Self-stigma is common and severe in persons with schizophrenia, major depressive disorder and bipolar disorder, especially those with lower income status in rural community in China. Persons with schizophrenia may have higher levels of self-stigma than those with bipolar disorder. Individual-level interventions should be developed to reduce self-stigma among persons with SMI in Chinese rural communities.

BackgroundAlthough 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.AimsTo 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.MethodTwo 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.ResultsCompared 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.ConclusionsSocioeconomic 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 interestNone.

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Background Little is known about poverty trends in people with severe mental illness (SMI) over a long time span, especially under conditions of fast socioeconomic development. Aims This study aims to unravel changes in household poverty levels among people with SMI in a fast-changing rural community in China. Method Two mental health surveys, using ICD-10, were conducted in the same six townships of Xinjin county, Chengdu, China. A total of 711 and 1042 people with SMI identified in 1994 and 2015, respectively, participated in the study. The Foster-Greer-Thorbecke poverty index was adopted to measure the changes in household poverty. These changes were decomposed into effects of growth and equity using a static decomposition method. Factors associated with household poverty in 1994 and 2015 were examined and compared by regression analyses. Results The proportion of poor households, as measured by the headcount ratio, increased significantly from 29.8% in 1994 to 39.5% in 2015. Decomposition showed that poverty in households containing people with SMI had worsened because of a redistribution effect. Factors associated with household poverty had also changed during the study period. The patient's age, ability to work and family size were of paramount significance in 2015. Conclusions This study shows that the levels of poverty faced by households containing people with SMI has become more pressing with China's fast socioeconomic development. It calls for further integration of mental health recovery and targeted antipoverty interventions for people with SMI as a development priority.

Background Little is known about the change in long-term prevalence of mental disorders during a period of sustained rapid socioeconomic development. Here we explore the prevalence change of severe mental disorders in a 21-year longitudinal study in a rural area of China. Methods Epidemiological surveys of mental disorders were done in May, 1994, and October, 2015, in six townships (total population 170 174 in 2015) in Xinjin County, Chengdu, China. Psychoses Screening Schedule (PSS) together with key informant method for household survey and general psychiatric interview were administered to identify the persons with severe mental disorders according to International Classification of Mental and Behavioural Disorders-10 (ICD-10) criteria. Findings Among all persons aged 15 years and older, the age-standardised lifetime prevalence of all mental disorders increased 48•2% from 870•1 per 100 000 population (95% CI 811•3-928•9 per 100 000 population) in 1994 to 1289•4 per 100 000 population (1218•0-1360•8 per 100 000 population) in 2015. The age-standardised lifetime prevalence of schizophrenia was the highest among all mental disorders and remained relatively stable from 1994 (416•0 per 100 000 population) to 2015 (427•9 per 100 000 population). Between 1994 and 2015, the age-standardised lifetime prevalence increased for affective disorders (41%), alcohol dependence and alcoholism (373•8%), drug and substance abuse (1809%), and mental disorder plus cerebrovascular disease (214%), brain trauma (388%), and senile dementia (126%). Moreover, age-standardised lifetime prevalence was significantly higher in men (1465•5 per 100 000 population) than in women (1179•0 per 100 000) in 2015 (p<0•0001). Interpretation Various mental disorders in people living in the rural community display different trends from 1994 to 2015. Although the age-standardised lifetime prevalence of all causes disorders increased from 1994 to 2015, the prevalence of schizophrenia remained relatively stable. Prevalence of affective disorders, alcohol dependence and alcoholism, drug and substance abuse, senile dementia, and other organic disorders increased sharply, possibly indicating the effect of socioeconomic development on mental disorders. Mental health policy and services should be improved and adjusted according to the prevalence change of mental disorders. The limitations of this study include: (1) the sample investigated was from one rural area of China; (2) only two surveys were done; and (3) as many young people in this rural area might move to work temporarily in urban areas, the final reported prevalence might underestimate the true prevalence in young people.