Schizophrenia is considered as one of the top 10 leading causes of disability and life survival time threatening, which is the main cause of mental disability. There are relatively few researches on early intervention and health management for patients with mental disability in China and abroad. In particular, there is a lack of research on interventions for mental disability at different time points in China.
To explore the effect of disability point matching (DPM) intervention programme based on intervention mapping theory on degree of disability, negative symptoms, insight, self-esteem level and family function in patients with schizophrenia disability.
A quasi-experimental study design was used in the research. The patients at P1 (disability1~<2 year, 70 cases), P2 (disability 2~<3 years, 70 cases) and P3 (disability≥3 years, 70 cases) were randomly divided into the intervention group (35 cases) and control group (35 cases) by using random numbers generated by SPSS. The control group at all three time points received routine care, and the intervention group received DPM based on the routine care. The duration of the intervention was 8 weeks, once a week. The patients were assessed using WHO Disability Rating Scale (WHO-DASⅡ), Positive and Negative Syndrome Scale-Negative Subscale (PANSS-N), Self-knowledge and treatment attitude questionnaire (ITAQ), Self-Esteem Scale (SES) and family adaptation, partnership, growth, affection, resolve (APGAR) before intervention, after 8 weeks of intervention, 3 months after 8 weeks of intervention and 6 months after 8 weeks of intervention, respectively. The health outcomes between the two groups at each time point were compared by using repeated measures analysis of variance.
There were main effects and interaction effects of time and group in the WHO-DASⅡ, PANSS-N, ITAQ and SES scores at P1 after DPM intervention (P>0.05), there were main effects and interaction effects of time and group in the APGAR score at P1 after DPM intervention (P>0.05). WHO-DASⅡ and PANSS-N scores were lower and ITAQ (P>0.05), SES, and APGAR scores were higher in the intervention group than the control group at after 8 weeks of intervention, 3 months after 8 weeks of intervention and 6 months after 8 weeks of intervention (P<0.05). There were main effects and interaction effects of time and group in WHO-DASⅡ、ITAQ、SES、APGAR scores of patients at P2 after DPM intervention. WHO-DASⅡ score was lower and SES score was higher in the intervention group than the control group at after 8 weeks of intervention and 6 months after 8 weeks of intervention (P<0.05), ITAQ and APGAR scores were higher in the intervention group than the control group at after 8 weeks of intervention, 3 months after 8 weeks of intervention and 6 months after 8 weeks of intervention (P<0.05). There were main effects and interaction effects of time and group in WHO-DASⅡ and ITAQ scores at P3 after DPM intervention. WHO-DASⅡI score was lower and ITAQ score was higher than the control group at after 8 weeks of intervention, 3 months after 8 weeks of intervention and 6 months after 8 weeks of intervention (P<0.05) .
The DPM intervention program based on intervention mapping theory is effective in improving the disability degree, negative symptoms, insight, self-esteem and family function in patients with schizophrenic disability.
In China, schizophrenia patients have a high demand for basic medical care, but irrational healthcare-seeking behaviors among them may cause a waste of health resources. So relevant policies have been promulgated to improve the ensuring of healthcare and reasonably guide schizophrenia patients to seek medical care. The current research on policy factors and healthcare-seeking behaviors has rarely addressed the association between mental health policies and healthcare-seeking behaviors of patients with schizophrenia.
To analyze the influence of policy factors on healthcare-seeking behaviors in schizophrenia patients, to understand the status and outcome of health service utilization in this group under the guidance of basic medical insurance policies and mental health policies, providing empirical evidence for policy improvement.
