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Zeng Q.,Shanghai JiaoTong University | He Y.,Shanghai JiaoTong University | Shi Z.,Shanghai Pudong New Area Mental Health Center | Tao H.,Changning District Mental Health Center | And 4 more authors.
Shanghai Archives of Psychiatry

Background: Depression and anxiety often occur in persons with chronic physical illnesses and typically magnify the impairment caused by these physical conditions, but little attention has been paid to this issue in low- and middle-income countries. Aim: Evaluate the effectiveness of a community-based psychological intervention administered by nonspecialized clinicians and volunteers for alleviating depressive and anxiety symptoms in individuals with chronic physical illnesses. Methods: A total of 10,164 community residents receiving treatment for diabetes or hypertension in Shanghai were arbitrarily assigned to a treatment-as-usual condition (n=2042) or an intervention condition (n=8122) that included community-wide psychological health promotion, peer support groups, and individual counseling sessions. The self-report Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder scale (GAD-7), and 12-item Short-Form Health Survey (SF-12) assessed depressive symptoms, anxiety symptoms, and quality of life at baseline and after the 6-month intervention. Results: Among the 8813 individuals who completed the baseline assessment, 16% had mild or more severe depressive or anxiety symptoms (PHQ-9 or GAD-7 >5) and 4% had moderate or severe depressive or anxiety symptoms (PHQ-9 or GAD-7 >10). The education component of the intervention was effectively implemented, but only 31% of those eligible for peer-support groups and only 9% of those eligible for individual counseling accepted these interventions. The dropout rate was high (51%), and there were significant differences between those who did and did not complete the follow-up assessment. After adjusting for these confounding factors, the results in individuals who completed both assessments indicated that the intervention was associated with significant improvements in depressive symptoms (F=9.98, p<0.001), anxiety symptoms (F=12.85, p<0.001), and in the Mental Component Summary score of the SF-12 (F=16.13, p<0.001). There was, however, no significant change in the self-reported rates of uncontrolled diabetes or hypertension. Conclusions: These results support the feasibility of implementing community-based interventions to reduce the severity of depressive and anxiety symptoms in persons with chronic medical conditions in lowand middle-income countries where psychiatric manpower is very limited. However, there are substantial methodological challenges to mounting such interventions that need to be resolved in future studies before the widespread up-scaling of this approach will be justified. Copyright © 2016 by Editorial Department of the Shanghai Archives of Psychiatry. Source

Tao H.,Changning District Mental Health Center | Song L.,Changning District Mental Health Center | Niu X.,Changning District Mental Health Center | Li X.,Shanghai JiaoTong University | And 5 more authors.
Shanghai Archives of Psychiatry

One possible reason for the less than satisfactory long-term outcomes for schizophrenia is the lack of coordination between inpatient and community-based services. Aim: Assess the effectiveness of a rehabilitation model for schizophrenia that integrates hospital and community services. Methods: Ninety patients with schizophrenia participating in an integrated rehabilitation program at 10 community centers in Changning, Shanghai (intervention group) and 52 community-based patients with schizophrenia randomly selected from all patients in Changning participating in routine outpatient care (control group) were assessed at enrollment using the Positive and Negative Syndrome Scale (PANSS) and the Morningside Rehabilitation Status Scale (MRSS) and then re-assessed 1 year later by clinicians who were blind to the group assignment of the patients. The patients' registered guardians (the vast majority were co-resident family members) were assessed at the same times using the Family Burden Scale (FBS), the Self-rating Depression Scale (SDS), the Self-rating Anxiety Scale (SAS) and the Social Support Rating Scale (SSRS). Results: At enrollment the clinical status of patients in the two groups (assessed with PANSS) was similar but the social functioning measures assessed by MRSS were significantly worse in the intervention group than in the control group. After one year the improvement of both clinical symptoms and social functioning measures were significantly greater in the intervention group than in the control group. In the year of follow-up, 3 individuals (3.3%) in the intervention group and 6 individuals (11.5%) in the control group were re-hospitalized (Fisher Exact Test, p=0.074). The feelings of burden, depression, anxiety and reported social support among guardians of patients in the intervention group were not significantly different from those for guardians of patients in the control group either at the time of enrollment or after the 1-year intervention. However, guardians in the intervention group showed a significant decrease in depressive and anxiety symptoms over the one-year follow-up. Conclusion: Rehabilitative approaches that integrate hospital and community services can improve clinical and social outcomes for patients with schizophrenia. Further development of these programs is needed to increase the proportion of patients who achieve regular employment (i.e., 'community re-integration') and to provide family members with better psychosocial support. Copyright © 2012 by Editorial Department of Shanghai Archives of Psychiatry. Source

