Challenges facing China's mental health services in the context of COVID-19

The real-world evidence to the effects of primary psychological healthcare system in diluting risks of suicide ideation in underrepresented children/adolescents: an observational, multi-center, population-based, and longitudinal study

BACKGROUND

Establishing a primary psychological healthcare system to prevent suicide was eagerly advocated. Such system was developed as a low-cost healthcare framework integrating family, school, and hospitals to provide early psychological screening and intervention. However, it remains unclear whether such a policy-driven and low-cost healthcare system could be practical, especially with equal benefits for underrepresented children/adolescents. We aimed to examine the real-world practical effects of the primary psychological healthcare system in preventing suicide ideation among children/adolescents, particularly underprivileged ones.

METHODS

The study was conducted using an observational, multi-center, population-based, and longitudinal design. A total of 19,140 children and adolescents were sampled from lower- and middle-income areas in Nanchong, western China, with the majority for being underprivileged and underrepresented. They were followed up for one year. The primary outcome was the incidence of reported severe suicide ideation after implementing the primary psychological healthcare system at the 0.5-year and 1-year follow-ups, compared to baseline. Subgroup analysis was conducted to examine the equal benefits of the system for underrepresented children/adolescents.

RESULTS

The risks of suicide ideation for children/adolescents included in the system were found to be significantly lower compared to those not included at 0.5-year (adjusted relative risk [aRR] 0.28, 95%CI 0.23-0.33; p < 0.001) and 1-year follow-ups (aRR 0.28, 95% CI 0.23-0.33; p < 0.001). The effects were also observed among underrepresented children/adolescents, including "left-behind" children/adolescents, "single-parent" children/adolescents and children/adolescents in especially difficult circumstances (CEDC, all pcorrected < 0.001). The effects in "left-behind" children/adolescents, CEDC, and "single-parent" children/adolescents were found to be non-inferior to the typically developing cohort at non-inferiority thresholds of 30%, 35%, and 45%, respectively (all pcorrected < 0.05).

CONCLUSIONS

The primary psychological healthcare system was effective in reducing suicide ideation risks among children/adolescents over a period of at least 1 year. However, certain underprivileged groups, such as orphans and unattended children, did not experience the same level of benefits, highlighting the need for targeted improvements.

Decomposition analysis of differences in depressive symptoms between agricultural and non-agricultural workers in China

BACKGROUND

Chinese workers are confronted with severe mental health issues. This study aimed to investigate the reasons for the differences in depressive symptoms between agricultural and non-agricultural workers in China, and to measure the contribution of relevant influencing factors.

METHODS

The data used in this study came from the 2018 China Family Panel Studies (CFPS) data. We used the brief 8-item Centre for Epidemiological Studies Depression Scale (CES-D8) to measure participants' depressive symptoms, and Fairlie decomposition model was used to analyze the influencing factors for the differences in depressive symptoms between agricultural and non-agricultural workers and their contribution.

RESULTS

The percentage of employed people with depressive symptoms was 14.44%. The percentage of agricultural workers (18.68%) with depressive symptoms was higher than that of non-agricultural workers (11.33%).The results of Fairlie decomposition analysis showed that 74.68% of the differences in depressive symptoms between agricultural and non-agricultural workers was due to observed factors, which were education level (39.63%), self-rated health (25.59%), marital status (-23.93%), residence (12.04%), job satisfaction (8.39%), chronic disease (5.52%), gender (5.11%), life satisfaction (3.59%), and body mass index (-1.28%) (all P < 0.05).

CONCLUSIONS

The percentage of depressive symptoms was higher in agricultural than in non-agricultural workers, which was primarily associated with differences in educational level, self-rated health, marital status, residence, job satisfaction, chronic disease, gender, life satisfaction, and body mass index between them.