Recognition and beliefs about treatment for mental disorders in mainland China: a systematic review and meta-analysis

Dualistic perspectives on illness coping experiences of individuals with depression and their spouses: a qualitative study

PURPOSE

Dyadic coping interventions alleviate emotional problems in patients and families with a variety of chronic illnesses. Current coping research on depression focuses mainly on the individual level. This study examined the experiences of people with depression and their spouses, using a dyadic coping perspective to support the implementation of a targeted dyadic intervention.

METHOD

Semi-structured, in-depth interviews were conducted with patients with depression and their spouses. The data were organized and analysed using Colaizzi's seven-step method.

RESULTS

The experiences of individuals with depression and their spouses were categorized into four themes and 12 subthemes: delays in medical care (delays in medical decision-making, delays in in-hospital care), spousal maladjustment (perceived stress of the illness, role conflict, negative emotions), coexistence of positive and negative dyadic coping strategies (shared coping, positive communication, emotional support, negative communication, overprotectiveness), and confusion and needs (fear of illness prognosis, desire for continuity of care).

CONCLUSION

Healthcare professionals should promote positive dyadic coping among individuals with depression and their spouses while caring for depressive illnesses. They should strengthen individuals' knowledge of the disease, attend to spouses' physical and mental health, explore couple-centred dyadic intervention strategies, and improve continuity in the healthcare system.

Gestational age at birth and cognitive outcomes in term-born children: Evidence from Chinese and British cohorts

INTRODUCTION

Older gestational age (GA) has been associated with more favourable cognitive outcomes in preterm children. Recent evidence suggests this may also apply to term-born children. This study aims to examine the association between GA and early neurodevelopmental outcomes in children born at term in China and the UK.

METHODS

Participants were term-born children from two cohorts, the Sichuan Multi-stratified Infants and Early Life (SMILE) study in China and the Developing Human Connectome Project (dHCP) in the UK. Early cognitive outcomes were assessed at 6 months in the SMILE study, and at 18 months in the dHCP. Linear regression models were conducted to examine the association between GA at birth and early cognitive outcomes in each cohort separately.

RESULTS

A sample of 1245 participants from the SMILE study and 406 participants for the dHCP were included in the analysis. In the SMILE study, longer GA was associated with better mental developmental (B = 2.47 [1.60, 3.34], P < .001) and psychomotor outcomes (B = 2.91 [2.01, 3.82], P < .001), after controlling for sex, parental education, family yearly income, maternal age, maternal depressive symptoms, and birth weight; in the dHCP, longer GA was associated with better cognitive (B = 1.35 [0.33, 2.37], P = .010) and motor outcomes (B = 1.49 [0.59, 2.39], P = .001), after controlling for sex, relative social deprivation, maternal depressive symptoms and birth weight.

CONCLUSIONS

Older GA in term-born toddlers is associated with more favourable developmental outcomes across different cultural contexts.

Global, regional, and national burden of major depressive disorder and alcohol use disorder attributed to childhood sexual abuse in 204 countries and territories, 1999-2019: An analysis for the global burden of disease study 2019

AIM

This study aims to elucidate the impact of childhood sexual abuse (CSA) on major depressive disorder (MDD) and alcohol use disorder (AUD) globally, regionally, and nationally, informing targeted public health interventions and policy.

METHODS

Using data from the Global Burden of Disease (GBD) Study 2019, we assessed the impact of CSA on MDD and AUD, analyzing disability-adjusted life years (DALYs) per 100,000 population. Our analysis included age, sex, geographic locations, temporal trends in age-standardized rates (ASR), and examined the relationship between the social development index (SDI) and the burden of these disorders.

RESULTS

From 1990 to 2019, the global ASR for MDD attributable to CSA increased by 1.9 %, while AUD decreased by 17.1 %. Significant gender disparities emerged, with females showing higher ASRs for MDD and males for AUD. The highest burden was observed in the 35-44 age group. Geographical analysis revealed the highest ASRs for MDD in Sub-Saharan Africa and for AUD in Eastern Europe, Central Europe, and High-income North America. A U-shaped relationship between SDI and disorder burdens was also identified.

CONCLUSIONS

Our findings indicate a slight increase in MDD and a significant decrease in AUD burdens globally due to CSA, underscoring the need for targeted interventions considering gender, geographical, and developmental differences. This calls for strategies tailored to each country's unique development, culture, and regional specifics.

