Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, USA.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
BMC Psychiatry. 2022 Feb 17;22(1):128. doi: 10.1186/s12888-021-03651-y.
A goal of China's 2012 National Mental Health Law is to improve access to services and decrease urban versus rural disparities in services. However, pre-reform data is needed for objective evaluation of these reforms' effectiveness. Accordingly, this study compares the pre-reform utilization of medical services for the treatment of schizophrenia in rural and urban communities in China.
In a large community-based study in four provinces representing 12% of China's population conducted from 2001 to 2005, we identified 326 individuals with schizophrenia (78 never treated). Comparing those living in urban (n = 86) versus rural (n = 240) contexts, we used adjusted Poisson regression models to assess the relationship of 'never treated' status with family-level factors (marital status, family income, and number of co-resident family members) and illness severity factors (age of onset, symptom severity and functional impairment).
Despite similar impairments due to symptoms, rural patients were less likely to have received intensive mental health services (i.e., use psychiatric inpatient services), and appeared more likely to be 'never treated' or to only have received outpatient care. Among rural patients, only having more than four co-resident family members was independently associated with 'never-treated' status (RR = 0.34; 95% CI, 0.12-0.94; p = 0.039). Among urban patients, only older age of onset was independently associated with 'never-treated' status (RR = 1.06; 95% CI 1.02-1.10, p = 0.003).
Identifying differential drivers of service utilization in urban and rural communities is needed before implementing policies to improve the utilization and equity of services and to define metrics of program success.
中国 2012 年《精神卫生法》的目标之一是改善服务的可及性，减少城乡服务差距。然而，需要改革前的数据来客观评估这些改革的效果。因此，本研究比较了中国城乡社区改革前精神分裂症治疗服务的利用情况。
在 2001 年至 2005 年期间，我们在中国四个省进行了一项大型社区为基础的研究，代表了中国 12%的人口，共确定了 326 名精神分裂症患者（78 名未经治疗）。将生活在城市（n=86）和农村（n=240）环境的患者进行比较，我们使用调整后的泊松回归模型评估了“未经治疗”状态与家庭层面因素（婚姻状况、家庭收入和共同居住家庭成员数量）和疾病严重程度因素（发病年龄、症状严重程度和功能障碍）之间的关系。
尽管症状造成的损害相似，但农村患者接受精神卫生服务的可能性较低（即，使用精神科住院服务），而且更有可能未经治疗或仅接受门诊治疗。在农村患者中，只有共同居住的家庭成员超过四人与“未经治疗”状态独立相关（RR=0.34；95%CI，0.12-0.94；p=0.039）。在城市患者中，只有发病年龄较大与“未经治疗”状态独立相关（RR=1.06；95%CI，1.02-1.10，p=0.003）。
在实施旨在提高服务利用和公平性以及确定计划成功指标的政策之前，需要确定城乡社区服务利用的不同驱动因素。
