The cross-sectional study of serious mental illness in Gansu province, China

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1 EJM-43153: Orijinal Makale The cross-sectional study of serious mental illness in Gansu province, China INTRODUCTION: To analyze the prevalence rate and distribution characteristics of serious mental illness in Gansu province, China. METHODS: We made the diagnosis for suspected patients with serious mental illness who were screened individually according to the questionnaire of clue among permanent residents by village or neighborhood committee in Gansu Province, China. International Statistical Classification of Illness and Related Health Problems, 10th Revision(ICD-10) and Chinese Classification and Diagnostic Criteria of Mental Disorders, 3th Revision(CCMD-3) were adopted as diagnostic criteria. RESULTS: At the end of year 2015, there are people were diagnosed with serious mental illness, with an overall prevalence rate of 1.8, and the prevalence rate of 1.34 for schizophrenia.the prevalence rate of serious mental illness in rural residents(2.5 ) was higher than in urban residents(0.8 ); and in male(1.9 ) was higher than in female(1.8 ).The prevalence rate of mental retardation with mental disorders and mental disorder due to epilepsy in male were higher than in female; but the prevalence rate of bipolar disorder and schizoaffective disorder in male were lower than in female. Most of the patients with serious mental illness in Gansu, China are years old(accounting for 50.4%), Han nationality(94.6%), illiterate or primary education background(72.3%), married(55.9%) and peasants vocational(79.5%). DISCUSSION AND CONCLUSION: Schizophrenia is the emphasis in prevention, cure and management of serious mental illness, and it s necessary to strengthen the policy assist about mental health for rural area in Gansu province, China. Key words: serious mental illness, cross-sectional study, prevalence rate, distribution characteristics 25 Ref.No: EJM Makale Grubu: Halk Sağlığı Makale Türü: Orijinal Makale Kayıt Tarihi: :42:05 Page 1 / 18

2 30 Original Files Tam Metin The cross-sectional study of serious mental illness in Gansu province, China Kayıt Tarihi: :06:26 35 Original articles Title page 40 The cross-sectional study of serious mental illness in Gansu province, China Page 2 / 18

3 Abstract (258 words) To analyze the prevalence rate and distribution characteristics of serious mental illness in Gansu province, China. We made the diagnosis for suspected patients with serious mental illness who were screened individually according to the questionnaire of clue among permanent residents by village or neighborhood committee in Gansu Province, China. International Statistical Classification of Illness and Related Health Problems, 10th Revision(ICD-10) and Chinese Classification and Diagnostic Criteria of Mental Disorders,3th Revision(CCMD- 3) were adopted as diagnostic criteria.we continued to collect basic information from the patients or family members with serious mental illness. At the end of year 2015, there are people were diagnosed with serious mental illness, with an overall prevalence rate of 1.8, and the prevalence rate of 1.34 for schizophrenia.the prevalence rate of serious mental illness in rural residents(2.5 ) was higher than in urban residents(0.8 ); and in male(1.9 ) was higher than in female(1.8 ).The prevalence rate of mental retardation with mental disorders and mental disorder due to epilepsy in male were higher than in female; but the prevalence rate of bipolar disorder and schizoaffective disorder in male were lower than in female. Most of the patients with serious mental illness in Gansu, China are years old(accounting for 50.4%), Han nationality(94.6%), illiterate or primary education background(72.3%), married(55.9%) and peasants vocational(79.5%). Schizophrenia is the emphasis in prevention, cure and management of serious mental illness, and it s necessary to strengthen the policy assist about mental health for rural area in Gansu province, China. Page 3 / 18

4 70 Key words serious mental illness, cross-sectional study, prevalence rate, distribution characteristics Page 4 / 18

5 1. Introduction Main text 75 At present, as in the Word Health Report 2001 published by WHO, there are totally about 4.5 hundred million patients who have all kinds of mind and cerebral illness all over the word, and they are the weakest group in many countries(1). Studies have predicted that after entering the 21st century various mental health problems will become more prominent, in 2020 the total burden 80 of illness prediction values and mental health problems would still be ranked first, the burden of mental illness to 2020 will rise to the illness burden of 1/4, mental illness in the total burden rankings ranks first(2). Therefore, it is very important to master the prevalence of serious mental illness to reasonably allocate health resources, and to effectively manage and treat all kinds of serious 85 mental disorders. Study area Gansu is situated at Northwest China, Loess Plateau. Belong to economic backwardness area. More than ten ethnic groups have inhabited in Gansu for generations, mainly including Han, Hui, Zang, Dongxiang and so on. There are cities and 86 counties within jurisdiction. It has a population of about 26 million; the urban population of about 10million, the rural population of about 16million; about 13million men and 13million women(3). 2. Object and method During August 2015 to September 2016, Firstly we trained the primary care Page 5 / 18