Socioeconomic status moderate the relationship between mental health literacy, social participation, and active aging among Chinese older adults: evidence from a moderated network analysis

OBJECTIVE

The aging population represents a formidable global challenge, with China experiencing an accelerated demographic shift. While previous research has established a directional link between mental health literacy, social participation, and active aging, the moderating effect of socioeconomic status (SES) on these associations remains underexplored. This study sought to address this gap by employing moderated network analysis, in contrast to the total score approaches commonly used in prior literature.

METHODS

A cross-sectional design was implemented, involving 1,032 Chinese individuals aged 60 and above, who completed the Mental Health Literacy Questionnaire, Active Aging Scale, Social Participation Questionnaire, and Socioeconomic Status Index Scale. The moderated network method was applied to explore the bidirectional relationships between mental health literacy, social participation, and active aging, while examining the moderating role of SES.

RESULTS

The analysis identified the strongest bidirectional relationships between attitudes toward mental illness and the development of spiritual wisdom. Seven interaction terms emerged involving mental health literacy, social participation, and active aging, moderated by SES. Notably, the most significant interaction terms were found between attitudes toward mental illness and engagement in active learning.

CONCLUSIONS

These results contribute novel insights into the bidirectional relationships among mental health literacy, social participation, and active aging, as well as the role of SES in moderating these relationships. The findings highlight the need for targeted policy interventions to address socioeconomic inequalities in later life, thereby fostering active aging.

Low mental health literacy is associated with depression and anxiety among adults: a population-based survey of 16,715 adults in China

BACKGROUND

Mental health literacy is a predictor of health outcomes in psychological distress. However, limited research has explored whether low mental health literacy is associated with recent depression and anxiety.

METHODS

We used data from the Guangdong Mental Health Survey, a provincial representative and a population-based survey with a multistage stratified cluster random sampling method. We included adults aged 18 and above living in communities from September to December 2021 in Guangdong, China. Eligible participants were those who completed the mental health literacy questionnaire and assessments for depression and anxiety symptoms. We assessed the proportion of individuals with low mental health literacy by categories of psychological symptoms and whether low mental health literacy was associated with depressive and anxiety symptoms in the general population and subgroups.

RESULTS

A total of 16,715 adults were included. We found that individuals with more severe symptoms had a greater proportion of low mental health literacy- it went from 89.4% in participants without depression or anxiety to 96.2% in people who co-occurred with depression and anxiety (x2 = 21.457, P < 0.001). After controlling confounders, low mental health literacy was associated with depression (adjusted Odds Ratio, aOR [95%CI]:2.74 [1.92-4.04]) and anxiety (2.27 [1.49-3.64]) in the total sample, when compared with adequate mental health literacy.

CONCLUSIONS

This study found a positive association between low mental health literacy and the presence of depression and anxiety. Tackling inadequate mental health literacy may be a key strategy to promote psychological well-being across the lifespan, especially for young adults.

Mental Health Literacy Among Urban and Rural Residents of Guangdong Province, China

Purpose

The study aims to understanding the mental health literacy level of urban and rural residents in Guangdong Province, the first major province in China, and its influencing factors is crucial.

Methods

A multi-stage stratified equal-volume random sampling method was adopted in October-December 2022 to select permanent residents aged 18 years and above in Guangdong Province for the questionnaire survey, which consisted of a general demographic information questionnaire and a national mental health literacy questionnaire. Rao-Scott χ²-test with correction based on sampling design, independent samples t-test and binary multivariate logistic regression analysis were performed.

Results

A total of 51744 individuals completed the questionnaire, including 31822 urban residents and 19200 rural residents. The rate of achievement of mental health literacy was 13.6% among urban residents, which was significantly higher compared to the rate of 8.6% among rural residents. Logistic regression analysis showed that female, higher education, being mental worker, being a retiree, having a higher monthly household income, maintaining a regular diet, and using electronic products for 2-6 hours per day were protective factors for mental health literacy attainment in urban residents, while having chronic diseases, being a smoker and having a history of drinking were identified as risk factors in urban residents. Among in rural residents, married, younger, higher education, being mental worker and using electronic products for 2-6 hours per day, maintaining a regular diet, and engaging in regular exercise were protective factors for achieving mental health literacy, while previous smoking was a risk factor.

Conclusion

The study revealed a low level of mental health literacy among urban and rural residents of Guangdong Province, with a significant disparity between the two areas. These findings highlight the need for continuing efforts to increase the dissemination of mental health knowledge in rural communities and improve levels of mental health literacy.