In November 2019, we obtained a sample of 2 314 schizophrenic individuals with valid key data by matching the personal data in the three-level psychiatric prevention and treatment network system in a district of Chongqing in 2018, with information related to personal health service utilization in the district obtained from the medical insurance information platform of Chongqing Human Resources and Social Security Bureau. Multivariate Logistic regression analysis was conducted with healthcare-seeking behaviors and the medical institution chosen for treatment as explained variables, participation in basic medical insurance (including basic medical insurance for rural and urban non-working residents or basic medical insurance for urban employees, and reimbursement for medical cost due to special outpatient diseases) and mental health policy coverage (involving community rehabilitation services, guardianship subsidy, subsidy from the local disability federation, subsidy from the 686 program, and free second-generation antipsychotics, and the mental disability certificate) as key explanatory variables, and patients' demographic characteristics as control variables.
Of the participants, 1 915 (82.76%) had medical visits, including 1 482 seeking outpatient treatment, and 795 seeking inpatient treatment. Among those seeking outpatient treatment, the prevalence of choosing primary, secondary and tertiary care institutions was 17.01% (252/1 482), 72.87% (1 080/1 482), and 10.12% (150/1 482), respectively. And the prevalence of choosing primary, secondary and tertiary care institutions for inpatient treatment was 4.78% (38/795), 65.16% (518/795), and 30.06% (239/795), respectively. Logistic regression analysis showed that the type of basic medical insurance, reimbursement for medical cost due to special outpatient diseases, receiving community rehabilitation services, enrolment in the 686 program and involvement in the free second-generation antipsychotics program were factors associated with healthcare-seeking behaviors (P<0.05). The type of basic medical insurance, reimbursement for medical cost due to special outpatient diseases, receiving community rehabilitation services, enrolment in the free second-generation antipsychotics program, and the level of mental disability were factors associated with choosing outpatient settings for treatment (P<0.05). The type of basic medical insurance and the level of mental disability were associated with choosing inpatient settings for treatment (P<0.05) .
Policy factors played a positive role in guiding schizophrenia patients to seek medical treatment, but some problems were also revealed, such as low patient participation and insufficient coverage pathways. In view of this, efforts should be made as soon as possible to optimize mental health policies and the social support and assistance system, increase patient participation of relevant programs via strengthening the publicity of relevant policies, actively guide home-based rehabilitation activities, further promote community-based delivery of mental health services, and continuously improve the mental health security system.
Socioeconomic development, lifestyle changes and the COVID-19 pandemic all have an impact on people's mental and physical health, which may affect the prevalence of mental disorders. Currently, there is still no sufficient epidemiological information of mental disorders in Xinjiang.
To investigate the prevalence and influencing factors of common mental disorders among people aged 15 and above in northern Xinjiang, then compare the data with those of their counterparts in southern Xinjiang, and summarize the overall prevalence of common mental disorders in Xinjiang, providing a scientific basis for the formulation of corresponding mental health plans.
From November 2021 to July 2022, a multistage, stratified, random sampling method was used to select 3 853 residents from northern Xinjiang to attend a survey. General Demographic Questionnaire, and self-assessment scales (the 12-Item General Health Questionnaire, Mood Disorder Questionnaire, Symptom Checklist-90, etc.) and other assessment scales (Hamilton Depression Inventory, Bech-Rafaelsen Mania Rating Scale, Brief Psychiatric Rating Scale, etc.) were used as survey instruments. Mental disorders were diagnosed by the ICD-10 classification of mental and behavioral disorders by two psychiatrists with at least five years' working experience, or by a chief or associate chief psychiatrist when there is an inconsistency between the diagnoses made by the two psychiatrists.
