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Cheng C, Yang CY, Inder K, et al. Urban-rural differences in mental health among Chinese patients with multiple chronic conditions. Int J Ment Health Nurs. 2019;29(2):224-234doi: 10.1111/inm.12666.
Cheng, C., Yang, C. Y., Inder, K., & Wai-Chi Chan, S. (2020). Urban-rural differences in mental health among Chinese patients with multiple chronic conditions. International journal of mental health nursing, 29(2), 224-234. https://doi.org/10.1111/inm.12666
Cheng, Cheng, et al. "Urban-rural differences in mental health among Chinese patients with multiple chronic conditions." International journal of mental health nursing vol. 29,2 (2020): 224-234. doi: https://doi.org/10.1111/inm.12666
Cheng C, Yang CY, Inder K, Wai-Chi Chan S. Urban-rural differences in mental health among Chinese patients with multiple chronic conditions. Int J Ment Health Nurs. 2020 Apr;29(2):224-234. doi: 10.1111/inm.12666. Epub 2019 Oct 14. PMID: 31609539.
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Int J Ment Health Nurs. 2020 Apr;29(2):224-234. doi: 10.1111/inm.12666. Epub 2019 Oct 14.

Urban-rural differences in mental health among Chinese patients with multiple chronic conditions.

International journal of mental health nursing

Cheng Cheng, Cong-Yan Yang, Kerry Inder, Sally Wai-Chi Chan

Affiliations

  1. School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia.
  2. Department of Nursing, Bengbu Medical College, Bengbu, Anhui, China.
  3. Department of Nursing, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China.
  4. University of Newcastle Singapore, Singapore, Singapore.

PMID: 31609539 DOI: 10.1111/inm.12666

Abstract

Mental health is impacted by social, economic, and environmental influences related to where people live. Mental health problems commonly co-occur with long-term physical conditions and impact individuals' health synergistically. Multiple chronic conditions (MCCs) including mental health problems are becoming a public health challenge globally. However, there is limited information about urban-rural differences in mental health among patients with MCCs in China. The present study aimed to identify differences in mental health between urban and rural patients with MCCs. Using a cross-sectional design, 347 patients with MCCs were recruited from a tertiary hospital in North Anhui, China. A self-reported questionnaire, including socio-demographic and clinical variables, the 12-item Short-Form survey version 2 on quality of life, and the Hospital Anxiety and Depression Scale, was administered to outpatients. Findings showed that rural participants reported more symptoms of anxiety and depression and had worse mental health compared to urban participants. Unemployment status, lower educational level, more long-term health conditions, and a higher degree of anxiety were associated with worse mental health. This study highlights disparities in mental health among patients with MCCs living in urban and rural areas of China. Appropriate mental health support programmes should be developed for patients with MCCs, especially for those living in rural areas.

© 2019 Australian College of Mental Health Nurses Inc.

Keywords: anxiety; depression; mental health; multiple chronic conditions; quality of life