Epidemiological characteristics and behaviors of online broadcast suicidality in China: implications for targeted prevention strategies

Objectives

Suicide is a global health concern, exacerbated by stigma around mental illnesses. Online platforms like Twitter and Sina Weibo have seen a rise in "online broadcast suicide," where individuals share suicidal thoughts and actions. However, there is limited understanding of the epidemiological characteristics, particularly in China. This study aims to analyze the demographics and behaviors of individuals engaging in online broadcast suicide in China to inform targeted prevention strategies.

Methods

A total of 525 incidents were identified through systematic retrieval of relevant news reports from online sources. Subsequently, a content analysis was performed on these reports to extract detailed information on the characteristics of each individual incident.

Results

Among the incidents analyzed, the male-to-female ratio was 1:1.6, with an average age of 23.1 ± 5.9 years. Approximately 71.9% took place in Southern China. Unemployment was reported in 15.0% of incidents. Relationship breakup (62.3%) was cited as the leading cause of suicide. Wrist cutting (58.2%) emerged as the predominant suicide method, and home (36.2%) was the most common location for these tragic events. Instant messaging apps were the primary platforms (54.7%) for conveying suicidal thoughts and actions. Additionally, among the 525 incidents examined, 12.0% disclosed having a mental disorder, and 7.6% had a history of prior suicide attempts. Significant variations were observed across age, gender, region, and occupation categories.

Conclusion

This study emphasizes the importance of developing suicide prevention programs for internet users. Besides, interventions should be customized to meet the specific needs of various populations.

Association of dietary patterns with depressive symptoms in Chinese adolescents: a cross-sectional study

Objective

Depression is highly prevalent in adolescents and may have adverse social and health consequences. To investigate the effect of diet on the occurrence of depression in adolescents, this study examined the correlation between dietary patterns and depression in adolescents.

Methods

A total of 853 participants were recruited in September to October 2022 in Taizhou, Zhejiang, China. The Chinese version of the Patient Health Questionnaire-9 was used to assess the subjects' depressive symptoms in the past 2 weeks. Relevant dietary information was obtained through a food frequency questionnaire. The associations between dietary patterns and the risk of depression were assessed using a logistic regression model.

Results

Four dietary patterns were identified by factor analysis, including the modern pattern, the snack-aquatic pattern, the traditional pattern, and the vegetarian pattern. The risk of mild depression among adolescents was higher in the Q2 and Q3 groups of the modern model than in the Q1 group of this type, and the risk of mild depression was higher in the Q4 group of the snack-aquatic model than in the Q1 group of this type; while the risk of moderate depressive symptoms was lower in the Q3 group of the vegetarian model compared with the Q1 group.

Conclusion

Modern and snack-aquatic patterns are associated with an increased risk of depression in Chinese adolescents, and vegetarian patterns are associated with a reduced risk of depression. The current findings emphasize the importance of adolescents consuming moderate amounts of rice flour, adequate vegetables and fruits, and reducing snack intake.

Personalized Help-Seeking Web Application for Chinese-Speaking International University Students: Development and Usability Study

BACKGROUND

The mental health of international students is a growing concern for education providers, students, and their families. Chinese international students have low rates of help seeking owing to language, stigma, and mental health literacy barriers. Web-based help-seeking interventions may improve the rate of help seeking among Chinese international students.

OBJECTIVE

This study aimed to describe the development of a mental well-being web app providing personalized feedback and tailored psychoeducation and resources to support help seeking among international university students whose first language is Chinese and test the web application's uptake and engagement.

METHODS

The bilingual MindYourHead web application contains 6 in-app assessments for various areas of mental health, and users are provided with personalized feedback on symptom severity, psychoeducation tailored to the person's symptoms and information about relevant interventions, and tailored links to external resources and mental health services. A feasibility study was conducted within a school at the University of Sydney to examine the uptake and engagement of the web application among Chinese international students and any demographic characteristics or help-seeking attitudes or intentions that were associated with its engagement.

RESULTS

A total of 130 Chinese international students signed up on the web application. There was an uptake of 13.4% (122/908) in the schools' Chinese student enrollment. Most participants (76/130, 58.5%) preferred to use the web application in Chinese and used informal but not formal help for their mental health. There was considerable attrition owing to a design issue, and only 46 students gained access to the full content of the web application. Of these, 67% (31/46) of participants completed 1 or more of the in-app mental well-being assessments. The most commonly engaged in-app assessments were distress (23/31, 74%), stress (17/31, 55%), and sleep (15/31, 48%), with the majority scoring within the moderate- or high-risk level of the score range. In total, 10% (9/81) of the completed in-app assessments led to clicks to external resources or services. No demographic or help-seeking intentions or attitudes were associated with web-application engagement.