The point prevalence rate and age-adjusted rate of common mental disorders in northern Xinjiang were 9.71% (374/3 853) and 10.07%, respectively. The point prevalence rate and age-adjusted rate of common mental disorders in the whole Xinjiang were 9.69% (750/7 736) and 9.90%, respectively. The point prevalence rates of mood disorders, anxiety disorders, schizophrenia, organic mental disorders, and mental retardation in northern Xinjiang were 4.83% (374/7 736), 3.63% (281/7 736), 0.63% (49/7 736), 0.23% (18/7 736), and 0.36% (28/7 736), respectively. Multivariate Logistic regression analysis for northern Xinjiang showed that: the risk of mood disorders in females was 1.854 times higher than that in males〔95%CI (1.325, 2.593) 〕; The risk of mood disorders increased by 5.210 times in 25-34-year-olds〔95%CI (1.348, 20.143) 〕 and 3.863 times in 35-44-year-olds 〔95%CI (1.030, 14.485) 〕 compared with that in those aged ≥65 years; The risk of mood disorders increased by 0.199 times in those with high school or technical secondary school education〔95%CI (0.078, 0.509) 〕 and 0.147 times in those with two- or three-year college and above education〔95%CI (0.056, 0.388) 〕 compared with that in illiteracies. The risk of anxiety disorder in females was 1.627 times higher than that in males〔95%CI (1.144, 2.315) 〕; The risk of anxiety disorder increased by 0.257 times in 15-24-year-olds〔95%CI (0.091, 0.729) 〕, 0.243 times in 45-54-year-olds〔95%CI (0.101, 0.583) 〕, and 0.210 times in 55-64-year-olds〔95%CI (0.067, 0.661) 〕 compared to that of those aged ≥65 years old. The risk of schizophrenia among people living in villages or towns was 4.762 times higher than that of those living in cities〔95%CI (1.705, 13.300) 〕; The risk of schizophrenia among people with high school or technical secondary school education was 0.079 times higher than that of illiteracies〔95%CI (0.015, 0.405) 〕.
The prevalence of mood disorders and anxiety disorders is high among all types of mental disorders in Xinjiang. Females, rural people, or low educated people in northern Xinjiang are more prone to various types of mental disorders.
There is a contradiction between a large population with severe mental illness and insufficient capacity to receive and treat them in China. Most of these patients long-termly live in the community, so it is essential for community health institutions to provide this population with timely and effective primary mental health services.
To analyze the characteristics of newly increased and decreased patients with severe mental illness in a community in Beijing from 2011 to 2021, so as to provide evidence for the implementation of community-based prevention and treatment of mental illnesses.
In January 2022, information of registered patients with severe mental illness (schizophrenia, bipolar disorder, schizoaffective disorder, persistent delusional disorder, mental disorders associated with epilepsy or mental retardation accompanied by mental disorders) in a community of Beijing was obtained through Beijing Municipal Mental Health Information Management System, including demographic characteristics, disease status and the status of file creation. The yearly morbidity, mortality and years of life lost (YLL) rates were calculated for years between 2011 and 2021. With the patient information up to December 31, 2010 as the baseline, the information of newly increased and deceased patients from 2011 to 2021 was counted.
From 2011 to 2021, the newly increased patients outnumbered the deceased ones, and the prevalence rate increased year by year since 2012, reaching 3.77‰ in 2021. Compared with the baseline, patients with severe mental illness in 2021 presented the following features: higher education level, a higher proportion of employers, a higher proportion of 60-year-olds and older, a lower proportion of schizophrenics, a higher proportion of patients with bipolar disorder, and a shorter duration of non-creation of files, and the differences were statistically significant (P<0.05). During the period, there were 212 newly increased patients, and most of them suffered from schizophrenia (57.08%, 121/212) or bipolar disorder (36.32%, 77/212). The age of the first onset was mostly between 19 and 45 years (65.57%, 139/212). The number of patients with 5 years or less of duration of non-creation of files was the most (40.57%, 86/212), and the average median was 8.5 (15.5) years. Among the 90 deceased cases, schizophrenics accounted for the highest percentage (86.67%, 78/90), and those aged over 60 years accounted for 74.44% (67/90). The top three causes of death were somatic disease (84.44%, 76/90), suicide (7.78%, 7/90), and accidental death (2.22%, 2/90). The YLL rate fluctuated between -0.250‰ and 1.436‰ during the period.
The period of 2011 to 2021 witnessed more newly increased community residents with severe mental illness than deceased ones, an increased prevalence trend of severe mental illness, a shortened duration of non-creation of files, and the aged as the major deceased group, and somatic diseases as the major cause of death. Targeted measures should be taken to cope with the above changes.
