A novel approach that can bring positive impact on mental health in developing countries like China and India

A study aimed at exploring service models that provide integrated care to patients with both mental illness and cardiovascular diseases in China has received grants from US National Institute of Mental Health (NIMH).

This multi-disciplinary and international study, which will be built on the existing research platform at The George Institute for Global Health at Peking University Health Science Center, is expected to shift clinical practice from isolated to integrated practice and bring real changes not only to China’s mental health care system but to the practice of mental health care across developing countries like India as well.

Pallab Maulik, Deputy Director and Head of Research and Development at The George Institute for Global Health, India, will be providing his technical inputs to the project. "The study will have implications for mental health care practice in India, as the scenarios are quite similar across China and India," he said, adding:  "Lessons learnt from China could be applied to India as well."

The burden of mental illness is increasing, both in China and worldwide. It is estimated by the World Health Organization (WHO) that mental illness is responsible for nearly 30% of the global burden of disease from non-communicable diseases. In China, the total number of individuals with various degrees of mental health disorders is assessed to be over 100 million. However, mental health services are not commonly provided in Chinese hospitals, including major urban centers like Beijing or Shanghai.

Similarly in India one in four people suffer from common mental health disorders like depression, anxiety disorders, emotional disorders and psychological distress. India also has one of the highest suicide rates in the world, especially amongst adolescents. Previous studies have showed the links between mental health and chronic diseases, like cardiovascular disease, the two major health challenges globally. According to the WHO World Health Survey, co-morbidity of these two illnesses is common, with the prevalence of depression (the third leading contributor to the global disease burden) significantly higher in patients with a chronic condition than in patients without a chronic illness.

"Although evidence-based effective management has been developed to address either cardiovascular disorders (CVD) or depression separately, there still lacks integrated care to patients with both diseases in China", said Professor Yangfeng WU. "This study aims to evaluate whether joint depression and CVD management can be provided with feasibly, effectively and at low-cost in rural China and improve the health outcomes".

The research proposes approaches which are quite new to the healthcare service in China, particularly to low-resource hospitals lacking highly trained mental health specialists. A similar situation exists in India where the results from this study may have an impact.

The novel concept includes recruiting a nurse in the cardiology ward who can screen, diagnose and treat patients with acute coronary syndrome (ACS), one of the most life-threatening CVD, and depression. With web-based support and guidance from a mental health expert ensuring a high standard of treatment and patient safety, the 'workforce re-engineering' study will make use of existing resources and maximize their positive impact on health.

With 20,000 ACS patients from 104 hospitals across mainland China, the Clinical Pathways for Acute Coronary Syndromes in China (CPACS-3) study will serve as the main platform for the proposed research. By building on this existing framework, the newly proposed research not only gains efficiency, but can be more effectively integrated into the healthcare framework in China by harnessing existing relationships with these hospitals.

"This study represents a strong local and international collaboration of researchers and academics from around the world, including The George Institute for Global Health in China, Australia and India, Peking University Institute of Mental Health, the Chinese Ministry of Health, and Duke University. We believe that this innovative, flexible and sustainable model can potentially be applied to a variety of chronic conditions, whether it is coronary artery disease, cerebrovascular disease, diabetes or cancer", Professor WU said.

Research reported in this publication was supported by the National Institute Of Mental Health of the National Institutes of Health under Award Number R01MH100332. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.