ObjectivesTo investigate rates of depression and suicidal ideation in medical students in mainland China and to explore wellness curricula and mental health services available to students.MethodsSecond and third year medical students (N=348) at one medical school in mainland China completed the Patient Health Questionnaire-9 (PHQ-9). Based on responses to the PHQ-9, students were labeled as depressed, with suicidal ideation, and/or impaired. Additionally, students’ feedback from a focus group (N=30) evaluating the current state of the school’s wellness curricula and mental health services was thematically analyzed.ResultsA total of 348 students responded (response rate = 99%) to the survey. Forty-seven of 348 (13.5%) students had moderate-severe depression. The mean PHQ-9 score was 6.02 (SD=3.44). Seven and a half percent of students reported suicidal ideation. The frequency of depression and suicidal ideation did not differ between second and third year medical students (p = 0.52). Nearly 30% of depressed students reported suicidal ideation. Depression and suicidal ideation were strongly correlated (r = 0.42, p < 0.001). Students with depression (p < 0.0001) or suicidal ideation (p = 0.004) were more likely to be impaired compared to students who were not. Focus group participants reported only off-campus student counseling services available to medical students in distress. No wellness curricula were established.ConclusionsRates of depression and suicidal ideation are high in medical students in mainland China. Mental health services are deficient and unlikely to address distress in students. Chinese medical schools should offer mental health support and treatment at an early stage, such as wellness curricula and proactive student counseling.

Internationally, the Peer Change Agent (PCA) model is the most frequently used conceptual framework for HIV prevention. Change agents themselves can be more important than the messages they convey. PCA selection is operationalized via heterogeneous methods based upon individual-level attributes. A sociometric position selection strategy, however, could increase peer influence potency and halt transmission at key network locations. In this study, we selected candidate PCAs based upon relative sociometric bridging and centrality scores and assessed their attributes in comparison to one another and to existing peer educators. We focused upon an emerging HIV epidemic among men who have sex with men in Southern India in 2011. PCAs selected based on their bridging score were more likely to be innovators when compared to other centrally-located PCAs, to PCAs located on the periphery, and to existing peer educators. We also found that sociodemographic attributes and risk behaviors were similar across all candidate PCAs, but risk behaviors of existing peer educators differed. Existing peer educators were more likely to engage in higher risk behavior such as receiving money for sex when compared to sociometrically selected peer changes agents. These existing peer educators were also more likely to exhibit leadership qualities within the overall network; they were, however, just as likely as other non-trained candidate peer change agents to report important HIV intravention behavior (encouraging condoms within their network). The importance of identifying bridges who may be able to diffuse innovation more effectively within high risk HIV networks is especially critical given recent efficacy data from novel HIV prevention interventions such as pre-exposure prophylaxis. Moreover, while existing peer educators were more likely to be leaders in our analysis, using peer educators with high risk behavior may have limited utility in enacting behavior change among sex worker peers or male clients in the network.

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Socio-cultural relevance of psychotherapeutics and delivery context of internet-based interventions will require significant adaptation for the Hong Kong setting. However, because of community engagement throughout the process of adaptation, we believe the CATCH-IT intervention can be adapted for Chinese adolescents in Hong Kong with retained fidelity. The revised intervention is called "Grasp the Opportunity".