior within the Chinese population. Identifying these barriers could assist in implementation science efforts to reach this population. OBJECTIVE This review systematically synthesizes findings related to the barriers to professional mental health help-seeking among Chinese adults. METHODS Two English language databases (PubMed and PsycINFO) and two Chinese databases (WANFANGDATA and CNKI) were searched to find relevant studies. Quality assessment was conducted in identified studies. Quantitative findings were tabulated and frequently reported barriers were ranked. Primary data obtained from qualitative studies were thematically analyzed. RESULTS Of 6,933 citations identified, 17 met inclusion criteria. There were 11 (64%) studies that reported quantitative methods; 3 (18%) employed qualitative research, and 3 (18%) mixed methods. Results indicated that frequently reported barriers to mental health help seeking among Chinese adults included a preference on self-reliance, seeking help from alternative sources, low perceived need toward help-seeking, a lack of affordability, negative attitude toward, or poor experiences with help-seeking. Less frequently mentioned barriers included stigma, families' opposition, limited knowledge about mental illness, a lack of accessibility, unwillingness to disclose mental illness, and fear of burdening family. CONCLUSIONS The current review identified a number of key barriers to help-seeking behavior. Effective strategies are needed to promote professional help-seeking among Chinese adults. Additional factors influencing professional mental health help-seeking need to be further investigated, as they may contribute to a better understanding the help-seeking behavior among Chinese.
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Affiliation(s)
- Wei Shi
- Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, University of Macau, Macau, China
| | - Zhuozhuo Shen
- Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, University of Macau, Macau, China
| | - Siyuan Wang
- Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, University of Macau, Macau, China
| | - Brian J Hall
- Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, University of Macau, Macau, China
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Zhang Z, Sun K, Jatchavala C, Koh J, Chia Y, Bose J, Li Z, Tan W, Wang S, Chu W, Wang J, Tran B, Ho R. Overview of Stigma against Psychiatric Illnesses and Advancements of Anti-Stigma Activities in Six Asian Societies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010280. [PMID: 31906068 PMCID: PMC6981757 DOI: 10.3390/ijerph17010280] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 12/27/2019] [Accepted: 12/28/2019] [Indexed: 12/14/2022]
Abstract
Background: In psychiatry, stigma is an attitude of disapproval towards people with mental illnesses. Psychiatric disorders are common in Asia but some Asians receive inadequate treatment. Previous review found that Asians with mental illness were perceived to be dangerous and aggressive. There is a need for renewed efforts to understand stigma and strategies which can effectively reduce stigma in specific Asian societies. The objective of this systematic review was to provide an up-to-date overview of existing research and status on stigma experienced by psychiatric patients and anti-stigma campaigns in China, Hong Kong, Japan, Singapore, Korea, and Thailand. Methods: A systematic literature search was conducted in the following databases, including PubMed, PsycINFO, Embase, Web of Science, and local databases. Studies published in English and the official language of included countries/territories were considered for inclusion in the systematic review. Any article on stigma related to any form of psychiatric illness in the six Asian societies was included. Results: One hundred and twenty-three articles were included for this systematic review. This review has six major findings. Firstly, Asians with mental illnesses were considered as dangerous and aggressive, especially patients suffering from schizophrenia and bipolar disorder; second, psychiatric illnesses in Asian societies were less socially-acceptable and were viewed as being personal weaknesses; third, stigma experienced by family members was pervasive and this is known as family stigma; fourth, this systemic review reported more initiatives to handle stigma in Asian societies than a decade ago; fifth, there have been initiatives to treat psychiatric patients in the community; and sixth, the role of supernatural and religious approaches to psychiatric illness was not prevailing. Conclusion: This systematic review provides an overview of the available scientific evidence that points to areas of needed intervention to reduce and ultimately eliminate inequities in mental health in Asia.
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Affiliation(s)
- Zhisong Zhang
- Faculty of Education, Huaibei Normal University, Huaibei 235000, China; (Z.Z.); (Z.L.); (W.C.); (R.H.)