References

  1. Bjelland, I., Dahl, A. A., Haug, T. T. & Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale: An updated literature review. Journal of Psychosomatic Research, 52, 69-77. - PubMed
  2. Blakemore, A., Dickens, C., Guthrie, E. et al. (2014). Depression and anxiety predict health-related quality of life in chronic obstructive pulmonary disease: Systematic review and meta-analysis. International Journal of Chronic Obstructive Pulmonary Disease, 9, 501-512. - PubMed
  3. Breslau, J., Marshall, G. N., Pincus, H. A. & Brown, R. A. (2014). Are mental disorders more common in urban than rural areas of the United States? Journal of Psychiatric Research, 56, 50-55. - PubMed
  4. Brown, R. L., Richman, J. A. & Rospenda, K. M. (2017). Economic stressors and psychological distress: Exploring age cohort variation in the wake of the Great Recession. Stress and Health, 33, 267-277. - PubMed
  5. Bruun, N. H. (2016). SF12: Stata module to validate sf12 input and calculate sf12 version 2 t scores. [Cited 18 July 2018]. Available from: URL: https://econpapers.repec.org/software/bocbocode/s458125.htm - PubMed
  6. Butterworth, P., Handley, T. E., Lewin, T. J., Reddy, P. & Kelly, B. J. (2014). Psychological distress in rural Australia: Regional variation and the role of family functioning and social support. Journal of Public Health, 22, 481-488. - PubMed
  7. Cai, M., Liu, E. & Li, W. (2018). Rural versus urban patients: Benchmarking the outcomes of patients with acute myocardial infarction in Shanxi, China from 2013 to 2017. International Journal of Environmental Research and Public Health, 15, 1930. - PubMed
  8. Caldwell, T. M., Jorm, A. F. & Dear, K. B. (2004). Suicide and mental health in rural, remote and metropolitan areas in Australia. Medical Journal of Australia, 181, S10. - PubMed
  9. Dekker, J., Peen, J., Koelen, J., Smit, F. & Schoevers, R. (2008). Psychiatric disorders and urbanization in Germany. BMC Public Health, 8, 17. - PubMed
  10. Dieterich, M., Irving, C. B., Bergman, H., Khokhar, M. A., Park, B. & Marshall, M. (2017). Intensive case management for severe mental illness. Cochrane Database of Systematic Reviews, 1, CD007906. https://doi.org/10.1002/14651858.CD007906.pub2 - PubMed
  11. Fan, Y., Ma, N., Ma, L., Xu, W., Steven Lamberti, J. & Caine, E. D. (2018). A community-based peer support service for persons with severe mental illness in China. BMC Psychiatry, 18, 170. - PubMed
  12. Fang, H., Chen, J. & Rizzo, J. A. (2009). Explaining urban-rural health disparities in China. Medical Care, 47, 1209-1216. - PubMed
  13. Good, B. J. & Good, M. J. (2012). Significance of the 686 Program for China and for global mental health. Shanghai Archives of Psychiatry, 24, 175-177. - PubMed
  14. Gould, C. E., O'Hara, R., Goldstein, M. K. & Beaudreau, S. A. (2016). Multimorbidity is associated with anxiety in older adults in the Health and Retirement Study. International Journal of Geriatric Psychiatry, 31, 1105-1115. - PubMed
  15. Gu, J., Chao, J., Chen, W. et al. (2017). Multimorbidity in the community-dwelling elderly in urban China. Archives of Gerontology and Geriatrics, 68, 62-67. - PubMed
  16. Gunn, J. M., Ayton, D. R., Densley, K. et al. (2012). The association between chronic illness, multimorbidity and depressive symptoms in an Australian primary care cohort. Social Psychiatry and Psychiatric Epidemiology, 47, 175-184. - PubMed
  17. Guo, Q., Bai, X. & Feng, N. (2018). Social participation and depressive symptoms among Chinese older adults: A study on rural-urban differences. Journal of Affective Disorders, 239, 124-130. - PubMed
  18. Hofmann, S. G., Wu, J. Q. & Boettcher, H. (2014). Effect of cognitive-behavioral therapy for anxiety disorders on quality of life: A meta-analysis. Journal of Consulting and Clinical Psychology, 82, 375. - PubMed
  19. Holden, L., Scuffham, P., Hilton, M., Vecchio, N. & Whiteford, H. (2010). Psychological distress is associated with a range of high-priority health conditions affecting working Australians. Australian and New Zealand Journal of Public Health, 34, 304-310. - PubMed
  20. Huang, Y., Wang, Y., Wang, H. et al. (2019). Prevalence of mental disorders in China: A cross-sectional epidemiological study. Lancet Psychiatry, 6, 211-224. - PubMed
  21. Jain-Chandra, M. S., Khor, N., Mano, R., Schauer, J., Wingender, M. P. & Zhuang, J. (2018). Inequality in China-Trends, Drivers and Policy Remedies. Working Paper 18/127. Washington, DC: International Monetary Fund. - PubMed
  22. Khan, M. M., Kramer, A., Khandoker, A., Prufer-Kramer, L. & Islam, A. (2011). Trends in sociodemographic and health-related indicators in Bangladesh, 1993-2007: Will inequities persist? Bulletin of the World Health Organization, 89, 583-593. - PubMed