CONCLUSIONS

There were promising levels of demand, uptake, and engagement with the MindYourHead web application. The web application appears to attract students who wished to access mental health information in their native language, those who had poor mental health in the past but relied on informal support, and those who were at moderate or high risk of poor mental well-being. Further research is required to explore ways to improve uptake and engagement and to test the efficacy of the web application on Chinese international students' mental health literacy, stigma, and help seeking.

The relationship between beliefs toward mental illnesses, empathic tendency and social distancing in university students

This study was conducted to determine the level of beliefs toward mental illnesses in university students and to examine its relationship with empathic tendency and social distance level. This descriptive and relational study was conducted at the Faculty of Health Sciences and Faculty of Nursing of a state university in Turkey. The sample of the study consisted of 678 students studying in the 4th grade of these faculties. Personal Information Form, the Beliefs Toward Mental Illness Scale (BMI), the Empathic Tendency Scale (ETS), and the Social Distance Scale (SDI) were used to collect data. It was determined that there was a high level of negative relationship between the students' mean BMI score and the age variable and the empathic tendency and social distance mean scores. It was seen that the mean Empathic Tendecy Scale and Social Distance Scale scores accounted for 86.6 % of the change in the mean BMI score (Adjusted R2 = 0.826). The mean BMI score of the students was found to be below the medium level. On the other hand, it was found that empathic tendency and social distance mean scores were above the medium level and had an effect on the mean BMI score. Psychosocial factors that are effective in the emergence of negative beliefs about mental illnesses in students should be investigated and studies should be carried out to increase awareness about negative beliefs.

Low mental health literacy and its association with depression, anxiety and poor sleep quality in Chinese elderly

BACKGROUND

Mental health literacy (MHL) is rarely reported in the Chinese elderly. This study explored the pattern of MHL in the Chinese elderly in relation to depression, anxiety and poor sleep quality.

METHODS

A cross-sectional study was conducted among older adults in Guangzhou, south China. Participants were investigated face-to-face using the Chinese National Mental Health Literacy Scale, the Patient Health Questionnaire-9 item (PHQ-9), the 7-item Generalized Anxiety Disorder (GAD-7) and the Pittsburgh Sleep Quality Index (PSQI). Mental Health Literacy Scale contains three dimensions: mental health knowledge, mental health skills (such as social support, cognitive reappraisal and attentional distraction) and mental health awareness. Multivariate logistic regression was used for examining the association between MHL and mental health.

RESULTS

A total of 506 older adults were recruited. The percentage of depression, anxiety, and poor sleep quality were 16.6%, 7.9% and 40.9%, respectively. MHL dimensions independently associated with depression included cognitive reappraisal (OR = 1.95, p < .001), attentional distraction (OR = 0.61, p = 0.044) and awareness (OR = 0.56, p = 0.027). MHL dimensions independently associated with anxiety symptoms included cognitive reappraisal (OR = 1.90, p = 0.011) and attentional distraction (OR = 0.44, p = 0.016). MHL dimensions independently associated with poor sleep quality included social support (OR = 0.75, p = 0.022), cognitive reappraisal (OR = 1.55, p = 0.003) and attentional distraction (OR = 0.65, p = 0.016).

CONCLUSION

Given the low MHL and its association with poor mental health in the Chinese elderly, policymakers and health professionals should improve the older adults' MHL, which could be conducive to the prevention and control of their mental health problems.

The state of mental health care in China

Over the past few years there have been considerable changes in China's mental health service system. This review provides an overview of the development of mental health services in China, including epidemiological data on psychiatric disorders, utilisation of mental health services, models of mental health service delivery, mental health resources and workforce, mental health policy framework and financial issues. We consider cultural and social factors including the involvement of family members in patient care, urbanisation and internal migration as well as the application of traditional Chinese medicine, which provides implications for mental health research and practice. Additionally, we also discuss major challenges and conclude by providing some specific recommendations on improving mental health services in China.

Application of the Delphi Method in the Study of Depressive Disorder

Depressive disorder is a common mental disorder that has a high prevalence and low visiting rate, which caused patients years lived with disability. Due to the complexity of the depressive disorder, the Delphi method is a better choice compared with other commonly used methods, which provides a new perspective for the prevention and treatment of depression. This article will summarize the clinical studies of depressive disorders using the Delphi method from four perspectives, and summarize the advantages and disadvantages of the Delphi method in depressive disorders research, arguing that the Delphi method can cross the gap between clinical research and clinical practice, and is a highly practical part of the research process.