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 119077, Singapore;
| | - Kaising Sun
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China;
| | - Chonnakarn Jatchavala
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand;
| | - John Koh
- Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Yimian Chia
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore; (Y.C.); (J.B.)
| | - Jessica Bose
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore; (Y.C.); (J.B.)
| | - Zhimeng Li
- Faculty of Education, Huaibei Normal University, Huaibei 235000, China; (Z.Z.); (Z.L.); (W.C.); (R.H.)
| | - Wanqiu Tan
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 119077, Singapore;
- The China-Singapore (Chongqing) Demonstration Initiative on Strategic Connectivity Think Tank, Chongqing 400043, China
| | - Sizhe Wang
- School of Mathematics, Jilin University, Changchun 2699, China;
| | - Wenjing Chu
- Faculty of Education, Huaibei Normal University, Huaibei 235000, China; (Z.Z.); (Z.L.); (W.C.); (R.H.)
| | - Jiayun Wang
- Faculty of Education, Huaibei Normal University, Huaibei 235000, China; (Z.Z.); (Z.L.); (W.C.); (R.H.)
- Correspondence:
| | - Bach Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam;
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Roger Ho
- Faculty of Education, Huaibei Normal University, Huaibei 235000, China; (Z.Z.); (Z.L.); (W.C.); (R.H.)
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 119077, Singapore;
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore; (Y.C.); (J.B.)
- Centre of Excellence in Behavioural Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 70000, Vietnam
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Zhong BL, Xu YM, Xie WX, Liu XJ, Huang ZW. Depressive Symptoms in Elderly Chinese Primary Care Patients: Prevalence and Sociodemographic and Clinical Correlates. J Geriatr Psychiatry Neurol 2019; 32:312-318. [PMID: 31480989 DOI: 10.1177/0891988719862620] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To estimate the prevalence of depressive symptoms (depression thereafter) and to identify the sociodemographic and clinical correlates of depression in a sample of elderly patients treated in the primary care setting in Wuhan, China. BACKGROUND Primary care is an opportune setting for the management of late-life depression in China, but there have been no representative studies on the clinical epidemiology of depression in elderly Chinese primary care patients. METHODS In total, 752 elderly patients (≥ 65 years) were consecutively recruited from 13 primary care centers in Wuhan, China, and interviewed with a standardized questionnaire. Depression was assessed with the 15-item Geriatric Depression Scale (GDS-15). RESULTS Of the elderly Chinese primary care patients, 30.6% had depression (GDS-15 ≥ 5). Correlates of depression were an education level of primary school or less (odds ratio [OR]: 1.94, 95% confidence interval [CI]: 1.36-2.77, P < .001), poor financial status (OR: 2.19, 95% CI: 1.16-4.15, P = .016), lack of an exercise habit (OR: 1.40, 95% CI: 1.06-1.74, P = .023), 2 or more chronic medical conditions (OR: 1.90, 95% CI: 1.34-2.69, P < .001), and loneliness (OR: 3.53, 95% CI: 2.46-5.08, P < .001). CONCLUSIONS Depression is prevalent among elderly Chinese primary care patients, indicating that elderly patients treated in primary care have a high level of need for mental health services in China. There is an urgent need to integrate mental health services into primary health care.
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Affiliation(s)
- Bao-Liang Zhong
- 1 Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, Hubei, China.,2 Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei, China
| | - Yan-Min Xu
- 2 Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei, China
| | - Wu-Xiang Xie
- 3 Peking University Clinical Research Institute, Peking University Health Science Center, Beijing, China
| | - Xiu-Jun Liu
- 2 Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei, China
| | - Zhuo-Wei Huang
- 2 Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei, China
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15
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Sun W, Li Y, Hu Y, Rao X, Xu X, Browning CJ, Thomas SA. Perspectives on the Training of Chinese Primary Health Care Physicians to Reduce Chronic Illnesses and Their Burden. Front Public Health 2019; 7:168. [PMID: 31312627 PMCID: PMC6614344 DOI: 10.3389/fpubh.2019.00168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/06/2019] [Indexed: 01/01/2023] Open
Abstract
This paper is a commentary on the training of Chinese Primary Health Care Doctors to reduce chronic illness and its burden. First, we will consider the policy position of the Chinese government concerning the development of a competent and enlarged primary physician workforce to deliver the proposed primary health care system reforms. We then turn to a review of the drivers of the high burden of chronic illnesses especially in older people in China. We argue that the curriculum for the training of primary health care medical practitioners should match the demonstrated high prevalence chronic illnesses and their risk factors and that there needs to specific competencies in prevention and mitigation of the diseases and their risk factors.