6 95 doctors to know how to screen the suspected patients by using the questionnaire of clue(4), and then the doctors would do this work in local permanent residents, after done this, we made the diagnosis for every be screened suspected serious mental illness patients by village or neighborhood committee in Gansu Province, China. Once be diagnosed with serious mental illness, whose 100 guardian would continue to be asked to accomplish the questionnaire of basic information(5), and persuaded to join in the project of management and treatment for serious mental illness patients, so the patients would get the follow-up services by the primary care doctor for free and enjoy more preferential policies by the government Object The screen object: the residents have domicile certificate or residence time is more than six months in the area of Gansu, China. The research object: the patients who were diagnosed with serious mental illness by psychiatrist, including schizophrenia(sp), mental retardation with 110 mental disorders(mrmd), mental disorders due to epilepsy(mde), shizoaffective disorder(sd), bipolar disorder(bd) and paranoid psychosis(pp) method Screening method: there are eleven items in the questionnaire of clue, if someone conform to one of them, who will be considered to be a suspected 115 patient. Diagnosis method: International Statistical Classification of Illness and Related Page 6 / 18

7 Health Problems, 10th Revision(ICD-10)(6) and Chinese Classification and Diagnostic Criteria of Mental Disorders,3th Revision(CCMD-3) (7)were adopted as diagnostic criteria. 120 Information collection: the patients who were diagnosed with serious mental illness would be asked to accomplish the questionnaire of basic information, under the premise of obtaining informed consent. The content of the questionnaire of basic information mainly included the patient s gender, age, ethnic group, occupation, education background, marital status and so on statistical analysis Results were analyzed by SPSS (version 19.0). Chi-square test were used for comparisons among groups. 3. Results 3.1. prevalence of serious mental illness in Gansu, China 130 At the end of year 2015, there are people were diagnosed with serious mental illness, with an overall prevalence of 1.8. of which the prevalence of schizophrenia was 1.34, mental retardation with mental disorders was 0.16, mental disorders due to epilepsy was 0.15, shizoaffective disorder was 0.04, bipolar disorder was 0.13 and paranoid psychosis was0.01. and it has 135 statistical significance in different kinds of serious mental Page 7 / 18

8 illness(x 2 = ,P=0.000). Table 1. Prevalence of serious mental illness in Gansu, China SP n Prevalence( ) X 2 P MRMD MDE BD SD PP All prevalence of serious mental illness in different area prevalence of serious mental illness in rural area(2.5 ) was higher than urban 140 area(0.8 ) (X 2 = ,P=0.000), and the prevalence of all kinds of serious mental illness also was higher than urban area. The distribution of all kinds of serious mental illness was different between rural and urban area(x 2 =40.052, P=0.000). 145 Table 2. Prevalence of serious mental illness in different area Urban area Rural area n Prevalence( ) n Prevalence( ) SP MRMD MDE BD SD PP All prevalence of serious mental illness between different gender X 2 P prevalence of serious mental illness of male(1.9 ) was higher than female(1.8 )( X 2 =30.250,P=0.000). MRMD and MDE of male were higher than female, but prevalence of BD and SD of male were lower than female. Table 3. Prevalence of serious mental illness between different gender Page 8 / 18

9 150 male female n Prevalence( ) n Prevalence( ) SP MRMD MDE BD SD PP All distribution of serious mental illness in different age group X 2 P 155 Distribution of six kinds of serious mental illness were different in each age group(x 2 = ; P=0.000), manifested as mental retardation with mental disorders mainly distributed in age group, and others mainly distributed in age group. Table 4. Distribution of serious mental illness in different age group Less than Above 75 n % n % n % n % n % n % n % n % SP MRMD MDE BD SD PP All X P distribution of serious mental illness in different ethnic groups Distribution of six kinds of SMI were different in each ethnic group(x 2 = ;P=0.000), patients of six kinds of SMI were mainly Han, secondly Hui. 160 Table 5. Distribution of serious mental illness in different nation Han Hui Dongxiang Zang Others n % n % n % n % n % SP MRMD MDE BD SD PP All X P distribution of serious mental illness in different education background Page 9 / 18

