Standardizing Treatment, Prevention & Management of Depression in China

Background

Mental disorders represent an ever-increasing global burden of disease across all population age groups. Depression is a mental disorder that is common worldwide, with onset often occurring prior to the age of 25 and a higher prevalence in women than in men. It is closely associated with a loss of productivity and substantial personal, social and economic decline, thereby creating significant demands on patients, families, society, and service providers . The World Health Organization (WHO, 2012) reported that depression affects 350 million people in communities across the world and represents the third leading contributor to the global disease burden The Chinese population is exposed to a high- stress lifestyle, which may result in a significant increase in mental health problems. A previous study conducted in China using a nationally representative dataset indicated that the prevalence of depression is high (37.9% for depressive symptoms and 4.1% for depression). Previous studies among Chinese adolescents have also demonstrated that a high prevalence of depressive symptoms (approximately 5.6-9.1%).

Aims

To explore a community-based mental health services system for the early identification of individuals with depressive symptoms and to provide mental health interventions for them; to develop a hospital-based system that improves access to mental health care and the management of patients diagnosed with clinical depression; and to provide policy recommendations to the government.

Project plan

A community-based baseline survey will be disseminated to voluntarily participating residents of the community for the purpose of identifying a cohort of individuals in the general population with depressive symptoms who may benefit from community-based prevention and intervention strategies. To investigate the prevalence of depressive symptoms in the general population with the aim of identifying and elucidating specific needs with respect to prevention and intervention strategies for depression.
Explore the efficacy of two community-wide, evidence-based intervention strategies in promoting psychological wellbeing and mitigating depressive symptoms to prevent the onset of clinical depression among the cohort identified in the baseline survey.
Identify a cohort of patients diagnosed with a first-time depressive episode (using the criteria outlined in the International Classification of Diseases, 10th edition) from the community cohort with depressive symptoms that allows for the investigation of the management of depressed individuals in China and their patterns of healthcare access. Specifically, in this objective we aim to explore socioeconomic and contextual factors that affect these patients’ access to healthcare.
Explore hospital-based interventions that implement standardized treatments for patients with depressive symptoms (regardless of severity), and to improve the communication between hospitals, families, and community health service centres to promote streamlined management of patients with depression.
Carry out an evaluate the interventions in terms of effectiveness, health, and economic burden, and to evaluate the potential ripple effects for the partners involved (e.g. improvements in lifestyle, family relationships, work productivity).
Establish a community-based system to improve the prevention and early identification of individuals with depressive symptoms and to promote the hospital-based system to improve healthcare access and management of patients with depression.

Impact

The project team engaged with the Health Commission of Shenzhen Nanshan District Administration to publish a government document entitled “A Protocol of Community-based Depression Prevention and Treatment”, based on the preliminary findings of the project. The project was then awarded funding from Health Appropriate Technology Promotion Project in Guangdong Province, which led to the introduction of governmental policies, as well as adopting the model in many general hospitals. The team were awarded “Excellent case of national social psychological service system construction” by the National Center for Mental Health. The community-based model of Depression Prevention and Treatment will be scaled up across China.

Publications and output

This project has a related case study Transforming Mental Health: Standardising the treatment, prevention, and management of depression in China.

You may visit the project website for more information.