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

Abstract

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.

Factor Structures of General Health Questionnaire-12 Within the Number of Kins Among the Rural Residents in China

“…For example, for rural older adults living only with children, their mental health was highly contingent on their family ties (Tang et al, 2019). Another study also showed having no family caregivers is important factors associated with a worse treatment status of people with severe mental illness in contemporary rural China (Ran et al, 2019). Thus, several scholars confirmed the importance and need to increase the public’s awareness and knowledge about common mental disorders (Yu et al, 2016).…”

Treatment Status of Elderly Patients With Severe Mental Disorders in Rural China

“…Together with China's demographic, aging is the increasing prevalence of severe mental illness (SMI) among older adults. [5][6][7] Severe mental illness is characterized as mental, behavioral, or emotional disorders (including schizophrenia, bipolar disorder, and major depressive disorder) that can result in serious functional impairment. 8,9 The burden of SMI is profoundly high among Chinese people aged 60 years or older, accounting for 22% of disability-adjusted life-years among all mental, neurological, and substance use disorders.…”

“…Rural residents might be more likely to live in poverty, be older, and have comorbid chronic diseases. 7 Furthermore, following rapid urbanization in China, shifts in traditional family structures and acceleration of rural to urban migration have resulted in higher prevalence of untreated mental illness in rural areas. 5,7,20 Lack of appropriate health care for older adults with SMI in rural China has become an urgent public health issue, as most mental health services and resources are concentrated in Chinese urban areas, especially large cities.…”

“…The study data were derived from the Chengdu Mental Health Project, 7,23,24 a longitudinal study on mental illness and mental health services in Xinjin County, Chengdu, China. Xinjin county is a representative middle-income rural county in southwest China.…”

“…Possible reasons may include: (1) in contrast to schizophrenia or bipolar disorder, major depressive disorder may have not been recognized as a psychiatric disorder requiring professional treatment, 31 especially in rural China; (2) older adults with major depressive disorders may be less likely to be recognized and go to see doctors, especially in rural community; and (3) older adults with major depressive disorders may have less aggressive or odd behaviors than those with schizophrenia and bipolar disorder, so family members do not think it is worth being treated. 7 The lower rate of treatment of major depressive disorder might be explained further in the context of China. Notably, Chinese proverb of "emotional problems is not an illness" may reflect the traditional Chinese beliefs, so many older adults may tend to accept depression as part of life but not an illness and adapt beliefs such as fate (mingyun), destiny (yuan), and tolerance (ren) as coping mechanisms, rather than seeking professional treatment.…”