[Impact of public health emergency on public psychology: analysis of mental health assistance hotlines during COVID-19 in Zhejiang province].

OBJECTIVE: To analyze the usage of mental health assistance hotline during COVID-19 in Zhejiang province from January 25th to February 29th 2020, and summarize the characteristics of the demand for mental health services and the dynamic changes of public mental health status during COVID-19 pandemic. METHODS: Both quantitative and qualitative methods were used. The calls related to pandemic were divided into four categories: medical, psychological, information and the others. The secondary categories of psychological calls were determined by text analysis. The number of calls were calculated weekly and the number of various types of calls over time were analyzed. We used stratified random sampling method to extract 600 cases of all kinds of calls related to pandemic and conducted a semantic analysis, through marking new, similar combination to form a feature set, then summed up the call content characteristics of each stage. Two hundred callers were followed up to understand how they felt about the call process in four aspects: the waiting time, call duration, the degree of problem-solving and the way to end the call. RESULTS: In a total of 13 746 calls, 8978 were related to pandemic, among which 12.59%(1130/8978) were about medical issues, 26.50%(2379/8978) were about mental health, 27.18%(2440/8978) were about information regarding the pandemic and 33.74%(3029/8978) were about other pandemic related issues. Pandemic situation, relevant policy release, frequency of advertising campaigns were predictors of the number of calls per day during the pandemic (P<0.05 or P<0.01). The number of calls differed by gender and identities of callers (both P<0.05). Finally 181 callers accepted telephone follow-up. Among them, 51.38%(93/181) of the callers thought that the waiting time was too long, 33.15%(60/181) of the callers thought that the call time was insufficient, 80.66%(146/181) of callers believed that the hotline could partially or completely resolve their concerns, and 39.23%(71/181) of the callers said the operator proposed to end the call. CONCLUSIONS: s The changes of the number and content of the mental health assistance hotline calls reflected that the public mental health status experienced four stages during the pandemic: confusion, panic, boredom, and adjustment. The specialized mental health assistance hotlines should be further strengthened, and the efficiency should be improved. Mental health interventions should be tailored and adopted according to the characteristics of the public mental health status at different stages of the pandemic.

Efficacy of interpersonal psychotherapy in mainland China: a systematic review and meta-analysis.

Objective: Interpersonal Psychotherapy (IPT) is an evidence-based therapy. There have been increasing demand and training opportunities of IPT in China. Reviewing current evidence on its use in Chinese patients can help us understand the applicability of IPT in China and identify knowledge gaps to encourage and better future research in this field. Method: We did a comprehensive search of three major electronic databases: PubMed (English), Chinese National Knowledge Infrastructure (CNKI) and WanFang Data (Chinese). We examined overall study design, outcome measures, data analyses and other parameters. We only selected articles of Randomized Clinical Trials (RCT) for this review. All study findings were grouped and summarized per psychiatric diagnoses. The meta-analysis and forest plots were performed whereas studies could be combined. Results: After a full text review of 132 articles, 40 were selected for the final review. Comparing with control groups, evidences supported the efficacy of IPT in Chinese patients with Major Depressive Disorder (MDD), Postpartum depression, Generalized Anxiety Disorder (GAD), Social Anxiety Disorder, Post Stress Traumatic Disorder (PTSD), and Post-psychotic Depression. It was also beneficial to college students and Chinese first-time mothers. Meta-analysis using a random-effects model consistently yielded significant score differences between the IPT and control groups (p < 0.0001) on MDD. Conclusion: This systematic review has identified the current best evidence for IPT efficacy in Chinese population. The findings support IPT as an effective treatment in Chinese with certain psychiatric conditions, consistent with those from many other studies throughout the world.

Clinical study on treatment of the earthquake-caused post-traumatic stress disorder by cognitive-behavior therapy and acupoint stimulation.

OBJECTIVE: To study the curative effect of acupoint stimulation on the earthquake-caused post-traumatic stress disorder (PTSD). METHODS: The 91 PTSD patients in Wenchuan hit by a strong earthquake were randomly divided into a control group of 24 cases treated by the cognitive-behavior therapy, and a treatment group of 67 cases treated by both cognitive-behavior therapy and acupoint stimulation. The scores were evaluated according to Chinese version of the incident effect scale revised (IES-R) and the self-compiled questionnaire for the major post-traumatic psychological condition, and the curative effect was compared between the two groups. RESULTS: The total scores of IES-R, the scores of all factors and the total scores of the questionnaire in the two groups after treatment were much lower than those before treatment (P < 0.01). The comparison of reduction in the factor scores between the two groups showed that the curative effect in the treatment group was better that of in the control group. CONCLUSION: The acupoint stimulation is effective for the PTSD patients, with better results than that of cognitive-behavior therapy used alone.