  23. Kovess-Masféty, V., Alonso, J., de Graaf, R. & Demyttenaere, K. (2005). A European approach to rural-urban differences in mental health: The ESEMeD 2000 comparative study. The Canadian Journal of Psychiatry, 50, 926-936. - PubMed
  24. Lam, E. T., Lam, C. L., Fong, D. Y. & Huang, W. W. (2013). Is the SF-12 version 2 Health Survey a valid and equivalent substitute for the SF-36 version 2 Health Survey for the Chinese? Journal of Evaluation in Clinical Practice, 19, 200-208. - PubMed
  25. Lam, C. L. K., Guo, V. Y., Wong, C. K. H., Yu, E. Y. T. & Fung, C. S. C. (2016). Poverty and health-related quality of life of people living in Hong Kong: Comparison of individuals from low-income families and the general population. Journal of Public Health, 39, 258-265. - PubMed
  26. Leung, C. M., Wing, Y. K., Kwong, P. K., Lo, A. & Shum, K. (1999). Validation of the Chinese-Cantonese version of the hospital anxiety and depression scale and comparison with the Hamilton Rating Scale of Depression. Acta Psychiatrica Scandinavica, 100, 456-461. - PubMed
  27. Li, J., Shi, L., Liang, H., Ding, G. & Xu, L. (2018). Urban-rural disparities in health care utilization among Chinese adults from 1993 to 2011. BMC Health Services Research, 18, 102. - PubMed
  28. Liu, J., Ma, H., He, Y.-L. et al. (2011). Mental health system in China: History, recent service reform and future challenges. World Psychiatry, 10, 210-216. - PubMed
  29. Lyratzopoulos, G., Elliott, M., Barbiere, J. M. et al. (2012). Understanding ethnic and other socio-demographic differences in patient experience of primary care: Evidence from the English General Practice Patient Survey. BMJ Quality & Safety, 21, 21-29. - PubMed
  30. Makovski, T., Schmitz, S., van den Akker, M., Zeegers, M. & Stranges, S. (2018). Multimorbidity and quality of life-Systematic literature review and meta-analysis. Revue d'Épidémiologie et de Santé Publique, 66, S327. - PubMed
  31. Marengoni, A., Angleman, S., Melis, R. et al. (2011). Aging with multimorbidity: A systematic review of the literature. Ageing Research Reviews, 10, 430-439. - PubMed
  32. McKee-Ryan, F., Song, Z., Wanberg, C. R. & Kinicki, A. J. (2005). Psychological and physical well-being during unemployment: A meta-analytic study. Journal of Applied Psychology, 90, 53. - PubMed
  33. McKenzie, K., Murray, A. & Booth, T. (2013). Do urban environments increase the risk of anxiety, depression and psychosis? An epidemiological study. Journal of Affective Disorders, 150, 1019-1024. - PubMed
  34. Mirza, I. & Jenkins, R. (2004). Risk factors, prevalence, and treatment of anxiety and depressive disorders in Pakistan: Systematic review. The BMJ, 328, 794. - PubMed
  35. Moubayed, S. P., Sampalis, J. S., Ayad, T. et al. (2015). Predicting depression and quality of life among long-term head and neck cancer survivors. Otolaryngology-Head and Neck Surgery, 152, 91-97. - PubMed
  36. National Health and Planning Commission (2015a). China statistics yearbook of health and family planning 2015. Beijing: Peking Union Medical College Press. - PubMed
  37. National Health and Planning Commission (2015b). National Mental Health Working Plan (2015-2020). [Cited 7 June 2019]. Available from: URL: http://www.gov.cn/gongbao/content/2015/content_2883226.htm - PubMed
  38. National Health and Planning Commission (2015c). 2015 Report on Chinese Resident’s Chronic Disease and Nutrition. Beijing: People's Medical Publishing House. - PubMed
  39. National Health and Planning Commission (2016). China Statistics Yearbook of Health and Family Planning 2016. Beijing: Peking Union Medical College Press. - PubMed
  40. National Rural Health Alliance (2017). Mental health in rural and remote Australia. [Cited 15 July 2019]. Available from: URL: https://www.ruralhealth.org.au/sites/default/files/publications/nrha-mental-health-factsheet-dec-2017.pdf - PubMed
  41. Paykel, E. S., Abbott, R., Jenkins, R., Brugha, T. S. & Meltzer, H. (2000). Urban-rural mental health differences in great Britain: Findings from the national morbidity survey. Psychological Medicine, 30, 269-280. - PubMed
  42. Peen, J., Schoevers, R. A., Beekman, A. T. & Dekker, J. (2010). The current status of urban-rural differences in psychiatric disorders. Acta Psychiatrica Scandinavica, 121, 84-93. - PubMed
  43. Que, J., Lu, L. & Shi, L. (2019). Development and challenges of mental health in China. General Psychiatry, 32, e100053. - PubMed
  44. Salkind, N. J. (2010). Bonferroni Procedure. Thousand Oaks: Encyclopedia of Research Design. - PubMed
  45. Stickley, A., Koyanagi, A., Roberts, B. & McKee, M. (2015). Urban-rural differences in psychological distress in nine countries of the former Soviet Union. Journal of Affective Disorders, 178, 142-148. - PubMed
