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Changes in treatment status of patients with severe mental illness in rural China, 1994–2015

  • Mao-Sheng Ran (a1), Xue Weng (a2), Yu-Jun Liu (a2), Tian-Ming Zhang (a2), Yue-Hui Yu (a2), Man-Man Peng (a2), Wei Luo (a3), Shi-Hui Hu (a4), Xin Yang (a5), Bo Liu (a6), Tin Zhang (a7), Graham Thornicroft (a8), Cecilia Lai-Wan Chan (a9) and Meng-Ze Xiang (a10)...
Abstract
Background

Although it is crucial to improve the treatment status of people with severe mental illness (SMI), it is still unknown whether and how socioeconomic development influences their treatment status.

Aims

To explore the change in treatment status in people with SMI from 1994 to 2015 in rural China and to examine the factors influencing treatment status in those with SMI.

Method

Two mental health surveys using identical methods and ICD-10 were conducted in 1994 and 2015 (population ≥15 years old, n = 152 776) in the same six townships of Xinjin County, Chengdu, China.

Results

Compared with 1994, individuals with SMI in 2015 had significantly higher rates of poor family economic status, fewer family caregivers, longer duration of illness, later age at first onset and poor mental status. Participants in 2015 had significantly higher rates of never being treated, taking antipsychotic drugs and ever being admitted to hospital, and lower rates of using traditional Chinese medicine or being treated by traditional/spiritual healers. The factors strongly associated with never being treated included worse mental status (symptoms/social functioning), older age, having no family caregivers and poor family economic status.

Conclusions

Socioeconomic development influences the treatment status of people with SMI in contemporary rural China. Relative poverty, having no family caregivers and older age are important factors associated with a worse treatment status. Culture-specific, community-based interventions and targeted poverty-alleviation programmes should be developed to improve the early identification, treatment and recovery of individuals with SMI in rural China.

