Workforce situation of the Chinese mental health care system: results from a cross-sectional study

Effectiveness of a modified behavioural activation treatment training program for primary medical staff to manage depressive symptoms among rural elderly in Hunan Province, China: study protocol for a cluster randomised controlled trial

INTRODUCTION

Depression is a major global health problem, with high prevalence rates of depressive symptoms observed among the elderly population in China, particularly exacerbating in rural areas. Due to a lack of professional mental health training and inadequate psychotherapy capacity within primary medical staff, rural elderly individuals grappling with depressive symptoms often encounter challenges in receiving timely diagnosis and treatment. In this landscape, the modified behavioural activation treatment (MBAT) emerges as a promising approach due to its practicality, ease of therapist training and application, patient acceptability, and broad applicability. However, existing evidence for MBAT mainly hails from developed countries, leaving a gap in its adaptation and implementation within rural China. This study aims to develop an MBAT training programme for primary medical staff to manage depressive symptoms among rural elderly and evaluate its effectiveness.

METHODS AND ANALYSIS

A cluster randomised controlled trial will be conducted in 10 randomly selected township hospitals in Lengshuijiang and Lianyuan, Hunan Province. We aim to recruit 150 participants, with 5 township hospitals selected for each group, each consisting of 15 participants. The intervention group will implement the MBAT training programme, while the control group will receive usual care training programme. Depressive symptoms, psychosocial functioning, quality of life and satisfaction will be measured at baseline, immediately post-intervention, and at 3 and 6 months post-intervention. Effectiveness will be assessed using linear or generalised linear mixed models.

ETHICS AND DISSEMINATION

This study has obtained approval from the Institutional Review Board of the Third Xiangya Hospital, Centre South University (No.: 2022-S261). Results will be disseminated through publication in international peer-reviewed journals and presentations at national and international conferences.

TRIAL REGISTRATION NUMBER

ChiCTR2300074544.

An Evaluation of the Health Economics of Postnatal Depression Prevention and Treatment Strategies in China: A Cost-Effectiveness Analysis

OBJECTIVE

The primary objectives of this study are to assess the cost-effectiveness of early postnatal screening and prenatal psychological interventions for the prevention and treatment of postpartum depression (PPD) among Chinese pregnant women. Additionally, we aim to explore the most cost-effective prevention and treatment strategies for PPD in China.

METHODS

We used TreeAge 2019 to construct a decision tree model, with the model assuming a simulated queue size of 10,000 people. The model employed Monte Carlo simulation to assess the cost-effectiveness of PPD prevention and treatment strategies. Transfer probabilities were derived from published studies and meta-analyses. Cost and effectiveness data were obtained from published sources and relevant studies. Incremental cost-effectiveness ratios (ICERs) were used to describe the results, with willingness-to-pay (WTP) thresholds set at China's gross domestic product (GDP) per capita.

RESULTS

Compared to the usual care group, the cost per additional quality-adjusted life year (QALY) for the early postnatal screening group and the prenatal psychological interventions is USD 6840.28 and USD 3720.74, respectively. The cure rate of mixed treatments for PPD has the greatest impact on the model, while patient participation in treatment has a minor impact on the cost-effectiveness of prevention and treatment strategies.

CONCLUSION

Both early postnatal screening and prenatal psychological interventions are found to be highly cost-effective strategies for preventing and treating PPD in China. Prenatal psychological interventions for pregnant women are the most cost-effective prevention and treatment strategy. As such, from the perspective of national payers, we recommend that maternal screening for PPD be implemented in China to identify high-risk groups early on and to facilitate effective intervention.

Barriers and facilitators to implementing a Canadian shared-care ADHD program in pediatric settings in Shanghai: a consolidated framework for implementation research approach

OBJECTIVES

The vast majority of children with Attention-Deficit Hyperactivity Disorder (ADHD) do not have access to proper diagnosis and treatment in China. The goal of this project is to identify the challenges and facilitators in implementing a Canadian ADHD Shared Care Pathways program in pediatric settings in Shanghai region.

METHODS

Purposive semi-structured focus groups were conducted on a total of 13 healthcare practitioners from the Shanghai Xinuha, Ninghai and Chongming hospitals. Two independent researchers conducted a thematic analysis of the data with themes emerging based on the Consolidated Framework for Implementation Research (CFIR).

