Yu-Tao Xiang

Mental health in China: challenges and progress

Over the past three decades, China’s economic reforms have achieved great success. However, rapid urban isation and economic growth are generating new challenges for the country and its mental health system. For various historical reasons, mental health services have been a low priority in China. In the past 5 years, both the international community and media have shown great interest in these services. Most international experts have assessed China’s mental health system according to western standards, and have focused on negative events that occasionally arise. We feel that a more balanced introduction to China’s mental health system is warranted, one that includes its pitfalls, progress, and challenges. An estimated 173 million Chinese people have a diagnosable psychiatric disorder, of whom 158 million have never received any treatment. China has roughly 20 000 psychiatrists, of whom only about 4000 are fully qualifi ed, which largely explains the extremely high number of untreated patients. Furthermore, two-thirds of the country’s 1·3 billion citizens live in rural areas, yet most mental health care resources are concentrated in psychiatric hospitals in cities. Until 2010, only one mental health professional was working in Tibet. The provision of accessible, dependable, and aff ordable mental health care for China’s massive rural population is thus a matter of urgency. In the past 5 years, the importance of mental health has begun to gain recognition. The Chinese Government has started taking eff ective steps to fi nance mental health services and provide regular training in mental health for primary care providers. Important steps included the 2005 eff ort to ensure that most new psychotropic drugs were covered by basic health insurance, and a 2010 initiative to build 550 psychiatric hospitals and psychological units in general hospitals by 2012. A promising development was the initiation of a national community-based service delivery model in psychiatry (the 686 project) in 2004. This project has integrated the resources of psychiatric hospitals and existing community health systems with the aim of training a core group of mental health pro fessionals in case management and the use of indiv idual service plans, to enable them to deliver training programmes and estab lish community-based services. The 686 project has helped to con vince central government to invest more than RMB 220 million (US

Lifetime Prevalence of Suicidal Ideation, Suicide Plans and Attempts in Rural and Urban Regions of Beijing, China

32·2 million) in communitybased mental health since 2004. As of Nov 30, 2011, the community-based service model within this project covered 391 million people at 766 sites in 170 cities. Approximately 1·83 million patients with severe psychiatric disorders have been registered, of whom about 390 000 patients with a high risk of violence have received rehabilitation services and regular follow-ups. China has more than 200 million migrant workers who take up temporary jobs in faraway urban regions and return home to rural areas only during the Lunar New Year. They are not covered by either communitybased mental health services or health insurance in the cities where they work. Provision of services to meet the mental health needs of this migrant population will be another huge challenge. In China, around 287 000 suicides (23 per 100 000 popu lation) took place each year during 1995–99, accounting for up to a third of suicides globally. Unlike suicide patterns in the west, China’s has a high female-to-male ratio (about 1·25:1); ingestion of pesticides is the most common method of suicide. Government data suggest that the suicide rate might be falling (6·6 per 100 000 by 2008), but much work is still needed towards suicide prevention. Local and western media have often blamed Chinese health authorities for the inadequate protection of

Prevalence and socio-demographic correlates of schizophrenia in Beijing, China

Objective: There has been no large-scale survey of suicide-related behaviours including suicidal ideations, plans and attempts in China involving both rural and urban areas and using standardized assessment tools. The aim of the present study was to determine the lifetime prevalence of suicide-related behaviour and its relationship with sociodemographic factors and psychiatric disorders in the rural and urban regions of Beijing, China. Methods: A total of 5926 subjects were randomly selected in Beijing and interviewed using the Composite International Diagnostic Interview. Basic sociodemographic and clinical data and data on suicide-related behaviour were also collected. Results: The overall lifetime prevalence estimates of suicidal ideation, plans and attempts were 2.3%, 1.4%, and 1.0%, respectively; the corresponding figures were 2.8%, 1.6%, and 1.3% in the rural sample, and 1.8%, 1.3%, and 0.9% in the urban sample. Age (>25years), female sex, unmarried status, lower education level, lower (RMB2000month−1) monthly income and presence of major medical disorders were significantly associated with increased risk of suicide-related behaviour. 36.2% of subjects with suicide-related behavior consulted a medical practitioner and 20.7% consulted a psychiatrist. Conclusions: The prevalence of lifetime suicide-related behaviour in Beijing is lower than in Western countries, but the low percentage of subjects treated for suicide-related behaviour indicates a major public health problem that should be addressed. National surveys are needed to further explore the prevalence of suicide-related behaviour in China.