Patients' and caregivers' knowledge and beliefs about mental illness in mainland China: A systematic review

This review aimed to systematically investigate patients' and caregivers' knowledge and beliefs about mental illness in mainland China. A total of 48 eligible studies (N = 11 895) were retrieved from eight electronic databases. Prevalence statistics were computed for themes (eg, stress) under each construct relating to knowledge or belief about mental illness (eg, beliefs about causes). Effect size r was calculated for each correlation with an identified construct. We found that only 27.8% of patients recognized the symptoms of schizophrenia. Although 65% of caregivers declared that they knew the names of the disorders that their ill relatives had, depression (43.6%), schizophrenia (28.5%) and anxiety disorders (18.1%) had low recognition rates. Both caregivers and patients preferred psychosocial explanations of mental illness. Pharmacological interventions (eg, antipsychotics), non-specific actives (eg, "getting out and learning more"), mental health professionals (eg, psychiatrists) and informal support (eg, family) were each considered helpful for different disorders by caregivers, whereas regular contact with mental health professionals was not highly rated as helpful by patients. Additionally, while more patients knew about the effects of the medications that they were taking, more caregivers emphasized the importance of medicine adherence. Psychosocial variables (eg, family burden) demonstrated significant effects on both groups' mental health literacy. The government should invest more in supporting caregivers of people with mental disorders and monitor the implementation of mental health policies.

Psychological Distress in Urbanizing China: How Does Local Government Effectiveness Matter?

Despite growing literature identifying key individual, family, community, and environmental factors as causes for mental disorders during the process of urbanization, the role played by local government has not been taken into account. In this article, we investigate how the effectiveness of local government affects residents' levels of psychological distress in areas of China undergoing urbanization. We measure the effectiveness of local governments according to their success in promoting access to the social security system through the distribution of social security cards among citizens. We hypothesize that higher local government effectiveness will reduce residents' psychological distress by alleviating worries about medical expenses and elder care. Drawing on data from the 2018 Urbanization and Quality of Life Survey (N = 3229) conducted in 40 localities undergoing rural-urban transition, we estimate three-level mixed-effects regression models to test the research hypotheses, allowing random effects at the township/county and neighborhood levels while controlling for a series of individual attributes. The results demonstrate that local government effectiveness is negatively associated with residents' psychological distress: effective local governments alleviate worries about medical expenses and elder care, and thereby reduce psychological distress. The findings indicate that, to reduce residents' worries and psychological distress during the process of rural-urban transition, it is essential to improve local government effectiveness, particularly in promoting residents' access to the social security system. Beyond demonstrating how local government effectiveness matters for residents' psychological distress, our research also illustrates how to properly model locational parameters in analyses of individual well-being.

Development of Chinese mental health first aid guidelines for psychosis: a Delphi expert consensus study

BACKGROUND

Family and friends of a person developing a mental illness or in a mental health crisis can help the person until treatment is received or the crisis resolves. Guidelines for providing this 'mental health first aid' have been developed and disseminated in high-income countries. However, they may not be appropriate for use in China due to cultural and health care system differences. The aim of this study was to use the Delphi expert consensus method to develop culturally appropriate guidelines for a member of the public providing mental health first aid to someone with psychosis in mainland China.

METHODS

A Chinese-language survey, comprising statements about how to provide mental health first aid to a person with psychosis, was developed. This was based on the endorsed items from the first round of the English-language questionnaire for high-income countries. These statements were rated by two expert panels from mainland China - a mental health professional panel (N = 31) and a lived experience panel (N = 41) - on how important they believed each statement was for a member of the public providing first aid to a person with psychosis in China. There were three Delphi rounds, with experts able to suggest additional items in Round 1. Items had to have at least 80% endorsement from both panels for inclusion.

RESULTS

Out of 208 statements, 207 were endorsed for inclusion in the Chinese-language guidelines. Eight new statements were also included. Compared to the English-language guidelines, the importance of family involvement was emphasized in the development of the Chinese-language guidelines.

CONCLUSIONS

While many of the actions in the English-language guidelines were endorsed by Chinese participants, a number of additional items point to the importance of developing culturally appropriate mental health first aid guidelines. These guidelines will form the basis for the development of Chinese Mental Health First Aid course aiming at training members of the public on how to provide first aid to someone with a mental health problem.