10 Distribution of six kinds of SMI were different in patients with different education background(x 2 = ;P=0.000), but all kinds of SMI were mainly distributed in patients with low academic qualifications. 165 College degree or above Table 6. Distribution of serious mental illness in different education background Senior high Junior high Primary school degree school degree education Uneducated background n % n % n % n % n % SP MRMD MDE BD SD PP All X P distribution of serious mental illness in different occupation Distribution of six kinds of SMI were different in patients with different occupation(x 2 = ;P=0.000), all kinds of SMI were mainly distributed in 170 farmer. Table 7. distribution of serious mental illness in different occupation Student professionals administrator worker retire unemployment farmer Not quite clear n % n % n % n % n % n % n % n % SP MRMD MDE BD SD PP All X P distribution of serious mental illness in different marital status Distribution of six kinds of SMI were different in patients with different marital status(x 2 = ;P=0.000), MRMD mainly distributed in spinsterhood 175 patients, others mainly distributed in married patients. Page 10 / 18

11 Table 8. Distribution of serious mental illness in different marital status Married Divorce Loss of spouse Spinsterhood Not quite clear n % n % n % n % n % SP MRMD MDE BD SD PP All X P Discussion At present, serious mental illness is widespread in the world. Study shows that the schizophrenia lifetime prevalence rate of word was 3.8 ~8.4, and the 180 lifetime prevalence rate of residents of the United States was as high as 13 (8). The data published by Center for mental health, Chinese Center for Disease Control and Prevention in 2009, to show that patients with serious mental illness had more than 16 million(9). Data in our study show that the prevalence of serious mental illness was 1.83, 185 schizophrenia was 1.34 in Gansu province, China, the total prevalence was higher than Tibet Autonomous Resgion(0.34 )(10), lower than Peking(4.23 )(11), Ningxia Hui Autonomous Region(1.95 )(12) and Guiyang city(2.33 )(13). As a whole, the prevalence of serious mental illness in Gansu province was at a low level throughout the country and the word. This could be firstly that 190 Gansu province located in the northwest inland of China, people s life rhythm and pressure are relatively slow and small. Secondly, the prevalence of serious Page 11 / 18

12 mental illness in different regions of Gansu province was quite different, and the prevalence rate of some ethnic minority areas was very low. Thirdly, there were some suspected patients refused to accept the clinical diagnosis, and some 195 patients refused to accomplish the questionnaire of basic information. The study showed prevalence of serious mental illness in rural area was apparently higher than urban area, the reason may be the conditions of economy, education, medical and so on of rural area are all legging behind urban area, so people in rural area have the more psychological and life pressure than in urban 200 area. Secondly, people in urban area have the more intense stigma, always trying to conceal the truth, and don t want to be known. As a whole, prevalence of serious mental illness of male was higher than female, and the prevalence of mental retardation with mental disorders and mental disorders due to epilepsy of male were higher, but the prevalence of shizoaffective disorder and bipolar 205 disorder of female were higher than male, so the mental health guidance and related psychological counseling for female have more significance of public health to prevent the incidence of mental illness. The study also discover that most of the patients with serious mental illness in Gansu, China are middle-aged, illiterate or primary education background, and their family economic situation 210 are low. According to the result of this study, we provide the following recommendations for the prevention and treatment of serious mental illness: 1. Strengthen the primary health care of patients with mental disorder. The most economical and Page 12 / 18

13 convenient medical institution is Primary Health Care Institutions for poor 215 patients with serious mental illness, good primary health care services is the premise of improving patients compliance and quality of life. Therefore, it is necessary to enable the grassroots doctors to master the basic skills of mental health care by special training, and so have the ability to provide the service of early discovery, early intervention, therapy guidance, crisis intervention and so 220 on. Especially rural area, of which medical level is relatively backwardness, should be as a top priority to strengthen. 2. Strengthen the education and publicity for public. In the process of investigation we found that most people have one-sided understanding, different degrees of prejudice and discrimination on mental illness, consequently enhanced the stigma of patients with mental 225 illness, and interfere with patients and their families to treat the disease actively. Therefore, in the future should focus on public education, and extensively propagandize the knowledge about mental illness, to make people realize that mental illness is a treatable disease, and understand the process of healing, thereby understand and respect the patients with mental disorders, increase 230 social care, reduce prejudice and discrimination, and builds a relaxed climate for the mental disorders. 3. To formulate mental health policy and legislation. At present, many patients with serious mental illness can t enjoy the service of treatment and rehabilitation. Government should improve the risk sharing mechanism of serious mental illness burden by strengthen the support of 235 medical care and social security system, so the patients and the families can Page 13 / 18