Subjective quality of life in outpatients with schizophrenia in Hong Kong and Beijing: relationship to socio-demographic and clinical factors

OBJECTIVEnThere has been no large-scale survey of schizophrenia in China involving both rural and urban areas using standardized assessment tools and diagnostic criteria. This study aimed to determine the lifetime prevalence of schizophrenia and its socio-demographic correlates in Beijing, China.nnnMETHODSnA total of 5926 subjects were randomly selected in Beijing and interviewed using the Composite International Diagnostic Interview (CIDI 1.0). Basic socio-demographic and clinical data were collected during the interviews.nnnRESULTSnThe lifetime prevalence of schizophrenia was 0.49%, and 0.44% and 0.55% for men and women, respectively. Unmarried status, lower monthly income, urban abode and positive family history were associated with an increased risk of schizophrenia; 9.7% of the subjects with lifetime schizophrenia reported a history of suicide attempts. The percentage of subjects with schizophrenia who were receiving treatment and their preference to seek treatment from mental health professionals were 58% and 29%, respectively.nnnCONCLUSIONSnNational surveys are urgently needed to further explore the prevalence of schizophrenia in China. The low percentage of subjects treated for schizophrenia is a serious public health issue that should be addressed in the near future.

Prevalence and socio-demographic correlates of major depressive episode in rural and urban areas of Beijing, China

PurposeThis study compared the subjective quality of life (SQOL) in schizophrenia patients living with their families in Hong Kong (HK) and Beijing (BJ) and explored the relationship between SQOL and basic socio-demographic and clinical factors.Materials and methodsTwo hundred and sixty-four clinically stable outpatients with schizophrenia were randomly selected in HK and 258 counterparts matched according to age, sex, age at onset, and length of illness in BJ. SQOL and psychiatric status were assessed with standard rating instruments.ResultsThere was no significant difference in any of SQOL domains between the two cohorts after controlling for potentially confounding variables. Positive, depressive and anxiety symptoms and drug-induced extrapyramidal side effects (EPS) were all significantly correlated with SQOL. Multiple regression analysis revealed that only depressive symptoms predicted all SQOL domains in both groups. Having removed depressive symptoms from the model, positive symptoms predicted all domains, anxiety predicted all but social domains, use of benzodiazepines (BZD) predicted all but physical domains, EPS predicted physical domain, and history of suicide predicted social domain in HK; anxiety predicted all domains, positive symptoms predicted all but physical domains, EPS, use of BZD and history of suicide all predicted physical domains, and length of illness predicted environmental domain in BJ.ConclusionDespite considerable differences between the two sites in terms of health care delivery and the economic conditions of the subjects, SQOL did not differ between HK and BJ. The conclusion is in line with previous studies that suggested that patients’ SQOL was independent of their living standard as long as it reached a certain minimum level. SQOL was more strongly related to the severity of depressive symptoms and had weak association with socio-demographic factors.

Characteristics and clinical correlates of prospective memory performance in first-episode schizophrenia.

OBJECTIVEnThis study aimed to determine the 12-month and lifetime prevalence of major depressive episode (MDE) and their socio-demographic correlates in both the urban and rural areas of Beijing, China.nnnMETHODSnA total of 4767 adults were randomly selected and interviewed in Beijing using the Composite International Diagnostic Interview (CIDI 1.0). Basic socio-demographic and clinical data were collected during the interviews.nnnRESULTSnThe overall 12-month prevalence of MDE was 3.2%; 2.8% and 3.8% for men and women, respectively. The overall lifetime prevalence of MDE was 5.3%; 4.4% and 6.3% for men and women, respectively. Being older than 25 years of age was independently associated with increased risk of MDE. Sixteen point three percent of the subjects with lifetime MDE attempted suicide while the rate of suicide attempts was only 0.2% in subjects without MDE. The percentage of subjects with MDE who received any type of treatment from medical practitioners was 33.1%; of them, only 5.4% sought help from mental health professionals.nnnCONCLUSIONSnNational epidemiologic surveys are needed to further explore the prevalence of MDE in China. The low percentage of subjects treated for MDE constitutes a major public health problem that should be urgently addressed.

Prospective memory and its correlates and predictors in schizophrenia: An extension of previous findings