Declaration of interest

None.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.
Corresponding author
Correspondence: Mao-Sheng Ran, Department of Social Work and Social Administration, University of Hong Kong, Pokfulam Road, Hong Kong, China. Email: msran@hku.hk
References
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1World Bank. GDP per Capita. World Bank 2015 (data.woldbank.org/indicator/NY.GDP.PCAP.CD).
2Ran, MS, Weng, X, Liu, YJ, Zhang, T-M, Thornicroft, G, Davidson, L, et al. Severe mental disorders in rural China: a longitudinal survey (abstract). Lancet 2017; 390: S37.
3Phillips, MR, Zhang, J, Shi, Q, Song, Z, Ding, Z, Pang, S, et al. Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001–05: an epidemiological survey. Lancet 2009; 373: 2041–53.
4World Health Organization. Mental Health Action Plan 2013–2020. WHO, 2013.
5Charlson, FJ, Baxter, AJ, Cheng, HG, Shidhaye, R, Whiteford, HA. The burden of mental, neurological, and substance use disorders in China and India: a systematic analysis of community representative epidemiological studies. Lancet 2016; 388: 376–89.
6Patel, V, Xiao, S, Chen, H, Hanna, F, Jotheeswaran, AT, Luo, D, et al. The magnitude of and health system responses to the mental health treatment gap in adults in India and China. Lancet 2016; 388: 3074–84.
7Ran, MS, Weng, X, Chan, CLW, Chen, EY-H, Tang, C-P, Lin, F-R, et al. Different outcomes of never-treated and treated patients with schizophrenia: 14-year follow-up study in rural China. Br J Psychiatry 2015; 207: 495500.
8Prince, M, Patel, V, Shekhar, S, Maj, M, Maselko, J, Phillips, MR, et al. Global mental health 1 - No health without mental health. Lancet 2007; 370: 859–77.
9Wang, PS, Berglund, P, Olfson, M, Pincus, HA, Wells, KB, Kessler, RC. Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62: 603–13.
10Saxena, S, Thornicroft, G, Knapp, M, Whiteford, H. Resources for mental health: scarcity, inequity, and inefficiency. Lancet 2007; 370: 878–89.
11Gong, P, Liang, S, Carlton, EJ, Jiang, Q, Wu, J, Wang, L, et al. Urbanisation and health in China. Lancet 2012; 379: 843–52.
12Xiang, YT, Yu, X, Sartorius, N, Ungvari, GS, Chiu, HF. Mental health in China: challenges and progress. Lancet 2012; 380: 1715–6.
13Clement, S, Schauman, O, Graham, T, Maggioni, F, Evans-Lacko, S, Bezborodovs, N, et al. What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychol Med 2015; 45: 1127.
14Andersen, RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behavior 1995; 36: 110.
15Hudson, CG. Socioeconomic status and mental illness: tests of the social causation and selection hypotheses. Am J Orthopsychiatry 2005; 75: 318.
16Patel, V, Araya, R, Chatterjee, S, Chisholm, D, Cohen, A, De Silva, M, et al. Treatment and prevention of mental disorders in low-income and middle-income countries. Lancet 2007; 370: 9911005.
17Lund, C, De Silva, M, Plagerson, S, Cooper, S, Chisholm, D, Das, J, et al. Poverty and mental disorders: breaking the cycle in low-income and middle-income countries. Lancet 2011; 378: 1502–14.
18Trani, JF, Bakhshi, P, Kuhlberg, J, Narayanan, SS, Venkataraman, H, Mishra, NN, et al. Mental illness, poverty and stigma in India: a case-control study. BMJ Open 2015; 5: e006355.
19Das, J, Do, QT, Friedman, J, Mckenzie, D, Scott, K. Mental health and poverty in developing countries: revisiting the relationship. Soc Sci Med 2007; 65: 467–80.
20Ran, MS, Chan, CLW, Chen, EYH, Mao, W-J, Hu, S-H, Tang, C-P, et al. Differences in mortality and suicidal behaviour between treated and never-treated persons with schizophrenia in rural China. Br J Psychiatry 2009; 195: 126–31.
21Ran, MS, Chui, CH, Wong, IYL, Mao, WJ, Lin, FR, Liu, B, et al. Family caregivers and outcome of people with schizophrenia in rural China: 14-year follow-up study. Soc Psychiatry Psychiatr Epidemiol 2016; 51: 513–20.
22Xinjin Bureau of Statistics. Statistic Report of Xinjin Economic and Social Development 2015. Xinjin Bureau of Statistics, 2015.
23Shen, Y, Wang, C. A Handbook of Epidemiological Investigation of Mental Illness. Renming Health Press, 1985.
24World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. WHO, 1992.
25Wing, JK, Cooper, JE, Sartorius, N. The Measurement and Classification of Psychiatric Symptoms . Cambridge University Press, 1974.
26Ran, MS, Xiang, MZ, Huang, MS, Shan, Y. Natural course of schizophrenia: two-year follow-up study in a rural Chinese community. Br J Psychiatry 2001; 178: 154–8.