  46. Sun, Y., Gregersen, H. & Yuan, W. (2017). Chinese health care system and clinical epidemiology. Clinical Epidemiology, 9, 167-178. - PubMed
  47. Szabo, C. P. (2018). Urbanization and mental health: A developing world perspective. Current Opinion in Psychiatry, 31, 256-257. - PubMed
  48. Tian, T., Chen, Y., Zhu, J. & Liu, P. (2015). Effect of air pollution and rural-urban difference on mental health of the elderly in China. Iranian Journal of Public Health, 44, 1084-1094. - PubMed
  49. Vassos, E., Agerbo, E., Mors, O. & Pedersen, C. B. (2016). Urban-rural differences in incidence rates of psychiatric disorders in Denmark. British Journal of Psychiatry, 208, 435-440. - PubMed
  50. Vogeli, C., Shields, A. E., Lee, T. A. et al. (2007). Multiple chronic conditions: Prevalence, health consequences, and implications for quality, care management, and costs. Journal of General Internal Medicine, 22, 391-395. - PubMed
  51. Wang, H. H., Wang, J. J., Wong, S. Y. et al. (2014). Epidemiology of multimorbidity in China and implications for the healthcare system: Cross-sectional survey among 162,464 community household residents in southern China. BMC Medicine, 12, 188. - PubMed
  52. Wang, S., Kou, C., Liu, Y. et al. (2015). Rural-urban differences in the prevalence of chronic disease in northeast China. Asia Pacific Journal of Public Health, 27, 394-406. - PubMed
  53. Ware, J. E., Kosinski, M., Turner-Bowker, D. M. & Grandek, B. (2005). How to Score Version 2 of the SF-12 Health Survey (with a Supplement Documenting Version 1). Lincoln: QualityMetric Incorporated. - PubMed
  54. Williams, D. R. (1990). Socioeconomic differentials in health: A review and redirection. Social Psychology Quarterly, 53, 81-99. - PubMed
  55. Wolff, J. L., Starfield, B. & Anderson, G. (2002). Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Archives of Internal Medicine, 162, 2269-2276. - PubMed
  56. World Health Organization (2008). Peer support programmes in diabetes: Report of a WHO consultation. Geneva: World Health Organization. [Cited 11 June 2019]. Available from: URL: https://www.who.int/diabetes/publications/Diabetes_final_13_6.pdf - PubMed
  57. World Health Organization (2014). Social Determinants of Mental Health. Geneva: World Health Organization. [Cited 11 June 2019]. Available from: URL: https://apps.who.int/iris/bitstream/handle/10665/112828/9789241506809_eng.pdf;jsessionxml:id=9E14AB950C019157466E8E83649C90FF?sequence=1 - PubMed
  58. World Health Organization (2018a). Mental health atlas 2017. Geneva: World Health Organization. [Cited 10 June 2019]. Available from: URL: https://apps.who.int/iris/bitstream/handle/10665/272735/9789241514019-eng.pdf?ua=1 - PubMed
  59. World Health Organization (2018b). Noncommunicable Diseases Country Profiles 2018. Geneva: World Health Organization. [Cited 10 June 2019]. Available from: URL: https://www.who.int/nmh/countries/2018/chn_en.pdf?ua=1 - PubMed
  60. Xiang, Y.-T., Ng, C. H., Yu, X. & Wang, G. (2018). Rethinking progress and challenges of mental health care in China. World Psychiatry, 17, 231-232. - PubMed
  61. Xiong, W. & Phillips, M. R. (2016). Translated and annotated version of the 2015-2020 National Mental Health Work Plan of the People's Republic of China. Shanghai Archives of Psychiatry, 28, 4-17. - PubMed
  62. Xu, X., Li, X. M., Xu, D. & Wang, W. (2017). Psychiatric and mental health nursing in China: Past, present and future. Archives of Psychiatric Nursing, 31, 470-476. - PubMed
  63. Xu, J., Wang, J., King, M. et al. (2018). Rural-urban disparities in the utilization of mental health inpatient services in China: The role of health insurance. International Journal of Health Economics and Management, 18, 377-393. - PubMed
  64. Yang, X. (2014). Rural-urban migration and mental and sexual health: A case study in southwestern China. Health Psychology and Behavioral Medicine, 2, 1-15. - PubMed
  65. Zajacova, A. & Lawrence, E. M. (2018). The relationship between education and health: Reducing disparities through a contextual approach. Annual Review of Public Health, 39, 273-289. - PubMed
  66. Zhang, L., Xu, Y., Nie, H., Zhang, Y. & Wu, Y. (2012). The prevalence of depressive symptoms among the older in China: A meta-analysis. International Journal of Geriatric Psychiatry, 27, 900-906. - PubMed
  67. Zhang, Y., Zhou, Z., Gao, J. et al. (2016). Health-related quality of life and its influencing factors for patients with hypertension: Evidence from the urban and rural areas of Shaanxi Province. China. BMC Health Services Research, 16, 277. - PubMed
  68. Zigmond, A. S. & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67, 361-370. - PubMed

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