14 reduce the economic burden. In addition, actively promote the mental health legislation, highlighting the role of Primary Health Care Institutions in the aspect of mental health services in the laws of mental health, and develop the mechanism of cooperation in departments of Health, Education, Social security, 240 Justice, Non-governmental organizations and so on, to ensure the sustainable development of Mental Health. 4. Carry out the monitoring of mental health services of Primary Health Care Institutions. Monitoring indicators should include the number of patients, medical service quality, patient condition, medical expenses and reimbursement and so on. In order to evaluate the 245 condition of patients and the quality of medical service. Page 14 / 18

15 References 1. WHO. The world health report Mental Health: New Understanding. New Hope. Geneva: WHO; Yin DK. Make concerted efforts to work together to promote the project of Mental Health in the new century. Chinese Mental Health Journal 2002; 1:4-8. (in Chinese) 3. <Gansu Development Yearbook> edit committee. Gansu Development Yearbook China Statistics Press, Beijing: 2014.(in Chinese) China s Ministry of Health. Work specification for the management and treatment of serious mental illness, Beijing: (in Chinese) 5. China s Ministry of Health. National basic public health service specification, Beijing: (in Chinese) 6. WHO. The international classification of diseases (ICD-10): classification of 260 mental and behavioral disorders (Tenth Edition). People's Medical Publishing House, Beijing:1993; , Psychiatric branch of Chinese Medical Association. Classification and diagnostic criteria of mental disorders in China (Third Edition). Shandong Science and Technology Publishing House, Shandong:2001; (in Chinese) Zhang MY, Shu L. Guide for prevention and treatment of schizophrenia. Medical Publishing House of Peking University, Chinese Medical Association: (in Chinese) 9. China s Ministry of Health, Civil Affairs, Public Security. Chinese mental health work plan ( ), Beijing: (in Chinese) Page 15 / 18

16 Wei G, Liu SM, Zhang W. Epidemiological investigation on mental disorders at Tibet in China I: major psychiatric disorders. Chin J Nerv Ment Dis 2008; 10: (in Chinese) 11. Liu YF, Song AX, Yu XM. Epidemiological surveys of mental disorders in Huairou district of Beijing. J Clin Psychosom Dis 2005; 1: (in 275 Chinese) 12. Wang Q, Li L, Yang Y. Inventory survey of serious mental illness in Ningxia Hui Autonomous Region. Journal of Ningxia Medical University 2012; 2: (in Chinese) 13. Lian YJ, Shi ZH, Hong F. Epidemiologic analysis on serious mental diseases 280 in residents of Nanming district of Guiyang city. Chin J Public Health 2014; 5: (in Chinese) Page 16 / 18

17 285 Kaynaklar The cross-sectional study of serious mental illness in Gansu province, China Kayıt Tarihi: :04: References 1. WHO. The world health report Mental Health: New Understanding. New Hope. Geneva: WHO; Yin DK. Make concerted efforts to work together to promote the project of Mental Health in the new century. Chinese Mental Health Journal 2002; 1:4-8. (in Chinese) <Gansu Development Yearbook> edit committee. Gansu Development Yearbook China Statistics Press, Beijing: 2014.(in Chinese) 4. China s Ministry of Health. Work specification for the management and treatment of serious mental illness, Beijing: (in Chinese) 5. China s Ministry of Health. National basic public health service 300 specification, Beijing: (in Chinese) 6. WHO. The international classification of diseases (ICD-10): classification of mental and behavioral disorders (Tenth Edition). People's Medical Publishing House, Beijing:1993; , Psychiatric branch of Chinese Medical Association. Classification and 305 diagnostic criteria of mental disorders in China (Third Edition). Shandong Science and Technology Publishing House, Shandong:2001; (in Chinese) 8. Zhang MY, Shu L. Guide for prevention and treatment of schizophrenia. Medical Publishing House of Peking University, Chinese Medical Association: (in Chinese) Page 17 / 18

18 China s Ministry of Health, Civil Affairs, Public Security. Chinese mental health work plan ( ), Beijing: (in Chinese) 10. Wei G, Liu SM, Zhang W. Epidemiological investigation on mental disorders at Tibet in China I: major psychiatric disorders. Chin J Nerv Ment Dis 2008; 10: (in Chinese) Liu YF, Song AX, Yu XM. Epidemiological surveys of mental disorders in Huairou district of Beijing. J Clin Psychosom Dis 2005; 1: (in Chinese) 12. Wang Q, Li L, Yang Y. Inventory survey of serious mental illness in Ningxia Hui Autonomous Region. Journal of Ningxia Medical University 2012; 2: (in Chinese) 13. Lian YJ, Shi ZH, Hong F. Epidemiologic analysis on serious mental diseases in residents of Nanming district of Guiyang city. Chin J Public Health 2014; 5: (in Chinese) 325 Page 18 / 18