Impact of training on primary care physicians’ management of depression and anxiety disorders in rural China

Abstract

Background: Primary care physicians (PCPs) in rural township health centers are the most easily accessible doctors to the residents in rural China, which covers 35% of the population. High prevalence of depression was reported among rural left-behind elderly and children as many workers had migrated to urban cities. Aim: This study explored mental health care provision by PCPs in rural China and the association with their training background. Methods: Rural township health centers in both developed and less developed counties of Zhejiang Province, China were chosen as the study sites. A total of 697 PCPs completed questionnaires between December 2019 and January 2020, and the number of valid questionnaires was 673, with a valid response rate of 79.3%. Results: The rural PCPs reported a median range of seeing 1 to 5 mental health patients per week. Over two-thirds (68.2%) of the respondents had never received any training on treating common mental health disorders (depression and anxiety) while 20.3% received at most 2 days of training; 6.4% received 3 to 20 days of training; and 5.1% received over 20 days of training. PCPs with mental health training were significantly associated with better mental health care in terms of confidence and practice characteristics (e.g. having patients who brought up mental health issues, providing follow-up), while years of practice made a difference in practice but not confidence. Conclusions: Training is the key determinant of the practice of mental health care by the PCPs in rural China. Our findings have implications for national policy to target two-thirds of rural PCPs who received no mental health training.

A Chinese help-seeking model for psychological distress in primary care: An adaptation of Andersen's Behavioral Model of Health Services Use

“…On the other hand, service users' perceived needs for treatment increase with severity of distress (Chen et al, 2020), and this is particularly true for sufferers of somatic symptoms, because their symptoms interfere with daily life Xu et al, 2022). Recognition of psychological distress, often through somatic symptom complaints, is determined by the competence and attitude of PCPs in mental health care (Sun et al, 2015(Sun et al, , 2023, and their relationship with service users (Sun, Lam, Lam, Lo, Chao, Lam, & Chan, 2019;Sun, Lam, Lam, Lo, Chao, Lam, & Wu, 2019). The combined effects of the specific components under predisposing, enabling, and need factors influence the help-seeking behaviors, determining the use of professional or informal help sources, or not seeking help (Jiang et al, 2018;Shi, Lu, et al, 2020;Shi, Shen, et al, 2020;Sun et al, 2017).…”

“…Community-based management programs of mental health have been piloted, such as establishing community mental health facilities and training of community health care professionals. The mental health service has been incorporated as part of the public health program which is focused on managing people with psychotic disorders (Liu et al, 2011), including follow-up of cases with a mild to moderate degree of psychotic disorders in the community by primary care physicians following a diagnosis by psychiatrists (Sun et al, 2023;Xu et al, 2022). Apart from managing psychotic disorders, there is a strong need for expanding community mental health care services to include depression and anxiety disorders, which are highly prevalent among the general public and have increasingly become a public health concern since the beginning of the COVID-19 pandemic (Shi, Lu, et al, 2020;Shi, Shen, et al, 2020;Zhang et al, 2021).…”

“…A recent study in rural areas of Zhejiang revealed that nearly one-third of PCPs had some mental health training, most having had around 4–16 sessions. They had more patients who brought up mental health issues (Sun et al, 2023). Findings from Hong Kong also showed that PCPs with mental health training treated three times the number of people with common mental disorders compared to other PCPs (Lam et al, 2018).…”

“…The proportion of PCPs with mental health training is small in Mainland China. Less than one-third of the surveyed rural PCPs had training in managing depression and anxiety (Sun et al, 2023). Short courses delivered by psychiatrists and focused on recognizing common mental health problems, psychosomatic symptoms, and their initial management can be applied to a larger number of PCPs (Clarke et al, 2006; Lam et al, 2016; Naismith et al, 2001; Walters et al, 2007).…”

“…A study in Shanghai found that PCPs tended to treat physical problems ahead of depression (Wu et al, 2007). Studies in Hong Kong and Zhejiang showed that PCPs’ ability and intention in mental health care could be enhanced by physician training (Lam et al, 2018; Sun et al, 2023) and long-term doctor–patient relationships (Sun, Lam, Lam, Lo, Chao, Lam, & Chan, 2019; Sun, Lam, Lam, Lo, Chao, Lam, & Wu, 2019).…”