OBJECTIVEnThe aim of this study was to examine prospective memory (PM) and its socio-demographic, clinical, and neurocognitive correlates in first episode schizophrenia (FES).nnnMETHODSnFifty-one FES patients and 42 healthy controls formed the study sample. Time- and event-based PM (TBPM and EBPM) performance were measured with the Chinese version of the Cambridge Prospective Memory Test (C-CAMPROMPT). A battery of neuropsychological tests was also administered. Patients clinical symptoms were evaluated with the Positive and Negative Symptom Scale (PANSS).nnnRESULTSnPatients performed significantly worse in both TBPM (8.7 ± 5.3 vs. 14.8 ± 3.5) and EBPM (11.3 ± 4.7 vs. 15.7 ± 2.7) than the controls. After controlling for age, gender, education level and neurocognitive test score, the difference in performance on the two types of PM tasks between patients and controls was no longer present. In multiple linear regression analyses, longer duration of untreated psychosis (DUP), lower scores of the Hopkins Verbal Learning Test-Revised (HVLT-R) and the categories completed of the Wisconsin Card Sorting Test (WCST-CC) and higher score of the Color Trails Test-2 (CTT-2) contributed to poorer TBPM performance, while lower score of HVLT-R, higher score of the perseverative errors of the Wisconsin Card Sorting Test (WCST-PE) and longer DUP contributed to worse performance on EBPM.nnnCONCLUSIONSnBoth subtypes of PM are impaired in first-episode schizophrenia suggesting that PM deficits are an integral part of the cognitive dysfunction in the disease process.

Quality of Life in Parents of Children with Attention-Deficit–Hyperactivity Disorder in Hong Kong

BACKGROUNDnProspective memory (PM) is the ability to remember to do something in the future without explicit prompts. Extending the number of subjects and the scope of our previously published study, this investigation examined the relationship between PM and socio-demographic and clinical factors, activities of daily living (ADL) and frontal lobe functions in patients with chronic schizophrenia.nnnMETHODSnOne hundred and ten Chinese schizophrenia patients, 60 from the previous study and 50 additional patients recruited for this study, and 110 matched healthy comparison subjects (HC) formed the study sample. Patients clinical condition and activity of daily living were evaluated with the Brief Psychiatric Rating Scale (BPRS) and the Functional Needs Assessment (FNA). Time- and event-based PM tasks and three tests of prefrontal lobe functions (Design Fluency Test [DFT], Tower of London [TOL], Wisconsin Card Sorting Test [WCST]) were also administered.nnnRESULTSnPatients level of ADL and psychopathology were not associated with PM functions and only anticholinergic medications (ACM) showed a significant negative correlational relationship with PM tasks. Confirming the findings of the previous study, patients performed significantly more poorly on all two PM tasks than HC. Performance on time-based PM task significantly correlated with age, education level and DFT in HC and with age, DFT, TOL and WCST in patients. Patients performance on the event-based PM correlated with DFT and one measure of WCST. In patients, TOL and age predicted the performance on time-based PM task; DFT and WCST predicted the event-based task.nnnCONCLUSIONSnInvolving a large sample of patients with matched controls, this study confirmed that PM is impaired in chronic schizophrenia. Deficient PM functions were related to prefrontal lobe dysfunction in both HC and patients but not to the patients clinical condition, nor did they significantly affect ADL. ACMs determined certain aspects of PM.

Relationships of sleep duration with sleep disturbances, basic socio-demographic factors, and BMI in Chinese people

Objective: There is no study on the quality of life (QOL) of parents of children with attention-deficit–hyperactivity disorder (ADHD), although QOL is increasingly gaining more attention and the interactions between children and their parents are bi-directional. The aim of the present study was therefore to survey the QOL of parents of children with ADHD in Hong Kong, and explore the relationships of sociodemographic and clinical variables with QOL. Method: Seventy-seven parents of children with ADHD were consecutively selected and the sociodemographic and clinical characteristics of the parents and their children were assessed. Results: Compared with the general population in Hong Kong, significantly lower scores in physical, psychological, social and environmental QOL domains were found in the parents of children with ADHD. On multivariate analysis, for the children with ADHD, the severity of emotional and hyperactivity/inattention symptoms, and having a comorbid pervasive developmental disorder were significantly correlated with one or more domains of QOL; while for the parents, educational level, household monthly income and having major medical conditions were significantly correlated with one or more domains of QOL. Conclusions: Parents of children with ADHD have low QOL and research is needed to understand the underlying problems.

Socio-demographic and clinical characteristics of 3129 heroin users in the first methadone maintenance treatment clinic in China.

OBJECTIVEnThis study aimed at determining the mean total sleep time (TST) and the relationship between sleep duration and basic socio-demographic factors and BMI sleep problems in Chinese subjects.nnnMETHODnA total of 5926 subjects were randomly selected and interviewed using standardized assessment tools.nnnRESULTSnThe reported mean TST was 7.76 h. Short sleepers were significantly older than medium and long sleepers. There were more urban residents who were short sleepers than medium and long sleepers. Short sleepers reported more sleep problems than medium and long sleepers. Short and long sleepers reported more psychiatric disorders than medium sleepers in both sexes, and short sleepers also had more major medical conditions in women. Short sleepers had a lower BMI than medium and long sleepers after controlling for the effects of age and psychiatric disorders in women.nnnCONCLUSIONSnNationwide epidemiologic surveys in China are needed to further explore the relationship between sleep duration and sleep problems.