Zheng H.,Changning District Mental Health Center | Chen S.L.,Jingan District Mental Health Center | Ji Y.W.,Jiangsu Community Health Service Center | Tao H.,Changning District Mental Health Center | Ji W.D.,Changning District Mental Health Center
Shanghai Archives of Psychiatry

Background: In large urban centers in China three common methods have evolved to provide services to the rapidly increasing numbers of elderly residents: traditional family support in the home; supplemental home visits by community service workers; and residential nursing homes for the elderly. The differential effects of these services on the quality of life, social support and psychological functioning of the urban elderly have not been systematically assessed. Hypothesis: The elderly receiving home visit services have a higher quality of life, better social support and less psychological symptoms than those who only receive family support or who have moved to live in nursing homes. Methods: Using cluster sampling methods, persons 65 years of age or older receiving three types of services -community-based home services, traditional family support, and residential home placement - were identified (100 persons for each type) and administered the 36-item Medical Outcome Study Short Form health survey (SF-36), the Social Support Rating Scale (SSRS) and the Symptom Checklist 90 (SCL-90). Results: There were no significant differences in gender, marital status, monthly income or educational level between the three groups but the mean age of the residential home residents was somewhat higher. The mean scores for all eight subscales on the SF-36 were higher in the community-based services group and traditional family support group than in the residential home group, but there were no significant differences between the community -support group and the traditional family support group. The mean (SD) SSRS social support measure was higher in the community-based home services (A) subjects than in the family support (B) and residential home (C) groups [36.8 (4.4), 25.3 (6.7) and 20.0 (30.4), respectively; F2,297=12.78, P<0.001; A > B > C] and the overall level of psychological symptoms assessed by SCL-90 was lower in the community-based home services subjects and family support subjects than in the residential home subjects [129.9 (38.7), 131.6 (28.4) and 139.0 (31.2), respectively; F2,297=8.98, P = 0.004; A, B < C]. The mean score of some of the SCL-90 subscales-somatization, interpersonal sensitivity, paranoid ideation, and psychoticism - were significantly higher in the family care group than in the community services group. These differences all remained significant after adjustment for demographic variables. Conclusion: Compared to elderly residents receiving traditional family support or those who have moved to residential homes, those provided community-based social services in their own homes report more robust social support networks. The quality of life and psychological health of elderly who stay in their own homes or in the homes of their relatives are better than those of elderly residents who move to a residential home. Prospective cohort studies are needed to confirm these cross-sectional results. Copyright © 2011 by Editorial Department of Shanghai Archives of Psychiatry. Source

Chen S.-L.,Changning District Mental Health Center | Ji W.-D.,Changning District Mental Health Center | Fang Y.-R.,Shanghai JiaoTong University | Wu Y.,Shanghai JiaoTong University | And 2 more authors.
Journal of Shanghai Jiaotong University (Medical Science)

Objective: To analyze the survival and relevant influence factors of patients with first diagnosed bipolar disorder and being treated by medicines. Methods: Clinical data of 785 patients with first diagnosed bipolar disorder were collected. The survival curves were plotted by the Kaplan-Meier method. The survival and influence factors were statistically analyzed by the Cox proportional hazard model for patients after being treated for one year. Results: Among 785 patients, the cumulative survival rates of 2.5, 5, 7.5, 10, and 12.5 months after treatment were 0.98, 0.96, 0.95, 0.94, and 0.65, respectively. By the end of follow-up, 82 patients died and the mortality rate was 10.4%. The mortality rate during twelve months after first treatment was 4.3%. Multivariate Cox regression analysis showed that the somatic diseases and combined antipsychotic drug treatment programs were relevant to the survival time of patients. Conclusion: For patients with first diagnosed bipolar disorder, early combined antipsychotic drug treatments can prolong the survival time of patients and increase the mortality rate. Somatic diseases are dangerous factors that influence the survival of patients. Source

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