Factors associated with mental health outcomes among patients with COVID-19 treated in the Fangcang shelter hospital in China.

INTRODUCTION: Faced with surging infections and considering that 80% of cases were mild and moderate, the city government transformed stadiums and exhibition centers into the Fangcang shelter hospitals in Wuhan. The aims of this study were to evaluate mental health outcomes among patients with COVID-19 treated in the Fangcang shelter hospitals and analyze potential risk factors associated with these symptoms, including PTSS, symptoms of anxiety, depression, insomnia, and perceived stress. METHOD: This cross-sectional study used an online survey to assess mental health problems of 461 confirmed COVID-19 patients in a Jianghan Fangcang shelter from February 15 to 22, 2020. A multivariable logistic regression analysis was performed to explore potential risk factors. RESULTS: Overall, 25.2%, 50.1%, 54.4%, 10.2%, and 39.7% of all patients reported symptoms of posttraumatic stress, anxiety, depression, insomnia, and perceived stress, respectively. Multivariable logistic regression analysis showed that female sex was associated with all investigated outcomes except insomnia. Patients with lower education level were more likely to endorse anxiety, depression, and higher perceived stress, while patients' family members with other diseases were more likely to endorse severe insomnia. Patients with illness onset to admission less than 7 days were associated with higher perceived stress. DISCUSSION: In this survey study, patients reported high rates of symptoms of posttraumatic stress, anxiety, depression, insomnia, and perceived stress. Combining with the special environment of the shelter hospitals and patient's psychological needs, the health care workers should give more effective interventions to relieve the patients' stress and improve their mental symptoms.

[A multilevel cross-sectional study of mental disorder in community settings in Zhejiang Province].

OBJECTIVE: To investigate the prevalence of mental disorder through the 12-item general health questionnaire (GHQ-12) survey and its related factors in community settings in Zhejiang Province. METHODS: A muti-level model was analyzed using data of 14,632 respondents nested in counties (cities), townships (urban districts), villages (urban neighborhoods) from the epidemiological survey of mental illnesses above 15 years old. RESULTS: The mean score measured by GHQ-12 was (1.54 +/- 2.15), which was lower than that of samples from four cities of Guangzhou, Chongqing, Taiyuan and Hangzhou (U = 11.08, P < 0.01). The mental disorder clustered within county (city) level, which represented 4.3% (chi(2) = 3.94, P < 0.05) of the total variance including four levels. After controlling for the county level, the mental disorder was associated with age, marital status, residency patterns, education, occupation and household incoming. In particular, it was reported that higher household incoming was significantly associated with better mental disorder among population in community settings. CONCLUSION: The prevalence of mental disorder clustered at the county (city) level is relatively lower with vulnerable groups including divorced, widowed, unemployed, retired, lower-income ones in community settings in Zhejiang Province.

Transcutaneous electrical acupoint stimulation as an adjunct therapy for obsessive-compulsive disorder: A randomized controlled study.

BACKGROUND: Transcutaneous electrical acupoint stimulation (TEAS) is thought to have potential to treat obsessive-compulsive disorder (OCD). OBJECTIVE: The purpose of this study was to determine whether adding TEAS to cognitive behavioral therapy (CBT) and clomipramine would improve the efficacy of these conventional treatments in OCD. METHODS: In this randomized controlled trial, 360 OCD patients were assigned to receive TEAS combined with CBT plus clomipramine (Group A, n = 120), TEAS combined with CBT plus placebo (Group B, n = 120), and simulated (placebo) TEAS combined with CBT plus clomipramine (Group C, n = 120) for 12 weeks. The primary outcome was measured using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). RESULTS: OCD symptoms in all patients reduced over time, however Groups A and B had a significantly greater reduction in Y-BOCS total score and the subscale for obsession and compulsion between week 2 and week 12 compared to Group C. Groups A and B had similar scores on these measures. Both groups had significantly higher rates of clinical response than Group C (88.3% and 81.7% vs. 67.5%, respectively, p < 0.001); and higher rates of remission (30.0% and 22.5% vs. 9.2%, respectively, p < 0.001). Group B experienced fewer adverse events than the other two groups. CONCLUSIONS: TEAS enhances the efficacy of conventional OCD interventions and avoids the adverse effects associated with conventional pharmacological treatment. It can be considered as an effective adjunct intervention for OCD.