RESULTS

Notable barriers identified by participants included: (1) lack of knowledge in the management of ADHD, primarily among general practitioners; (2) lack of resources such as lack of staff, time, and medication for ADHD; (3) challenges in implementing an international multicentre intervention (such as communication difficulties between teams and integration of resources available in different hospitals); and (4) mental health stigma, difficulties in identifying ADHD patients, and logistical problems related to medication procurement rules put in place by provincial governments. Notable facilitators included: (1) the strong motivation of stakeholders and their confidence in their ability to learn and subsequently execute action plans to achieve the implementation goal; (2) the compatibility between the values and goals of the stakeholders and those of the program despite some cultural tension, a positive learning climate, strong tensions for change, and the high interest of organization leaders in engaging in the program (3) the perceived benefits of the program, such as standardization of the diagnostic and treatment process, and engaging primary care providers in ADHD management; and (4) the strong relationship between participating institutions and schools as well as provincial health initiatives available to support collaborative models of care. Mixed factors to implementation were also explored.

CONCLUSIONS

Appropriate training of health care providers, cultural adaptation of the program, increase public awareness about ADHD to decrease stigma, as well as strong project management and guidelines that clearly describe the role and expectations of each team member appeared essential to successful implementation.

Perspectives of parents of adolescents with repeated non-suicidal self-injury on sharing their caretaking experiences with peers: a qualitative study

Background

The prevalence of non-suicidal self-injury among adolescents has increased over the years. Most parents, however, are poorly informed and confused about this behavior. Sharing caretaking experiences with parents in similar situations seems to be beneficial. Nevertheless, few researchers have explored the views of parents who share their caretaking experiences with peers.

Aim

This study aimed to investigate the perspectives of parents of adolescents with repeated non-suicidal self-injury on sharing their caretaking experiences with peers as well as the motivations for and barriers to this behavior.

Methods

This qualitative study adopted a purposive sampling method. Participants (16 mothers and 2 fathers) were recruited from the mental health center of a tertiary hospital in Chengdu, Sichuan, China. A total of 18 semistructured face-to-face individual interviews were conducted. All interviews were audio-recorded and analyzed thematically using NVivo 11.

Results

Three themes and nine subthemes were identified: (1) sharable caretaking experiences: reflection and transformation, self-emotional management, and diversified support; (2) motivations for sharing: empathy, reciprocity, and meaning; and (3) barriers to sharing: inadequate knowledge, low self-identity, and concerns for children.

Conclusion

Parents accumulate a wealth of experience during their long-term care of adolescents with repeated non-suicidal self-injury. Although most parents are willing to share their caretaking experiences with peers, there are several barriers. Therefore, in order to increase parents' motivation to share, psychological education is necessary.

Association between specific social activities and depressive symptoms among older adults: A study of urban-rural differences in China

Background

Engaging in social activities can help older persons with their depressed symptoms. Few studies, however, have looked into the connection between social interactions and depressed symptoms in Chinese older persons. The aim of this study was to investigate differences in older Chinese individuals' social activity involvement and depressive symptoms across urban and rural settings.

Methods

A cross-sectional investigation using information from the 2018 China Health and Retirement Longitudinal Study (CHARLS), which was limited to older individuals aged 60 and over. Generalized linear models were constructed to assess the effects of participants' characteristics and specific social activities on CES-D scores. The association between specific social activities and depressed symptoms was investigated using multivariate logistic regression analysis.

Results

In this study, it was discovered that older individuals had a prevalence of depressed symptoms of 36.2%, with rural older adults having a greater prevalence of depressive symptoms (39.7%) than urban older adults (30.9%). Our results showed that for urban respondents, providing help to others (not regularly. OR = 0.753, 95% CI: 0.579–0.980, P = 0.035), going to a sport (not regularly. OR = 0.685, 95% CI: 0.508–0.924, P = 0.013), and using the Internet (not regular. OR = 0.613, 95% CI: 0.477–0.789, P < 0.001; almost weekly. OR = 0.196, 95% CI: 0.060–0.645, P = 0.007) were all significantly and negatively associated with depressive symptoms, while for rural respondents, interacting with friends (not regularly. OR = 1.205, 95% CI: 1.028–01.412, P = 0.021) and using the Internet (not regularly. OR = 0.441, 95% CI: 0.278–0.698, P < 0.001) were significantly and negatively associated with depressive symptoms.

Conclusions

According to our research, there is a cross-sectional relationship between participating in a specific social activity and depressed symptoms in Chinese older adults, and this relationship varies across urban and rural older adults. This suggests that taking part in specific social activities may be crucial for reducing depression symptoms in older persons, developing more focused interventions that might support healthy aging, and offering a guide for policymakers and activists working to improve the mental health of seniors.