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Affiliation(s)
- Wenmin Sun
- Health and Family Planning Capacity Building and Continuing Education Center of Shenzhen Municipality, Shenzhen, China
| | - Yang Li
- Health and Family Planning Capacity Building and Continuing Education Center of Shenzhen Municipality, Shenzhen, China
| | - Yiting Hu
- Health and Family Planning Capacity Building and Continuing Education Center of Shenzhen Municipality, Shenzhen, China
- Shenzhen International Primary Health Care Research Institute, Shenzhen, China
| | - Xin Rao
- Health and Family Planning Capacity Building and Continuing Education Center of Shenzhen Municipality, Shenzhen, China
- Shenzhen International Primary Health Care Research Institute, Shenzhen, China
| | - Xingzhi Xu
- Health and Family Planning Capacity Building and Continuing Education Center of Shenzhen Municipality, Shenzhen, China
- Shenzhen International Primary Health Care Research Institute, Shenzhen, China
| | - Colette Joy Browning
- Shenzhen International Primary Health Care Research Institute, Shenzhen, China
- School of Nursing and Healthcare Professions, Federation University, Ballarat, VIC, Australia
- Research School in Population Health, Australian National University, Canberra, ACT, Australia
| | - Shane Andrew Thomas
- Shenzhen International Primary Health Care Research Institute, Shenzhen, China
- Research School in Population Health, Australian National University, Canberra, ACT, Australia
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Zhong BL, Xu YM, Xie WX, Liu XJ. Quality of life of older Chinese adults receiving primary care in Wuhan, China: a multi-center study. PeerJ 2019; 7:e6860. [PMID: 31106067 PMCID: PMC6499053 DOI: 10.7717/peerj.6860] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/27/2019] [Indexed: 12/25/2022] Open
Abstract
Background Quality of life (QOL) is an important primary care outcome, but the QOL of older adults treated in primary care is understudied in China. This study examined QOL and its associated factors in older adults treated in Chinese primary care. Methods A total of 752 older patients (65+ years) were consecutively recruited from 13 primary care centers in Wuhan, China, and interviewed with a standardized questionnaire, concerning socio-demographics, major medical conditions, loneliness, and depression. QOL and depression were measured with the Chinese six-item QOL questionnaire and the shortened Geriatric Depression Scale, respectively. Multiple linear regression was used to identify factors associated with poor QOL. Results The average QOL score of primary care older adults was (20.7 ± 2.5), significantly lower than that of the Chinese general population. Factors significantly associated with poor QOL of Chinese primary care older adults included engaging in manual labor before older adulthood (unstandardized coefficient [β]: −0.702, P < 0.001), no living adult children (β: −1.720, P = 0.001), physical inactivity (β: −0.696, P < 0.001), having ≥ four major medical conditions (β: −1.813, P < 0.001), hearing problem (β: −1.004, P = 0.017), depression (β: −1.153, P < 0.001), and loneliness (β: −1.396, P < 0.001). Conclusions Older adults treated in Chinese primary care have poorer QOL than the general population. Addressing psychosocial problems at Chinese primary care settings could be helpful in improving QOL in Chinese older adults.
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Affiliation(s)
- Bao-Liang Zhong
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, Hubei Province, China.,Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei Province, China
| | - Yan-Min Xu
- Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei Province, China
| | - Wu-Xiang Xie
- Peking University Clinical Research Institute, Peking University Health Science Center, Beijing, China
| | - Xiu-Jun Liu
- Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei Province, China
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