Severe mental disorders in rural China: a longitudinal survey

Abstract

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.

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

“…The study data are derived from the CMHP, a longitudinal study on mental illness and mental health services in Xinjin County, Chengdu, which is a representative middle-income rural county in Southwest China. 2,7,21 People with SMI (with schizophrenia, or mood disorders (bipolar disorder or major depressive disorder)) were identified from two mental health surveys on mental disorders and mental health services in the population who were over 15 years old in the same six townships of Xinjin County, Chengdu, China in 1994 (population: 123 572) and 2015 (population: 152 776) respectively (Fig. 1).…”

“…9 Few studies had been conducted to explore the treatment status of people with SMI in China, especially rural China, where limited healthcare resources are available. 2,3,7 The relationship between poverty and mental health is a central concern of global poverty and is of great interest to both health and economic policymakers. 16–18 In China, poverty may be an important factor influencing treatment status.…”

“…Chengdu Mental Health Project (CMHP), an ongoing longitudinal mental health project, provides a unique opportunity to explore the impact of social development on the treatment status of individuals with SMI in rural China. 2…”

“…1 The rapid socioeconomic development associated with increased urbanisation and migration may have a negative impact on family systems, which can have significant adverse consequences for individuals with severe mental illness (SMI). 2,3 SMI, a leading cause of disability, is characterised in this study as mental, behavioural or emotional disorders (including schizophrenia, bipolar disorder and major depressive disorder) that can result in serious functional impairment. 4 In the Chinese population, the burden of SMI is profoundly high during a period of rapid social development.…”

An economic evaluation of a mobile text messaging intervention to improve mental health care in resource-poor communities in China: a cost-effectiveness study

“…With a rapid change in the socio-economic development over the past three decades, the rise in the incidence rates of severe mental disorders has become a major public health problem in China [ 1 ]. Severe mental disorders, which include schizophrenia, bipolar disorder and severe depression are complex psychiatric disorders that manifest into disabling conditions of hallucinations, delusions, and disordered thinking and behavior [ 2 ]. Due to their disabling effects, it has devastating costs to patient, families, and society.…”