| BackgroundMental disorders bring serious harm to human physical and mental health,which not only damage the patient’s family and social function, but also bringabout heavy economic burden to patients and society. In China, many provincesand autonomous regions carried out large-scale surveies employing theinternational diagnostic criteria and standardized mental health examinationquestionare, however, in which there was few studies on the mental healthservice utilization. As the capital of Shaanxi Province and political economiccenter of Northwesten China, Xi’an city is lack of the basic epidemiologyinformation of mental disorder about the community population. In order toexplore the prevalence of mental disorders and mental health service utilizationamong general population, it is necessary to systematicly carry outepidemiological survey to provide reliable information and scientific data for thegovernment to develop mental health policy. ObjectiveTo assess the prevalence, distribution characteristics and comorbidity ofmental disorders in urban and rural residents of Xi’an, and to study the status ofhealth care utilization and help seeking behavior among community population,as well as its related factors that affect utilization and help seeking behavior.MethodsA representative sample of the Xi’an general population aged16years andolder was interviewed from May to August2010. Respondents were selectedfrom a stratified two-stage probabilities proportional to size (PPS) sample of thenon-institutionalized household population. The World Health OrganizationComposite Intemational Diagnostic Interview Version3.0(CIDI-3.0) was usedto assess mental disorders and health care utilization according to Diagnosticand Statistical Manual of Mental Disorders (DSM-IV) criteria. SPSS11.5software was used to data analysis. The30days,12month and lifetimeprevalence of mental disorders were described. The utilization of health services,help seeking behaviors and related factors among the community population andpsychiatric patients were analyzed. Statistical significance was based ontwo-tailed tests evaluated at the0.05level of significance.Results1. The prevalence, distribution and comorbidity of mental dosordersTotally3578Xi’an citizens were sampled and it completed2500subjects(69.87%). The final sample was composed of2447subjects after deleting someunqualified data. The respondent rate was68.39%. There were950males and1497females. The cohort ranges from16to75years old and mean age was46.7士13.2years.The30-day,12-month and lifetime prevalence of any DSM-IV disorders were3.51%,7.19%,21.01%, respectively. The top three of the lifetimeprevalence of specific disorders were tobacco dependence (8.29%), panicattacks (6.21%) and major depressive disorder (3.88%).Any mental disorders were more common in men than women (29.68%vs15.50%, χ2=70.492, P=0.000). Lifetime prevalence of any mental disordersamong group of divorced/separated/widowed (36.00%) was significantly higherthan that of married persons (20.43%) and unmarried (19.81%). Among otherdifferent groups such as age, education level, urban and rural areas, and workingconditions, there was no statistical significance of lifetime prevalence of anymental dosorders.Among specific mental disorders, the liftime prevalence of intermittentexplosive disorder was difference between different age groups (χ2=14.397, P=0.013) and the prevalence of26～35years was highest (3.86%).The lifetime prevalences of alcohol abuse (0.20%vs5.89%), tobaccodependence (0.53%vs20.53%), intermittent explosive disorder(1.67%vs2.95%)among female group were lower than that of male group. The lifetimeprevalences of specific phobia (2.54%vs0.95%), panic attacks (7.08%vs4.84%) of female were higher than male.Among group of divorced/separated/widowed group, the lifetimeprevalences of major depressive disorder (16.00%), social phobia (3.00%),specific phobia (8.00%), panic attacks (12.00%) were significantly higher thanthat of married and unmarried population (P <0.05).The liftime prevalence of tobacco dependence differed statisticallysignificant between different education level group (χ~2=8.854, P=0.012). Theprevalence of junior/high school group (9.49%) was significantly higher thanthat of illiterate/primary school group (6.46%) and college higher education level (5.35%).Among the different occupations, panic attacks differed statisticallysignificant (χ~2=10.050, P=0.007), the prevalence in the unemployed groupwasthe highest (7.69%). Tobacco dependence was also difference statistically (χ~2=15.681, P=0.000), the prevalence of the employed was the highest (10.77%).Specific phobia differed statistically significant (χ~2=8.994, P=0.011), theprevalence of the employed was the lowest (1.08%).The prevalences of specific phobia (2.68%), panic attacks (7.13%) of therural area were significantly higher than that of urban area (P<0.05). But theprevalence of alcohol abuse prevalence (3.41%) and tobacco dependence(10.24%) of the urban area were significantly higher than that of rural area (P<0.05).The prevalence of lifetime comorbid any of two or three common mentaldisorders was3.11%, which refer to affective disorders, anxiety disorders andsubstance use disorders. The male population is liability to mental disorderco-morbidity.2. Mental health service utilization and help-seeking behaviorIn the community population of Xi’an city, the total lifetime utilization rateof mental health service was2.45%, and the12-month utilization rate was1.27%. The lifetime utilization rate of professional mental health service was1.35%. In the population of suffered mental disorders of Xi’an city, the totallifetime utilization rate of mental health service was4.67%, and the12-monthutilization rate was2.33%. The lifetime utilization rate of professional mentalhealth service was3.31%. The utilization of mental health service in thecommon mental disorders was poor. The12-month utilization rates of affectivedisorders, anxiety disorders, substance use disorders were1.50%,3.96%,2.97% respectively.The lifetime utilization rate in married population (3.11%) washigher than that of the divorced/separated/widowed (0.58%) and the unmarried(0.97%). The difference was statistically significant (χ~2=7.004, P=0.030).Of71.43%patients with help-seeking contacted non mental healthprofessionals, especially general physician or other medical personnel (61.90%).Only28.57%of the patients visited professional mental health personnel,mainly psychiatrist (23.81%). Eleven cases (52.38%) delayed for help. Delayduration ranged from1week to25month. The main reasons for delayed seekinghelp were as follows: lack of perception and knowledge of the mental disorders(54.55%), not satisfied with the treatment or services (27.27%) and worry aboutthe economy issues(18.18%).ConclusionsThe30-day,12-month and lifetime prevalence of any DSM-IV disorderswere3.51%,7.19%,21.01%respectively among Xi’an community population.The prevalence of lifetime comorbid any of two or three common mentaldisorders was3.11%. The top three of the lifetime prevalence of specificdisorders were tobacco dependence (8.29%), panic attacks (6.21%) and majordepressive disorder（3.88%）. The male and the divorced/separated/widowedpersons were liability to mental disorder. The lifetime prevalence of mentaldisorders in Xi’an was in a higher level compared with some other cities inChina.The total lifetime utilization rate of mental health service was2.45%, theutilization rate of professional mental health service was1.35%. In thepopulation of suffered mental disorders, the total lifetime utilization rate ofmental health service was4.67%, the lifetime utilization rate of professionalmental health service was3.31%. Majority patients contacted non mental health professionals, especially general physician and often delay help-seeking. Mentalhealth service utilization in the community population of Xi’an city was in thelower level compared with some other cities in China. |
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