The actual capacity of community health service institutions in Shanghai for the diagnosis and treatment of depressive disorders has not been systematically evaluated, and there is a lack of empirical research on the urban-suburban differences.

To assess the current capacity of community health service institutions in Shanghai in the screening, diagnosis, treatment and management of depressive disorders, investigate the knowledge mastery and practical difficulties of community general practitioners, focus on analyzing urban-suburban differences, and provide evidence for optimizing the primary mental health service system.

A cross-sectional questionnaire survey was conducted among 244 community health service centers across 16 administrative districts in Shanghai from July to August 2025. A total of 2 222 valid questionnaires were collected from institutional managers and general practitioners (244 and 1 978 questionnaires from institutions and doctors, respectively). The institutional survey mainly covered: screening tools for depressive disorders, relevant laboratory/examination items, drug allocation, psychotherapy, related management, and the establishment of specialized clinics in medical institutions. The survey for community general practitioners mainly focused on: knowledge of diagnosis and treatment of depressive disorders, cognition of screening tools for depressive disorders, cognition of differential diagnosis between depressive disorders and bipolar disorder, cognition of follow-up for depressive disorders, and difficulties in the diagnosis, treatment and management of depressive disorders.

Among the 244 community health service institutions in 16 districts of Shanghai, 80 (32.8%) and 164 (67.2%) subjects were urban and suburban institutions, respectively; among 1 978 general practitioners, 505 (25.5%) and 1 473 (74.5%) subjects were urban and suburban practitioners, respectively. Regarding screening tools for depressive disorders, the allocation rate of Self-rating Depression Scale (SDS), Patient Health Questionnaire-9 (PHQ-9) and Center for Epidemiologic Studies Depression Scale (CES-D) in urban institutions was 47.5%, 43.8% and 12.5%, respectively, compared with 44.5%, 38.4% and 7.3% in suburban institutions. In terms of examinations, the availability rate of electroencephalography and echocardiography in urban and suburban community health service centers was 17.5% vs 4.3% and 70.0% vs 51.8%, respectively; the proportion of electroencephalography and echocardiography was higher in urban areas than in suburban areas (P<0.05). In terms of therapeutic drugs, the allocation rate of benzodiazepines and selective serotonin reuptake inhibitors (SSRIs) in urban and suburban community health service centers was 95.0% vs 91.5% and 38.8% vs 33.5%, respectively. In terms of specialized clinics, the availability rates of psychosomatic disease clinics and psychological counseling clinics in urban and suburban community health service centers were 17.5% vs 4.3% and 15.0% vs 28.0%, respectively; the rate of psychosomatic disease clinics was higher in urban areas, while the rate of psychological counseling clinics was lower in urban centers than in suburban centers (P<0.05). The main difficulties in the management of depressive disorders in community health service centers included: limited medical resources, limited dedicated managerial staff and time (95.1%), lack of therapeutic drugs and psychotherapy skills (87.7%), and poor patient compliance with distrust in community medical staff (60.2%). The awareness rate of the diagnostic duration of depressive symptoms (minimum duration of depressive symptoms for diagnostic significance) among urban and suburban general practitioners was 52.3% and 57.6%, respectively, indicating the urban community general practitioners were lower than the suburban community general practitioners (P<0.05). The awareness rates of PHQ-9 and SDS among urban and suburban general practitioners were 64.0% vs 57.8% and 65.9% vs 59.5% respectively, indicating the urban community general practitioners were higher than the suburban community general practitioners (P<0.05). The awareness rates of decreased sleep need, distractibility and inflated self-esteem were 61.2% vs 67.3%, 41.2% vs 49.6% and 57.2% vs 64.3%, respectively, indicating the urban community general practitioners were lower than the suburban community general practitioners (P<0.05). The awareness rate of monthly follow-up was 73.9% in urban areas and 82.1% in suburban areas, indicating that the urban community general practitioners were lower than the suburban community general practitioners (P<0.05). The suburban general practitioners reported the higher rates of difficulties in diagnosis and treatment (including insufficient suicide risk assessment ability, insufficient non-pharmacological treatment ability and insufficient post-treatment efficacy evaluation ability) than the urban general practitioners (P<0.05). In management difficulties, suburban practitioners also reported the higher rates of insufficient health education capacity on depressive disorders, lack of expert guidance in communities, and lack of two-way referral channels with higher-level hospitals (P<0.05).

