Author:
Yang Lawrence H.,Phillips Michael R.,Li Xianyun,Yu Gary,Grivel Margaux M.,Zhang Jingxuan,Shi Qichang,Ding Zhijie,Pang Shutao,Susser Ezra
Abstract
Abstract
Background
A goal of China’s 2012 National Mental Health Law is to improve access to services and decrease urban versus rural disparities in services. However, pre-reform data is needed for objective evaluation of these reforms’ effectiveness. Accordingly, this study compares the pre-reform utilization of medical services for the treatment of schizophrenia in rural and urban communities in China.
Methods
In a large community-based study in four provinces representing 12% of China’s population conducted from 2001 to 2005, we identified 326 individuals with schizophrenia (78 never treated). Comparing those living in urban (n = 86) versus rural (n = 240) contexts, we used adjusted Poisson regression models to assess the relationship of ‘never treated’ status with family-level factors (marital status, family income, and number of co-resident family members) and illness severity factors (age of onset, symptom severity and functional impairment).
Results
Despite similar impairments due to symptoms, rural patients were less likely to have received intensive mental health services (i.e., use psychiatric inpatient services), and appeared more likely to be ‘never treated’ or to only have received outpatient care. Among rural patients, only having more than four co-resident family members was independently associated with ‘never-treated’ status (RR = 0.34; 95% CI, 0.12–0.94; p = 0.039). Among urban patients, only older age of onset was independently associated with ‘never-treated’ status (RR = 1.06; 95% CI 1.02–1.10, p = 0.003).
Conclusions
Identifying differential drivers of service utilization in urban and rural communities is needed before implementing policies to improve the utilization and equity of services and to define metrics of program success.
Publisher
Springer Science and Business Media LLC
Subject
Psychiatry and Mental health
Reference54 articles.
1. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2018 Nov;392(10159):1789–858.
2. He H, Liu Q, Li N, Guo L, Gao F, Bai L, et al. Trends in the incidence and DALYs of schizophrenia at the global, regional and national levels: results from the global burden of disease study 2017. Epidemiol Psychiatr Sci. 2020;29:e91.
3. Collins PY, Patel V, Joestl SS, March D, Insel TR, Daar AS, et al. Grand challenges in global mental health. Nature. 2011 Jul 6;475(7354):27–30.
4. Yang LH, Phillips MR, Lo G, Chou Y, Zhang X, Hopper K. “Excessive thinking” as explanatory model for schizophrenia: impacts on stigma and “moral” status in mainland China. Schizophr Bull. 2010;36(4):836–45.
5. Ran M-S, Chen EY-H, Conwell Y, Chan CL-W, Yip PSF, Xiang M-Z, et al. Mortality in people with schizophrenia in rural China: 10-year cohort study. Br J Psychiatry. 2007;190(3):237–42.
Cited by
3 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献