Assessing the Hierarchical Healthcare System for Common Mental Disorders in Older Adults: a Mixed Method Study in Kunshan

Abstract

AbstractBackground: Common mental disorders (CMDs) can be defined as depression and anxiety, which have a great influence on the quality of life among older adults. CMDs are becoming a serious public health problem among the older adult population, especially depression. Effective management can improve the overall well-being of older adults. The policy significance of combining the hierarchical healthcare system (HHS) and CMDs is to promote the screening of high-risk elderly groups represented by depression, promote the prevention system of early detection, diagnosis, and treatment of elderly diseases, improve the early prevention and management mechanism of mental disorders, improve the psychological serviceability of older adults, and achieve healthy aging. This study aims to investigate the attitudes of older adults in Kunshan towards mental health services in the community and to assess the conditions and challenges of HHS for older adults’ CMDs in Kunshan. Methods: The quantitative analytical sample is restricted to older adults aged over 60 years who lived in Tinglin or Jinxi communities in Kunshan and who responded to the attitude survey (n=100). Attitudes were measured by asking older adults about their willingness or concern for community mental health services. The two-sample t-test and the chi-square test were used to compare the characteristics of the Tinglin and Jinxi communities. Logistic regression was used to determine the adjusted associations between sex, education, and attitudes related to managing common mental disorders in two communities. The qualitative data is obtained from semi-structured qualitative interviews with 7 relevant experts from 7 medical or social departments in Kunshan, including Jinxi People's Hospital, Jinxi Community Health Center (CHC), Mental Disorders Prevention and Treatment Department (MDPTD) of CHC in Jinxi, Kunshan Mental Health Center (KMHC), Kunshan First People's Hospital, Tinglin Community, and the Civil Affairs Bureau (CAB). The semi-structured interview was designed around the current situation of medical systems and mental health services in Kunshan, challenges in managing CMDs in older adults, and science communication for mental health. All interviews will be imported into Nvivo 12 for thematic analysis through grounded theory. Results: 74% of participants from Tinglin have an education level of Grade 9 and above, but only 28% of those from Jinxi at the same educational attainment. Tinglin residents demonstrated higher levels of understanding and acceptance of mental health. 60% of participants from Tinglin understand mental health, while only 18% in Jinxi. Tinglin residents (17%) show a higher willingness to seek professional treatment compared to Jinxi (4%). Tinglin (68%) exhibited a more favorable attitude towards community-recommended treatment compared to Jinxi (36%). Residents in Tinglin (50%) expressed the necessity of professional psychiatrists in the community, while only 14% in Jinxi. However, only 30% of residents in Tinglin showed a low will to cooperate, while 66% in Jinxi. It was also found that there was a significant association between education level and attitudes towards mental health in older adults. The qualitative results first introduced Kunshan’s family physicians and HHS model, management of severe mental disorders (SMD), screening for dementia, daily care center (DCC) and psychiatric rehabilitation station (PRS), and social workers policy. These provide guidance and experience for the implementation of management of CMD in the elderly. However, the implementation of HHS for older adults’ CMDs is hampered by multiple obstacles from older adults, their families, communities, the medical system, society, and the government. The interviewees also stressed the importance of science communication. Conclusions: With the current level of social development and medical resources, implementing HHS for the CMDs in older adults in Kunshan faces many difficulties at this stage.