27Ran, MS, Xiang, MZ, Chan, CLW, Leff, J, Simpson, P, Huang, MS, et al. Effectiveness of psychoeducational intervention for rural Chinese families experiencing schizophrenia: A randomised controlled trial. Soc Psychiatry Psychiatr Epidemiol 2003; 38: 6975.
28Janca, A, Drimmelen, J, Dittmann, V, Isaac, M, Ustun, TB, et al. ICD-10 Symptom Checklist for Mental Disorders. WHO, 1994.
29Ran, MS, Mao, WJ, Chan, C, Chen, EY, Conwell, Y. Gender differences in outcomes in people with schizophrenia in rural China: 14-year follow-up study. Br J Psychiatry 2015; 206: 283–8.
30Ran, MS, Xiao, Y, Chui, CHK, Hu, XZ, Yu, YH, Peng, MM, et al. Duration of untreated psychosis (DUP) and outcome of people with schizophrenia in rural China: 14-year follow-up study. Psychiatry Res 2018; 267: 340–5.
31Ran, MS, Zhang, TM, Wong, IYL, Yang, X, Liu, CC, Liu, B, et al. Internalized stigma in people with severe mental illness in Rural China. Int J Soc Psychiatry 2018; 64: 916.
32Ostrow, L, Jessell, L, Hurd, M, Darrow, SM, Cohen, D. Discontinuing psychiatric medications: a survey of long-term users. Psychiatr Serv 2017; 68: 1232–8.
33Papageorgiou, G, Cañas, F, Zink, M, Rossi, A. Country differences in patient characteristics and treatment in schizophrenia: data from a physician-based survey in Europe. Euro Psychiatry 2011; 26: 1728.
34Ran, MS, Xiang, MZ, Simpson, P, Chan, CLW. Family-Based Mental Health Care in Rural China. Hong Kong University Press, 2005.
35Maura, J, de Mamani, AW. Mental health disparities, treatment engagement, and attrition among racial/ethnic minorities with severe mental illness: a review. J Clin Psychology in Med Settings 2017; 24: 187210.
36Nortje, G, Oladeji, B, Gureje, O, Seedat, S. Effectiveness of traditional healers in treating mental disorders: a systematic review. Lancet Psychiatry 2016; 3: 154–70.
37Saraceno, B, Levav, I, Kohn, R. The public mental health significance of research on socio-economic factors in schizophrenia and major depression. World Psychiatry 2005; 4: 181–5.
38Ran, M, Lin, FR, Huang, D, Chan, CLW, Li, J, Mao, WJ, et al. The family economic status and outcome of people with schizophrenia in Xinjin, Chengdu, China: 14-year follow-up study. Int J Soc Psychiatry 2017; 63: 203–11.
39Kessler, RC, Demler, O, Frank, RG, Olfson, M, Pincus, HA, Walters, EE, et al. Prevalence and treatment of mental disorders, 1990 to 2003. New Eng J Med 2005; 352: 2515–23.
40Demyttenaere, K, Bruffaerts, R, Posada-Villa, J, Gasquet, I, Kovess, V, Lepine, JP, et al. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 2004; 291: 2581–90.
41Garrido, MM, Kane, RL, Kaas, M, Kane, RA. Perceived need for mental health care among community-dwelling older adults. J Gerontology 2009; 64(6): 704–12.
42Ran, MS, Xiang, MZ, Conwell, Y, Lamberti, JS, Huang, M-S, Shan, Y-H, et al. Comparison of characteristics between geriatric and younger subjects with schizophrenia in community. J Psychiatr Res 2004; 38: 417–24.
43Brenes, GA, Danhauer, SC, Lyles, MF, Hogan, PE, Miller, ME. Barriers to mental health treatment in rural older adults. Am J Geriatr Psychiatry 2015; 23: 1172–8.
44Andrade, LH, Alonso, J, Mneimneh, Z, Wells, JE, Al-Hamzawi, A, Borges, G, et al. Barriers to mental health treatment: results from the WHO World Mental Health surveys. Psychol Med 2014; 44: 1303–17.
45Schomerus, G, Van der Auwera, S, Matschinger, H, Baumeister, SE, Angermeyer, MC. Do attitudes towards persons with mental illness worsen during the course of life? An age-period-cohort analysis. Acta Psychiatr Scand 2015; 132: 357–64.
46Corrigan, PW, Druss, BG, Perlick, DA. The impact of mental illness stigma on seeking and participating in mental health care. Psychol Sci in Pub Interest 2014; 15: 3770.
47Dixon, A, McDaid, D, Knapp, M, Curran, C. Financing mental health services in low and middle income countries: equity and efficiency concerns. Health Policy Plan 2006; 21: 7182.
48Koenders, JF, de Mooij, LD, Dekker, JM, Kikkert, M. Social inclusion and relationship satisfaction of patients with a servere mental illness. Int J Soc Psychiatry 2017; 63: 773–81.
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Changes in treatment status of patients with severe mental illness in rural China, 1994–2015

  • Mao-Sheng Ran (a1), Xue Weng (a2), Yu-Jun Liu (a2), Tian-Ming Zhang (a2), Yue-Hui Yu (a2), Man-Man Peng (a2), Wei Luo (a3), Shi-Hui Hu (a4), Xin Yang (a5), Bo Liu (a6), Tin Zhang (a7), Graham Thornicroft (a8), Cecilia Lai-Wan Chan (a9) and Meng-Ze Xiang (a10)...
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