Community health service institutions in Shanghai, especially those in suburban areas, should strengthen the allocation of screening tools, relevant examinations and medications. It is necessary to improve general practitioners' mastery of depressive disorder knowledge, health education ability and psychotherapy skills. Institutional construction, resource allocation and capacity improvement should be strengthened to promote an integrated management system and enhance the efficiency of primary mental health services.

上海市社区卫生服务机构在抑郁障碍诊疗中的实际能力尚未得到系统性评估，且缺乏城郊差异的实证研究。

评估上海市社区卫生服务机构在抑郁障碍筛查、诊疗、管理等方面的能力现状，了解社区全科医生的知识掌握情况与实践困难，重点分析城郊差异，为优化基层精神卫生服务体系提供证据支持。

采用横断面问卷调查法，于2025年7—8月对上海市16个行政区的244家社区卫生服务中心进行调查，收集机构管理人员及全科医生的有效问卷共2 222份（机构244份、医生1 978份）。机构调研主要内容为：医疗机构开展抑郁障碍的筛查工具、相关检验/检查项目、药品配备、心理治疗、相关管理、专病门诊开设情况等。社区全科医生调研的主要内容为：对抑郁障碍诊疗相关知识的了解情况、对抑郁障碍筛查工具认知情况、对抑郁障碍与双相障碍鉴别认知情况、对抑郁障碍随访认知情况、开展抑郁障碍诊疗和管理存在的困难和问题等。

上海市16个行政区的244家社区卫生服务机构中，城区80家（32.8%）、郊区164家（67.2%）；1 978名全科医生中城区505名（25.5%）、郊区1 473名（74.5%）。上海市社区卫生服务机构在抑郁障碍筛查工具方面，城区抑郁自评量表（SDS）、患者健康问卷抑郁自评量表（PHQ-9）、抑郁障碍流行病学量表（CES-D）配备率分别为47.5%、43.8%、12.5%，郊区则分别为44.5%、38.4%、7.3%；在检验/检查方面，城区和郊区社区卫生服务中心脑电图检查、超声心动图开展率分别为17.5%与4.3%、70.0%与51.8%，城区脑电图及超声心动图配备比例高于郊区（P<0.05）；在治疗药物方面，城区和郊区社区卫生服务中心苯二氮类药物和选择性5-羟色胺再摄取（SSRIs）配备率分别为95.0%与91.5%、38.8%与33.5%；在相关专病门诊方面，城区和郊区社区卫生服务中心开展心身疾病门诊和心理咨询门诊分别为17.5%与4.3%、15.0%与28.0%，城区社区卫生服务机构心身疾病门诊开展率高于郊区，心理咨询门诊开展率低于郊区（P<0.05）；目前社区卫生服务中心在抑郁障碍管理方面的主要困难包括：医疗资源有限、能投入专项管理人员和时间有限（95.1%）及缺乏治疗的药物和心理治疗相关技能（87.7%）以及患者依从性差、对社区医护人员不信任（60.2%）。城区和郊区社区全科医生在症状持续时间（抑郁症状至少持续多少时间具有诊断意义）方面的认知度为52.3%和57.6%，城区社区全科医生低于郊区（P<0.05）；城区和郊区社区全科医生对PHQ-9、SDS的认知度分别为64.0%与57.8%、65.9%与59.5%，城区社区全科医生高于郊区（P<0.05）；城区和郊区社区全科医生在睡眠需求减少、容易分心、自尊膨胀认知度分别为61.2%与67.3%、41.2%与49.6%、57.2%与64.3%，城区社区全科医生低于郊区（P<0.05）；上海市城区和郊区社区全科医生对抑郁障碍随访认知情况，在每月通过电话等方式随访认知方面郊区社区全科医生（82.1%）高于城区（73.9%）（P<0.05）；城区和郊区社区全科医生在抑郁障碍诊疗中的困难：在自杀风险评估能力不足、非药物治疗能力不足、诊疗后疗效评估能力不足方面郊区社区全科医生高于城区（P<0.05），管理中的困难：在抑郁障碍相关健康教育能力不足、缺乏专家下沉社区指导、缺乏与上级医院双向转诊的途径方面郊区社区全科医生高于城区（P<0.05）。

上海市社区卫生服务机构，尤其是郊区社区卫生服务中心，在筛查工具、相关检查、检验项目、药品的配备方面有待加强，需要提升全科医生对抑郁障碍知识掌握程度、健康教育能力、心理治疗技术等。应加强制度建设、资源配置与能力提升，推动形成整合式管理体系，提升基层精神卫生服务效能。