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International Journal of Mental Health Systems
Published in: International Journal of Mental Health Systems 1/2019

Open Access 01-12-2019 | Mood Disorders | Research

Current needs for the improved management of depressive disorder in community healthcare centres, Shenzhen, China: a view from primary care medical leaders

Authors: Kendall Searle, Grant Blashki, Ritsuko Kakuma, Hui Yang, Yuanlin Zhao, Harry Minas

Published in: International Journal of Mental Health Systems | Issue 1/2019

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Abstract

Background

The prevalence of depressive disorder in Shenzhen is higher than for any other city in China. Despite national health system reform to integrate mental health into primary care, the majority of depression cases continue to go unrecognized and untreated. Qualitative research was conducted with primary care medical leaders to describe the current clinical practice of depressive disorder in community healthcare centres (CHC) in Shenzhen and to explore the participants’ perceptions of psychological, organizational and societal barriers and enablers to current practice with a view to identifying current needs for the improved care of depressive disorder in the community.

Methods

Seventeen semi-structured, audio-recorded interviews (approx. 1 h long) were conducted in Melbourne (n = 7) and Shenzhen (n = 10) with a convenience sample of primary care medical leaders who currently work in community healthcare centres (CHC) in Shenzhen and completed any one of the 3-month long, Melbourne-based, “Monash-Shenzhen Primary Healthcare Leaders Programs” conducted between 2015 and 2017. The interview guide was developed using the Theoretical Domain’s Framework (TDF) and a directed content analysis (using Nvivo 11 software) was performed using English translations.

Results

Despite primary care medical leaders being aware of a mental health treatment gap and the benefits of early depression care for community wellbeing, depressive disorder was not perceived as a treatment priority in CHCs. Instead, hospital specialists were identified as holding primary responsibility for formal diagnosis and treatment initiation with primary care doctors providing early assessment and basic health education. Current needs for improved depression care included: (i) Improved professional development for primary care doctors with better access to diagnostic guidelines and tools, case-sharing and improved connection with mentors to overcome current low levels of treatment confidence. (ii) An improved consulting environment (e.g. allocated mental health resource; longer and private consultations; developed medical referral system; better access to antidepressants) which embraces mental health initiatives (e.g. development of mental health departments in local hospitals; future use of e-mental health; reimbursement for patients; doctors’ incentives). (iii) Improved health literacy to overcome substantive mental health stigma in society and specific stigma directed towards the only public psychiatric hospital.

Conclusions

Whilst a multi-faceted approach is needed to improve depression care in community health centres in Shenzhen, this study highlights how appropriate mental health training is central to developing a robust work-force which can act as key agents in national healthcare reform. The cultural adaption of the depression component of the World Health Organisation’s mental health gap intervention guide (mhGAP-IG.v2) could provide primary care doctors with a future training tool to develop their assessment skills and treatment confidence.
Appendix
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Footnotes
1
At the time of research initiation this program was called the Monash-Shenzhen Primary Healthcare Leaders Program. The program has been recently renamed to become: Shenzhen General Practice Clinical Leadership Training.
 
2
Directed content analysis
Hsieh and Shannon [48] identify three types of qualitative content analysis: summative, conventional, and directed. Summative content analysis involves the counting of words or content and the interpretation of that quantification. In conventional content analysis, categories emerge out of the analysis rather than through preconceived categories being imposed on the data. Directed content analysis involves the application of conceptual categories to a new context.
Directed content analysis is appropriate to use when “existing theory or prior research about a phenomenon that is incomplete… would benefit from further description,” with the goal “to validate or extend conceptually a theoretical framework or theory” (Hsieh and Shannon [48], p. 1281).
 
3
The five-in-one policy is directed at patients with psychiatric disorders and potentially violent behavior (not depressive disorder) to improve their multi-sectorial care between services (hospital, community case management, neighborhood committees, schools and police). Thus for difficult cases, the police are often involved in facilitating care. This creates the perception of criminality rather than illness.
 
4
The five-in-one policy is directed at patients with psychiatric disorders and potentially violent behavior (not depressive disorder) to improve their multi-sectorial care between services (hospital, community case management, neighborhood committees, schools and police). However, it appears that community understanding of mental health is such that depression is potentially confused with psychotic disorders and thus patients worry that doctors will need to inform the police.
 
5
Baidu is a widely used internet service provider in China.
 
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Metadata
Title
Current needs for the improved management of depressive disorder in community healthcare centres, Shenzhen, China: a view from primary care medical leaders
Authors
Kendall Searle
Grant Blashki
Ritsuko Kakuma
Hui Yang
Yuanlin Zhao
Harry Minas
Publication date
01-12-2019
Publisher
BioMed Central
Published in
International Journal of Mental Health Systems / Issue 1/2019
Electronic ISSN: 1752-4458
DOI
https://doi.org/10.1186/s13033-019-0300-0

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