[Epidemiological survey of mental illnesses in the people aged 15 and older in Zhejiang Province, China].

OBJECTIVE: To describe the current prevalence and distribution of all types of mental disorders in Zhejiang Province and use this data to develop a provincial mental health plan. METHODS: Stratified multi-stage cluster randomization was used to identify 14 counties (cities), 70 townships (urban districts), 140 villages (urban neighborhoods) and 15,000 subjects > or = 15 years of age. Psychiatric nurses used an expanded version of the General Health Questionnaire (GHQ) to identify subgroups of subjects at high, moderate and low risk of having a mental disorder, then psychiatrists determined their diagnoses by administering a structured psychiatric examination (SCID) that employs American diagnostic criteria for mental disorders (DSM-IV) to 100% of high-risk, 40% of moderate-risk and 10% of low-risk subjects. RESULTS: 14 639 subjects completed the screening and 4,788 completed the psychiatric examination. The adjusted overall current rate of mental disorders was 17.3% (95% CI = 16.0%-18.7%), which dropped to 13.4% (12.2%-14.7%) if the non-specific (NOS) disorders were excluded. The most common diagnostic groups were affective disorders (8.6%, 7.9%-9.5%), anxiety disorders (4.3%, 3.6%-5.1%), and substance use disorders (3.0%, 2.4%-3.8%). The most common specific disorders were major depressive disorder (4.3%, 3.7%-4.9%), alcohol use disorder (2.9%, 2.3%-3.7%), dysthymia (1.6%, 1.3%-1.9%) and specific phobias (1.2%, 0.8%-1.8%). The overall prevalence was higher in rural than in urban areas (RR = 1.23, 95% CI = 1.11-1.37) and slightly higher in women than in men (RR = 1.11, 1.00-1.22). CONCLUSIONS: Mental disorders seriously affect the social and economic development of Zhejiang Province; they are a major public health problem that urgently needs to be addressed. To do this, it is necessary to develop and implement a comprehensive province-wide mental health plan and regularly evaluate its effectiveness.

[Clinical study on treatment of obsessive compulsive neurosis by acupoint stimulating control].

OBJECTIVE: To study the clinical effect of acupoint stimulating control (ASC) in treating obsessive compulsive neurosis. METHODS: The comparative study was conducted in 65 patients with obsessive compulsive neurosis, they were divided into two groups, the 33 patients in the control group treated with chlorimipramine and the 32 in the tested group treated with ASC. The therapeutic efficacy and adverse reaction were assessed according to the standard for clinical efficacy evaluation by Yale-Brown scale for obsession (Y-BOCS)and adverse reaction scale. RESULTS: The curative rate and markedly effective rate in the control group was 24.2% (8/33) and 27.3% (19/33), which in the tested group was 37.5% (12/32) and 34.4% (11/32) respectively. Significant difference was shown in comparison of Y-BOCS score between the two groups from the end of the 4th week of treatment (P < 0.05), indicating the efficacy in the tested group was better than that in the control group. Moreover, the occurrence of adverse reaction was higher in the control group than that in the tested group. CONCLUSION: ASC is a treatment with good effect, less adverse reaction and favourable safety superior to the treatment by chlorimipramine.

[A multilevel analysis on the association between socioeconomic status and psychiatric disorders].

OBJECTIVE: To explore the association between psychiatric disorders and socioeconomic status such as education, income, employment and area of community settings in Zhejiang province. METHODS: Data were from the epidemiological survey of mental illnesses aged 15 and older in 2001 (n = 14 632). Psychiatric disorders were measured by GHQ-12 with a cut-point 4. Logistic multilevel analysis was the main statistical method being used. RESULTS: The overall prevalence of psychiatric disorders was 18.5%(95% confidence intervals, 17.9% to 19.1%), higher than the data from Hebei province (u = 4.39, P < 0.001). Annual household income and employment were strongly associated with psychiatric disorders especially for those with low income (odds ratio 3.45, 95%CI: 1.72 - 6.67) and unemployment (odds ratio 2.03, 95%CI: 1.73 - 2.40). Factors as regional effect and education level showed weak or inconsistent association with psychiatric disorders after controlling on other indicators. CONCLUSION: Inverse gradient relation between psychiatric disorders and SES seemed as the main result of low SES individual characteristics and some minor effects at the county level.