Transforming Mental Health: Standardising the treatment, prevention, and management of depression in China

Depression, characterised by persistent low mood or loss of pleasure or interest in activities for long periods of time, has become a major public health problem especially in low- and middle-income countries (LMICs). Early screening for depressive symptoms and timely identification of depressive disorders may improve health outcomes for affected individuals and the cost-effectiveness of mental health programmes.

The Depression Cohort in China (DCC) was conducted in 80 primary care centers in Shenzhen by a team of researchers from Sun Yat-Sen University, University of Toronto and Shenzhen Nanshan Center for Chronic Disease Control. The project which ran from 2018 to 2023, explored the standardisation of prevention and treatment of depression including depression screening, detection, and treatment for local residents. The project established a depression cohort of more than 5,000 residents through primary care centers. Among these, about 4,000 were sub-threshold depressed (i.e. participants with depressive symptoms (PHQ-9>5) without meeting the diagnostic criteria of a major depressive episode).

During the 12-month follow-up period after the baseline screening, 5.97% of these sub-threshold depressed individuals were first diagnosed with Major Depressive Disorder (MDD).

A key aim of the project was to integrate the research findings into mental health policy. The project team collaborated with policymakers from the project’s inception, regularly reporting project progress to the public health department, sharing findings with mental health policymakers, and discussing how they can be integrated into the subsequent health policies and plans. This close connection encouraged policymakers to pay attention to the importance of depression prevention and treatment in communities and led to an agreement that the project’s evidence should be translated into actionable policy.

In 2021, based on the preliminary findings of the project, the Health Commission in Shenzhen Nanshan District officially issued a policy document named ‘A Protocol of Community-based Depression Prevention and Treatment’. The objectives of the protocol included:

• Establishing community-based models of depression prevention and treatment including screening, referral, and regular follow-up

• Using digital tools for interventions and management

• Cultivating the general practitioners about depression recognition

• Establishing a system for mental health crisis intervention

• Mental health knowledge dissemination

This policy change has had a significant impact by expanding project coverage, training healthcare providers, integrating screening into routine care, and digital management.

• Expanding project coverage: After the policy document was issued, the project established and promoted a community-based model for depression prevention and treatment in Shenzhen Nanshan District. Over 80 primary care centers joined the project to conduct the depression screening.

• Training: The project held an academic forum on ‘Depression in the community’ for five consecutive years, training over 400 general practitioners to screen for depression effectively.

• Integrating screening into routine care: General practitioners selectively screen and refer individuals with sub-threshold depressive symptoms during routine visits (about 100,000 individuals annually).

• Digital management: The project developed a smartphone application to manage all the routine activities including enrollment screening, follow-up management and referrals. The project also developed a Wechat mini-programme to provide Internet-based Cognitive Behavioral Therapy (ICBT).

The project has led to provincial and national impact. ‘The application and promotion of the Community Model of Depression Prevention and Treatment’ model was promoted in Guangdong Province, which led to the introduction of governmental policies, and the adoption the model in many general hospitals.

The implementation of the project attracted the attention of the National Center for Mental Health (a national-level technical institution focused on mental health under the National Health Commission) and was awarded the ‘Excellent case of the construction of national psychological service system’. The National Center for Mental Health included the project as a reference for the construction of ‘Depression community population cohort’ in China’s ‘2030 Brain Initiative’, with the project team participating in the construction of the cohort as one of the partners. The community-based model of depression prevention and treatment will be introduced nationwide.

Upon completion of the GACD grant, the project secured additional funding from the local government in Guangdong Province. This funding allows for the continued implementation of community-based depression apply it to various populations. Watch a video highlight about the MH10 Project